岁组牙龈出血为课件

The Epidemiology of periodontal diseases,Department of Preventive Dentistry School & Hospital of Stomatology Wuhan University Minquan Du 杜民权,Periodontal diseases,Gingivitis is defined as an inflammatory process of the gingiva in which the junction epithelium, although altered by the disease, remains attached to the tooth at its original level Periodontitis is also an inflammatory condition of the gingival tissues, characterized by loss of attachment of the periodontal ligament and the bony support of the tooth From the viewpoint of public health that periodontal diseases are slowly progressing inflammatory diseases.,Periodontal diseases,Local factors: oral hygiene, dental plaque and calculus Systemic factors: unusual syndromes associated with defects, malnutrition and hormonology imbalance,The 3rd National Oral Helath Survey 2005,12岁组牙龈出血为57.7% 3544岁人群牙周炎患病率41.0% 6574岁人群牙周炎患病率52.3%,An Index is a graduated, numerical scale with upper and lower limits, with scores in the scale corresponding to specific criteria 指数:表明某种现象变动的程度。指标作用或 批示作用的标识。用数值级差作标准，测量 和比较疾病的扩展范围和严重程度,指 数,An Ideal Index,简单 Simplicity 价廉 Acceptability 有效 Validity 可靠 Reliability 敏感 Sensitivity 能用统计学方法处理 Quantifiability,The Measurement of Periodontal Diseases,In contrast to the stability of the DMF index for caries over a 50-year period, the philosophical basis for measuring periodontal disease has changed several times over a shorter time. Clinical measures used for gingivitis and periodontitis were first described 40 years ago.,Periodontal health index,1. Oral hygiene index simplified 简化口腔卫生指数 2. Plaque Index 菌斑指数 3. Turesky Modified Quigley-Hein Plaque Index 4. Gingival Index 牙龈指数 5. Sulcus bleeding index 龈沟出血指数 6. Community periodontal index 社区牙周指数,Oral hygiene index simplified (OHI-S),Debris index 软垢指数 Calculus index 牙石指数,Oral hygiene index simplified,牙面：16 11 26 31唇面，36 46舌面,计分方法：,牙面计分之和,软垢、牙石计分,受检牙面数,个人计分简化牙石计分简化软垢计分,检查方法：视诊，探诊,Criteria for DI,0 = No debris in the surface of the teeth. 牙面无软垢 1 = Debris covered less than one third area of the surface. 软垢覆盖面积占牙面1/3以下 2 = Debris covered between one third to two third area of the surface. 软垢覆盖面积为牙面1/3与2/3之间 3 = Debris covered more than two third area of the surface. 软垢覆盖面积占牙面2/3以上,0,1,3,2,debris index,Scores and criteria for CI-S,0 = No calculus in the surface of the teeth. 龈上、龈下无牙石 1 = Calculus covered less than one third area of the surface. 龈上牙石面积占牙面1/3以下 2 = Calculus covered between one third to two third area of the surface.龈上牙石面积占牙面1/32/3之间，或牙颈部有散在的龈下牙石 3 = Calculus covered more than two third area of the surface.龈上牙石面积占牙面2/3以上，或牙颈部有连续而厚的的龈下牙石,calculus index,0 1 2 3,Plaque Index, PLI 菌斑指数,The principal difference between the PLI and OHI-S approach is that the PLI scores plaque according to its thickness at the gingival margin rather than its coronal extent, a measure claimed to be more valid. 检查方法: 视诊+探诊 检查时用探针轻划牙面，根据菌斑的量和厚度记分 PLI可以检查全口牙面，也可检查指数牙 每颗牙检查4个牙面：mesial, distal, buccal, and lingua surfaces,Criteria for use of the Plaque Index,0 = no plaque in the gingival area . 龈缘区无菌斑 1 = a film of plaque adhering to the free gingival margin and adjacent area of the tooth, the plaque may be recognized only by running a probe across the tooth surface. 龈缘区的牙面有薄的菌斑，但视诊不可见，若用 探针尖的侧面可刮出菌斑 2 = moderate accumulation of soft deposits within the gingival pocket, on the gingival margin and/or adjacent tooth surface, which can be seen by the naked eye. 在龈缘或邻面可见中等量菌斑 3 = abundance of soft matter within the gingival pocket and/or on the gingival margin and adjacent tooth surface 龈沟内或龈缘区及邻面有大量软垢,plaque index,0 1 2 3,Turesky Modified Quigley-Hein Plaque Index,Quigly & Hein, 1962 Turesky, 1970 Ramfjord指数牙：16, 21, 24, 36, 41, 44 检查方法: 菌斑染色剂使菌斑染色，根据面积记分,Scores and criteria for QT,0牙面无菌斑 1牙颈部龈缘处有散在的点状菌斑 2牙颈部连续薄带状菌斑宽度1mm 3牙颈部菌斑面积1mm牙面1/3 4菌斑覆盖面积占牙面1/32/3 5菌斑覆盖占面积2/3或以上,Turesky Modified Quigiey-Hein PL,0 1 2 3 4 5,Gingival Index, GI 牙龈指数,Loe and Silness, in the early 1960s 观察牙龈情况，检查牙龈颜色和质的改变，以及出血倾向 检查方法：钝头牙周探针，结合视诊和探诊 全口牙或指数牙，4个牙周围的牙龈,Scores and criteria for the Gingival Index,0 = Normal gingiva 牙龈健康 1 = Mild inflammation: slight change in color, slight edema. No bleeding on probing 牙龈的色有轻度改变并轻度水 肿，探诊不出血 2 = Moderate inflammation: redness, edema, and glazing. Bleeding on probing. 牙龈中等炎症：牙龈色红,水肿光 亮，探诊出血 3 = Severe inflammation: marked redness and edema. Ulceration. Tendency to spontaneous bleeding. 牙龈明 显红肿或有溃疡,并有自动出血倾向,gingival index,0 1 2 3,群体患牙龈炎程度的衡量标准,牙龈指数 牙龈炎流行程度 0.1-1.0 轻度 1.1-2.0 中度 2.1-3.0 重度 由于牙龈指数能反映牙龈炎症的有无与程度,且临床应用简便,无论在牙周疾病的现况调查中或实验流行病学研究中,多采用此标准,Sulcus bleeding index, SBI 龈沟出血指数,Muheman & Son, 1971 反映牙龈炎活动状况 检查方法：视诊+探诊 检查时观察牙龈颜色和形状，牙周探针轻探龈沟，观察出血情况 不用菌斑染色,Scores and criteria For SBI,0 =龈缘和龈乳头外观健康，轻探龈沟后不出血 1 =龈缘和龈乳头外观健康，轻探龈沟后出血 2=牙龈因炎症而有颜色改变，无肿胀或水肿,探诊后出血 3=牙龈有颜色改变和轻度水肿，探诊后出血 4=牙龈不但有色的改变并明显肿胀，探诊后出血 5=牙龈有色的改变，明显肿胀，有时有溃疡，探诊后出血或自动出血,Community periodontal index, CPI 社区牙周指数,WHO, 1982, worldwide use 不仅反映牙周组织的健康状况，也反映牙周的治疗需要情况 操作简便，重复性好，适合于大规模的口腔流行病学调查,A specially designed lightweight CPI probe with a 0.5 mm ball tip is used, with a black band between 3.5 to 5.5 and rings at 8.5 and 11.5 mm from the ball tip.,Community Periodontal Index,检查方法：探诊为主、结合视诊 检查项目：牙龈出血 牙石 牙周袋深度,指数牙,1714 1323 2427 4744 4333 3437,16 11 26 27 47 46 31 36 37,16 11 26 46 31 36,检查顺序：按顺时针方向检查每一颗功能牙 探诊力量：应在20g以下，简单测试方法是将CPI探针插入拇指甲沟内，轻轻压迫显示指盖发白且不造成疼痛和不舒服的感觉为适宜力量,Community Periodontal Index,WHO规定： A sextants should be examined only if there are two or more teeth present which are not indicated for extraction. 每个区段内必须有2颗或2颗以上功能牙，并 且无拔牙指征，该区段才做检查。检查区段 内以最重情况记分,Community Periodontal Index,成年人的后牙区段，有时缺失一颗指数牙或有拔牙指 征，则只检查另一颗指数牙。,如果一个区段内的指数牙全部缺失或有拔牙指征时，则检查此区段内的所有其余牙齿，以最重情况记分。,每颗指数牙的所有龈沟或牙周袋都须检查到。,每个区段两颗功能牙检查结果，以最重情况记分。,六个区段中记分最高区段的记分则作为个人CPI记分。,Codes and criteria used in the CPI,0 Healthy 健康 1 - Bleeding observed, directly or by using a mouth mirror, after probing. 牙龈探诊后出血（直接或口镜观察） 2 - Calculus detected during probing, but all of the black band on the probe visible 探诊有牙石存在，但探针黑区全部可见 3 - Pocket 4-5 mm (gingival margin within the black band on the probe 牙周袋4-5毫米（探针黑区部分在龈下） 4 - Pocket 6 mm or more (black band on the probe not visible ).牙周袋6毫米或以上（探针黑区全部在龈下） X - Excluded sextant (less than two teeth present). 除外区段（余留牙不足2颗） 9 - Not recorded 不做记录,CPI,4 2 3 2 2,0 1 0 1 0 1,4,1,Community Periodontal Index,优点：操作简便，容易掌握 缺点： （1）牙龈出血和牙石被高估 （2）没有记录牙周附着丧失的程度 牙周袋有真性牙周袋和假性牙周袋两种 有时候牙周探针深度不能真实反映牙周组织 的破坏程度, 牙周组织的附着水平是客观反映牙周炎的指标,Community Periodontal Index of Treatment Needs,计分标准 0= 不需要治疗 1= 需要口腔卫生指导以改进个人口 腔卫生状况 2= 需要口腔卫生指导及洁治 3= 需要口腔卫生指导、洁治和复杂 牙周治疗,The epidemic characteristics of periodontal diseases 流行特征,WHO criteria for perodontal conditions (15-year-old）,More than 70% of adults in all parts of the world have some degree of gingivitis and periodontitis. Gingivitis and calculus are more prevalent and severe in developing countries. There are fewer global differences in the prevalence and severe periodontitis.,Global distribution,几个国家1519岁学生牙周状况(WHO),Geographic distribution,在我国，牙周病的流行情况农村比城市严重 牙石平均检出区段数农村高于城市 所有年龄组软垢指数都较高，但仍然是农村高于城市,Geographic distribution,湖北省15岁年龄组牙龈出血和牙结石情况 2005,工业化国家的儿童、青少年在60年代初，牙龈炎的患病率也相当高； 70年代后，由于牙科公共卫生学的发展，人群中的牙病不但得到控制，且预防工作的开展逐年有所提高，青、少年儿童的龋病、牙龈炎患病情况持续下降，然后扩大到成年人,Distribution of time,Distribution of time,全国15岁年龄组牙结石平均检出区段数（1995） 城市 1983 1995 北京 3.07 2.73 上海 1.98 2.39 天津 2.11 1.80 辽宁 1.32 2.60 山东 1.78 1.30 浙江 2.05 1.88 湖北 3.23 2.99 广东 2.48 1.96 甘肃 1.52 0.75 四川 3.03 1.91 云南 2.29 2.38 ,The severity of the disease increased with advancing age Periodontitis is not a disease of aging The prevalence and severity of gingivitis from 56 years old begin, then progressed to periodontitis. Periodontitis progressed with age,Distribution of Age,全国1274岁年龄组不同性别CPITN最高记分的百分数（1995） 年龄 0 1 2 3 4 12 31.01 16.30 52.03 - - 15 21.58 10.41 67.72 0.22 0.00 18 14.82 6.50 77.98 0.03 3544 2.85 1.69 81.89 11.15 2.06 6574 0.63 1.42 61.06 17.86 4.26 ,Distribution of Age,Epidemiologic evidence is that there are no inherent differences between men and women in susceptibility to periodontitis Usually Men have poorer periodontal health than women Smoking for men women usually exhibit better oral hygiene than do men,Distribution Gender,湖北省3544岁牙周袋和附着丧失情况 2005,Race and ethnicity in themselves cannot be considered demographic risk factors for periodontitis,Distribution of Race,Gingivitis and poorer oral hygiene are clearly related to lower SES, but the relationship between periodontitis and SES is less direct. The widely observed relation between SES levels and gingival health is a function of better oral hygiene among the more educated, and a greater frequency of dental visits among the more dentally aware and those with dental insurance.,Socioeconomic status,Oral Hygiene Tobacco use Nutrition Systemic conditions,Risk factors for periodontal diseases,Oral Hygiene,the relation between plaque deposits and gingivitis to be one of cause and effect. less calculus, both supragingival and subgingival, as a result of better oral hygiene and more professional dental care. Plaque and calculus deposits correlate poorly with severe periodontitis Plaque control is vital to the maintenance of periodontal health The etiologic role of oral hygiene in periodonttitis might be similar to that of sugar in dental caries,Tobacco use,Smoking is a major risk factor for periodontitis The relative risk is twice as smokers than nonsmokers Smoking is thought to suppress the vascular reaction that follows gingivitis There is some evidence that smoking could increase the dental deposits and calculus accumulation and gingival inflammation,Nutrition,营养缺乏将造成牙周组织功能降低。蛋白质缺乏可使牙周结缔组织变性，牙槽骨疏松 还可影响抗体蛋白合成，免疫能力下降 维生素与牙周组织胶原合成有关，它们的缺乏会造成牙周组织创伤愈合困难,Systemic conditions,Diabetes Cardiovascular diseases Adverse pregnancy outcomes,Diabetes,Type I (insulin-dependent diabetes mellotus) Type II (non-insulin-dependent diabetes mellotus) Patients have more gingivitis and more deep pockets than nondiabetis Peiodontitis progresses more rapidly in poorly controlled diabetics Vascular changes, PMN dysfuntion, abnormal collagen synthesis and genetic predisposition,Cardiovascular diseases,Aa has been involved with endocarditis Bacteria adhere to damaged heart values,Adverse pregnancy outcomes,Preterm low weight birth PLBW: 10% in China Relative risk is 7 IL-1,IL-6, PGE2, TNF-, MMPs,谢谢,2005年第三次全国口腔健康流行病学调查牙周病状况调查,1. 指标 牙龈出血、牙结石、牙周袋、附着丧失（LOA） 牙龈出血是牙龈炎的指征 牙结石反映口腔卫生状况 牙周袋是牙周炎最重要的病理改变之一 附着丧失是反映累积的牙周附着破坏的情况,2. 检查项目 12岁组：检查牙龈出血、牙结石 35-44岁组：检查牙龈出血、牙结石、牙周袋、附着丧失 65-74岁组：检查牙龈出血、牙结石、牙周袋、附着丧失,3. 检查的牙齿 各年龄组受检者的全口牙齿都要进行牙龈出血、牙结石、牙周袋的检查 35-44岁组和65-74岁组受检者按照ID号的单双数对1，3象限或2，4象限的牙进行附着丧失的检查,4. 记分方法 （1）牙龈出血： 0探诊后牙龈没有出血 1探诊后牙龈有出血 9不作记录（大量牙石覆盖牙面、残根或 有不良修复体而无法检查） X缺失牙,（2）牙石： 0没有牙石 1有龈上牙石或龈下牙石 9不作记录（残根或有不良修复体而无法检查） X缺失牙,3）牙周袋： 0没有牙周袋 （探诊时第一段黑区全部可见） 1牙周袋4-5mm（探诊时龈缘在探针的第一段黑区内）