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  • Loe 1986

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    Low et al

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    Low et al

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    © All Rights Reserved
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    Signaler comme contenu inapproprié
    264 vues10 pages

    Loe 1986

    Transféré par

    anushka
    Low et al

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF ou lisez en ligne sur Scribd
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    sur 10
    Natural history of periodontal disease in man Rapid, moderate and no loss of attachment in Sri Lankan laborers 14 to 46 years of age ‘Libe 1, Anerud A, Boysen Hand Morrison E: Nasural history of periadontal sisease in man. Rapid, moderate and no loss of attachment in Sri Lankan laborers 14 046 years of age. J Clin Periodontol 1986; 13: 431-440. Abstract. This paper describes the initiation, rate of progress of periodontal disease and consequent tooth loss in a population never exposed to any pro- rams or incidents relative to prevention end treatment of dental diseases. The group consisted of 480 male laborers at two tea plantations in Sri Lanka, The study design and basctine data have been published. At the initial examination in 1970, the age of the participants ranged between 14 and 31 years, Subsequent ‘examinations occurred in 1974, 1973, 1977, 1982 and 1985. Thus, the study covers the age range 14-46 years. Throughout the study, the clinical indices were scored by the same two examiners, both well-irained and experienced periodonti- tis, Intra examiner reproducibility for each index was tested at baseline and ‘epested periodically during the study. The data for each examination were computerized and updated on an ongoing basis. At the last examination in 1985. there were 161 individuals who had participated in the first survey. ‘This population did not perform any conventional oral hygiene measures and consequently displayed quite uniformly large aggregates of plaque, calculus aad s#ain on their teeth, Virtually all gingival units exhibited inflammation, Based on imerproximal joss of atchment and tooth mortality rates three subpopulations ‘were idemtfied: (1) individuals (~-8°) with rapid progression of periodontal disease (RP), those (~81%) with moderate progression (MP), and a group (~ 11%) who exhibited no progression (NP) of periodontal disease beyond gingivitis. ‘AC3S years of age, the mean loss of attachment in the RP group was ~9 mm, the MP group had ~4 mm and the NP group had less than 1 mm loss of attachment. At the age of 45 years, the mean loss of attachment in the RP group was ~ 13mm and the MP group ~7 mm. The annual rate of destruction is the RE acounaid Peters 0 gd Lin te ‘Simm. and in the NP group between 0.05 and 0.09 mm Sine ths popeaton ‘as wrualy caves fee camry T-maaing elo doe ree oa Aiease. Te the RP group, cooth lous already oourred 320 yeas of ae aod increased throughou te ext 25 years. AUS years of age, 12 eth ed een las at 40 years of age 20 teeth were ssing and at 48 al teeth were lot fa the MP groups, tooth morality stared afer 30 yeas of age and incensed throughout the dade, AUS yeas of ap, the mean lus of eth ths group wat ee The NP group etseatialy shoved wo toa ows 1H. Lie, A. Anerud, H. Boysen and E, Morrison National inte of Dena! Reeearch, National Inaisten of Heat, Bethondn Hearylane, USA ay words: Natural history ~ periodontal ie. fate ~ los of atchrnent tooth lnm. Almost ail of our knowledge of peri- a function of time, are virtually aon odontal morbidity and tooth morality existent. of the human dentition stems from The material presented here is de- 10mm 7 0.00 2.00 390 043 1.08 4.98 om 20 499 026 197 733 on + 15 27 074 2m 453 om iz ws un 22 28a a 290 me 22 292 28.76 22 23 aa a0 338 Be 22 297 2m 358 290 5a 428 489 418 ne 508 02 13.96 642 S104 19.58 6.28 om 67% 557 5688, as om 7m a a7 9 as 53.04 1838 625 nw ae wt 2.08 435 5150 1053 os 08 ss me we Re se eS BoD BH aw se berween 5-9 mm or 10 mm or more (Table 9). The annual rate of attach- ‘ment loss at this age had increased 10 approximately 0.5 mm {Table 6) and tooth mortality rates were on the in- ‘crease (Table 7). The non-progressing diaasee group (NP) ‘The nowprogressing disease (NP) group averaged approximately 10% of ‘he planation group examined at vari- ous age levels (Table 10). Between 15 ‘and 19 years, approximately 38% of the ‘otal population showed 0 loss of at- tachment beyond 2 mm at any one site AC25, there were still 13% of the cohort ‘who had not developed periodontal de- struction to any degree. Between 30 and 35. the mean loss of attachment was still Approximately | mm (Fig. 8), advancing toward the age of 40 at a rate of 0.05 ‘mm per year (Table 6) ‘Tooth loss was inconspicuous (Tabie 8) and did not seem to increase as the individuals approached 40 years of age (Table 7). Prague, gingiva, calcutus end cartes In the subpopulations ‘At 15 years of age, the group with rapid developing periodontal (RP) disease bhad a mean plaque index score of 2.04, reflecting the presence of visible plaque in all interdental areas. 96% of the sur face scored PU=2 and the rest scored Pllm3, This level of oral hygiene was basically maintained through the next 30 years. The group with moderately progressing (MP) und non-progressing (NP) disease were not much different Natural history 37 ig. 7, Mean loss of attachment ~Sei Lanka. Five year age groups in maxilary and man dibular teeth (moderately progresting dis. am) Mitlerer Attachmenierbst Sri Lanka. 5. ahces Atersgrppen bei Oberkiefen eid Us terkiforsthnen (Krankts mii absiger Pro sresion) Parte dautache moyenne & SH Lanka. Groupes ge par 5 ars. powr les dens rpiricures (Masia) et Wfirieures (Mandible) (Malo «ea progression modirte: MP) eee Fig. 5, Meaa loss of attachment ~ Se Lanka Five year age groups in maxilary and maim. sibular teeth (no disease progewion). Mitlerer Attachmeniveratt~ Sri Lanka. 5- Jahres Altersgraapen bei Oberkicfer nd Une terkifersthnen. {Reine Progresion de Krankiet) Perted‘tiache moyenne Sri Lanta, Grouper age par $ ans, pour les dens sopricures ‘(Maxila) et nforewes (Mandible). ‘Gragpe sans progression de la maledie: NP) sn Lee etal, ‘Table 10. Frequency sd degree of attachment los (LA) in mesial root surface is Si Lankan tea lhorers between 14 and 35 years of age (no disease progression) ‘ean LA Percent Messuramants of Atmchment Lowt ‘Aga _Number "mm Simm 24mm 69mm > 10mm wu o1 om 10 mom me sm oon sar 0 oO won OW 9 tok om uv oe aM om am 00 wm Om 20 0m = ooo we Boon 25% © 90000 a vom 2@ am = 000 a MOR 67 amon 2 6 OB re er er) BoB oe 2p 71 oc | Om a 5 0@ = 4m om om re) 53m tm m6 (wr sm 4m 0m mz 48 om se um 1m 00 ma 2 om 26 755 0m (Oe a 2 o7 Cn m1 om mo =m 0D (Om m2 Ce Cr Bot 48 a en Bt 1s a Bot im ee en er) = 1 toe eu ve om Ow ‘A mean Pil=20 was observed at 15 years of age and maintained throughout the decades to follow. Gingival index scores were also very similar for the 3 groups, although there may have been a tendency for the rapid progressing (RP) group to score higher Eetween 15 and 25 years than the other two disease categories. Certainly, forthe W years and older age groups no dif- ference in gingival inex scores could be discerned, ‘Gingival caries was almost non-exist- ent both for mesial and buccal tooth Surfaces. All three groups of individuals ‘cored zero cates in 98-59 of the tooth surfaces. In the few instances gingival caries occurred it was equally often lo- sated above, at, or below the gingival ‘margin ‘Supre- and subgingival calculus was seen ia all 3 subpopulations. The RP ‘rou showed clearly the highest rate of ‘lculus formation before 20 years of ‘age, at which time more than 90% of the tooth surfaces developed supete and subgingival calculus. In comparing the three groups age by age (Fig. 9}, the RP ‘rou showed the bighest can calcu index and the highest frequency of scores CI=2 oF 3. However, the NP {roup also exhibited callus formation ‘early in life. By 15 years of age supra- ‘and subgingival caleulus occurred in 36% of the interproximal surfaces. The percent of involved surfaces increased steadily throughout the twenties and thirties, but never reached the levels ex- hibited by the RP and MP groups. +s ee ee 9. Mean exiclus ides ~ Si Lanka (me- Sal root surfaces for all valid observations). Mtlerer Zobmseinindex~ Sri Lanka, (Me ale Warseloberflichen bet aligemesngi ‘Beobocknungen). Indie de tartre moyen & Si Lanka (3 ‘adialires misiles pour tutes les ans volables). Discussion ‘This study was designed to characterize) ‘the initiation and progress of periodon- tal diease during major portions off than’ life (Loc etal, 197), The present report describes on the basis of repeated. craminations, tbe development of pes ‘odontal disease from the early lesion confined to the marginal gingiva, through the various stages of periodon- tal destitions, to the Uimate lat of teeth before 45 years oft. ‘An imporeant feature ofthis investi- sation is thatthe study population at ‘Ro time duting ther 4S years of ie sezived any ype of dental eatmentor ‘made any Coostous effort fo prevent or intervene with the development of the disease, Furthermore, the homogeneity. ofthe group as regards ethic, Vicoomest, eduction and. ntion (Lée et af. 1978a), suggests that ‘fedence be gives 10 jor differ. Sea Dias characters EO Jation dental caries was virtually ‘nistent, substantially facilitated analyses, and especially the of the role of periodontal disease i tooth mortality in this population. In general, this report extends and’ ‘expands on the longitudinal data ported earlier (Loe et al. 19788, by ‘and confirms the conczpt that in abvence of any intervention the lows periodontal attachment is contin struction of the periodontium will to exfoliation of the teeth. However, al sigoificant finding of this stady is that ‘even under identical extraneous circumm- stances, this population exhibited wide ranges of severity of this disease I is a matter of record (Ancrud et j al, 1978) that all 15-year-oids exhibited ‘Sogivits and that both the frequency and severity of the gingival iesion in- destruction of the periodontium (RP), As altexdy commented on, the ini- und (2) the other exhibiting arelative'y cation of the periodontal leion in the moderate progression of the disease different areas of the dentition may MP). ‘occur at different age levels. Also, the Rapidly progressing periodontal dis- rate of progress of the disease clearly ‘ase may start before of after the age of varies between group of individuals, 15 years, It may be confined to the frst within the individual dentition as well molars and incisors during the carly as at different age levels, ss shown in stages, but soon inciudes all groups of these studies. However, under natural teeth (Fig. 5). The main characterise conditions, inthe absence of any inter- ofthis form of periodontal disease isthe vention and irespective of vafiations in rate of destruction. The mean annual pace and patterns, the periodontal Je- rate of attachmeat loss at 15 years of sion age (013 mm) was relatively ow and pf of slow progress must be ascribed to the fact that rela- and Seas ee Scustes eo with which periodontal attachment is rapidly and moderately progressing dis- Jost, had quadrupled (0.5 mm per ease groups, the advancement of the le- i). As this subpopulation ap- sions will continue until the entire pe- ‘proached 30 years of age, the mean rate riodontium is included and will lead to ‘of attachment loss had increased to ap- the loss of the tooth, of multiple teeth roximately I mm ger yea. or the entire dentition. Tote os followed a similar patter, "I sbould be mbasied hata a wot of the years and beyond, tooth mortality in- ‘focal wed dramatic so bat pew 25. xE=ORA mle Resa of and 30-yeary-of-age-the-‘eiz of loath — disegss.peogeene(Socransky etal ria 1S wsth Li ierense in sever- ee, Beworn 35 and 40 yee of _ iy we ae phonons i. he Tate of tooth loss increased to SUET as Fheumatoid and osteo- 2.3 teeth per year; and as this subpopu+ artis, thuluple and Tavera? evomR, lation approached 40 years of age esoen- ancriosceross, glascoma, ete. The fact aly all teeth were lost. Approximately remains however, that owe time, ia the 10% of the plantation group exhibited absence of any interference and irres rapidly progressing periodontal disease. pective of possible short periods of ac- Moderately progressing periodontal tivity and inactivity, periodontal disease dtseate oocured in more than 80% of in man shows continuous progress the tea laborers, It started before 2D Perhaps the finding of small group ears of age and as in the rapidly pro- (10%) of Sri Lankan lea laborers pa aresing disease group, the first signs of —ticipating in both the longitudinal and periodontal destruction are found in the crost-sctionl studies who showed first molars and the incisors. From 15 seaially no progress of the periodootal {0.25 years of age, the lesions progresi dente beyond the gingival lesion, was a fairly even pace of 051.0 mm per the most significant result of the prwent yest, As these individuals approach 30 study. The mere presence of such a Years all teth are involved and the rate group among a population who gexer~ increases to 0.3 mm per year. Between ally exhibits various degrees of rampant 30 and 40 years of age the anual rate periodontal disease is surprising and ine of attachment loss is again approxi-iguing, and wil be subject to future mately 0.1 mm. The aceeleration mows sty. of attachment during the late twenties ‘contirms the earlier observation (Le as very few tecth were lost before the steady, age of twenty (Fig. 4). However, at 20 tal les does not File out discrete '978c) that the rate of progression 2usammentaseung fteachment loss in the group exhibiting {tachment et drt ‘rapid progression of the disease (RP). Djcar Verofentictim bechrebt dea Be- A this time, however, we can offer 10 gan, de Stirke der Prograsividt wed den explanation for this change in the dit- dans foleaden Zannrritet be ier Deval, ‘ase rate in either popalation. Aerangsrruppe, die nlemals im den Geass Nawural history 439 voo zthnbeilkundiches Priventions- und Betundlangsprogrammen kommen is. Diese Gruppe bestand aus 480 cuzmnlichen Arbctern von 2 Tesplantagen in Sri Lanka, Die Organisation der Smale und die Aus sangpdaton siod berets versffeticht wor ‘de, Bi der Ausgangrumtersochung im Jahre 1970 waren die Probenden reischen (4 und 31 Jahre alt, Die dann — ‘hungen wurden in deo Jahren 1971. 1973, 197, 1982 und 1985 vorgenommen. Die Ge- famistadie dct algo eine Alternstreunng vom 16-46 Jahren. Wabrend dee Getamisti ie worden die Kiiseben Indizes von den ‘lichen 2 Unterscheaden repinie, beide ‘got ausgebildete und erfahrene Parodoato}o- ‘gen. Die awischen den Untersuchenden vor legende Wiedesbolbarheit ener jeden Indes: ‘egistrierung wurde be det Ausgangsuntersi- chung geteiet und wabrend der ‘Untersuchung von Zeit Zeit widertolt. ie regitrierten Daten warden in Dator = fasit und latced grordaet. Bei der letzten Untersuchung in Jab 1985 waren vou det ‘uaprnglichen Gruppe 161 Probanden vor Ihandeo, die bereits an der ervien Unteroo- ‘chung wlgenortmen fatten, Bai diewr Population kam keine konven- Aonelle orale Hypiene wor. Dicker Paquebe- ag, reichicher Zahastein und Zahovestir- ‘bungen waren die Regel Sogut wi all Zabs= ‘eischregionen ‘it Zechen rapider Progreation der paro-

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