Dr. Hazem El Ajrami Master Degree in Orthodontic & Pedodontic Al Azhar university Lama K El Banna

2. College of Dentistry
Community Dentistry
Indices Used For The Assessment of
Dental Caries
Dr. Hazem El Ajrami

3. • Indices Used For The Assessment of Dental
Caries:
1. Prevalence Index.
2. DMF Index.
3. The def Index.
4. DMF-S Index.
5. Slack Index.
6. Caries Index of Treatment Needs (CCITN).

4. 4. DMF-S Index (Decayed, Missing, Filled-
Surfaces Index):
This is a more sensitive measure of dental
condition per person reaching its greatest
usefulness where accurate work is to be done
involving the use of dental x-ray, and for
measurements during clinical trials of caries
preventing agents. This index counts the
number of the affected tooth surfaces (surface
counts). Here the unit of measurement is not
the tooth (as in DMF) but the tooth surface.

6. • Certain difficulties are encountered in the use
of surface indices. One of them is the score to
be allocated to extracted teeth, which may have
been attacked by one surface only, although its
extraction results in the loss of four or five
surfaces. The extracted teeth are given score
five (for posterior teeth) or four (for anterior
teeth) as advocated by some authors.

7. Number of D+M+F surfaces
DMFs Index =
Number of teeth examined

8. 5. Slack Index:
A sensitive classification of the extent of
carious lesions was advocated by Slack et al.,
(1958) where the size of the lesion is indicated
on a scale running from 1 to 3.
 D1: The probe catches in a pit or fissure but
does not penetrate to the dentin.
 D2: Obvious carious lesion involving the dentin,
but cavitation had not proceeded to more than
one quarter of the crown.
 D3: Cavitation had proceeded so that more than
one quarter of the crown is involved.

12. Total number of the affected teeth scores
Slack Index =
Total number of the affected teeth
 Slack index of an individual equals the total
number of the affected teeth scores divided by
the total number of the affected teeth.

13. 6. Community Caries Index of Treatment
Needs (CCITN):
For oral health planners, it is important to
evaluate not only changes in caries prevalence
among the population but also current
treatment needs. The rationale underlying the
CCITN is that estimation of treatment need
should encompass more than the restorative
need: Emphasis should be on prevention, thus
"Prevention instead of extension" or
"Prevention before extension" in contrast to
G.V. Black's traditional concept of "Extension
for prevention".

15. Table of Community Caries Index of
Treatment Needs:
Score Diagnosis Treatment need
0 Intact enamel
P
1 Primary active enamel caries
P
2:1 Primary dentin caries without
cavitation into dentin
P
2:2 Recurrent (secondary) caries without
cavitation
P
3:1 Primary dentin caries with cavitation
P + R
3:2 Recurrent (secondary) caries with
cavitation
P + R

16. Score Diagnosis Treatment
need
4:1 Primary (active) root caries without
cavitation
P
4:2 Recurrent (active) root caries
without cavitation
P
5:1 Primary root caries with cavitation
P + R
5:2 Recurrent root caries with cavitation
P + R
Modified from Axelsson (1988)
P = Prevention
R = Restoration

17. • Pitts (1997) used the iceberg model to
illustrate caries treatment needs in relation to
progressive, cavitated, and stable, non
cavitated coronal lesions, at the clinically
detectable or sub clinical level.

20. Dental caries, one of the most common diseases
of man, constitutes a major health problem. Both
the prevalence and severity of this disease have
increased with the advance of civilization.
Dental caries, develops in an individual from
host-agent interaction which occurs in a certain
set of local environmental conditions. This
means, changes in the host-agent-environment
balance.

21. Dental caries results of 3 groups of factors:
1. Host factors.
2. Agent factors.
3. Environmental factors.

22. 1. Host Factors:
A. Race or ethnic group.
B. Age.
C. Sex.
D. Inheritance.
E. Emotional disturbance.
F. Nutrition.
G. Variation of caries within the mouth.

23. A. Race or ethnic group :
Race has long been considered to be an important
factor in the frequency of dental caries, yet little work
has been done which would differentiate racial or
ethnic heredity from environment. In a study upon
army recruits during World War II, including various
racial groups, all gathered in the same geographical
area, specially both Chinese and Negro population
have been shown to have lower caries rates than
corresponding white population.

24. In USA, studies have shown marked difference in
caries experience between white and black even when
income and education were standardized. Blacks have
more caries than white people, the difference in caries
experience indicate that white people receive
different standards of care from that received by
black or due to dietary or cultural differences
between them.

25. B. Age:
 The effects of dental caries upon the dentition
are cumulative, hence evidence of a disease
experience increases with age.
 The risk of carious attack is greatest shortly
after eruption of the tooth into the mouth.
 If the teeth have reached age 26 without
developing dental caries, there is a strong
possibility that they will remain caries-free
for the rest of the individual’s life.

26. It is generally believed that dental caries was
essentially a disease of childhood and that its
incidence among adults was very low
compared with its pre- and post-pubertal
period.
It was found that the greatest intensity of
caries incidence in permanent teeth occurs in
the decade between 15-25 years of age. Pit
and fissure caries is the predominant type
occurring at this period.

28. The period between 25 - 35 years showed a
pronounced decrease in caries incidence. This
is because the more susceptible tooth surfaces
has already affected by caries.
Another increase in caries incidence occurs at
about 45-55 years which is of the proximal
type. Over 60 years of age, acute root caries
occurs because root surface becomes denuded
by gingival recession.

31. C. Sex:
Many statistical studies have been made to
differentiate between the dental caries
experience among males and females. In young
people, caries has been seen to be higher in
females, but some studies show no significant
difference between the sexes and few showed
slightly higher caries for males at certain ages.

32.  An impression has long been held that
pregnancy accelerates dental caries in the
females. No evidence has been found to
substantiate this impression, in spite of several
careful studies.
 Although the female might be expected to
show a higher caries rate due to earlier tooth
eruption as a consequence of earlier female
growth and maturation, a sex difference was
not clearly demonstrated.

33. Thank You