the use of different cut-off levels to determine disease presence. Some workers use
intraoral radiographs to measure from the CEJ to the alveolar crest, while others use a
periodontal probe to determine clinically the distance from the CEJ to the base of the
periodontal crevice or pocket. Radiographic studies on children with a primary or a
mixed dentition indicate that loss of attachment is uncommon under the age of 9
years. A microscopic examination of the root surfaces of 200 extracted molars,
however, demonstrated a mean attachment loss of 0.26 mm on two-thirds of the
surfaces on 94% of teeth. Clinically, such small changes are insignificant and difficult
to detect.
Cut-off levels at which disease is diagnosed in adolescents have been set at 1, 2, or 3
mm. Larger cut-off values provide more stringent criteria for the detection of
attachment loss and consequently the disease appears less prevalent. An exception to
this trend was seen in a study of 602, 14-15-year-olds in the United Kingdom; 51.5%
of the subjects were diagnosed as having periodontal disease determined by a
CEJ⎯alveolar crest distance of 3 mm. Additional radiographic features were also
used, namely an irregular contour of the alveolar crest and a widened, coronal
periodontal ligament space. Such observations may result from minor tooth
movements following eruption of the second molars and consolidation of the
occlusion, or from remodelling of bone after orthodontic treatment. It is, therefore,
likely that 51.5% is a considerable overestimate of disease prevalence in this age
group. If a cut-off value of 2 mm is deemed acceptable, the majority of studies put the
prevalence of disease in adolescents at 1-11%. This suggests that chronic adult
periodontitis initiates and progresses during the early teenage years.
Observations made with respect to periodontal disease in children include:
- When loss of attachment occurs at interproximal sites it is a consequence of
pathological change and correlates closely with the presence of subgingival calculus; - The prevalence of periodontal destruction correlates positively with DMF (decayed,
missing, and filled) teeth or surfaces. This suggests either, that carious or broken
down surfaces predispose to plaque accumulation, or perhaps more likely, that in the
absence of oral health care, periodontal disease and caries progress independently; - When the loss of attachment occurs on buccal or palatal surfaces, it is more often
associated with trauma from an incorrect toothbrushing technique than with an
inflammatory response.
Key Points
Loss of attachment:
- plaque-induced;
- trauma-induced;
- detected radiographically;
- decayed, missing, and filled (teeth) link.
11.9 RISK FACTORS FOR PERIODONTAL CONDITIONS AND DISEASES
11.9.0 Introduction
A risk factor can be defined as a state or occurrence that increases the probability of
an individual developing a disease. Risk factors for periodontal disease can be