The Periodontal Index: A. L. Russell Examining
The Periodontal Index: A. L. Russell Examining
The Periodontal Index: A. L. Russell Examining
BY A . L . R U S S E L L *
from a full-mouth x-ray survey. They con- employed with the group of examinees seen
cluded, quite correctly, that an estimate of here yesterday.
recession was unreliable in diagnosis of the
individual patient; this in view of large Another analogy might make the point
numbers of individuals with high recession more clearly. No single determination of
scores accompanied by minimal bone loss, blood cholesterol is adequate to determine
and the large numbers of individuals with
low recession scores and substantial bone
loss. But it will be seen at once that the
average degree of bone loss for a given de-
gree of recession is quite constant, as shown
by the regression lines in Figure 1. The
average degree of bone loss for the entire
group could have been computed from the
average recession score with a high degree
of precision. In appraising the status of the
whole group, in short, the recession score
would have been quite as valid and mean-
ingful as the data from the more complex
and costly x-ray examination. The recession
*School of Public Health and School of Dentistry, Fig. 1. Relation between gingival recession and alve-
University of Michigan. olar bone loss (Sandler and Stahl).
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Fig. 2. Examination site in Osegere, Nigeria. Fig. 3. Examination site in Sarrin, Lebanon.
conditions. Figures 2 and 3 are illustra- The figure also illustrates one of the dis-
tions of some of the situations i n which advantages common to indices of this sort
examinations have been conducted. Figure —the fact that such scores are abstractions
2 shows the examination i n progress i n and relatively meaningless, unless one is
Osegere, i n western Nigeria, and Figure 3 familiar with conditions they are intended
the examination room and instruments i n to assess. This is just as true, for example,
Sarrin, i n the Beka'a Valley i n Lebanon. of the Dow-Jones index or the index of
A s was the common experience, electric freight car loadings as it is of P I or D M F .
power was unavailable i n either of these
locations, though Sarrin had walking water Some concept of the range of scores
—water that walked into the village on the shown i n Figure 4 may be had through
heads of women from a source about three
miles away.
*The Epidemiology and Biometry Branch, National Fig. 4. P I scores for groups of civilians aged 40-49
Institute of Dental Research, National Institutes of years, examined by members of a single research or-
Health. ganization.
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There was obvious selection into two groups Table 4 shows some findings from one
—good and bad. Y o u n g men i n the sample of these surveys and illustrates another
scored far and away better than young method for the analysis of the relation be-
men the nation over; far and away better, tween P I findings and a concomitant vari-
in fact, than young women i n the sample, able. In this instance, P I data have been
which is unusual and surprising. In the used to divide a population group into a
older age groups there was rather more trichotomy of those with essentially normal
disease than we would expect to find i n a tissues, those with gingivitis only, and those
sample from the general United States pop- with advanced destructive periodontal dis-
ulation. ease as evidenced by pocketing or loss of
mobility. In these E s k i m o men, there was
Population findings. But P I is used not no difference i n average levels of serum
so much i n the study of disease as disease vitamin A between men i n whatever group
as it is used to establish a basis for study at whatever age. M u c h the same result was
of the characteristics of the people i n w h o m had when the analysis was made of average
disease occurs. levels of serum ascorbic acid, as shown i n
Table 5. These findings were typical of the
One of the first findings i n field studies series; there was no consistent or significant
of periodontal disease was the fact that i n pattern of association between these and
the United States, disease tends to be the other nutrients, an observation which sets
more widespread and severe i n persons of up a rather formidable inference that vita-
the less favorable socioeconomic status. min A or C nutrition is not a major factor i n
This general tendency is illustrated i n Table adult periodontal disease.
3, an array of P I scores for persons exam-
ined i n Birmingham i n 1957. There is a
8
TABLE 5
TABLE 3
Serum Vitamin C (in mg./100 ml)
Education and Periodontal Disease Alaska Scouts, 1958
(Birmingham, 1957)
Ages Ages
Average to Ages 35,
Periodontal Periodontal Condition 24 25-34 over
Scores for
Persons with White Negro Normal gingival tissues .50 .56 .48
Gingivitis only, without
8 years of school or less 1.42 2.18 pocket formation .52 .54 .46
9 to 11 years of school .93 1.09 With advanced destruc-
12 years of school .52 .80 tive periodontal
13 years of school or more .29 .41 disease .55 .50 .58
Page 18/590 RUSSELL
data from the U n i t e d States is unique i n In short, then, P I is here; it has been
that it presents P I scores and associated used widely; it works; and through its use
data for an area probability sample of the we have gained a considerable insight into
entire nation. 3
These findings are, and the population characteristics of periodon-
probably w i l l be for many years to come, tal disease.
the principal baseline for periodontal dis-
ease i n N o r t h A m e r i c a .
REFERENCES
1. Dental health, pp. 175-98. (in: Nutrition Section, 6. Russell, A . L . : World epidemiology and oral
Office of International Research, National Institutes of health, pp. 21-39. (in: Kreshover, S. J . , and McClure,
Halth. Republic of Nigeria nutrition survey. Wash- F. J., editors. Environmental variables in oral disease.
ington, Public Health Service, March 1967. xxvi + 299 Washington, American Association for the Advance-
P.). ment of Science, 1966. xii + 311 p.)
2. Greene, J. C. and Vermillion, J. R. : The simplified 7. Russell, A . L . : Epidemiology of periodontal dis-
oral hygiene index. Am. Dent. A . J., 68:7-13, Jan. 1964. ease. Int. Dent. J., 17:282-96, June 1967.
3. Kelly, J . E . and Van Kirk, L . E . : Periodontal dis- 8. Russell, A . L . and Ayers, Polly: Periodontal dis-
ease in adults, United States, 1960-1962. National Cen- ease and socioeconomic status in Birmingham, A l a .
ter for Health Statistics Series 11, No. 12. Washington, Am. J . Pub. Health, 50:206-14, Feb. 1960.
U . S. Public Health Service, Nov. 1965. 30 p. 9. Russell, A . L . , Leatherwood, E . C , Consolazio,
4. Russell, A . L . : A system of classification and scor- C. F . and Van Reen, Robert: Periodontal disease and
ing for prevalence surveys of periodontal disease. J . nutrition in South Vietnam. J . Dent. Res., 44:775-82,
Dent. Res., 35:350-9, June 1956. July-Aug. 1965.
5. Russell, A . L . : International nutrition surveys: 10. Sandler, H . C , and Stahl, S. S.: The influence
a summary of preliminary dental findings. J . Dent. of generalized diseases on clinical manifestations of
Res., 42:233-44, Jan.-Feb. 1963. periodontal disease. A m . Dent. A . J . , 49:656-71, Dec.
1954.