1. EPIDEMIOLOGY OF PERIODONTAL DISEASE

3. ASPECT OF NORMAL GINGIVA

4. CLINICAL NORMAL GINGIVA

5. HEAVILY PIGMENTED GINGIVA

7. Supragingival calculus is depicted on the buccal surfaces of maxillary molars adjacent to orifice for Stenson’s duct

8. Extensive supragingival calculus on the lingual surfaces of lower anterior teeth

9. Extensive supragingival calculus is on the lingual surfaces of lower anterior teeth

10. Dark pigmented deposits of subgingival calculus on the distal root of an extracted lower molar.

12. A lower incisor depicting a prominent root without any attached gingiva and accompanying gingival recession

13. A patient following the placement of a soft tissue graft to gain attached gingiva and treat the gingival recession

14. Overhanging margin of restoration and atrophied and inflamed gingival papilla

15. Marginal supragingival plaque and gingivitis

16. Marginal gingivitis and irregular gingival contour.

17. 48-hour plaque growth. Generalized gingivitis at the margins of almost all teeth

18. Generalized marginal inflammatory lesion

19. Generalized diffuse inflammatory lesion

20. Papillary gingival enlargement

21. Different degrees of recession

22. Insertion of a probe into the gingival sulcus

23. Bleeding appears about 30 seconds after probing.

24. Heavy calculus deposits on facial surfaces of upper first molar and second premolar.

25. Generalized gingival bleeding

26. Clinically normal gingiva- probe in place

27. Clinically normal gingiva- profuse bleeding after 30 seconds.

28. Generalized marginal gingivitis

29. Localized diffuse gingivitis

30. Extent of pocket revealed by periodontal probe on mesial of central incisor

31. Different types of periodontal pockets

33. The epidemiology is the science of epidemics
The epidemiology is the science of epidemics. Epidemiological methods are utilized for determining what proportion of the population at a given time is affected by a disease

34. The purpose of epidemiology is to increase understanding of the disease process to identify the risk factors or deteminants of disease.
One of the most valuable employed in dental epidemiology is the epidemiologic index which help in defining diagnosis

35. A GOOD EPIDEMIOLOGY INDEX : Must be easy to use
Permit the examination of many people in a short period of time

36. TYPES OF DENTAL INDICES
1/ Measures the number or proportion of people in a population with or without a specific condition at a specific point in time or interval of time
2/ Merasures the number of people affected and severity of the specific condition at a specific time or interval of time

37. INDICES I. Plaque indices II. Gingival indices
III. Periodontal indices
IV. Treatment needs indices

38. Plaque indices
Plaque index
Interdental hygiene index
Hygiene index

39. Only when scraped with explorer
Plaque index
This index concerns thickness of plaque along the gingival margin; this plaque plays role in the etiology of gingivitis
Grade Description
No plaque
Thin film of plaque at the gingival margin, visible
Only when scraped with explorer
Moderate amount of plaque along the gingival
margin;
Interdental space free of plaque;
Plaque visible with the naked eye.
Heavy plaque accumulation at the gingival margin;
Interdental space filled with plaque

40. Gingival Index Grade Description
Normal gingival, no inflammation, no discoloration, no bleeding
Mild inflammation, slight color change, mild alteration of gingival surface
No bleeding
Moderate inflammation, erythema, swelling, bleeding on probing, or when
Pressure applied
Severe inflammation, severe erythema and swelling, tendency toward spontaneous Hemorrhage, some ulceration

41. Papilla bleeding index
Grade Description
1-point seconds after probing the mesial and distal sulcus with a
periodontal probe, a single bleeding point is observed
2 -line/Points Thin film of plaque at the gingival margin, visible only when scraped with an explorer
3 -Triangle The interdental triangle becomes more or less filled with blood
4 - Drops Profuse bleeding. Immediately after probing, blood flows into the interdental area to cover portions of the tooth or gingiva

42. Periodontal Disease Index (PDI)
0 No inflammation, no alterations in the gingiva
Gingiva
Mild to moderate gingivitis at some locations on the gingival margin
Mild to moderate gingivitis of the entire gingival margin
Advanced gingivitis with severe erythema, hemorrhage, ulceration Periodontium
Up to 3mm of attachment loss, measured from the cementoenamel junction
mm of attachment loss
More than 6 mm of attachment loss

43. COMMUNITY PERIODONTAL INDEX OF TREATMENT NEEDS (CPITN)
Code CPI TN
Healthy
Bleeding on probing I . Oral hygiene instruction
Supra and\or Subgingival
calculus II . I+ calculus removal
Iatrogenic marginal
irritation
Shallow pockets up to
5 mm III . I+II+ complex treatment
Deeper pockets from
6mm

44. The Periodontal Screening and Recording ( PSR )
The PSR examination was developed in order to streamline the data gathering and record keeping for the screening periodontal examination

45. The PSR exam is patterned after the Community Periodontal Index of treatment needs (CPITN ) of the world health organization

46. This exam is completed with periodontal probe that has a ball at the tip and a black or colored band from mm While six sites are examined per tooth

47. The score for each sextant is determined and recorded

48. PSR Codes Code 0 : The deepest probing in the sextant is < 3.5mm
The colored band on the probe remains completely visible
There is no bleeding, calculus, or defective restorations
The patient needs preventive care only

49. Code 1:The colored band on the probe remains visible There is no calculus or defective restorative margins There is bleeding at the gingival margin Plaque must be removed and the patient instructed in proper oral hygiene

50. Code 2: The colored band on the probe remains completely visible There is detectable calculus and or defective restorative margins Treatment consists of plaque and calculus removal, Correction of plaque retentive factors and oral hygiene instruction

51. Code 3: The colored band on the probe is partially submerged in the pocket

52. Code 4: The colored band on the probe is completely submerged at one site

53. Code *: An asterisk is added to the numerical sextant score when furcation involvement, mobility, muccogingival problem or recession is present