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ORIGINAL RESEARCH Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 4  |  Page : 423-425
Community periodontal index of treatment needs index: An indicator of anaerobic periodontal infection


Department of Periodontics, Sri Ramachandra Dental College, Sri Ramachandra University, Porur, Chennai - 600 116, India

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Date of Submission17-Aug-2008
Date of Decision29-Jan-2009
Date of Acceptance12-Jun-2009
Date of Web Publication29-Jan-2010
 

   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

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 2019 Sep 19];20:423-5. Available from: http://www.ijdr.in/text.asp?2009/20/4/423/59441
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) [1] which was later adopted by International Dental Federation in 1985 for use in epidemiological studies and for periodontal evaluation in clinical dentistry.

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. [2]

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. [3] 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 Top


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. [4]

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). [5]

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.

Statistical analysis

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 Top


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 Top


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. [6] 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. [7] 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). [8]

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). [6] The above results were in accordance with the study reported by Grisi et al., 1999. [2]

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. [9] 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), [10] Loesche et al. (1987), [11] Schmidt et al. (1988), [12] and Grisi et al. (1998). [13]

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 Top

1.Ainamo J, Barmes D, Beagrie G, Cutress T, Martin J, Sardo-Infirri J. Development of the world health organization (WHO) community periodontal index of treatment needs (CPITN). Int Dent J 1982;32;281-91.  Back to cited text no. 1      
2.Grisi MF, Salvador SL, Martins W Jr, Catandi N, Silva-Neto CR. Correlation between the CPITN score and anaerobic periodontal infections assessed by BANA assay. Braz Dent J 1999;10:93-7.  Back to cited text no. 2  [PUBMED]    
3.Loesche WJ, Bretz WA, Lopatin D, Stoll J, Rau CF, Hillenburg KL et al. Multi-center clinical evaluation of a chair side method for detecting certain periodontal bacteria in periodontal disease. J Periodontology 1990;61:189-96.  Back to cited text no. 3      
4.Grisi MF, Correa Filho TA, Fanganiello CL, Martins Júnior W, Silva-Neto CR, Salvador SL. Relationship between the presence or absence of gingival bleeding and the enzymatic BANA test. Braz Dent J 2001;12:23-6.  Back to cited text no. 4      
5.Flemmig TF. Periodontitis. Ann Periodontol 1999;4:32.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  
6.Loesche WJ, Syed SA, Schmidt E, Morrison. Bacterial profiles of subgingival plaque in periodontitis. J Periodontology 1985;56:447-55.  Back to cited text no. 6      
7.Loesche WJ, Bretz WA, Kerschensteiner D, Stoll J, Socransky SS, Hujoel P, et al. Development of a diagnostic test for anaerobic periodontal infection based on plaque hydrolysis of Benzoyl-DL-Arginine Napthylamide (BANA). J Clin Microbiol 1990;28:1551-9.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  
8.Loesche WJ, Lopatin DE, Stoll J, van Poperin N, Hujoel PP. Comparison of various detection methods for periodontopathogenic bacteria: Can culture be considered the primary reference standard. J Clin Microbiol 1992;30:418-26.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]  
9.Bretz WA, Lopatin D, Hujoel P, Taylor C, Loesche WJ. BANA hydrolysis and T. denticola and/or B. gingivalis in periodontal plaques. In: Annual Session of IADR 18. San Francisco, 1989. Apud J Dent Res 1989;68:241.  Back to cited text no. 9      
10.Grisi MF, Novaes AB, Ito IY, Salvador SL. Relationship between clinical probing depth and reactivity to the BANA test of Samples of subgingival microbiota from patients with periodontitis. Braz Dent J 1998-9:77-84.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]  
11.Schmidt EF, Bretz WA, Hutchinson RA, Loesche WJ. Correlation of the hydrolysis of benzoyl-arginine naphthylamide (BANA) by plaque with clinical parameters and subgingival levels of spirochetes in periodontal patients. J Dent Res 1988;67;1505-9.  Back to cited text no. 11      
12.Syed SA, Gusberti FA, Loesche WJ, Lang NP. Diagnostic potential of chromogenic substance for rapid detection of bacterial enzymatic activity in health and disease associated periodontal plaque. J Periodontal Res 1984;19;618-21.  Back to cited text no. 12      
13.Grisi MF, Novaes AB, Ito IY, Salvador SL. Relationship between clinical probing depth and reactivity to the BANA test of samples of subgingival microbiota from patients with periodontitis. Braz Dent J 1998;9:77-84.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]  

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Correspondence Address:
R Suresh
Department of Periodontics, Sri Ramachandra Dental College, Sri Ramachandra University, Porur, Chennai - 600 116
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.59441

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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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