tooth brush, oral hygiene, traditional methods, periodontal disease, RESULTS Table, students present, principal method, Journal of periodontology, periodontal diseases, Nigerian population, secondary school scholars, MAC GREGOR, tooth brushing, Dental caries, Journal of clinical periodontology, Community dentistry and oral Epidemiology, B. OLSSON Efficiency
APPLICATION OF COMMUNITY PERIODONTAL INDEX OF TREATMENT NEED (CPITN) IN ENUGU (NIGERIA) : STUDY OF secondary school
STUDENTS AGED BETWEEN 12-18 YEARS
S. MADUAKOR*, Y. LAUVERJAT**, S. CADOT***, R. DA COSTA NOBLE**, C. LAPORTE, AND JL. MIQUEL***
INTRODUCTION A significant prevalent of periodontal disease
has been established in Nigeria by several authors (2)(3). This prevalence varies from one region to another (8)(14), also from different socio-economic and age groups (7)(9)(18). In this study involving 330 secondary school students aged between 12-18 yeats in Enugu, East of Nigeria, attempt is made at identifying their periodontal treatment needs with the intention of knowing the measures necessary to ensure a good periodontal health now and in the future. Account is taken of the fact that there are two major methods of oral hygiene praticed by the population : - tooth brush and tooth paste, - chewing sticks. It is known that a good percentage of Nigerians, in fact, Africans, use the chewing stick as their principal methods of oral hygiene. (4)(16)(21) Sote E.O. MATERIALS AND METHODS
A total of 330 students were studied. 4 secondary schools
were selected for the study : . 2 special secondary schools (for the privileged). One for boys and the other girls. . 2 ordinary secondary schools (public). One for boys and the other for girls. In each school, an average of 82 students were studied : . 41 junior students
(J.S.2) . 41 senior students (S.S.2). With the co-operation of the principals of the respective schools, the students were not informed of the proposed exercise to avoid any modifications of the situations of oral health
: students presenting with chronique medical conditions
(sickle-cell anaemia, Epilepsy and diabetes) were excluded. *Dentistry Department University of Nigeria
- NSUKKA - NIGERIA. ** Department of Periodontology - Bordeaux II University FRANCE. *** Department of Epidemiology
and Public Health - Bordeaux II University FRANCE.
Six teeth were examined, each representing a sextant since the students are below 20 years. (1)(11).
Codes 0 1 2 3 4
Periodontal Condition No bleeding No calculus No pathological pocket Bleeding on probing gingival margin
No calculus No pathological pocket Presence of calculus (sub ou supra gingival) with or without bleeding No pathological pocket Pathological pocket of 4-5 mm with or without bleeding and calculus Pathological pocket of 6 mm or more with or without bleeding and calculus
A Questionnaire Design
ed to know the age, sex, socioeconomic background, method (principal) of oral hygiene and attitude towards oral health of the students was administred before the clinical periodontal examination : the highest C.P.I.T.N in each sextant after examination of the four sites (labial, lingual/ palatal, mesical and distal) was retained as the score for the sextant : The average score for each subject was calculated. All examinations were conducted within the same month.
RESULTS Table II : Classification according to age groups/sex
Age Sex Males Females Total
12-12 63,4% 52 36,5% 30 100% 82
14-15 41% 57 59% 81 100% 138
16-18 70% 77 30% 33 100% 110
Total 56,4% 186 43,6% 144 100% 330
Application of community...
The question in view is to determine which principal method of oral hygiene is practiced : tooth brush/ paste or chewing stick. 80 % of the students use tooth brush/paste against 20% who use chewing stick : this tendency holds for the 3 age groups.The population is distributed in 3 age groups / -the 12-13 years representing 25% ; the 16_18 years, 33% and the 14-15 years, 42% : In general, among the 330 students examined, the boys are more numbrous than the girls (56,40% against 43,60%). This relation varies from one age groups to another : -the boys remain on majority in the agegroups 12-13 years and 16-18 years (60,40% and 70% respectively) where as in the age group 14-15 years, the girls from the majority. The question in view is to determine which principal method of oral hygiene is practiced : tooth brush/
paste or chewing stick. 80% of the students use tooth brush/paste against 20% who use chewing stick : this tendency holds for the 3 age groups.
Table III : classification according to age groupes and method of oral hygiene
Age Method of oral hygiene Brush Toothpaste Chewing stick Total
12-13 77% 63 23% 29 100% 82
14-15 80% 111 20% 27 100% 138
16-18 82% 90 18% 20 100% 110
Total 80% 264 20% 66 100% 330
Table IV : The prevalence of periodontal disease condition / group of age
CPITN Group of age 12-13 yrs 82 14-15 yrs 138 16-18 yrs 110 Total 10
0 19,5% 16 12,3% 17 3,6% 4 37
1 63,4% 52 60,8% 84 44,6% 49 11,8% 185
2 17,1% 14 26,1% 36 50,9% 56 56,3% 106
3 0% 0 0,72% 1 0,9% 1 31,4% 2
4 0% 0 0% 0 0 0,54% 0
TOTAL 100% 82 100% 138 100% 110 0 330
In general, more than half of the population (56,30%) present with bleeding (Code I) ; a third (31,40%), calculus (Code 2) and only 2 students present with periodontal pocket of 4-5mm (Code 3). A preponderance of bleeding on probing is observed among the age group 12-13 years (63,40% ) as well as in the age group 14-15 years (60,80% ). There is a diminution of bleeding in group 16-18 years (44,60%)
giving way to calculus which accounts for 50,90%. With advancing of age, there is decreasing "absence of disease" (Code 0) : - 19,5% for age group 12-13 years ; 12,3% for the 14-15 years and only 3,6% for the 16-18 years. The corollary is that as the population grows oldern the more the intensity of periodontal diseases, tensity of periodontal diseases.
Table V : the prevalence of periodontal disease in relation to oral hygienemethod
CPITN Oral hygiene Method Tooth Brush/Paste 264 Chewing stick 66 Total 330 Treatment
0 12,4% 32 10,6% 7 11,4% 37 No treatment
56,1% 148 56,1% 37 56,1% 185 Motivation
31,8% 84 33,3% 22 32,5% 106 Motivation + Scaling polishing
3 0,4% 1 1,5% 1 0,9% 2 Complex treatment
4 0% 0 0% 0 0% 0 Complex treatment
Application of community...
One does not see a significant difference
between the students using either of the methods of Oral Hygiene :
Nevertheless, there is slight advantage for the use of tooth brush/paste (31,8% against 33,3% (Code 2).
Table VI : the severity of periodontal disease in relation to the age groups
CPITN 0 2,79 2,29 1,39 2,16
CPITN 1 1,28 1,18 1,28 1,25
CPITN 2 1,88 2,32 3,15 2,45
CPITN 3 0,00 0,04 0,01 0,02
CPITN 4 0,00 0,01 0,02 0,01
The severity or the average number of sextants affected for each student augment with age. Generally this population presents 2,45 sextants with problem of calculus and has a tendency of increasing severity as the age advances : 1,88 sextants for the 12-13 years ; 2,32 sextants for the 14-15 years group and 3,15 sextants for the 16-18 years. In the same manner the population presents 2,16
sextants without periodontal disease (Code 0) and there is decreasing - order tendency for the age groups : - 2,79 sextants for the 12-13 years ; 2,29 sextants for the 14-15 years and 1,39 sextants for the 16-18 years. The severity of bleeding (Code I) remains stable in all the age-groups with an average of 1,95 sextants effected,
Table VII : treatment needs
Nb of cases Motivation
Scaling and polishing Complex treatment No need for treatment
12-13 yrs 14-15 yrs 138 16-18 yrs 110 Total 330
24,9% 82 41,8% 84 33,3% 49 100% 185
63,4% 52 60,8% 36 44,6% 56 56,3 106
17,1% 14 26,1% 1 50,9% 1 31,4% 2
0% 0 0,72% 17 0,9% 4 0,54% 37
19,5% 16 12,3% 3,6% 11,8%
More than half of the population 56,3% need education on oral hygiene measures (motivation). Just 1/3 (31,4%) need scaling and polishing. Only 2 children out of 30 need complex treatment. 55% of those needing scaling and polishing and from the age group 16-18 years. 45% of those needing motivation are from the age group 14-15 years. 2/3 of students aged between 12-15 years and almost 1/2 of those aged between 16-18 years need motivation. Again 1/2 of the 16-18 years need scaling and polishing ; 1/4 of the 14-15 years and only 1/5 of the 12-13 years need the same scaling and polishing. 20% of the students aged between 12-13 years do not have need for any treatment where as all the students aged between 16-18 years except 4, need periodontal treatment. The need for treatment increases with age.
DISCUSSION In this study, one notes an augmentation of the prevalence and severity of periodontal pathology with increasing age. This is in conformity with the result of various publications (15) in Nigeria, (14) Tanzania, (12) Sierra)Leone and (16) Zaire. Inspite of the high prevalence of bleeding (code 1), the severity is remarkably low (1,25 sextants out of six). There is only a case of juvenile periodontitis (0,3%) which confirms the figure of 0,3% - 0,7% given for Nigeria / Thailand (18) and other studies on the black-race : (6) (9) which give the figures of between 0,1 and 0,5%. The treatment need of this population is generally covered by motivation and scaling / polishing. In a population where the rate of clinical consultation is
Application of community...
abysmally low 27% (5% only having ever had scaling / polishing) the necessity for the moblilisation of efforts towards information and education on oral health and oral hygiene measures become very important. Concerning the method of oral hygiene, there is a striking shift from the use of chewing stick to the use of brush and tooth paste with advancing age. This trend is completely in keeping with the observations which link the choice and use of tooth brush / tooth paste with increasing self-esteem (16) (13). The tooth brush / kpaste shows a slight advantage over chewing stick. If at this tender age group (12-18 years) there is already a difference, the advantage will be more pronounced later in life. The chewing
stick however, can be a good method of oral hygiene as documented for Nigeria (21) ; Ethiopia (17) an Kenya (5). The tendency where by the tooth brush / paste is seen as a status-symbol (evidence of modernisation) should be disabused. Most of those who use the tooth brush / paste do not know how to use them and sometimes do not have the financial means to change them as and when due, or even to procure the tooth paste. The consequence is far-reaching. The World Health Organisation
should give her weight on the campaign for the correct use of the very available and cheap chewing stick. If the oral Health For All
by the year 2000 is to be a reality, the correct uses of tooth brush / paste and the chewing sticks should be simultaneously encouraged.
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