Periodontal health status in adult Brazilians of Nova Friburgo City

Periodontal disease is an inflammatory condition that can reach the periodontal protection, gingival and support, alveolar bone, cementum and periodontal ligament. Early diagnosis is important to prevent periodontal disease. Periodontal Screening and Recording (PSR) have been used in this study to evaluate the presence of periodontal disease at Planning Clinic of the Federal University of Fluminense, Nova Friburgo, RJ, Brazil. Periodontal examinations were performed on 200 patients using OMS probe – 621 approved by American Dental Association (ADA). The results show that sextants 1 and 3 had higher prevalence of code 3, probing depth ranging from 3.5 to 5.5 mm, bleeding on probe, followed by edentulous sextants. Sextants 2, 4, 5 and 6 had code 2, presence or absence of bleeding on probe, calculus and/or excesses of the margins restorations. The asterisk code represented 44.5% of all sextants evaluated. This study demonstrates a higher diagnosis of periodontitis, due to the criteria of PSR that diagnosis is based on the worst code of all sextants. The analysis of data reveals that alveolar bone loss was the most frequent in this study population. PSR index was effective for the diagnosis of periodontal conditions of adults’ population from Nova Friburgo, RJ, Brazil.


INTRODUCTION
Periodontal disease is an inflammatory condition of bacterial origin which begins with gingival inflammation (gingivitis) and may or may not lead, over time, to extend the inflammation to supporting tissues of the teeth (periodontitis) (Socransky et al., 1984).
Despite the scientific and clinical advancement in the treatment of periodontal diseases, the prevalence of more more advanced forms in adult and elderly populations is high.Periodontal diagnosis shoud be done early, so that pathologies are identified in their initial forms, which can still be reversible (Rosell et al., 1999).
In the early 90s, the American Academy of Periodontology developed an index based on CPITN, the Periodontal Screening and Recording (PSR), with the goal of improving *Corresponding author.E-mail: gabrielacruz@id.uff.br.Tel: 55-22-25287168.Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License the oral health of the US population through early diagnosis of periodontal changes (Nasi, 1994).
The PSR is a simplified periodontal record, which represents a practical and effective method, which is appropriate for investigating patients with periodontal disease (Wallace, 2006;Lo Frisco et al., 1993;Wood and Johnson, 2008;Polk et al., 2012;Relvas et al., 2014).The PSR is a tool for early diagnosis and selection of the treatment according to disease severity.Through this tool, information may be obtained about the periondontal status, determined procedures, evaluation and maintenance of patients (Gjermo, 1994).Furuya (1992), Khocht et al. (1995), Löe et al. (1986), Nasi (1994) and Turpin (1994)  Data on oral health in the municipality of Nova Friburgo are scarce.No epidemiological survey on the distribution of periodontal disease using the PSR or any other periodontal index was found in the present research.Based on these findings and the importance of diagnosis, treatment and prevention of periodontal disease, this study aims to assess the prevalence and severity of periodontal disease using the PSR in patients residing in Nova Friburgo, Rio de Janeiro, Brazil seeking care in the Dental Clinic of the Dental Faculty, Nova Friburgo.These data will allow the identification of periodontal disease in this population, direct patients to specific dental treatment at the Dental Clinic UFF-NF, and assist in the direction of public policy in the municipality of Nova Friburgo.

MATERIALS AND METHODS
Two-hundred subjects, with age ranging from 45.5 ± 17.5 (mean ± standard deviation (SD)) were recruited from Planning Clinic of the Federal University of Fluminense, Nova Friburgo, RJ, Brazil.All participants were informed about the nature of the research and informed consent forms were signed.The protocol was presented to and approved by the Ethical Committee under the number protocol CAAE 133.354.13.2.0000.5243.The sample calculation was based on the number of habitants of Nova Friburgo, according to the last IBGE in 2010.The calculation of sample size was obtained with confidence level of 95%, 5% significance level (p = 0.05), critical value Z α/2 = 1.96 and acceptable margin of error of 7.5% considering a reliable estimate of the population proportion.The sample size for this study was set to 171 individuals.
The clinical periodontal parameters were performed using a probe OMS-621 (Trinity, São Paulo, SP, Brazil) approved by American Dental Association (ADA) by a single examiner.The examiner was previously trained and calibrated.The weighted Kappa test was used to verify the examiner calibration and was based on the analyses of average of all pair wise comparisons between the first and second examinations with intervals of 1 week to analyze the PSR scores of twenty individuals, 10% of total number of subjects.The means values obtained by the study examiner revealed the minimum agreement of 0.91 to PSR.
The OMS-621 probe has a sphere of 0.5 mm diameter in active tip and an area encoded in black 3.5 to 5.5 mm.The periodontal health status was determined using the periodontal screening record (PSR) (Nasi, 1994).All parameters were evaluated in sites per tooth for all sextants (excluding third molars).
In the analysis of the periodontal screening record (PSR), initially, the upper and lower maxilla were divided in sextants, each sextant received a code: (1) first sextant, -14 to 17; (2) second sextant, -13 to 23, (3) third sextant, -24 to 27, (4) fourth sextant, -37 to 34, (5) fifth sextant, 33 to 43 and (6) sixth sextant, 44 to 47 teeth, X code represent an edentulous sextant.Then the tests were made with tip of the probe into the gingival sulcus.The scores ranged from 0 to 4, or may not, this remarked with an asterisk (*), based on criteria listed: All codes were registered on data paper which was developed for research, containing patient identification such as race, gender and age.The diagnosis criteria were based on the worst code of the entire sextant.

Data analysis and statistical methods
Data were analyzed to determine descriptive analysis of subjects according to age, race, gender and PSR score by sextants.Data analysis was performed by evaluating the percentage of frequency of codes examined.Data were analyzed in Statistix program for Windows, Analytical Software (Version 9.0, Download Free Trial Version of Statistix 9, Tallahassee, USA).

RESULTS
Among the 200 study subjects, with age range of 45.5±17.5 (mean ± SD).Number and percentage of de Lucena et al.   were distributed by sex and race as shown in Table 1.
The PSR scores were distributed by sextants.The results of the number of occurrence and frequency were presented as shown in Table 2. *Code presented 44.5% presence (n=89) and 55.5% absent (n=111).It reveals the presence of mobility, furcation involvement, gingival recession>3.5 mm and mucogingival problems in sextants evaluated.These results demonstrate that most individuals had been diagnosed of periodontitis due to higher prevalence of scores 3 and 4, followed by gingivitis scores 1 and 2 (Table 3).

DISCUSSION
This study is based on data from Nova Friburgo population, state of Rio de Janeiro, Brazil.In the present study, it was observed that sextant 1 showed a higher prevalence of lost teeth (24.5%).According Anderson (2002), the presence of pits and fissures inaccessible to cleaning in occlusal surface of the first permanent molar, coupled with socioeconomic status and type of the Brazilian diet, leading to rapid installation carious process and subsequent tooth loss.
The population presented a high rate of periodontal changes such as tooth mobility, furca involvement, gingival recession greater than 3.5 mm and mucogingivatis problems (44.5%).The PSR score most prevalent in this study was code 2. This result is consistent with that of Salkin et al. (1993) applying the PSR in Philadelphia's population, USA, found that code 2 was the most prevalent (41.9%).
The PSR index is a periodontal diagnostic system, which in addition to registering the necessity of treatment so quickly, easy, low cost, educating and motivating the patient, promotes recognition of periodontal disease, but the PSR does not replace the conventional periodontal diagnosis system, because this is not a detailed periodontal examination (Furuya, 1992;Turpin, 1994;Charles and Charles, 1994;Khocht et al., 1995).
Regarding periodontal disease, the results show that 54.0% of the subjects evaluated present diagnosis of periodontitis and 39% of the population have compatible diagnostic of gingivitis.The diagnosis is established by the worst sextant, which may explain this high percentage of periodontitis in the population.
This result reveals that the population of Nova Friburgo need orientation on oral health, monitoring and periodontal treatment.According Ainamo (1984), when it concerns the necessity of treatment, although the elimination of all signs of inflammation is an important therapeutic goal, not always is it possible to be achieved in a certain population, subject or dental site.For Rossell et al. (1999), to reduce the necessity of treatment, a good treatment plan after careful analysis of the data should be developed to achieve not only periodontal health, but oral health.

Conclusion
Based on the results of this study, periodontal health of Nova Friburgo population requires specific care attention due to higher diagnosis of periodontitis condition.Preventive and curative periodontal programs with focus on oral hygiene, periodontal exams and periodontal treatments are suggests in order to decrease the disease in the population.

Table 2 .
Distribution of PSR score by sextants number and percentage (n = 200).