APPLICATION OF COMMUNITY PERIODONTAL INDEX OF

TREATMENT NEED (CPITN) IN ENUGU (NIGERIA) :

STUDY OF SECONDARY SCHOOL STUDENTS AGED BETWEEN 12-18 YEARS
S. MADUAKOR*, Y. LAUVERJAT**, S. CADOT***, R. DA COSTA NOBLE**, C. LAPORTE, AND JL. MIQUEL***
INTRODUCTION
A significant prevalent of periodontal disease has
been established in Nigeria by several authors (2)(3).
This prevalence varies from one region to another
(8)(14), also from different socio-economic and age
groups (7)(9)(18).
In this study involving 330 secondary school students
aged between 12-18 yeats in Enugu, East of Nigeria,
attempt is made at identifying their periodontal
treatment needs with the intention of knowing the
measures necessary to ensure a good periodontal
health now and in the future. Account is taken of the
fact that there are two major methods of oral hygiene
praticed by the population :
- tooth brush and tooth paste,
- chewing sticks.

Six teeth were examined, each representing a sextant

since the students are below 20 years. (1)(11).
TABLE 1
Codes

Periodontal Condition

No bleeding
No calculus
No pathological pocket

Bleeding on probing gingival margin

No calculus
No pathological pocket

Presence of calculus (sub ou supra

gingival) with or without bleeding
No pathological pocket

Pathological pocket of 4-5 mm with or

without bleeding and calculus

Pathological pocket of 6 mm or more

with or without bleeding and calculus

It is known that a good percentage of Nigerians, in

fact, Africans, use the chewing stick as their principal
methods of oral hygiene. (4)(16)(21) Sote E.O.
MATERIALS AND METHODS
A total of 330 students were studied.
4 secondary schools were selected for the study :
. 2 special secondary schools (for the privileged).
One for boys and the other girls.
. 2 ordinary secondary schools (public). One for
boys and the other for girls.
In each school, an average of 82 students were
studied :
. 41 junior students (J.S.2)
. 41 senior students (S.S.2).
With the co-operation of the principals of the
respective schools, the students were not informed of
the proposed exercise to avoid any modifications of
the situations of oral health : students presenting with
chronique medical conditions (sickle-cell anaemia,
Epilepsy and diabetes) were excluded.
*Dentistry Department University of Nigeria - NSUKKA - NIGERIA.
** Department of Periodontology - Bordeaux II University FRANCE.
*** Department of Epidemiology and Public Health - Bordeaux II
University FRANCE.

A questionnaire designed to know the age, sex, socioeconomic background, method (principal) of oral
hygiene and attitude towards oral health of the students
was administred before the clinical periodontal
examination : the highest C.P.I.T.N in each sextant
after examination of the four sites (labial, lingual/
palatal, mesical and distal) was retained as the score
for the sextant : The average score for each subject
was calculated.
All examinations were conducted within the same
month.
RESULTS
Table II : Classification according
to age groups/sex
Age

12-12

14-15

16-18

Total

Males

63,4%
52

41%
57

70%
77

56,4%
186

Females

36,5%
30

59%
81

30%
33

43,6%
144

Total

100%
82

100%
138

100%
110

100%
330

Sex

Odonto-Stomatologie Tropicale

Application of community

The question in view is to determine which principal

method of oral hygiene is practiced : tooth brush/
paste or chewing stick.

paste or chewing stick.

80% of the students use tooth brush/paste against
20% who use chewing stick : this tendency holds for
the 3 age groups.

80 % of the students use tooth brush/paste against

20% who use chewing stick : this tendency holds for
the 3 age groups.The population is distributed in
3 age groups / -the 12-13 years representing 25% ;
the 16_18 years, 33% and the 14-15 years, 42% : In
general, among the 330 students examined, the boys
are more numbrous than the girls (56,40% against
43,60%). This relation varies from one age groups to
another : -the boys remain on majority in the agegroups 12-13 years and 16-18 years (60,40% and
70% respectively) where as in the age group 14-15
years, the girls from the majority.
The question in view is to determine which principal
method of oral hygiene is practiced : tooth brush/

Table III : classification according

to age groupes and method of oral hygiene
Age

12-13

14-15

16-18

Total

Brush Toothpaste

77%
63

80%
111

82%
90

80%
264

Chewing stick

23%
29

20%
27

18%
20

20%
66

Total

100%
82

100%
138

100%
110

100%
330

Method of
oral hygiene

Table IV : The prevalence of periodontal disease condition / group of age

CPITN

TOTAL

12-13 yrs
82

19,5%
16

63,4%
52

17,1%
14

0%
0

0%
0

100%
82

14-15 yrs
138

12,3%
17

60,8%
84

26,1%
36

0,72%
1

0%
0

100%
138

3,6%
4

44,6%
49

50,9%
56

0,9%
1

100%
110

37

11,8%
185

56,3%
106

31,4%
2

0,54%
0

0
330

Group of age

16-18 yrs
110
Total 100%
330

In general, more than half of the population (56,30%)

present with bleeding (Code I) ; a third (31,40%),
calculus (Code 2) and only 2 students present with
periodontal pocket of 4-5mm (Code 3). A preponderance of bleeding on probing is observed among
the age group 12-13 years (63,40% ) as well as in the
age group 14-15 years (60,80% ). There is a
diminution of bleeding in group 16-18 years (44,60%)

giving way to calculus which accounts for 50,90%.

With advancing of age, there is decreasing absence
of disease (Code 0) : - 19,5% for age group 12-13
years ; 12,3% for the 14-15 years and only 3,6% for
the 16-18 years.
The corollary is that as the population grows oldern
the more the intensity of periodontal diseases, tensity
of periodontal diseases.

Table V : the prevalence of periodontal disease in relation to oral hygienemethod

CPITN

Tooth Brush/Paste
264

12,4%
32

56,1%
148

31,8%
84

0,4%
1

0%
0

Chewing stick
66

10,6%
7

56,1%
37

33,3%
22

1,5%
1

0%
0

Total
330

11,4%
37

56,1%
185

32,5%
106

0,9%
2

0%
0

Treatment

No treatment

Motivation

Motivation
+ Scaling polishing

Complex treatment

Complex treatment

Oral hygiene Method

30

Odonto-Stomatologie Tropicale

Application of community

One does not see a significant difference between the

students using either of the methods of Oral Hygiene :

Nevertheless, there is slight advantage for the use of

tooth brush/paste (31,8% against 33,3% (Code 2).

Table VI : the severity of periodontal disease in relation to the age groups

CPITN

CPITN

CPITN

CPITN

CPITN

Population

12-13 yrs

82

2,79

1,28

1,88

0,00

0,00

14-15 yrs

138

2,29

1,18

2,32

0,04

0,01

16-18

110

1,39

1,28

3,15

0,01

0,02

Total

330

2,16

1,25

2,45

0,02

0,01

Age

49

The severity or the average number of sextants

a ffected for each student augment with age.
Generally this population presents 2,45 sextants with
problem of calculus and has a tendency of increasing
severity as the age advances : 1,88 sextants for the
12-13 years ; 2,32 sextants for the 14-15 years group
and 3,15 sextants for the 16-18 years.
In the same manner the population presents 2,16

sextants without periodontal disease (Code 0) and

there is decreasing - order tendency for the age
groups : - 2,79 sextants for the 12-13 years ; 2,29
sextants for the 14-15 years and 1,39 sextants for the
16-18 years.
The severity of bleeding (Code I) remains stable in all
the age-groups with an average of 1,95 sextants
effected,

Table VII : treatment needs

Age

Nb of cases

Motivation

Scaling and polishing

Complex treatment

No need for treatment

12-13 yrs

24,9%
82

63,4%
52

17,1%
14

0%
0

19,5%
16

14-15 yrs
138

41,8%
84

60,8%
36

26,1%
1

0,72%
17

12,3%

16-18 yrs
110

33,3%
49

44,6%
56

50,9%
1

0,9%
4

3,6%

Total
330

100%
185

56,3
106

31,4%
2

0,54%
37

11,8%

More than half of the population 56,3% need

education on oral hygiene measures (motivation).
Just 1/3 (31,4%) need scaling and polishing. Only 2
children out of 30 need complex treatment. 55% of
those needing scaling and polishing and from the age
group 16-18 years. 45% of those needing motivation
are from the age group 14-15 years. 2/3 of students
aged between 12-15 years and almost 1/2 of those
aged between 16-18 years need motivation. Again 1/2
of the 16-18 years need scaling and polishing ; 1/4 of
the 14-15 years and only 1/5 of the 12-13 years need
the same scaling and polishing.
20% of the students aged between 12-13 years do
not have need for any treatment where as all the
students aged between 16-18 years except 4, need
periodontal treatment.
The need for treatment increases with age.

DISCUSSION
In this study, one notes an augmentation of the
prevalence and severity of periodontal pathology with
increasing age. This is in conformity with the result of
various publications (15) in Nigeria, (14) Tanzania,
(12) Sierra)Leone and (16) Zaire.
Inspite of the high prevalence of bleeding (code 1),
the severity is remarkably low (1,25 sextants out of
six). There is only a case of juvenile periodontitis
(0,3%) which confirms the figure of 0,3% - 0,7% given
for Nigeria / Thailand (18) and other studies on the
black-race : (6) (9) which give the figures of between
0,1 and 0,5%.
The treatment need of this population is generally
covered by motivation and scaling / polishing. In a
population where the rate of clinical consultation is
31

Odonto-Stomatologie Tropicale

Application of community

abysmally low 27% (5% only having ever had scaling

/ polishing) the necessity for the moblilisation of
e fforts towards information and education on oral
health and oral hygiene measures become very
important.

stick however, can be a good method of oral hygiene

as documented for Nigeria (21) ; Ethiopia (17) an
Kenya (5).
The tendency where by the tooth brush / paste is
seen as a status-symbol (evidence of modernisation)
should be disabused. Most of those who use the
tooth brush / paste do not know how to use them and
sometimes do not have the financial means to
change them as and when due, or even to procure
the tooth paste. The consequence is far-reaching.

Concerning the method of oral hygiene, there is a

striking shift from the use of chewing stick to the use
of brush and tooth paste with advancing age. This
trend is completely in keeping with the observations
which link the choice and use of tooth brush / tooth
paste with increasing self-esteem (16) (13).

The World Health Organisation should give her

weight on the campaign for the correct use of the very
available and cheap chewing stick. If the oral health
for all by the year 2000 is to be a reality, the correct
uses of tooth brush / paste and the chewing sticks
should be simultaneously encouraged.

The tooth brush / kpaste shows a slight advantage

over chewing stick. If at this tender age group (12-18
years) there is already a difference, the advantage
will be more pronounced later in life. The chewing

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