This document discusses various indices used to assess gingivitis and periodontal disease epidemiology. It describes the Gingival Index (GI) which evaluates gingival inflammation severity and location on a scale of 0-3. The Oral Hygiene Index (OHI) assesses oral cleanliness based on debris and calculus. The Community Periodontal Index of Treatment Needs (CPITN) is a World Health Organization index that identifies periodontal treatment needs (from none to complex treatment) based on probing depth and bleeding. These indices provide standardized measures for evaluating populations and indicating periodontal health programs and treatment needs.

1. Epidemiology of
Periodontal Disease
PRESENTED BY
SARA AHMED MAHMOUD
Ass. Prof, Pediatric & Community
Dentistry,
Faculty of Oral & Dental Medicine,
Cairo University

2. WHAT IS AN INDEX?
• “ a numerical value describing the relative status
of a population on a graduated scale with
definite upper and lower limits, which is
designed to permit and facilitate comparison
with other populations classified by the same
criteria and method”.

3. Indices Used for Assessment of
Gingival and Periodontal
Diseases

4. I-Gingival changes/gingivitis
• Papillary, Marginal & Attached gingival (PMA).
• Gingival index (GI)

5. 1-Papillary,Marginal& Attachedgingival(PMA).
• It is the first numerical system of recording gingival
condition.
• Light, mirror & blunt probe
• All teeth are examined.

6. 0 Normal
1 Mild
enlargement
2 Enlargement +
bleeding on
probing
3 Enlargement+
sp bleeding
4 Necrotic
5 Atrophy
0 Normal
1 Mild enlargement
2 Enlargement+
bleeding on
pressure
3 Enlargement+
Sp bleeding
4 Necrotic
0 Normal
1 Mild
enlargement+
loss of stipp
2 Enlargement +
redness + pocket
3 Deep pocket

7. • The no. of the affected P.M.A. units are counted &
considered separate estimates.
• Mild: if 1-4 papillae & 0-2 margins
• Moderate: if 4-8 papillae & 2-4 margins
• Severe: if > 8 papillae & > 4 margins

8. 2-Gingival index (GI)
(loe and Sillness)
• Purpose:
• Severity of gingival inflammation & its location.
Partial recording system
6 2 4
4 2 6

9. Appear. Bleed. Inflam.
0 normal no no
1 Slight change in color,
texture & mild edema
no mild
2
Redness
Hypertrophy
Edema
probing moderate
3
Marked Redness.
Hypertrophy
Edema
spontaneous severe

10. Average GI Inflammation
2.1 - 3.0 severe
1.1 - 2.0 moderate
0.1 - 1.0 mild
< 0.1 no
GI for a specific tooth = AVERAGE (points for the 4 surfaces)
GI for patient = AVERAGE (Gingival Indices for all 6 teeth)
GI for a group =total score of ind./no. of ind.

11. II- Oral hygiene indices
• Oral Hygiene Index(OHI)
• Simplified oral hygiene index (OHI-S)
( Greene and Vermillion 1964)

12. •Oral debris: soft foreign matter on the surface of
teeth that consist of bacterial plaque, material alba, and food
debris

13. •Dental calculus: a hard deposit of inorganic salts
composed primarily of calcium carbonate and phosphate
mixed with debris, microorganisms, and desquamated
epithelial cells

14. 2-Oral Hygiene Index(OHI) 3-Simplified oral
hygiene index (OHI-S)
Assess oral cleanliness ( debris or calculus) Assess oral cleanliness ( debris or
calculus)

16. Criteria:
Debris index
0=No debris or stain
1=Soft debris covering not more than one third of the tooth
surface
2=Soft debris covering more than one third, but not more than
two thirds
3= Soft debris covering more than two thirds

17. Criteria:
Calculus index
0=No calculus
1=Supragingival calculus covering not more than third of the
exposed tooth surface
2=Supragingival calculus covering more than one third but not
more than two thirds of the exposed tooth surface or the
presence of individual flecks of subgingival calculus
3=Supragingival calculus covering more than two third of the
exposed tooth surface or a continuos heavy band of subgingival
calculus

18. Individual score:
DI = total debris scores (0-6)
No. of teeth scored (12 surf)
CI = total calculus scores (0-6)
No. of teeth scored (12 surf)
OHI=DI +CI ( 0 to 12)
Individual score:
DI-S =total debris scores (0-3)
No. of teeth scored (6)
CI-S = total calculus scores (0-3)
No of teeth scored (6)
OHI-S=DI-S +CI-S ( 0 to 6)

19. V-Periodontal diseases
• Periodontal index (PI).
• Community periodontal index of treatment
needs (CPITN).

20. 1- Periodontal index (PI).
Russel’sindex
• Composite index (records reversible & irreversible changes)
Total recording system
0: normal
1: mild gingivitis (not circum).
2: gingivitis (circum + no epith attach breakdown).
6: gingivitis + pocket form.
8: advanced destruction with loss of masticatory function.

21. • 1-2 gingival affection.
• 6-8 periodontal affection.
• 2-6 gingival and periodontal affection.

22. Lilienthal et al., 1964
Partial recording system
7 14
41 7

23. 3-Community periodontal index of
treatment needs (CPITN)
PURPOSE
• Epidemiological purposes.
• Periodontal health awareness programs
• Indicator of periodontal treat. need.
Total or partial recording system
61 6
6 61

24. World Health Organization Probe
WHO-621
• Ball-ended tip of 0.5 mm in diameter
• Color coded band of 2mm , beginning 3.5 mm
from the tip.
• Modification: 2 further graduations at 8.5 & 11.5 mm.

25. • Probing force is divided into:
• (i) Working component :determine pocket depth (// long axis)
• (ii) Sensing component: determine subgingival calculus and
overhanging restorations
INDICATORS:
• Gingival inflammation
(Bleeding on probing)
• Calculus or overhanging
restorations
• Periodontal pockets

26. • Code 0- Healthy
• Code 1- Bleeding
• Code 2- Calculus
• Code 3- Pocket depth 4-5mm
• Code 4- Pocket >6 mm
• Code X- Only one tooth or no teeth in the sextant.

27. code CPITN TREATMENT NEEDS
TN-0 No treatment (Home care)
TN-1 Oral hygiene instruction
TN-2 + Professional cleaning& scaling
TN-3 + Complex treatment
(deep scaling, root planning and
complex surgical procedures)

28. Advantages and Disadvantages
• Simple and rapid recording
with international
uniformity.
• Partial recording, exclusive
of important signs of past
periodontal disease