2. CONTENTS
INTRODUCTION
DEFINITIONS
OBJECTIVES OF AN INDEX
IDEAL REQUISITS OF ANINDEX
CRITERIA FOR SELECTING ANINDEX
CLASSIFICATION OF INDICES
PURPOSES AND USES OF ANINDEX
INDICES USED FOR ASSESSING ORALHYGIENE
INDICES USED TO MEASURE PLAQUE ANDDEBRIS
INDICES USED FOR ASSESSMENT OFCALCULUS
INDICES USED FOR ASSESSING GINGIVALINFLAMMATION
INDICES USED FOR ASSESSMENTOF GINGIVAL BLEEDING
INDICES USED FOR ASSESSMENT OF PERIODONTALDISEASES
INDICES USED FOR ASSESSING TOOTHMOBILITY
CONCLUSION
REFERENCES 2/48
3. INTRODUCTION
3/48
Dental index or indices are devices to find out the
incidence, prevalence and severity of the disease, based on
which preventive programs can be adopted.
An index is an expression of the clinical observation in a
numerical value. It helps to describe the status of the
individual or a group with respect to a condition being
measured.
An index score can be more consistent and less subjective
than a word description of that condition.
4. DEFINITIONS
A numerical value describing the relative status of a population on a graduatedscale
An index is an expression of clinical observation in numeric values. It is used to describe the
4/48
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–results
in an‘’iRnduesxseslcl.oAre.lth–at19is56m’oreconsistent and less subjective than a word description of that
condition. – ‘’Esther M Wilkins’’- 1987
Oral indices are essentially set of values, usually numerical with maximum and minimum
limits, us‘e’Edp
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p opulations with that same vsaarmiaeblcersitearisa ainsd fmouenthdodisn’
’. other individuals, samples or
populations. – ‘’George P Barnes’’ - 1985- ‘’Irving Glickman – 1950’’
5. OBJECTIVES OF ANINDEX
The main purpose or objective of using indices in
dental epidemiology is to increase understanding
of the disease process, thereby leading to method
of control and prevention.
In addition it attempts to discoverpopulations
at high and low risk and to define specific problem
under investigation.
5/48
6. IDEAL REQUISITES OF ANINDEX
6/48
Clarity, simplicity and objectivity
Validity
Reliability
Quantifiability
Sensitivity
Acceptability
7. CRITERIA FOR SELECTING ANINDEX
Simple to use and calculate.
Should permit the examination of many people in a short period oftime.
Should require minimum armamentarium and expenditure.
Should be highly reproducible in assessing a clinical condition when used by oneor
more examiners.
Should not cause discomfort to the patient and should be acceptable to thepatient.
Should be free as possible from subjectiveinterpretation
Should be amenable to statistical analysis
Should be strongly related numerically to the clinical stages of the specificdisease
under investigation.
7/48
8. CLASSIFICATION OF INDICES
8/48
BASED ON THE DIRECTION IN WHICH THEIR SCORES
CAN FLUCTUATE
IRREVERSIBLEINDICES
REVERSIBLEINDICES
DEPENDING UPON THE EXTENT TO WHICH AREASOF
ORAL CAVITYAREMEASURED
FULL MOUTH INDICES
SIMPLIFIED INDICES
9. BASED ON DISEASE ENTITY WHICH THEYMEASURE
9/48
Diseaseindex
Symptom index
Treatment index
SPECIAL CATEGORIES AS-
Simple index
Cumulative index
10. USES OF ANINDEX
10/4
8
FOR INDIVIDUALS -
Provide individual assessment to help patient recognize an oral problem.
Reveal degree of effectiveness of present oral hygiene practices.
Motivate the person in preventive and professional care for elimination
and control of oral disease.
Evaluate the success of individual & professional treatment over a period
of time by comparing index scores.
IN RESEARCH:
Measure effectiveness of specific agents or devices for prevention/control/treatment
of oral conditions.
IN COMMUNITY HEALTH :
Show prevalence and trends of incidences.
Assess needs of a community
11. INDICES FOR ASSESSING ORALHYGIENE
AND PLA
To classify and
OHI comprises
DEBRIS IND
CALCULUS I
Mouth is divide
QUE
ORAL HYGIENE INDEX (OHI)
960 by John C Greene & Jack R vermillion.
assess oral hygiene status.
of 2 components
EX(DI)
NDEX(CI)
METHODOLOGY
d into 6 segments:
Developed in 1
Rules:
1. Only fully erupted permanent teeth scored
2. Third molars & incompletely erupted teeth are not scored
3.The Buccal & lingual debris scores are both taken on the tooth in a segment having the
greatest surface area covered by debris
4.Similarly calculus scores are taken on the tooth in a segment having the greatest surface area
covered by supra & sub-gingival calculus.
5.Using no.5 explorer(shepherds’ hook) debris & calculus are estimated by running on
Buccal/labial or lingual surface noting occlusal or incisal extent of the debris as it is removed
from the tooth surface.
6. Thus in this buccal/labial or lingual scores are not taken from same tooth
11/4
8
12. PROCEDURE –
Each segment examined for debris or calculus.
From each segment one tooth is used for calculating the individual index for that segment.
The tooth used for the calculation must have the greatest area covered by either debris or calculus.
Buccal/labial and lingual surfaces.
DI – no:23 explorer (shepherd’s hook)
CI – no:5 explorer
CRITERIA OF SCORING (DI)AND (CI)
12/4
8
13. CALCULATION
DI = Buccal total score + Lingual Total score
No: of segments
CI = Buccal total score + Lingual Total score
No: of segments
OHI = DI+CI
DI & CI = 1-6
OHI = 0-12
Higher the score poorer the oral hygiene
13/4
8
14. SIMPLIFIED ORAL HYGIENE INDEX (OHI-S)
ng and required more decision –
1964,John C Greene &
Oral hygiene index was
making. So effort was
Number of tooth surfaces s
Method of selecting the sur
The scores, which can be o
ED
Jack R vermillion.
determined to be simple and sensitive, it was time- consumi
made to make more simplified index with equal sensitivity.
DIFFERENCE
cored 16 rather 12
face
btained
SURFACES AND TEETH TO BE EXAMIN
14/4
8
15. SUBSTITUTION –
16 -17 , 26 – 27, 36- 37 OR 38, 31-41, 46 – 47 OR 48 , 17 – 18. 11-21
EXCLUSIONS - Natural teeth with full crown restorations and surfaces reduced in heightby
trauma/caries not scored.
INSTRUMENTS: Mouth mirror,no:23 explorer(shepherd’s Crook)
Scoring and method are same as that of OHI.
CALCULATION (DI-S AND CI-S)
DI-S = Total score
No : of surfaces examined
CI-S = Total score
No : of surfaces examined
OHI-S = DI-S + CI-S
15/48
16. INTERPRETATION
For DI-S & CI-S score –
For OHI-S score -
Study of epidemiology of periodontal diseases.
16/48
17. PLAQUE INDEX (PII)
of plaque on the
ooth
d that a single
n the gingival one third.
ment of plaque because of the coronal extent
ss of the plaque at the gingival area of the t
plaque. To overcome this, it is recommende
up of patients.
re missing.
acial and lingual surface of tooth.
Described by Silness P and Loe H in 1964.
This index measures the thickness of plaque o
Used as full mouth index/simplified index.
Advantages –
It is unique among indices used for the assess
tooth surface area and assesses only the thickne
Demonstrate good validity and reliability
Drawback:
One criticism is the subjectivity in estimating
examiner to be trained and used with each gro
INDEX TEETH:16,12,24,36,32,44
No substitution if any one of the above teeth a
Areas examined: Distofacial , Facial, Mesio-f
Instruments: Mouth mirror, Dental explorer.
17/48
18. PROCEDURE –
Tooth is dried and examined visually.
Explorer Is passed across the tooth surface in the cervical third and near the entrance of gingival sulcus. When no
plaque adheres to the point of explorer, the area is considered to have a ‘0’ score. When plaque adheres, a score of ‘1’ is
assigned. Plaque that is on the surface of calculus deposits and on dental restorations of all types in cervical third is
evaluated and included.
SCORING CRITERIA–
PII for a tooth
CALCULATION AND INTERPRETATION–
= Scores of 4 areas
PII for individual =
4
Total scores
no: of teeth examined
Total score
PII for group =
no: of individuals
18/48
19. TURESKY – GILMORE- GLICKMAN MODIFICATION OF
THE QUIGLEY – H IN PLAQUE INDEX
ocused on the gingival third of the tooth
th, using basic fuchcin mouthwash as a
disclosing agent.
The Quigley – Hein p
Modification was do
laque
e by s
lmore N.D and Glickman I in 1970.
ginal criteria. This system of scoring
s of each numerical score.
Method – labial , buccal and lingual surfaces are asse
Scoring criteria -
ation :
s examined
>2 = High
Quigley G. Hein . J in 1962
surfacSce.oreThey examined onl
, reported a plaque measurement that f
y the Criteriafacial surfaces of theanterior
tee
0 n
1 flec
n gingi
o plaque
ksindeofxstainwasmofodifitheedby Turesky
S, Gi
tvrengtalmahenirginngthe objectivity
of t
h
eori
plaque is r2elativelyeasyDefito
u
Instruments used – Moouthng
i
3 Ging
isteivebeclineauseooffplaqtheobjeuective
d
e
f
i
n
i
t
i
o
n
ngivmirroral mandarginDisclosingagent.
ival third of surface
ssed after u
4 Two-
Calculati5on and interGprreeta
surfa
IS = TS/ No of surface
0-1 = low
thirds of surface
ter then 2/3rd of the
ce
SCORE CRITERIA
0 E No plaque
1 Separate flecks of plaque at
the cervical margin of the
tooth
2 A thin continuous band of
plaque at the cervical margin
of the tooth
3 nA band of plaque wider then
1mm covering less than 1/3rd
of the crown of the tooth
sing disclosing agent.
4
5
Plaque covering at least 1/3rd
but less then 2/3rd of the
crown of the tooth
Plaque covering 2/3rd or more
of the crown of the tooth
19/48
20. GLASS INDEX
20/48
It was developed by GLASS R.L in 1965.
This index assesses the presence and extent of debris accumulation , for evaluating tooth – brushing
efficacy..
CRITERIA –
Code 0 – no visible debris
Code 1 – debris visible at gingival margin but discontinuous less than1mm in height
Code 2 – debris continuous at gingival margin – greater than 1mm in height.
Code 3- debris involving entire gingival third of the tooth
Code 4- debris generally scattered over tooth surface
CALCULATION –
Debris index score per person – total debris score of all the teeth examined / total no of teeth examined.
Glass criteria of scoring places more emphasis on the gingival third of the tooth surface than does the
OHI- S, and so this index is useful in clinical trials of preventive and therapeutic agents.
21. SHICK AND ASH MODIFICATION OF
PLAQUE CRITERIA –
21/48
The original criteria of plaque component of RAMFJORD’S periodontal disease was modified by SHICK
R.A and ASH M.M in1961.
Scoring criteria – only fully erupted teeth should be scored and missing teeth should not be substituted.
– PS = TOTAL SCORE/ NO. OF TEETH EXAMINED
Criteria
Calculati
on
Score
0
Absence of dental plaque
1
At the gingival margin covering less than 1/3rd of the gingival half of the facial or lingual surface
of
Dental plaque covering more than 1/3rd but less than 2/3rd of the gingival half of the facial or
lingual surface of the tooth.
Dental plaque covering 2/3rd or more of the gingival half of the facial or lingual surface of the
tooth
2
3
22. NAVY PLAQUE INDEX (NPI)
22/48
The navy plaque index was developed by GROSSMAN F.D & FEDI P.F in 1970. This index was designed
to assess the plaque control status among naval personnels and to measure any subsequent changes.
METHOD :
The navy plaque index is obtained by scoring the amount of plaque found on six selected teeth (index teeth)
by using a disclosing solution. The teeth examined are.
16, 21,24,36,41,44 and surfaces are – facial and lingual of the each six teeth, the facial surfaces are divided
into three major areas as – GingivalArea (G), Mesial ProximalArea (M) and Distal ProximalArea (D).
The stained plaque in contact with the gingival is scored as follows-
Area M = 3
Area G = 2
Area D = 3 when plaque is found not in contact with gingival tissue but is found on any tooth surface, one
point is added to the facial or lingual score.
Calculation – the highest for any of the six teeth scored is the patient’s NAVYplaque index score. All teeth
scores are added to give the total NPI score.
23. INDICES USED FOR ASSESSMENTOF
CALCULUS
23/48
CALCULUS SURFACE INDEX (CSI) - ENNEVER J, Sturzenberger C.P and Radike A.W in 1961.
MARGINAL LINE CALCULUS INDEX (MLCI)- Muhlemann H.R and Villa P.in 1967.
CALCULUS SURFACE SEVERITY INDEX (CSSI) - The calculus surface severity index was developed
by ENNEVER J , et al in 1961 as a companion index to their calculus surface index (CSI)
24. INDICES USED FOR ASSESSING GINGIVAL
INFLAMMATION
PAPILLARY – M ARGINALATTACH MENT INDEX (PMA)-
MAURYMASSLER AND SCHOUR .L 1944.
No. of gi ted mation.
A gingival u art
Papilla gingiva, Marginal gingiva,At tached gingiva
Pr y only
m
esence or absence of
axillary and mandibu
ch g
nd
RITERIA
Papillary component (p) Marginal com mponent
score criteria
0
1
2
3
4
5
1
Normal
En
ngival units effected were coun rather
gorgem
then
ent,
the
slight
severit
in
cy
in
ofi
n
f
l
a
m
Might papillary size, no bleeding
2 enlargemeMETHODnt
O
nit was dividedObviointous
threeincreacomseinpbl
size , BO Pressue
ry
vious engorgement ,
meedentsing–on pressure
3 Excessive inc in S
inflamsize,
spmoatntaneousionon ea bl
labrleedincisors,ing
canines a in
4 NecroticSCpORIapillaNGC
N
5 Atrophy and loss Re
p
ollen collar, spontaneous
einedgivingal,unbeitginninisrecogrdedand
u
s
u
a
l
l
filtpremratolarsion were examined.
ecrotic gingiva
coesnentsion(mof)the free
Attached co
marginal gingiva below CEJ
due to inflammatory
changes.
score criteria
0 Normal
score criteria
0 Normal
1 b Slight engorgement with lossof
stippling, changes in color may
or may not be present
2
3
w Obvious engorgementwith
marked inc in redness and
pocket formation
Advanced periodontitis and
deep pockets.
24/48
25. Calculation of the Index –
USES –
Clinical trials
On individual patients
Epidemiologic surveys
PMA = P+M+A
25/48
26. GINGIVAL INDEX
Developed by Loe H and Silness P in1963.
For assessing severity of gingivitis.
Instrument: MOUTH MIRROR , PERIODONTALPROBE.
METHOD – The severity of gingivitis is scored
INDEX TEETH –
h.
on all teeth or on selected index teet
ingival scoring units.
Tissues surrounding each tooth divided into 4 g
DISTO-FACIALPAPILLA
FACIALMARGIN
MESIO-FACIALPAPILLA
LINGUAL GINGIVALMARGIN
26/48
Advantage –
• The sensitivity and reproducibility is good
provided the examiner's knowledge of periodontal
biology and pathology is optimal
27. SCORING CRITERIA–
Calculation and interpretation –
GI score for a tooth = Scores from 4 areas
GI score individual =
GI score for group =
4
Sum of indices of teeth
No: of teeth examined
Sum of all members
Total no of individuals
Use –
Severity of
gingivitis,
controlled
clinical trials of
preventive or
therapeutic
agents
27/48
28. MODIFIED GINIGVALINDEX
Lobene, Weatherford, Ross, Lamm and Menaker in 1986.
Assess the prevalence and severity of gingivitis.
ortant changes in GI –
28/48
ence or absence of bleeding.
erate inflammation.
ion of gingival probing to assess the pre
ition of scoring system for mild and mod
d -
pilla of all
n MGI , labial and lingual surfaces ofth
eeth except 3rd molars are examined an
e gingival margins and the interdentalpa
d scored.
SCORING –
Imp
SCORE CRITERIA
0 Normal
Eliminat
Redefin
1 s Mild inflammation, slight change in
color, little change in texture of any
portion of gingival unit
Metho
2 Mild inflammation of entire gingival unit
To obtai
3 Moderate inflammation of gingival unit
erupted t
4 Severe inflammation of gingival unit
29. PAPILLARY MARGINAL INDEX(PM)
Developed by MUHLEMANN H.R and MAZOR Z.S in 1958.
SCORING CRITERIA
score criteria
0 normal
1 Bleeding from gingival sulcus on
gentle probing, tissue otherwise
become normal.
2 Bleeding on probing, change in
color due to inflammation, no
edema
3 BOP
, color change, edematous
swelling
4 Ulceration with additional
symptoms
29/48
30. SULCUS BLEEDING INDEX (SBI)
Developed by MUHLEMA
Modification of PAPILLAR
Score 0 – health looking pap
Score 1 – healthy looking gi
Score 2 – bleeding on probin
Score 3 – bleeding on probin
Score 4 –bleeding on probing
Score 5 –spontaneous bleed
Four gingival units are score
gingival (M units) and the m
are added and divided by fou
NN H.R AND SEN.S in 1971.
Y – MARGINAL INDEX of MUHLEMANN and MAZOR Z.S.
SCORING CRITERIA
illary and marginal gingiva no bleeding on probing;
ngiva, bleeding on probing;
g, change in color, no edema;
g, change in color, slight edema;
, change in color, obvious edema;
ing, change in color, marked edema.
d systematically for each tooth: the labial and lingual marginal
esial and distal papillary gingival (P units). Scores for theseunits
r gives the sulcus bleeding index.
30/48
31. GINGIVAL BLEEDING INDEX (GBI)
In 1974, Carter and Barnes introduced a Gingival Bleeding Index, which records the presence or absence of
gingival inflammation.
pper anterior, upper
onds is allowed for
btained by noting
The mouth is divided into
left, lower left, lower ante
Bleeding is generally imm
re- inspection of each seg
Bleeding is recorded as pr
the total units of bleeding.
Gingival Bleeding I
AINAMO & BAY (1975),
six segments and flossed in the following order; upper right, u
rior and lower right.
ediately evident in the area or on the floss; however, thirty sec
ment.
esent or absent. For each patient a Gingival Bleeding Score is o
ndex (GBI)-
is performed through gentle probing of the orifice of the gingival crevice.
31/48
32. PAPILLARY BLEEDING INDEX
32/48
Introduced by Saxer and Muehlemann (1975), as cited by Muehlemann (1977).
A periodontal probe is inserted into the gingival sulcus at the base of the papilla on the mesial
aspect, and then moved coronally to the papilla tip. This is repeated on the distal aspect of the
papilla.
The intensity of any bleeding is recorded as:
Score 0 – no bleeding;
Score 1 – A single discreet bleeding point;
Score 2 – Several isolated bleeding points or a single line of blood appears;
Score 3 – The interdental triangle fills with blood shortly after probing;
Score 4 – Profuse bleeding occurs after probing; blood flows immediately into the marginal
sulcus.
33. EASTMAN INTERDENTAL BLEEDING INDEX
35/48
Caton & Polson (1985) developed the Eastman Interdental Bleeding Index(EIB).
A wooden interdental cleaner is inserted between the teeth from the facial aspect,depressing
the interdental tissues 1 to 2 mm. This is repeated four times and the presence or absence of
bleeding within 15 s is recorded.
Path on insertion should be parallel to occlusalsurface.
Insertion and removal of interdental cleaner is done 4 times and then moved on to next
interproximal area.
SCORE = no. of bleeding areas/total no. of areas Х 100
34. PERIODONTAL INDEX
RUSSELL’S PERIODONTAL INDEX (RPI) –
Developed by Russell A.L in1956
To estimate deeper periodontal diseases.
All teeth present examined.
Gingival tissue surrounding each tooth assessed for gingival inflammation and periodontal involvement.
Instruments : Mouth Mirror, plain probe.
SCORING CRITERIA
CALCULATION AND INTERPRETATION
PI score per person = Sum of individual scores
No: of teeth present
34/48
35. PERIODONTAL DISEASE INDEX (PDI)
Developed by SIGURD P.RAMFJORD IN 1959.
MOST IMPORTANT FEATURE OF PDI IS MEASUREMENT OF THE LEVEL OF THE
PERIODONTAL ATTACHMENT RELATED TO THE CEJ OF THETEETH.
COMPONENTS - SCORING METHODS -
PLAQUE,
CALCULUS,
GINGIVAL &
PERIODONT
AL
16
21
24
36
41
44
35/48
36. PLAQUE COMPONENT OF THE PDI–
SURFACES – FACIAL, LINGUAL, MESIAL, DISTAL
INSTRUMENTS- MOUTH MIRROR, DENTALEXPLORER
SCORING CRITERIA–
SHICK AND ASH modification of plaquec riteria –
C
t
onsis
he fac
Scor
a and restricting the scoring of plaque
elected teeth are same as that of plaque
should be scored and missing teet
gingival half, of
onent
ld not be
substi
Cal
SCORE CRITERIA
0 No plaque present
1 Plaque present but not on all
inter
surf
a
proximal, buccal and lingual
ces of the tooth
2 Plaqu
bucc
toot
e present on all interproximal,
al and lingual surfaces of the
h , but covering half than one
half
t of six te3ethexcluding the
interproximalPlaqareuial and lingual surfaces of
the index teetinterh. S
surfa
ing criteria – only fully erupted
tehalfeth
tuted.
culation – PS = TOTAL SCORE/NO.OF
of these surfaces
e extending over all to the
proximal , buccal and lingual comp ces,
and covering more than one
of these surfaces h shou
TEETH EXAMINED
Score
36/48
Criteria
0 absence of dental plaque
1 At the gingival margin covering less
then 1/3rd of the gingival half of the
facial or lingual surface of the tooth
2
3
Dental plaque covering more than
1/3rd but less than 2/3rd of the
gingival half of the facial or lingual
surface of the tooth
Dental plaque covering 2/3rd or more
of the gingival half of the facial or
lingual surface of the tooth
37. CALCULUS, GINGIVAL AND PLAQUE COMPONENT
(PDI)
37/48
Calculus component – assess the presence and extent of calculus on the facial andlingual
surfaces of the six index teeth.
Instruments – MOUTH MIRROR, DENTALEXPLORER
Scoring criteria –
Score 0 – Absence of calculus
Score 1 – Supragingival calculus extending only slightly belowFGM
Score 2 – Moderate amount of supra and subgingival calculus or subgingivalalone.
Score 3 – Abundance of supra and subgingivalcalculus
Calculation – No of teeth examined/ totalteeth.
38. GINGIVAL AND PERIODONTALCOMPONENT
Gingival status is scored first.
Dried superficially by gently touching with absorbing cotton, and examined for color change, form ,
consistency and bleeding.
Crevice depth is recorded in relation to CEJ.
Instruments used – mouth mirror and university of Michigan probe number 0 probe.
Score 0 - Absence of signs of inflammation
Score 1 – mild to moderate inflammatory changes not extending around the tooth.
Score 2 - mild to moderately severe gingivitis extending around the tooth.
leed , and
Score 3 – s
ulceration.
Score 4 – g
evere gingivitis characterized by marked redness , swelling , tendency to b
ingival crevice in any of the four areas , extending apically to CEJ but not more then 3 mm.
Score 5 - gingival crevice in any of the four areas , extending apically to CEJ between 3-6mm.
Score 6 - gingival crevice in any of the four areas , extending apically more then 6 mm from CEJ.
Calculation –
PDI – TOTAL OF INDIVIDUAL TOOTH SCORES/NUMBER OF TEETH
EXAMINED
SCORING CRITERIA
38/48
39. COMMUNITY PERIODONTAL INDEXOF
TREATMENT NEEDS (CPITN)
Developed by “joint committee” of WHO & FDI in 1982.
To survey and evaluate periodontal treatment needs.
PROCEDURE -
Dentition divided into sextants
Each sextant given a score
ADVANTAGES:
Simplicity
Speed
International uniformity.
INSTRUMENT USED - CPITN PROBE
39/48
40. CPITN PROBE
from 3.5mm - 5.5mm
culus
WHO periodontal examination prob
Used for
Measurement of pocket depth &
Detection of subgingival calculus.
Weight = 5gms
2 types:
CPITN-E(epidemiological probe)
Pocket depth measured through color
“Ball tip” diameter 0.5mm; easy de
CPITN-C ( clinical probe)
Variant probe basic probe
2 additional markings
8.5mm & 11.5 mm
Detailed assessment & recording of d
e.
coding; black mark starting
tection of sub gingival cal
eep pockets. 40/48
41. Best estimators of the worst periodontal condition of the mouth.
>20 years
Molars examined in pairs & highest score recorded.
Up to 19 years
CODING CRITERIA-
41/48
42. COMMUNITY PERIODONTALINDEX(CPI)
INCLUSION – MEASUREMENT OF ‘’LOSS OF ATTACHMENT ‘’AND ELIMINATIO
OF THE ‘’TREATMENT NEEDS’’category.
INSTRUMENTS USED – MOUTH MIRROR , THE CPITN – C PROBE.
SCORING CRITERIA –
Score 0 – healthy.
Score 1 – bleeding observed, directly or by using mouth mirror, afterprobing.
Score 2- calculus detected during probing, but all of the black band on the probevisible.
Score 3 – pocket 4 – 5 mm ( gingival margin within the black band on the probe)
Score 4 – pocket 6 mm or more ( black band on the probe not visible)
X- excluded sextant
9 – not recorded
This index is based on the modification of the earlier used community periodontal indexof
treatment needs (CPITN).
N
Loss of attachment –
Criteria of scoring
Code o – loss of attachment 0-3mm (CEJ not visible and CPI score 0-3).
Code 1 – loss of attachment 4- 5 mm (CEJ within the black band).
Code 2 – loss of attachment 6- 8mm (CEJ between the upper limit of the black band and the
8.5mm ring )
Code 3 – loss of attachment 9- 11mm (CEJ between the 8.5mm and 11.5mm rings)
Code 4- loss of attachment 12mm or more(CEJ beyond the 11.5mm rings ).
X – excluded sextant (less than two teeth present )
9 – not recorded ( CEJ neither visible nor detectable)
42/48
43. GRADE 1- slightly more then normal
43/48
ASSESSMEP
R
NI
C
TH
A
OR
D
F(
1
T9
7
2
O)
:OTH MOBILITY
1- s lighMtmILoLbEilRity(1985)– has described the most common clinical method in which tooth is held between handles of the
2- Modtewraoteinstruments& moved back and forth or with metallic instrument and onefinger.
3- ex tenCsirviteermiaov–ementin a lateral or mesiodistal direction combined with
vertical displacement in the alveolus.
WASERMAN ET AL(1973):
SCORE 0- no detectable mobility
SCORE 1- distinguishable tooth mobility
SCORE 2- crown of tooth moves more than 1mm in any direction
SCORE 3 – movement of more than 1mm in1a-nynodrimrecatlion.
GLICKMAN/ CARRANZA F.A(129-7s2li)g–ht-> ¾ mm of bucco-lingual movement
3- moderate- up to approximately 2mm movement bucco-lingually
4- severe- more than 2 mm
GRADE 2- moderately more than normal
GRADE 3 – severe mobility faciolingually and or mesiodistally combined with vertical displacement.
FLESZAR INDEX (1980) - devised a system for recording tooth
m obilGityE,NasCfOollRow(1s9:84).-assessed mobility as –
M0 - Firm Tooth
M 1- D
S
l
E
i
g
G
h
R
ti
E
n
E
c
r
1
e
a
–
s
e
H
d
o
m
r
i
o
z
o
b
n
i
l
t
i
a
t
y
lmobility of crown is from detectable to 1mm.
M 2–
D
D
E
e
G
f
i
n
R
i
E
t
e
E
t
2
o–
co
m
ns
o
ib
d
ielirtayb
o
le
fi
c
n
r
c
o
r
w
e
a
n
s
e
r
a
i
n
n
g
m
e
s
o
f
b
r
i
o
l
m
i
t
y1
b
-
u
2
t
m
n
o
m
tihmorpiaziornmtaelnlty
.o
f
fu nctiDonE.GREE3 – mobility of crown is observed in vertical or apical direction.
M3 – Extreme mobility, a loose tooth that would be Incomparable in
function.
44. LOVDAL’S INDEX(1994) –
First degree – Teeth that were somewhat more mobile than normal.
Second degree – Teeth showing conspicuous mobility in transverse but not axial direction.
Third degree – Teeth being mobile in axial as well as on transverse direction.
GRALES AND SHALES(1999) –
GRADE 2 – Mobility between 1- 2mm
GRADE 3 – Mobility >2mm buccolingually
LEONARD ABRANMS AND POTASHNICK’S(1999) –
CLASS 1 – Mobility less than 1m
Class 2 – mobility with in 1- 2mm
Class 3 – mobility >2mm
Lindhe (1997) –
44/48
Degree 1 – movability of crown of tooth less than 1mm in horizontal
GRADE 0 – No apparent mdiorebcitliotyn
GRADE 1-D
M
eg
o
rb
eielit2
y–
lem
ssotvh
aabn
il1
itmym
o
f
b
c
u
r
o
c
w
c
o
n
l
i
o
n
f
g
u
t
o
a
o
l
l
t
yhmore than 1mm in horizontal
direction
Degree 3 – movability of crown of tooth in vertical as well
45. NYMAN'S INDEX –
Zero degree – Normal – less than 0.2 mm
Degree 1 – Horizontal / Mesiodistal mobility of 0.2 – 1mm
Degree 2 – Horizontal / Mesiodistal mobility of 1-2 mm.
Degree 3 – Horizontal / Mesiodistal mobility exceeding 2mm and / or vertical mobility.
KIESER(2001) –
GRADE 0 – physiologic mobility
GRADE 1 – Slight mobility
GRADE 2 – Moderate mobility
GRADE 3 – Marked mobility
45/48
46. CONCLUSION
46/48
Periodontal indices have contributed to identification, prevention and
treatment of periodontal disease over the years since their inception. These
indices are based on the prevailing understanding of the pathogenesis and
progression of periodontal disease. Thus, with the better understanding ofthe
periodontal disease process these indices have changed from the simple
Russell’s
Periodontal Index to the current Moustakis’s Genetic SusceptibilityIndex.
Each of these indices has its merits and limitations, so, an ideal index which
detects the ongoing progressive periodontal destruction and also identifiesthe
active and inactive sites of disease, is the need of the hour
47. REFERENCES
47/48
Soben Peter. Indices in dental epidemiology,4th edition
Soben Peter. Indices in dental epidemiology , 3rd edition
Essentials Of Preventive and Community Dentistry 3ed.123-231.
Kinane DF, Lindhe J. Pathogenesis of periodontitis.
Kunaal Dhingra and Kharidhi Laxman Vandana. Indices for measuring
periodontitis : A literature review, International Dental Journal 2011; 61: 76–84
In: Lindhe J, Karring T, Lang NP, Eds. Clinical Periodontology and Implant
Dentistry.
Maria Augusta Bessa Rebelo and Adriana Corrêa de Queiroz, Federal
University of Amazonas Brazil. Gingival indices : state of art , Gingival
Diseases – Their Aetiology, Prevention andTreatment
