| Abstract|| |
Background : Community periodontal index of treatment needs (CPITN) index is commonly used to measure periodontal disease. It's uniqueness, apart from assessing the periodontal status, also gives the treatment needs for the underlying condition. Benzoyl-DL-arginine napthylamide (BANA) test is a chair side diagnostic test used to detect the presence of putative periodontal pathogens. We correlated the CPITN scores of patients with BANA test results to assess the validity of CPITN as an indicator of anaerobic periodontal infection.
Objectives : The present study was aimed to correlate the CPITN scores with the BANA activity of subgingival plaque. The objective was to assess the validity of CPITN index as indicator of anaerobic periodontal infection.
Patients and Methods : A total of 80 sites were selected from 20 patients with generalized chronic periodontitis. After measuring the probing depth with CPITN C probe, the highest score from each sextant was selected according to the CPITN criteria and subgingival plaque samples were collected using a sterile curette and the BANA test was performed.
Results : Kendall's tau-b and Chi- square test were used to assess the correlation between the BANA test results and CPITN scores. Results indicated sensitivity (92.86%), specificity (80%) and agreement (91.25%); indicating the validity of CPITN in assessing anaerobic infection.
Conclusion : There was a significant correlation between BANA test results and scores 3 and score 4 of CPITN index (P < 0.001) clearly indicating the presence of anaerobic periodontal infection.
Keywords: Community periodontal index of treatment needs, benzoyl-DL-arginine napthylamide, chronic periodontitis, putative periodontal pathogens
|How to cite this article:|
Muthukumar S, Suresh R. Community periodontal index of treatment needs index: An indicator of anaerobic periodontal infection. Indian J Dent Res 2009;20:423-5
Chronic periodontitis is a multifactorial disease which is very prevalent in developed and developing countries. Many clinical indices are used in the clinical evaluation of this condition. Prior to 1982, indices were being developed to carry out community periodontal services which were found to be cumbersome. In this scenario a new perspective became available to the periodontist where the community periodontal index of treatment needs (CPITN) was developed on an initiative by WHO (Ainamo et al. 1982)  which was later adopted by International Dental Federation in 1985 for use in epidemiological studies and for periodontal evaluation in clinical dentistry.
|How to cite this URL:|
Muthukumar S, Suresh R. Community periodontal index of treatment needs index: An indicator of anaerobic periodontal infection. Indian J Dent Res [serial online] 2009 [cited 2020 Feb 21];20:423-5. Available from: http://www.ijdr.in/text.asp?2009/20/4/423/59441
In 1990 this index was slightly modified and the periodontal screening and recording system was instituted and endorsed by the American Dental Association, American Association of Periodontology. This index system helps in prevention and treatment of periodontal disease. 
The primary etiological agent in chronic periodontitis is plaque microorganisms. Benzoyl-DL-arginine napthylamide (BANA) test is a simple chair side test which detects the putative microorganisms present in plaque.  CPITN is based on the causative factor (plaque) for periodontitis. In the present investigation, validity of the CPITN is assessed by correlating the presence of putative periodontal pathogens as evidenced by BANA test.
| Patients and Methods|| |
The subjects for this study were selected from the out patient department of Sri Ramachandra Dental College and Hospital. The patients were selected by a convenient sampling technique on the basis of clinical examination using the following criteria. 
Patients suffering from generalized form of chronic periodontitis, above the age group of 35 years, free from systemic diseases, patients who have not received any local or systemic antimicrobial and anti- inflammatory therapy for the past six months, patients who have not received any periodontal treatment for at least one year before examination, pregnant women and women who were on contraceptive medication were not selected for the study.
Most affected sites in each quadrant were selected according to the CPITN index from 20 patients with generalized form of chronic periodontitis (more than 30% of the sites with probing depth more than 5 mm, or attachment loss more than 1 mm). 
The BANA test detects the synthesis of a Trypsin-like enzyme produced by three putative periodontal pathogens: P. gingivalis, B. forsythus and T. denticola. This enzyme hydrolyzes the synthetic peptide of the BANA reagent and releases a chromophore, beta-napthylamide, which is coupled to Evans black dye, and read as a color change on the reagent test card.
According to the test protocol, subgingival plaque samples were collected with curretes, placed on reagent cards, incubated for 15 minutes at 55°C and visually evaluated for color changes and the results were interpreted using the BANA reagent interpretation chart [Figure 1].
- Negative: No blue color is observable on a pale red back ground.
- Weak positive: Faint blue color on a pale red background.
- Positive: Distinct patches of blue somewhat larger and darker than the weak positive reaction on a pale red background.
The results so obtained were subjected to statistical analysis and plotted in the form of tables.
Kendall's- tau b and Chi square test were used to find out the correlation between the BANA test results and CPITN scores. Sensitivity, specificity and agreement were also calculated.
| Results|| |
Of the 80 sites analyzed, 13 (16.25%) were BANA negative, 16 (20%) were weak positive, and 51 (63.75%) showed positive results [Table 1],[Table 2],[Table 3] [Figure 2].
| Discussion|| |
The objective of the present study was to determine the possible correlation of the BANA test results with the CPITN scores. BANA test (BANAMET LLC) format was used because of its advantages over the immunological, cultural and DNA probe methods.  BANA test is helpful as a simple objective chair side test to find out the presence of more than one anaerobic organism, which is considered as periodontopathic.  The limitation of the BANA test is that it does not identify which of the three BANA positive species is present in the plaque. However, as all the three species are anaerobes it allows the clinicians to determine that an anaerobic infection is present.
In the present study, 80 sites were selected from 20 patients and the BANA test was performed. When the CPITN scores were correlated with the BANA test results out of the 80 sites examined,16 (20%) were weak positive and 51 (63.8%) were positive indicating the presence of anaerobic organisms, which was in accordance with Loesche (1987,1990,1992). 
In the present study, CPITN score 0 showed significant correlations with negative BANA reactions (80%). The presence of positive reactions (20%), may be explained by the ability of the BANA test to identify the microbial colonization of pre-clinical infection (presence of microorganisms but not to the extent of producing disease).  The above results were in accordance with the study reported by Grisi et al., 1999. 
Positive BANA test reactions are significantly correlated with CPITN score 2. This may be explained by the fact that even though pocket depth was less, clear gingival changes were present at the site which may have been colonized by BANA positive microorganisms.  The highly significant positive BANA test reactions for the CPITN scores 3 and 4 suggest a significant correlation between the increasing CPITN scores and putative microorganisms. These findings are in agreement with the results of Syed et al.(1984),  Loesche et al. (1987),  Schmidt et al. (1988),  and Grisi et al. (1998). 
The negative BANA test reactions may be due to the presence of putative microorganisms below the detection level of BANA test and/or presence of non-putative microorganisms.
CPITN is primarily based on the probing pocket depth, though it also takes into consideration other factors which may predispose for plaque accumulation (overhanging restorations) in addition to the primary causative factor (plaque). However, it is basically a treatment need index and it cannot be replaced for the probing depth, clinical attachment level and bleeding on probing as it does not reflect the distinct differences in periodontal conditions.
Correlating the CPITN index scores with primary etiological factors adds weight to the validity and versatility of this index. This correlation of the CPITN index with the BANA test clearly demonstrates the sensitivity/specificity of the index. Thus CPITN index scores can be considered indicators of anaerobic periodontal infection.
| References|| |
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Department of Periodontics, Sri Ramachandra Dental College, Sri Ramachandra University, Porur, Chennai - 600 116
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]