GMJ ORAL PROCEEDINGS

GULF MEDICAL JOURNAL

CLINICAL EVALUATION OF GINGIVAL SULCUS DEPTH IN

PRIMARY DENTITION BY COMPUTERIZED, PRESSURE-
SENSITIVE FLORIDA PROBE
Anukriti Pathak1*, B. Nandlal2
1Specialist
Pediatric Dentist & Adjunct Clinical Faculty, Thumbay Hospital, Dubai; 2Head of Department, Department of
Pedodontics and Preventive Dentistry, JSS Dental College and Hospital, JSS University, Mysore, Karnataka, India
*Presenting Author

ABSTRACT
Introduction: Knowledge of the norms of gingival sulcus depth is essential for the assessment of
the extent of periodontal detachment as well as in the treatment of the affected tissue. In the past,
the gingival sulcus depth in primary dentition has been measured by conventional periodontal probes
and indigenously designed probes for more precise measurements. The periodontal probing system
Florida Probe incorporates the advantages of constant probing force, precise electronic
measurements, and computer storage of data. Various studies have been conducted using the Florida
Probe system in permanent dentition.
Objective: The aim of the study is to clinically evaluate the gingival sulcus depth in primary dentition
using Florida Probe.
Materials & Methods: A single examiner recorded the gingival sulcus depth of the 20 primary
teeth, at six sites on each tooth, with computerized, pressure-sensitive Florida Probe.
Results: The mean gingival sulcus depth in primary dentition as measured by Florida Probe (0.2 mm
precision) was found to be 1.20 mm with a standard deviation of 0.25 mm.
Conclusion: Florida Probe could be a better alternative to conventional probes to measure the
gingival sulcus depth not only in permanent dentition but also in primary dentition. The advantages
of constant force probing, a smaller tip diameter, accurate precision, and acceptance by children
render the method appropriate for evaluating the gingival sulcus depth in primary dentition.
Keywords: Computerized pressure-sensitive Florida Probe, gingival sulcus depth, primary dentition
Citation: Pathak A, Nandlal B. Clinical evaluation of gingival sulcus depth in primary dentition by
computerized, pressure-sensitive Florida Probe. Gulf Medical Journal. 2016;5(S1):S43–S51.

INTRODUCTION receive periodontal examination as part of their

Periodontal diseases in adults are often traced routine dental visits2. Measuring the gingival
to the early years of life. Gingival diseases sulcus depth is among the prime criteria to
found in primary dentition may progress to determine the onset of periodontal diseases3.
jeopardize the periodontium of permanent The gingival sulcus is a shallow V–shaped
teeth1. This has aroused considerable interest in groove, bounded by the surface of the tooth on
the study of gingival and periodontal diseases in one side and the epithelial lining of the free
children. gingival margin on the other side. It extends
around the circumference of the tooth in the
Early diagnosis is important for successful
cervical region of the crown. The gingiva is
treatment. Hence, it is imperative that children
attached to the tooth with the help of the
Correspondence: Dr. Anukriti Pathak, junctional epithelium, located at the bottom of
Specialist Pediatric Dentist and Adjunct Clinical the gingival sulcus.
Faculty, Thumbay Hospital, Dubai, UAE. The onset of periodontal disease is signified
Email: [email protected] by the loss of attachment of the junctional

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ANUKRITI PATHAK, B. NANDLAL GMJ. ASM 2016;5(S1):S43–S51

epithelium from the tooth surface, resulting in a periodontal probe. Because of the inaccuracy of
deepened gingival sulcus (also known as the manual pocket probing, in 1979, the National
periodontal pocket). Hence, measuring variation Institute of Dental Research (NIDR) in the US
in the normal sulcus depth is critical in requested the development of more sensitive
diagnosing periodontal disease. methods7. The criteria were met by the Florida
The knowledge of sulcus depth is also Research Group, which developed the Florida
helpful in the restorative dentistry of primary Probe system. It incorporates the advantages of
teeth for the margin placement of the constant probing force, precise electronic
prefabricated crown below the marginal gingiva measurements, and computer storage of data8.
so that it does not impinge upon the epithelial The present study is aimed at assessing the
attachment3. The depth of the sulcus or tooth gingival sulcus depth in primary dentition by
to be treated at the buccal margin should be more sensitive methods, i.e., using
measured as a baseline to properly trim the computerized, pressure-sensitive Florida Probe,
crown margins. As the buccal area presents the and evaluating the relationship among age,
shallowest sulcus, a simple measurement would gender, and gingival sulcus depth.
help determine how far apically the gingival
MATERIALS & METHODS
margin of the crown should be placed to
The participants comprised 30 subjects (15 male
prevent damage to the gingival attachment4.
and 15 female) aged 4–6 years who were
Thus, knowledge of the norms of gingival
randomly selected from JSS Public School in
sulcus depth is essential not only for the
Mysore, India. They were classified into three
assessment of the extent of periodontal
groups (each with 10 subjects) on the basis of
detachment and in the treatment of the affected
age and further (with five subjects each) on the
tissue but also for restorative procedures3.
basis of gender. Systemically healthy children
Gingival sulcus depth has not been studied with sets of firm primary teeth that had not
so extensively in primary dentition as in adult undergone scaling and oral prophylaxis in the
dentition. In 1966, Rosenblum et al. conducted last six months were included in the study. The
a gingival sulcus depth study using a specially exclusion criteria comprised systemic disease;
designed instrument on 29 children of 3 years advanced gingivitis or gingival pathologies;
to 6.2 years5. It was found that the mean pulpal pathogenesis; the evidence of caries at
gingival sulcus depth for the entire primary the buccal, lingual, or proximal surface; missing,
dentition was 2.1 mm, with a range of 0.5 mm supplementary, or mobile teeth; mixed
to 4.6 mm5. Chawla et al. designed a new dentition; malocclusion; parafunctional habits;
instrument made by various modifications in and uncooperative children.
the amalgam carrier; they found the mean
During the first appointment, oral hygiene
gingival sulcus depth to be 1.44 mm, with a
instructions were reinforced and
range of 0.73 mm to 2.93 mm3. Bimstein et al.
recommendations were given for home use of
evaluated gingival sulcus depth using a
fluoride-containing toothpastes and
periodontal probe calibrated in millimeters4.
mouthrinsing solutions. The children were
The average gingival sulcus depths around the
asked to perform oral hygiene measures under
primary maxillary and primary mandibular teeth
the supervision of their parents. The parents
were found to be 1.5 mm and 1.3 mm,
were offered an explanation of the study
respectively4. In 2006, Gomes-Filho et al.
procedure; written informed consent was
evaluated the relationship among the age,
obtained from those who voluntarily agreed to
gender, race, gingival width, and probing depth
have their children participate in the study. The
of primary teeth6.
study protocol described herein was approved
The traditional method to record sulcus by the college ethical committee concerning the
depth is using manual probing with a graduated use of human subjects in clinical examinations.

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CLINICAL EVALUATION OF GINGIVAL SULCUS DEPTH IN
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The subjects were recalled after seven days Florida Probe system comprises a probe
of reinforcement of oral hygiene instructions. A handpiece, displacement transducer with digital
thorough history and complete dental readout, foot switch, computer interface, and
examination were conducted on the recall personal computer.
appointments. Dental caries was recorded Study Conducted Using Florida Probe
according to the Modified Møller’s Index (1966) System as per Manufacturer’s Instructions
on a computerized proforma9. The examination
A single examiner recorded the gingival sulcus
was only clinical. Subjects with dental caries
depth in 30 subjects (15 male and 15 female)
grades 0, 1, and 2 at the occlusal surface, but
using the Florida Probe system13. The subjects
with no evidence of caries at the buccal, lingual,
were made to wear the occlusal stent. Pocket
and proximal surface were considered for the
depth was measured at six sites per tooth: three
study. The Plaque Index (PI) of Silness and Löe
facial and three lingual. To measure pocket
(1964) was used to record the plaque10, 11.
depth, the tip of the probe was placed at the
Subjects with plaque scores of 0 and 0.1–0.9
base of the sulcus, and the sleeve was brought
(excellent or good) were considered for the
to the gingival margin.
study. The Gingival Index (GI) of Löe and
As confirmed by the manufacturers, no
Silness (1967) was used to record gingival
changes were required to be made to the
inflammation11, 12. Subjects with scores of 0–1.0
angulation or probing pressure of Florida Probe
(healthy gingiva or mild gingivitis) were
for the primary dentition. Florida Probe Pocket
included in the study. The subjects were
Depth Handpiece products, with a normal tip
balanced for caries, gingivitis, and plaque using
length of 10.8mm, were used13. The tips were
the Dental Caries Index, Gingival Index, and
made from implant-grade titanium and marked
Plaque Index, respectively, for all age groups
with 3 mm, 6 mm, and 9 mm blue bands for
and genders.
visual reference. They were 0.45 mm in
A custom-made occlusal stent was prepared
diameter and had a straight wire design with a
for the maxillary and mandibular arches. The
flat bottom and rounded corners. The standard
stent was prepared with self-cure clear resin
model of the Florida Probe system comes with
using the sprinkle-on method on a cast model
a 15 gm probing force set in the encoder13. The
obtained from an alginate impression of each
Florida Probe software is designed for a
subject. It was created in a way that it covered
maximum of 32 adult teeth. However, the
the occlusal/incisal one-third on the buccal and
missing tooth mode of the software was used to
lingual sides (thickness of about 2–3 mm).
remove the molar teeth from each subject
Vertical grooves were made on the stent using a
(leaving 20 teeth totally), to represent the
straight fissure bur and contra-angled micro-
primary teeth set found in children. Data
motor handpiece to guide the probes at six sites
entered directly from the Probe Handpiece
on each tooth: mesio-buccal (MB), mid-buccal
products was recorded at 0.2 mm precision (1.2
(B), disto-buccal (DB), mesio-lingual (ML),
mm, for example). It is expected that the higher
mid-lingual (L), and disto-lingual (DL). The
precision numbers obtained from the Florida
stent was made to fit on the occlusal/incisal
Probe data would help with increased accuracy
surfaces of the teeth, and measurements were
and precision over manual probing.
made using Florida Probe by placing it in the
Statistical Analysis
groove made on the stent.
Statistical calculations were performed using the
Measurement of Gingival Sulcus Depth
SPSS software for Windows, Version 16.0
with Florida Probe System
(Statistical Presentation System Software, SPSS
FP32 version 6.6.2 with PD/CEJ standard
Inc., New York). The one-way analysis of
probe tips (Florida Probe Corporation,
variance (ANOVA) procedure was carried out
Gainesville, USA) were used in this study13. The
for each tooth type for the purpose of

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ANUKRITI PATHAK, B. NANDLAL GMJ. ASM 2016;5(S1):S43–S51

comparing any variations in gingival sulcus The significance levels were fixed at 5%,
depth in the age groups of 4, 5, and 6. An i.e., the 0.05 (significant), 0.01 (significant), or
independent sample t-test was performed for 0.001 (highly significant) levels. Any probability
each tooth type for comparison between value above 0.05 was considered non-
genders. A paired sample t-test was conducted significant.
for each tooth type to compare the maxillary
and mandibular arches. Repeated measures RESULTS
ANOVA was performed in both males and Table 1 displays the descriptive data pertaining
females to compare the differences in the mean to the distribution of subjects according to age
values of the gingival sulcus depth between the and gender.
buccal and lingual surfaces for each tooth type.
Table 1. Distribution of subjects according to age and gender
Gender No. of teeth No. of sites
Age groups No. of subjects
Females Males N n
4 10 5 5 200 1200
5 10 5 5 200 1200
6 10 5 5 200 1200
Total 30 15 15 600 3600
Table 2. Age-wise variation of mean gingival sulcus depth by type of primary teeth
Tooth Age N n Mean S. D. p value
4 20 120 1.23 0.17
Maxillary central incisor 5 20 120 1.15 0.23 0.548
6 20 120 1.17 0.27
4 20 120 1.24 0.20
Lateral incisor 5 20 120 1.11 0.19 0.151
6 20 120 1.12 0.27
4 20 120 1.21 0.22
Canine 5 20 120 1.29 0.21 0.505
6 20 120 1.25 0.24
4 20 120 1.14 0.20
First molar 5 20 120 1.09 0.20 0.527
6 20 120 1.17 0.26
4 20 120 1.32 0.22
Second molar 5 20 120 1.27 0.25 0.027*
6 20 120 1.54 0.46
4 20 120 1.10 0.21
Mandibular central incisor 5 20 120 1.06 0.26 0.830
6 20 120 1.09 0.16
4 20 120 1.22 0.20
Lateral incisor 5 20 120 1.14 0.28 0.298
6 20 120 1.12 0.13
4 20 120 1.20 0.16
Canine 5 20 120 1.19 0.22 0.711
6 20 120 1.24 0.20
4 20 120 1.09 0.18
First molar 5 20 120 1.07 0.24 0.550
6 20 120 1.15 0.25
4 20 120 1.28 0.22
Second molar 5 20 120 1.42 0.31 0.215
6 20 120 1.33 0.21
4 200 1200 1.20 0.21
Overall teeth 5 200 1200 1.18 0.26 0.299
6 200 1200 1.22 0.28
S. D. – Standard deviation, *<0.05 Significant

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Significant variations in probing depth were significant (p < 0.001), with females having
observed among the three age groups for the greater sulcus depth than males (Table 3).
maxillary second molar. The results were found Significant differences (p < 0.05) in probing
to be non-significant for all the teeth (Table 2). depth were observed for the central incisors.
Females were found to have significantly (p The mean of the probing depth for the
< 0.05) greater sulcus depth for the maxillary maxillary arch was greater than that for the
central incisors and mandibular second molars. mandibular arch, though not statistically
The difference between the overall teeth of significant (Table 4).
males and females was observed to be highly
Table 3. Gender-wise variation of mean gingival sulcus depth by type of primary teeth
Tooth Gender N n Mean S. D. p value
M 30 180 1.11 0.24
Maxillary central incisor 0.011*
F 30 180 1.25 0.18
M 30 180 1.13 0.20
Lateral incisor 0.340
F 30 180 1.18 0.25
M 30 180 1.21 0.26
Canine 0.155
F 30 180 1.29 0.17
M 30 180 1.10 0.25
First molar 0.288
F 30 180 1.16 0.19
M 30 180 1.34 0.46
Second molar 0.489
F 30 180 1.41 0.18
M 30 180 1.04 0.25
Mandibular central incisor 0.159
F 30 180 1.12 0.16
M 30 180 1.11 0.25
Lateral incisor 0.100
F 30 180 1.20 0.15
M 30 180 1.18 0.23
Canine 0.262
F 30 180 1.24 0.14
M 30 180 1.08 0.22
First molar 0.471
F 30 180 1.12 0.23
M 30 180 1.27 0.23
Second molar 0.032*
F 30 180 1.41 0.26
M 300 1800 1.16 0.28
Overall teeth 0.000***
F 300 1800 1.24 0.22
***<0.001 Highly significant; *<0.05 Significant
Table 4. Arch-wise variation of mean gingival sulcus depth by type of primary teeth
Tooth Arch N n Mean S. D. P value
Maxillary 60 360 1.18 0.23
Central incisor 0.014*
Mandibular 60 360 1.08 0.21
Maxillary 60 360 1.16 0.23
Lateral incisor 0.956
Mandibular 60 360 1.16 0.21
Maxillary 60 360 1.25 0.22
Canine 0.280
Mandibular 60 360 1.21 0.19
Maxillary 60 360 1.13 0.22
First molar 0.471
Mandibular 60 360 1.10 0.22
Maxillary 60 360 1.37 0.34
Second molar 0.547
Mandibular 60 360 1.34 0.25
Maxillary 300 1800 1.22 0.27
Overall teeth 0.051
Mandibular 300 1800 1.18 0.24
*<0.05 Significant

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The overall mean of the gingival sulcus 0.28. The mean values of the gingival sulcus
depth for primary teeth in females was 1.24 ± depth at the buccal and lingual surfaces in each
0.22. The mean values of the gingival sulcus tooth type are mentioned in Table 6. In males,
depth at the buccal and lingual surfaces in each the buccal sulcus depth was observed to be
tooth type are mentioned in Table 5. In females, shallower than the lingual sulcus depth for the
the buccal sulcus depth was found to be maxillary lateral incisors and first molars with a
shallower than the lingual sulcus depth (non- non-significant difference. The buccal sulcus
significant difference) for the maxillary central depth was significantly shallower for the
incisors, maxillary lateral incisors, maxillary maxillary central incisors and mandibular first
second molars, mandibular canines, and molars. The buccal sulcus depth was
mandibular second molars. The buccal sulcus significantly deeper than the lingual sulcus
depth was observed to be significantly depth for the maxillary canines. It was also
shallower for the maxillary and mandibular first deeper for the maxillary second molars,
molars. It was found that the buccal sulcus mandibular central incisors, lateral incisors,
depth was significantly deeper than the lingual canines, and second molars, but the difference
sulcus depth for the mandibular central and was non-significant.
lateral incisors. It was also deeper for the The mean gingival sulcus depth for the
maxillary canine, but the difference was non- entire primary dentition was found to be 1.20 ±
significant. 0.25 mm. The mean values of the gingival
The mean of the gingival sulcus depth for sulcus depth in each primary tooth type are
primary teeth in males was found to be 1.16 ± mentioned in Table 7.
Table 5. Mean gingival sulcus depth at buccal and lingual surfaces by type of primary teeth in females
Maxillary Mandibular
Tooth type
Buccal Lingual Buccal Lingual
Central incisor 1.24 1.27 1.20 1.05
Lateral incisor 1.16 1.21 1.34 1.07
Canine 1.34 1.25 1.22 1.26
First molar 1.07 1.26 0.98 1.26
Second molar 1.39 1.42 1.38 1.44

Table 6. Mean gingival sulcus depth at buccal and lingual surfaces by type of primary teeth in males
Maxillary Mandibular
Tooth type
Buccal Lingual Buccal Lingual
Central incisor 1.04 1.18 1.06 1.03
Lateral incisor 1.15 1.10 1.17 1.06
Canine 1.34 1.08 1.21 1.16
First molar 1.06 1.14 0.92 1.25
Second molar 1.38 1.37 1.30 1.25

Table 7. Mean gingival sulcus depth in primary dentition

Maxillary Mandibular
Tooth type
Mean S. D. Mean S. D.
Central incisor 1.18 0.23 1.08 0.21
Lateral incisor 1.16 0.23 1.16 0.21
Canine 1.25 0.22 1.21 0.19
First molar 1.13 0.22 1.10 0.22
Second molar 1.37 0.34 1.34 0.25

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Figure 1. Measuring gingival sulcus depth with Florida Probe

Figure 2. Child undergoing Florida Probe examination

force during measurement. The system

DISCUSSION
incorporates the use of computer software and
A growing amount of research and data a footswitch for efficient data capture, which
emphasize the relevance of the prevention, early eliminates transcribing problems. This could
diagnosis, and early treatment of periodontal reduce bias since examiners would have no
diseases in children. To avoid erroneous knowledge of the measurements obtained using
diagnoses and unnecessary treatments, the Florida Probe. The 0.2 mm resolution of
pediatric dentist is required to differentiate measurement attainable with Florida Probe
between the pathologic processes and normal eliminates the need for rounding to a higher or
changes that occur in the periodontium with lower value. Because of this level of resolution,
age14. normal distributions would be more closely
The conventional periodontal probe is the approximated, likely reflecting changes in
standard instrument used for the assessment of measurement over time. This contrasts the step-
probing depth and the clinical attachment level. function of the whole millimeter differences
However, other probes have been introduced to created with conventional probe measurements.
reduce probing errors typically associated with Decisions for change might therefore be made
conventional probing. Florida Probe may have at lower cut-off points with Florida Probe than
some advantages over a conventional probe. with a conventional probe15.
Florida Probe applies constant, standardized

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Age-wise Variation of Mean Gingival Sulcus Chawla et al., Rosenblum et al., and Bimstein et
Depth al, who reported similar patterns in their
In the present study, the gingival sulcus depth studies3–5. The shallowest sulcus depth for the
was observed to increase from the ages of 4 first primary molar may be due to the special
years to 6 years, but the results were significant configuration of the buccal bulge in the tooth.
only for the maxillary second molars. This is Table 4 indicates the mean gingival sulcus
contrary to the findings of Gomes-Filho et al., depth for the maxillary teeth (1.22 ± 0.27 mm)
wherein the gingival sulcus depth was found to was more than that for the mandibular teeth
increase on the basis of age from 4 to 6 years6. (1.18 ± 0.24 mm). This result was in accordance
The results were significant in the majority of with the study by Bimstein et al., wherein the
the teeth. average sulcus depth was found to be 1.5 mm
Gender-wise Variation of Mean Gingival around the maxillary teeth and 1.3 mm around
Sulcus Depth the mandibular teeth4. The fact that the
maxillary teeth had a greater sulcus depth than
In the present study, the mean gingival sulcus
the mandibular teeth may be explained by the
depth was observed to be greater in females
differences in the ages of tooth eruption and
than males, but significant differences were
the eruption process itself. The difference in the
found only for the maxillary central incisors and
gingival sulcus depth at the buccal and lingual
mandibular second molars. Gomes-Filho et al.
surfaces (Tables 5 and 6) may be due to the
did not demonstrate significant gender
difference in the tooth morphology of each
differences in the majority of the teeth6. The
tooth type and their alignment in the arch.
mean gingival sulcus depth was found to be
greater in males than females in a study by In their study, Newman et al. reported the
Chawla et al., but the difference was noted as mean gingival sulcus depth in permanent
statistically insignificant3. dentition to be 1.8 mm1. In the present study,
the mean gingival sulcus depth for primary
Mean Values of Gingival Sulcus Depth in
teeth was found to be 1.20 mm. It was observed
Primary Dentition
that the gingival sulcus depth for primary teeth
In the present study, the mean gingival sulcus
was lesser than for permanent teeth. Similar
depth in primary dentition was noted as 1.20 ±
findings have been reported in other studies.
0.25 mm. The readings were found to be close
The presence of shallow gingival sulcus in
to those of other studies. Ainamo et al. observed
primary dentition may be due to the small size
an average gingival sulcus depth of 1 mm in 20
of teeth and jaws, and a less powerful
children aged 3 to 10 years16. Chawla et al., who
musculature in children.
reported the mean depth as 1.44 mm with a
Knowledge of the gingival sulcus depth is
range of 0.73 mm to 2.93 mm, also used a new
helpful in restorative dentistry for primary teeth
instrument reading to one-tenth of a millimeter3
for the margin placement of a prefabricated
Gomes-Filho et al. noted the probing depth in
crown below the marginal gingival so that it
primary dentition was from 1.03 ± 0.91 mm to
does not impinge upon the epithelial
2.08 ± 0.07 mm6. Conversely, Rosenblum et al.
attachment4.
observed higher values of 2.1 mm with a range
of 0.5 mm to 4.6 mm5. In the present study, the gingival sulcus
depths at the three buccal sites of the maxillary
The mean gingival sulcus depth in both
and mandibular first molars in females were
males and females increased gradually from the
noted to be 1.23 mm and 1.05 mm (MB), 0.90
primary central incisor to primary second molar
mm and 0.81 mm (B), and 1.09 mm and 1.09
(in both the maxillary and mandibular arches)
mm (DB), respectively. The gingival sulcus
except in the primary first molar, wherein the
depths at the three buccal sites of the maxillary
depth was lesser than in the primary canine
and mandibular first molars in males were
(Table 3). These results were in accordance with

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observed to be 1.29 mm and 0.94 mm (MB), gingival sulcus in the mixed dentition.
0.89 mm and 0.78 mm (B), and 1.01 mm and ASDC J Dent Child. 1983;50(4):264–7.
1.03 mm (DB), respectively. The B (mid-buccal) 5. Rosenblum FN. Clinical study of the depth
site presents the shallowest sulcus at the buccal of the gingival sulcus in the primary
margin; the crown margins should be trimmed dentition. J Dent Child. 1966;33(5):289–97.
according to the mid-buccal measurement of 6. Gomes-Filho IS, Miranda DA, Trindade
the gingival sulcus depth to prevent damage to SC, de Souza Teles Santos CA, de Freitas
CO, da Cruz SS, et al. Relationship among
the gingival attachment. gender, race, age, gingival width, and
The current study offers cross-sectional probing depth in primary teeth. J
data; however, longitudinal studies are required Periodontol. 2006;77(6):1032–42.
to evaluate the age variations in the gingival 7. Gibbs CH, Hirschfeld JW, Lee JG, Low SB,
sulcus depth in primary dentition. These norms Magnusson I, Thousand RR, et al.
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computerized periodontal probe--the
but should be taken into consideration for the
Florida Probe. J Clin Periodontol.
diagnosis and treatment of periodontal diseases 1988;15(2):137–44.
and restorative procedures. One of the 8. Eley BM, Cox SW. Advances in periodontal
drawbacks of the study is its sample size; a diagnosis. 2. New clinical methods of
larger epidemiological survey is required to diagnosis. Br Dent J. 1988;184(2):71–4.
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The present study strongly suggests that 10. Loe H, Silness J. Periodontal disease in
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