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MORNING
1
PERIODONTAL
INDICES
GUIDED BY:
DR. NAVRAJ LAMDARI
DR. LAL BABU KAMAIT
DEPARTMENT OF
SUBMITTED BY: PERIODONTICS
SHEKHAR KUMAR COLLEGE OF MEDICAL
2
MANDAL SCIENCES, BHARATPUR
Roll no: 26 NEPAL
BDS IV
CONTENTS
INTRODUCTION
DEFINITIONS
CLASSIFICATION OF INDEX
IDEAL REQUISITES OF AN INDEX
OBJECTIVES AND USES OF INDEX
ORAL HYGIENE AND PLAQUE INDEX
GINGIVAL AND PERIODONTAL DISEASE INDICES
RECENT ADVANCES IN PERIODONTAL INDICES
CONCLUSION
3
REFERENCES
INTRODUCTION
SCIENTIFIC FASHION
-LORD KELVIN
4
DEFINITIONS
According to Russell A.L , an index is defined as A
numerical value describing the relative status of the
population on a graduated scale with definite upper and
lower limits which is designed to permit and facilitate
comparison with other population classified with the same
criteria and the method
6
IDEAL REQUISITES OF AN INDEX
SPECIFICI CLARITY SIMPLICIT
TY Y
QUANTIF
IABI
LITY
IDEAL OBJECTIVI
REQUISITES TY
OF INDEX
ACCEPTABI
LITY
VALIDITY
SENSITIVI RELIABILI
TY TY 7
OBJECTIVES
FOR INDIVIDUAL IN RESEARCH IN COMMUNITY
9
Depending upon the extent to which
areas of oral cavity are measured :
10
According to the entity which they
measure
11
General indices :
12
INDICES USED FOR ORAL HYGIENE
ASSESSMENT
Composed of 2 components:
14
RULES OF ORAL HYGIENE INDEX
1 Only fully erupted permanent
teeth are scored.
2 Third molars and incompletely
erupted teeth are not scored
because of the wide variations in
heights of clinical crowns.
3 The buccal and lingual debris
scores are both taken on the
tooth in a segment having the
greatest surface area covered by
debris.
4 The buccal and lingual calculus
scores are both taken on the
tooth in a segment having 15 the
greatest surface area covered by
supragingival and subgingival
DEBRIS INDEX CRITERIA 0 No debris or
stain
present
1 Soft debris
covering
not more than 1/3rd
the
tooth surface, or
presence
of extrinsic stains
2 Soft debris
without
covering
other debris
more than
regardless 1/3 rd
,
but
of not
the area covered
more than 2/3rd,of
3 Soft debris
the
covering more
exposed tooth
than 2/3
surface
rd
of the
exposed
CALCULUS INDEX CRITERIA
SCORE CRITERIA
0 No calculus present
18
SIMPLIFIED ORAL HYGIENE INDEX
Developed by John C Greene and Jack R Vermillion in
1964 as OHI was time consuming and required more
decision making
11 21
26 27,28
36 37,38
31 41
46 47,48 20
CALCULATION INTERPRETATION
DI S = Total score/No
of surfaces DI S and CI-S
Good -0.0-0.6
Fair 0.7-1.8
CI-S = Total score/ No Poor 1.9 -3.0
of surfaces
OHI S
Good - 0.0-1.2
OHI -S= DI-S+ CI-S Fair 1.3- 3.0
Poor 3.0 -6.0 21
USES
Widely used in epidemiological studies of periodontal
diseases.
46 Lingual
Procedure:
Apply a disclosing agent before scoring.
Patient is asked to swish for 30 sec and then expectorate but not
rinse.
Examination is made by using a mouth mirror.
M
MI
M
D O/I
Rating scores 1
Excellent : 0 (no 1 1 1
debris)
Good : 0.1- 0
1.7
Fair : 1.8 Debris score for 1
tooth = 4/5
PLAQUE INDEX
Silness and Loe in 1964 12
Distal
Mesial 36
44
Lingual
32
Buccal
SCORING CRITERIA
Score Criteria
0 No Plaque
A film of plaque adhering to the free gingival
margin and adjacent area of tooth the plaque
1 may be seen in situ only after application of
disclosing solution or by using probe on tooth
surface
Moderate accumulation of soft deposits
within the gingival pocket, or the tooth and
2
gingival margin which can be seen with the
naked eye
Abundance of soft matter within the gingival
3 pocket and/or on the tooth and gingival
27
margin
CALCULATION INTERPRETA
Plaque index for
area
0-3 for each surface TION
Rating Scores
Plaque index for Scores added and then divided by Excellen 0
a tooth four
t
Plaque index for Scores for individual teeth are
group of teeth added and then divided by number
of teeth.
Good 0.1-0.9
Plaque index for Indices for each of the teeth are
the individual added and then divided by the
total number of teeth examined Fair 1.0-1.9
Plaque index for All indices are taken and divided by
group number of individual
Poor 2.0-3.0
28
USES
29
ADVANTAGE
Good validity and reproducibility
Can be used as full mouth or simplified
DRAWBACK
Subjectivity in estimating plaque
30
Turesky, Gilmore, Glickman modification
of the Quigley-Hein plaque index
Quigley and Hein in 1962 reported a plaque measurement
that focused on the gingival third of the tooth surface.
33
OLEARY INDEX
(plaque control record)
O' leary T, Drake R, Naylor in1972
Method of recording the presence of the plaque
on individual tooth surfaces
Suitable disclosing solution such as Bismarck
brown, Diaplac or similar is painted on all
exposed tooth surfaces..
The operator (using an explorer or a tip of a
probe) examines each stained surface for soft
accumulations at the dentogingival junction.
When found, they are recorded by making a
dash/red colour in the appropriate spaces on the
Calculation
PLAQUE INDEX =The number of plaque
containing surfaces
The total number of
available surfaces
Since plaque is stained ,identification
and record making is easy
Also aids in patient education
wback
ds only the presence or absence of plaque
BLEEDING POINT INDEX
Provides an evaluation of gingival inflammation
around each tooth in patients mouth
Bleeding on probing recorded on distal ,facial
,mesial and gingival surface
Calculation=(no of bleeding surface/total no of
tooth surface)*100
Demonstrates gingival inflammation characterized
by gingival bleeding rather than presence of
GINGIVAL AND PERIODONTAL
DISEASE INDICES
GINGIVAL INDEX
PERIODONTAL INDEX
CPITN
Lingual
Distal
Facial 38
:
METHOD
All surfaces of all teeth or selected teeth or selected surface of all
teeth or selected teeth are scored.
The teeth and gingiva are first dried with a blast of air and/or cotton
rolls.
The tissues are divided into 4 gingival scoring units: Disto facial
papilla, Facial margin, Mesio facial papilla and Entire lingual margin.
Absence of
0 inflammation/normal gingiva
Mild inflammation, slight
change in color, slight
1 edema, no bleeding on
probing
Moderate inflammation,
moderate glazing, redness,
2 edema and hypertrophy.
bleeding on probing
Severe inflammation,
marked redness and
3 hypertrophy ulceration.
40
CALCULATION AND INTERPRETATION
If the scores around each tooth are INTERPRETATION:
totaled and divided by the number 0.1 - 1.0 : mild
of surfaces per tooth examined (4), gingivitis
the gingival index score for the 1.1 2.0 : moderate
tooth is obtained. gingivitis
Totaling all of the scores per tooth 2.1 3.0 : severe
43
RUSELLS PERIODONTAL INDEX
44
METHOD
All the teeth are examined in this index.
lower score.
45
FIELD STUDIES CLINICAL STUDIES /
RADIOGRAPHIC FINDINGS
0 Negative. Neither overt Radiographic appearance is essentially
inflammation in the investing normal.
tissues nor loss of function due
to destruction of supporting
bone.
1 Mild gingivitis. An overt area of
inflammation in the free gingiva
does not circumscribe the tooth
2 Gingivitis. Inflammation
completely circumscribe the
tooth, but there is no apparent
break in the epithelial
attachment
4 Used only when radiographs are There is early notch like resorption of
available. alveolar crest.
6 Gingivitis with pocket formation. There is horizontal bone loss involving the
The epithelial attachment is entire alveolar crest, up to half of the length
46
broken and there is a pocket. of the tooth root.
There is no interference with
CALCULATION AND INTERPRETATION
RPI score per person = Sum of individual scores
No of teeth present
Treatment needs implies that the CPITN assesses only those conditions
potentially responsive to treatment, but not non treatable or irreversible
conditions. 48
Procedure :
The mouth is divided into sextants :
17- 14 13- 23 24- 27
47 44 43- 33 34 37
The 3rd molars are not included, except where they are functioning in
place of 2nd molars.
49
Probing depth is recorded either on all the teeth in a
sextant or only on certain indexed teeth as recommended
by who for epidemiological surveys.
CPITN-E CPITN-C 52
PROBE PROBE
COD CRITERIA TREATMENT
E NEEDS
0 Healthy TN-0 No need of
periodontium treatment
1 Bleeding observed TN-1 Self care
during / after
probing
2 Calculus or other TN-2 Professional
plaque retentive care
factors seen or felt
during probing
3 Pathological pocket TN-2 Scaling and
4-5 mm. gingival root planning
margin situated on
black band of the
probe.
4 Pathological pocket TN-3 Complex
6mm or more. Black therapy by 53
54
COMMUNITY PERIODONTAL INDEX (CPI)
Based on modification of CPITN
Modification is done by including loss of
attachment and eliminating treatment
needs category.
Code Criteria
0 loss of attachment 0-3 mm, CEJ not visible
1 loss of attachment 4-5mm
2 loss of attachment 6-8mm
3 loss of attachment 9-11mm
4 loss of attachment 12mm or more
X excluded sextant
9 not recorded
56
PILLARY MARGINAL ATTACHMENT INDEX(PM
BY SCHOUR & MASSLER, (1944)
To count number of gingival unit affected with gingivitis that is
correlated with severity of gingival inflammation.
The facial surface of gingiva around a tooth divided into three
units:
Papillary gingiva (P),
Marginal gingiva (M), and
Attached gingiva (A).
Usually central incisor to second premolars are examined.
PAPILLARY COMPONENT (P)
0= NORMAL; NO INFLAMMATION.
5+= Recession of the free marginal gingiva below the CEJ due
to inflammatory changes.
ATTACHED COMPONENT(A)
0= Normal; pale rose; stippled.
1+= slight engorgement with loss of stippling; change
in color may or may not be present.
2+=obvious engorgement of attached gingivae with
marked increase in redness. Pocket formation present.
3+=advanced periodontitis. Deep pockets evident.
CALCULATION:
USES:
On clinical trails
On individual patient
For epidemiological surveys
61
PERIODONTAL DISEASE INDEX (PDI)
FIRST INTRODUCED BY RAMFJORD IN 1959
COMPOSED OF THREE COMPONENTS:
I. PLAQUE COMPONENT,
II. CALCULUS COMPONENT AND
III. GINGIVAL & PERIODONTAL COMPONENET.
. ALL THE THREE COMPONENTS WILL BE SCORED SEPARATELY USING SIX
RAMFJORD SELECTED TEETH.
16 21 24 44 41 36
PLAQUE COMPONENT:
Scoring is done after staining with Bismark
Brown solution.
Score Criteria
0 No plaque
SCO CRITERIA
RE
0 No calculus
70
BASIC PERIODONTAL EXAMINATION
(BPE) INDEX
Developed by British Society of Periodontology in
1986
Derived from the community periodontal index of
treatment needs (cpitn)
Simple and rapid screening tool that is used to
indicate the level of examination needed and to
provide basic guidance on treatment need
Not a diagnostic tool
71
72
GENETIC SUSCEPTIBILITY INDEX FOR
PERIODONTAL DISEASE
Genetic markers denote susceptibility toward disease
manifestation and it would be useful to exploit the
information hidden into them and to derive a Genetic
Susceptibility Index (GSI)
Single Nucleotide Polymorphisms (SNPs) in genes
encoding molecules of the host defense system are
assessed and an association is established between SNP
and disease status
73
PERIODONTAL SCREENING AND RECORDING
(PSR) INDEX
Introduced in 1992 by American Academy of Periodontology
(AAP) and American Dental Association(ADA)
Endorsed by the World Health Organization (WHO)
Adaptation of the Community Periodontal Index of Treatment
needs (CPITN)
Used to measure gingival bleeding upon probing, calculus on
a tooth, and periodontal pocket depth in each sextant of the
oral cavity
74
CALCULATING PSR
75
ADVANTAGES
76
LIMITATIONS
77
DPC DETAILED PERIODONTAL CHART
Used to measure pocket depths.
A pocket measuring probe/ Williams probe is
used.
Main components to record:
- Pocket depth (mm)
- Mobility
- Recession (mm)
- Bleeding on probing
- Furcation
MOBILITY
Two blunt instruments are used to asses a
tooths mobility.
e.g end of mirror and probe
To quantify mobility, Millers index of mobility
is used:
GRADE MOBILITY
Grade Normal physiological mobility (<1mm)
0
Grade Movement up to 1mm in horizontal
1 plane
Grade Movement greater than 1mm in
2 horizontal plane
Grade Severe mobility greater than 2mm or
4 vertical mobility
FURCATION
The furcation is the point at which the two roots
divide.
A pocket measuring probe is used (nabers probe)
84
REFERENCES
Essentials of Public health dentistry 5E, Soben Peter
Carranza's Clinical Periodontology, 12E (2015) , Newman,
Takei, Klokkevold, Carranza
H
ttps://www.mah.se/capp/methods-and-indices/oral-hygiene-in
dices/simplified-oral-hygiene-index--ohi-s/
Dhingra k, vandana k l; indices for measuring periodontitis:
a literature review. international dental journal. 2011; 85
THANK
YOU 86