COMMUNITY PERIODONTAL INDEX OF TREATMENT NEEDS (CPITN)By Cutress

•Advocated by Cutress, Barmes, Sardo-Infirri and J Ainamo in 1980.•Finalized and described in 1983.•Originally intended as a screening procedure for epidemiological purposes.•Adopted in developing periodontal health awareness programmes.

Historical Background

To determine periodontal status and treatment needs by CPITN index

What is the CPITN for?

Sextants Examined only if there are two or more

teeth present

Divided into six sextants

17-14, 13-23, 24-27, 37-34, 33-43, 44-47

Adjacent Sextant

Index Teeth 20 years or more

17 16 11 26 27 47 46 31 36 37

!6 to 19 years old 16 11 26 46 31 36

Box Chart Use for recording CPITN Data

Probing Must be in the same plane as the long

axis of the tooth

Ball-end should be kept in contact with the root surface

A light not a firm grip of the instrument is recommended

Codes And Criteria Code X - When only one tooth or no

functional teeth are present in a sextant. Code 0 - Healthy Tissues Code 1 - Bleeding observed during or after

probing Code 2 - Supra- or subgingival calculus seen

or felt during probing Code 3 - Pathological Pocket of 4 or 5mm Code 4 - Pathological Pocket of 6mm or more

Type of Measure Periodontal pockets Calculus Gingival Bleeding

Classification of Treatment Needs Treatment needs are assigned based on

the highest code received by each sextant. TN 0 – no further therapy needed.(0/X)

TN 1 – need to improve personal oral hygiene.(1>)

TN 2 – patient requires oral hygiene improvement and professional scaling(2>)

TN 3 – patient requires complex treatment (4)

Treatment needs are assigned based on the highest code received by each sextant. TN 0 – no further therapy needed.(0/X)

TN 1 – need to improve personal oral hygiene.(1>)

TN 2 – patient requires oral hygiene improvement and professional scaling(2>)

TN 3 – patient requires complex treatment (4)

HOW TO CALCULATE AND SUMMARIZE THE RECOMMENDED STANDARD TABULATIONS OF A CPTIN SURVEY

Subjects: 21 Adults

0 0 0

0 0 00 0 4

0 0 40 1 0

0 1 01 1 0

1 1 1

4 3 1

2 3 13 3 3

3 4 3X 4 4

4 4 X1 2 2

2 2 2

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

0 0 0

1 1 01 1 3

1 1 13 2 3

2 3 20 0 0

1 0 0

0 0 X

3 3 32 1 3

3 2 12 0 2

0 2 02 2 3

2 2 X

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

3 3 3

3 3 34 0 1

1 0 04 4 3

4 4 12 2 4

1 1 1

X X X

X X X

(17) (18)

(19)

(20)

(21)

Note: TOTAL H + B + c +P1 + P2 = (100%)

Table IPrevalence of Persons Affected

Age No. Examin

ed

No. of Dentate Persons

% Persons Coded

H B C P1 P2

35 - 44 21 20 5 20 10 30 35

Step 1: Count the number of charts with Code 0

only. Count the number of charts with a Code

1 recorded as the highest score. Count the number of charts with the

Code 2 recorded as the highest score. Count the number of charts with Code 3

recorded as the highest score. Count the number of charts with Code 4

recorded as the highest score.

So.. Subject has Code 0(number 1) Subjects has Code 1 (numbers 2, 4, 9,

12) Subjects has Code 2 (numbers 8 and 4) Subjects has Code 3 (numbers 10, 11,

13, 15, 16, 17) Subjects has Code 4 (numbers 3, 5, 6, 7,

18, 19, 20)

Step 2: Calculate the percentage (prevalence) To obtain the prevalence of subjects with

Codes 0, 1, 2, 3, 4, as their highest score, divide the counts of codes respectively, by the total number of dentate subjects and multiply 100.

Code 0 = 1/20 * 100

Code 1= 4/20 * 100

Code 2 = 2/20 * 100

Code 3 = 6/20 * 100

Code 0 = 7/20 * 100

Step 3: Tabulate data

Note (A.): Scores H + B + C +P1 + P2 + X do not = 6 (except

when all sextants score 0, 1 or X)

Table IIMean Number of Sextants Affected per Person

Age No. of Dentate Persons

% Persons Coded

H B C P1 P2 X

A.) 35 – 44*

20 1.60 4.20 2.90 1.90 0.70 0.20

B.) 35 – 44+

20 1.60 1.30 1.00 1.20 0.70 0.20

Note (B.): MNS H + B + C +P1 + P2 + X = 6

Table II (A): Step 1:

Form the charts of dentate persons, count the number of sextants which have Healthy tissues (H) – that is sextants coded 0 Bleeding (B) – that is sextants coded 1 of

higher Calculus (C) – that is sextants coded 2 or higher Pockets 4 -5mm (P1) - that is sextants coded 3

or higher Pockets 6mm or deeper (P2) - that is sextants

coded 4 or higher Edentate or excluded - that is sextants coded X

There are: 32 scored 0 84 scored 1 or higher scores 58 scored 2 or higher scores 38scored 3 or higher scores 14 scored 4 or higher scores 4 scored X

Step 2: For each condition, obtain the mean number

of sextants (MNS) per person by dividing the total number of sextants that score (or higher) by the number of dentate subjects

Example:MNS Bleeding = # of Coded 1 (84) / # of dentate

subjects (20) = 4.2

Table II (B.): Step 1:

Count the number of sextants of dentate persons which have: Healthy tissues (H) – that is sextants coded 0 Bleeding (B) – that is sextants coded 1 Calculus (C) – that is sextants coded 2 Pockets 4 -5mm (P1) - that is sextants coded 3 Pockets 6mm or deeper (P2) - that is sextants

coded 4 Edentate or excluded - that is sextants coded X

These are: 32 scored 0 26 scored 1 20 scored 2 24 scored 3 14 scored 4 4 scored X

Step 2: For each condition obtain MNS per person by

dividing the total number of sextants with scores 0, 1, 2, 3, 4, or X by number of dentate subjects

Example:MNS bleeding = # of coded 1 (26) / # of dentate subjects (20) = 1.3

Table IIITreatment Needs

Age No. of Dentate Persons

% TN 0 % TN 1 % TN 2 (mean # of sextants)

% TN 3 (mean # of sextants )

A.) 35 – 44 20 5 95 75 (2.9) 35 (0.7)

The three types of treatment needs (TN) are defined: TN 0 = no treatment required –

Periodontally Healthy TN 1 = oral hygiene instruction (OHI) TN 2 = Scaling and prophylaxis (SC) + OHI TN 3 = Complex Treatment + SC + OHI

Table IVFrequency Distribution

Age No. of Sextants

Sextant scores ( # of Subjects)

H B C P1 P2 M

35 – 44 0 11 9 13 11 13 171 1 3 1 3 4 22 1 5 2 2 1 13 2 1 2 2 0 04 3 0 1 0 2 05 1 2 1 1 0 06 1 0 0 1 0 NA