INDICES

PREVENTIVE AND COMMUNITY

DENTISTRY
DENTITION CHART
Deciduous teeth
DENTITION CHART
• Permanent teeth
 DENTAL INDICES
An index is defined as a numerical value
describing the relative status of a
population on a graduated scale with a
definite upper and lower limits designed to
permit and facilitate comparison with other
populations classified by the same criteria
and methods.
 IDEAL REQUIREMNTS
OF AN INDEX
 Simple • High validity and
 Clear reliability OR High
 Reproducible sensitivity and
specificity
 Quantifiable or
measurable
 Acceptable
COMMONNLY USED INDICES IN
DENTISTRY
• DMFT/dmft
• OHI-S
• CPITN
• Plaque index of Silness and Loe
• Gingival index of Silness and Loe
 DMFT / dmft
• This index gives a D = Decayed = 1
total score of all the
affected teeth and M = Missing = 1
provides a caries F = Filled = 1
experience score for
an individual
 DMFT INDEX & SCORES
• D = Decayed = 1 •
• M = Missing = 1
• F = Filled = 1
Examples done for you
 Say if 44 pupils have 35
decayed 21 missing and
•
8 filled teeth then the
average DMFT is
D+M+F/ No of pupil =
1.45
 ORAL HYGIENE INDEX -
SIMPLIFIED
• One of the most popular indicators for
determining oral hygiene status in epidemiologic
study
• The OHI was developed in 1960 by Greene and
Vermilion and a simplified version of the OHI
called OHI-S was proposed in 1964
• The OHI-S differ from the OHI in the number of
tooth surface scored ( 6 rather than 12)
 ORAL HYGIENE INDEX -
SIMPLIFIED
• The OHI-S has 2 • The term oral debri
components include plaque,
1. The Debri score materia alba and food
2. The Calculus score remnants
 Selection of tooth surfaces
• The six surfaces examined for
the OHI-S are selected from 16 11 26
the 4 posteriors and 2 anterior
teeth 46 31 36
• In the posterior portion of the
dentition, the buccal surface of
the upper 1st molars (16, 26)
and the lingual surface of the
lower 1st molars (36,46) are
examined
• In the anterior portion of the
mouth, the labial surfaces of
the upper right (11) and lower
left central incisors (31) are
examined
 Criteria for classifying debris
Score Criteria

0 No debris or stain present

1 Soft debris covering not more

than 1/3 of the tooth surface, or
presence of extrinsic stain without
other debris regardless of surface
area covered
2 Soft debris covering more than
1/3 but not more than 2/3 of the
exposed tooth surface
3 Soft debris covering more than
2/3 of the exposed tooth surface
 CRITERIA FOR CLASSIFYING
CALCULUS
Scores Criteria

0 No calculus present

1 Supragingival calculus covering not more than 1/3 of the

exposed tooth surface
2 Supragingival calculus covering more than 1/3 but not more
than 2/3 of the exposed tooth surface or the presence of
individual flecks of subgingival calculus around the cervical
portion of the tooth or both
3 Supragingival calculus covering more than 2/3 of the
exposed tooth surface or a continuous heavy band of
subgingival calculus around the cervial portion of the tooth
or both
 CALCULATING OHI-S
• Oral Hygiene Index (OHI-S) = D I + C I
6
In OHI-S the minimum score is 0 and the
maximum score can be 6
 ORAL HYGIENE INDEX-S
 Advantages:  Disadvantages:
 It takes less time to • Results are biased
score. • The index is not sensitive.
• It is not ideal for clinical
 It is easy to score.
trials {Research}.
 It is useful in survey
work
 PLAQUE INDEX of
SILNESS AND LOE
 Plaque Index (PI) was  The principal difference
developed by silness and Loe between the Plaque Index and
to be used along with gingival OHI-S is that the PI assesses
index (GI) to help correlate only the thickness of plaque at
plaque accumulation with the gingival margin rather than
gingival inflammation its coronal extent on the tooth
 the same surfaces of the teeth surface area. It has been
are scored as in the GI and the proved that measuring plaque
same scoring system of 0 to 3 thickness is more valid than
is used. measuring its coronal extent.
 This index is applied to
longitudinal studies and clinical
trials because it is very
sensitive to small changes in
the amount of dental plaque
 CRITERIA FOR PLAQUE INDEX

Score Criteria

0 No plaque in gingival area

1 Film of plaque adhering to free gingival margin and adjacent area of tooth,
plaque
may be noticed by running a probe across tooth surface

2 Moderate accumulation of soft deposits within gingival pocket, on gingival

margin, and or on adjacent tooth surface, which can be seen by naked ey

3 Abundance of soft matter within gingival pocket and\or on gingival margin and
adjacent tooth surface
 GINGIVAL INDEX OF
LOE AND SILNESS
• The most frequently used
index for evaluating gingivitis is
the Loe & Silness gingival
index.
 With this index, it is possible to
measure
 bleeding tendencies
 color, contour changes of the
gingiva
 alternations in the consistency
of tissue
 and the presence of
ulcerations.
• Bleeding is the most important
criterion of inflammation in this
index; however, the distinction
between normal {0} and mild
inflammation {l} is based on
visual appearance of the
tissues
• The gingival condition around
each tooth is examined, and a
score for the mesial, distal,
buccal, and lingual areas is
recorded. If desired, the
gingival index can also be
used on only selected teeth in
the mouth
 GINGIVAL INDEX OF
SILNESS AND LOE
Score Criteria

0 • Normal gingival

1 •Mild inflammation-slight change in color, slight edema,

no bleeding on probing
2 •Moderate – bleeding on probing

3 •Severe inflammation, marked redness and edema

ulceration, tendency toward spontaneous bleeding
SCORING FOR GINGIVAL INDEX
• The sums of scores from the four areas of each tooth are
divided by the number of teeth examined to produce a
gingival index for the individual.
• Because bleeding on probing can be scored more
objectively than a visual assessment of change in color,
from and consistency of gingival tissues, the intensity of
probing with a blunt instrument must be carefully
controlled.
• The basic intention of this index is not to assess the
depth or extent of a pocket or to determine bone loss but
only to evaluate the status of gingival health
 CPITN INDEX
• 3 indicators of periodontal status are used
for this assessment
• Presence or absence of gingival bleeding
• Supra or subgingival calculus
• Periodontal pockets-subdivided into
shallow (4-5 mm) and deep (6mm or
more)
 CPITN probe
• A specially designed
light weight probe
with a 0.5-mm ball tip
is used, bearing a
black band between a
3.5 and 5.5 mm from
the ball tip.
 SEXTANT
• The mouth is divided into Upper right Upper Upper left
6 sextant defined by the posterior anterior posterior
18-14 24-28
teeth number 13-23
• A sextant should be lower right Lower lower left
examined only if there are posterior anterior posterior
44-48 38-34
two or more teeth present 33-43
and not indicated for
extraction.
• When only 1 tooth remain
in a sextant it shuld be
included in the adjacent
sextant
 TEETH TO BE EXAMINED
• For adults aged 20 years and over, the teeth to be examined are
• The 2 molars in each posterior sextant are paired for recording, and if one is
missing, there is no replacement. If no index teeth or tooth is present in a
sextant qualifying for examination, all the remainng teeth in that sextant are
examined
• For young people up to the age of 19 years, only six teeth 16,11,26,36,31
and 46 are examined
• For children under 15 recording for pocket should not be attempted. ie., only
bleeding and calculus should be considered
• If no index tooth is present in a sextant qualifying for examination, single
fully erupted incisor or premolar may be substituted

17 16 11 26 27
47 46 31 36 37
SENSING GINGIVAL POCKET
• The sensing force used should
be no more than 20 gms
• A practical test for establishing
this force is to place the probe
point under he thumb nail and
press until blanching occurs
• For sensing sub gingival
calculus, the lightest force that
will allow movement of the
probe ball point along the tooth
surface should be used
• The depth of insertion read
against the colour coding.
• Atleast 6 point on each tooth
should be examined
EXAMINATION AND RECORDING
Score Criteria

4 Pocket > 6 mm (black area of probe not visible

3 Pocket 4 or 5 mm (gingival margin situated on black area of probe

2 Calculus felt during probing but all the black area of the visible

1 Bleeding observed, directly or by using mouth mirror, after sensing

0 Healthy
 FURTHER READING
• Norman O. Harris ; Arden G. Christen
Chapter 13 – Periodontal Disease – Risk
Assessment and Evaluation in ‘Primary
preventive dentistry’ 4th edition.
• World health Organisation; Extracts of
Oral Health Methods and Indices (copies
provided)
END