CPITN INDEX (Community Periodontal Index of Treatment Needs)

Kalinga Institute of Dental Sciences, KIMS, BBSR-24
INTRODUCTION
CPITN was introduced by JUKKA AINAMO , DAVID BARMES , GORGE BEAGRIE , TERRY CUTRESS , JEAN MARTIN and JENNIFER SARDO-INFIRRI for Joint working committee of the WHO and FDI in 1982 .
Developed primarily to survey and evaluate periodontal treatment needs rather than determining past and present periodontal status i.e. recession of the gingival margin and alveolar bone .
SCOPE AND PURPOSE
PROCEDURE
SEXTANT
INDEX TEETH
INSTRUMENTS USED
CPITN PROBE
Introduced by WHO in 1978.
Weight: 5gms
Working force: 20-25 gms.
Designed for 2 purposes :
1. Measurement of pocket depth
2. Detection of Sub-gingival calculus
PROBING PROCEDURE
EXAMINATION PROCEDURE
CALCULATION OF CPITN
COMMUNITY PERIODONTAL INDEX (CPI)
This index is modification of CPITN.
SUMMARY
CPITN is a screening procedure for identifying actual and potential problems posed by periodontal diseases both in the community and in the individual, introduced in 1982.
The CPITN records the common treatable conditions namely,
- periodontal pockets
- gingival inflammation
- dental calculus
- other plaque retentive factors
CPITN PROBE (introduced by WHO in 1978) is used to measure of pocket depth & detect sub-gingival calculus.
COMMUNITY PERIODONTAL INDEX (CPI) is the modification of CPITN which includes measurement of “loss of attachment”

1. DEPARTMENT OF PUBLIC HEALTH DENTISTRY TOPIC OF PRESENTATION: CPITN INDEX (Community Periodontal Index of Treatment Needs) PRESENTED BY: JEBAN JYOTI SAHU ROLL NO.: 1879032

2. CONTENTS INTRODUCTION SCOPE AND PURPOSE PROCEDURE SEXTANT INDEX TEETH INSTRUMENTS USED CPITN PROBE PROBING PROCEDURE EXAMINATION PROCEDURE CALCULATION OF CPITN COMMUNITY PERIODONTAL INDEX (CPI) SUMMARY

3. INTRODUCTION CPITN was introduced by JUKKA AINAMO , DAVID BARMES , GORGE BEAGRIE , TERRY CUTRESS , JEAN MARTIN and JENNIFER SARDO-INFIRRI for Joint working committee of the WHO and FDI in 1982 . Developed primarily to survey and evaluate periodontal treatment needs rather than determining past and present periodontal status i.e. recession of the gingival margin and alveolar bone . Treatment needs imply that CPITN assesses only those conditions potentially responsive to treatment , but not nontreatable or irreversible conditions .

4. SCOPE AND PURPOSE The CPITN procedure is recommended for epidemiological surveys of periodontal health. It provides guidance on planning and monitoring of the effectiveness of periodontal care programme and dental personnel required. The CPITN records the common treatable conditions namely, - periodontal pockets - gingival inflammation - dental calculus - other plaque retentive factors It doesn’t record irreversible changes such as recession or other deviations from periodontal health such as tooth mobility or loss of periodontal attachment .

5. ADVANTAGES: Major Advantages of CPITN are : Simplicity Speed International Uniformity LIMITATIONS: Does not record the position of gingival margin. Does not provide assessment of past periodontal breakdown.

6. PROCEDURE The dentition is divided into 6 parts called sextants . Each sextant is given a score. For epidemiological purposes the score is identified by examination of specified index teeth . For clinical practise the highest score in each sextant is identified after examining all teeth.

7. SEXTANT The Mouth is divides into 6 sextants defined by tooth numbers as shown below- 17-14 13-23 24-27 47-44 43-33 34-37 The third molars are not included except where they are functioning in place of second molars. The treatment need in a sextant is recorded only if there are 2 or more teeth present and not indicated for extraction. When only one tooth is present in a sextant, it is included in the adjacent sextant.

8. INDEX TEETH In Epidemiological surveys for adults, aged 20 years or more, only 10 teeth, known as the Index Teeth are examined. The ten specified index Teeth are :- The Molars are examined in pairs and only one score, the highest is recorded. Only one score is recorded for each sextant. 17/16 11 26/27 47/46 31 36/37

9. For young people upto 19 years, only 6 Index teeth are examined. The second molars are excluded as Index Teeth at these ages because of the high frequency of false pockets. (non-inflammatory, associated with tooth eruption) 16 11 26 46 31 36 The six Index teeth selected are : When examining children less than 15 years, Pockets are not recorded although probing for bleeding and calculus are carried out as a routine.

10. INSTRUMENTS USED CPITN - C PROBE CPITN - E PROBE CPITN PROBE MOUTH MIRROR

11. CPITN PROBE CPITN-E PROBE CPITN-C PROBE Introduced by WHO in 1978. Weight: 5gms Designed for 2 purposes : 1. Measurement of pocket depth 2. Detection of Sub-gingival calculus It has a 0.5mm ball at the tip and mm markings are at 3.5,5.5,8.5 and 11.5 and colour coding from 3.5 to 5.5. Working force: 20-25 gms.

12. CPITN- C PROBE CPITN- E PROBE

13. PROBING PROCEDURE A tooth is probed to determine pocket depth and to detect subgingival calculus and bleeding response . PROBING FORCE WORKING COMPONENT SENSING COMPONENT To determine POCKET DEPTH To detect SUBGINGIVAL CALCULUS Working force shouldn’t exceed 20gms- a practical test for establishing this force is to gently insert the probe point under the finger nail without causing pain or discomfort. Pain to the patient during probing is in most cases indicative of the use of a too heavy probing force.

14. The probe is inserted between the tooth and gingiva , and the sulcus depth is noted against the color code or marking. The ball end of the probe should be kept in contact with root surface. Direction of probe during insertion should be whenever possible in the same plane as the long axis of the tooth. ‘Walking’ the probe should be done with short upward & downward movements. Recommended sites for Probing: A tooth should be probed in atleast 6 points., MESIO-BUCCAL, MID-BUCCAL, DISTO-BUCCAL, & THE CORRESPONDING SITES ON THE LINGUAL SURFACE.

15. EXAMINATION PROCEDURE The aim is to determine the highest score applicable to each sextant with the least no. of measurements. For a sextant to be validly scored, the requirement is that more than one functional tooth should be present. NO YES SCORE ‘ X’ , & MOVE TO NEXT SEXTANT EXAMINE INDEX TEETH (in epidemiological procedure) EXAMINE ALL TEETH (in clinical screening procedure) Once the highest score has been determined (for each sextant) there is no need to examine for the presence of the lower score in that sextant.

16. ‘CODES AND CRITERIA’ & TREATEMENT NEEDS CODES CRITERIA TREATMENT NEEDS CODE 0 NO SIGNS OF DISEASE ( HEALTHY PERIODONTIUM ) TN 0 NO NEED FOR PERIODONTAL TREATMENT CODE 1 GINGIVAL BLEEDING AFTER GENTLE PROBING TN 1 NEED FOR IMPROVING THE PERSONAL ORAL HYGIENE OF THAT INDIVIDUAL CODE 2 PRESENCE OF SUPRA OR SUBGINGIVAL CALCULUS TN 2a NEED FOR SCALING . NEED FOR IMPROVING PERSONAL ORAL HYGIENE CODE 3 PATHOLOGICAL POCKET OF 4-5mm PRESENT , i.e, when the gingival margin is on the black area of the probe TN 2b SCALING AND ROOT PLANING. NEED FOR IMPROVING PERSONAL ORAL HYGIENE CODE 4 PATHOLOGICAL POCKET OF 6mm OR MORE PRESENT, the black area of CPITN probe is not visible TN 3 COMPLEX TREATMENT WHICH COULD INVOLVE DEEP SCALING, ROOT PLANING & MORE COMPLEX SURGICAL PROCEDURES. CODE X When only one or no teeth are present in a sextant (third molars are excluded unless they function in place of second molars)

17. COMMUNITY PERIODONTAL INDEX OF TREATMENT NEEDS (CPITN)

18. CALCULATION OF CPITN 3 3 3 3 4 3 1 1 1 1 1 X 4 4 4 4 X 4 3 1 2 3 1 1 1 3 3 3 3 3 3 2 2 2 2 1 3 1 2 3 X X X X X X 1 2 2 2 2 2 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) EXAMPLE: The following recordings of a group of 11 adults of age group 35-44yr. STEP 1: Count the no. of charts with CODE 0 ONLY. This identifies no. of subjects with healthy sextants (H) Count the no. of charts with CODE 1 Recorded as highest score. (0,X,1) This identifies no. of subjects with gingival bleeding (B) Count the no. of charts with CODE 2 Recorded as highest score. (0,X,1,2) This identifies no. of subjects with calculus & other plaque retentive factors (C) Count the no. of charts with CODE 3 Recorded as highest score. (0,X,1,2,3) This identifies no. of subjects with pockets of 4-5mm (P1) Count the no. of charts with CODE 4 Recorded as highest score. This identifies no. of subjects with pockets of 6mm or more (P2)

19. CALCULATIONS: The Chart shows: Greatest Code CODE 0 CODE 1 CODE 2 CODE 3 CODE 4 No. of Subjects 1 (1) 2 (2), (3) 2 (6), (9) 2 (8), (10) 3 (4), (5), (7) STEP 2: Calculate the percentages (prevalence): To obtain prevalence of subjects with CODES (0,1,2,3,4) as their highest score = Counts of CODES/No. of subjects respectively. Total no. of dentate subjects X 100 CODE 0 = 1 10 X 100 = 10 CODE 1 = 20 CODE 2 = 20 CODE 3 = 20 CODE 4 = 30

20. STEP 3: Tabulate the data: Table : Prevalence of persons affected AGE(yrs) NO. EXAMINED NO. OF DENTATE PERSONS % PERSONS CODED 35-44 11 10 H B C P1 P2 10 20 20 20 30 *NOTE: Total H + B + C + P1 + P2 = (100%)

21. COMMUNITY PERIODONTAL INDEX (CPI) This index is modification of CPITN. The modification is done by the inclusion of measurement of ‘ Loss of Attachment ’ and elimination of the ‘ Treatment Needs ’ category. INSTRUMENTS USED: MOUTH MIRROR The CPITN - C PROBE PROCEDURE: Same as that of CPITN.

22. SCORE CRITERIA Healthy 1 Bleeding on probing 2 Calculus detected during probing 3 Pocket 4-5mm 4 Pocket 6mm or more X Excluded sextant (less than 2 teeth) 9 Not recorded SCORE CRITERIA Loss of attachment 0-3mm 1 Loss of attachment 4-5mm 2 Loss of attachment 6-8mm 3 Loss of attachment 9-11mm 4 Loss of attachment 12mm or more X Excluded sextant (less than 2 teeth) 9 Not recorded

23. SUMMARY CPITN is a screening procedure for identifying actual and potential problems posed by periodontal diseases both in the community and in the individual, introduced in 1982. The CPITN records the common treatable conditions namely, - periodontal pockets - gingival inflammation - dental calculus - other plaque retentive factors CPITN PROBE (i ntroduced by WHO in 1978) is used to m easure of pocket depth & detect sub-gingival calculus. COMMUNITY PERIODONTAL INDEX (CPI) is the modification of CPITN which includes measurement of “loss of attachment”

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