2. CONTENTS:
+ Introduction
+ Definition
+ Ideal requisites
+ Uses of indices
+ Classification
+ Criteria for selecting
index
+ Indices used to
assess
• Gingival
inflammation
• Gingival bleeding
• Periodontal
diseases
• Pigmentation
• Tooth mobility
• Indices and their
current trends
• conclusion
3. UNTIL YOU CAN COUNT IT, WEIGH IT, OR EXPRESS IT IN
A QUANTITATIVE FASHION, YOU HAVE SCARCELY
BEGUN TO THINK ABOUT THE PROBLEM IN A
SCIENTIFIC FASHION -lord kelvin
4. DEFINITION:
+ An index is defined as “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 population classified with
the same criteria and the method. -
Russell.A.L
7. CLASSIFICATION
Based on
the
direction in
which
scores can
fluctuate
Extent to
which
areas of
oral cavity
are
measured
According
to entity
which they
measure
General
indices
Full
mouth
simplified
Disease
Symptom
Treatment
Simple
&
cummulative
8. Criteria for selecting an index:
+ Simple to use and calculate.
+ Require minimum armamentarium and expenditure.
+ Permit examination of many people in a short period
of time.
+ Highly reproducible in assessing a clinical condition
when used by one or more examiners.
+ Should not cause discomfort to patient and should be
acceptable to patient.
9. PAPILLARY-MARGINAL-ATTACHMENT
INDEX
+ MAURY MASSLER AND SCHOUR .L 1944.
+ No. of gingival units effected were counted
rather than the severity of inflammation
METHOD
+ Presence or absence of inflammation on each
gingival unit is recorded and usually only
maxillary and mandibular incisors, canines and
premolars were examined.
12. GINGIVAL INDEX(Loe H and Silness
J)-1963+ Severity of gingivitis
+ Disto facial papilla, facial margin, mesio facial
papilla, lingual margin
Calculation:
GI score for a tooth = Scores from 4 areas/4
GI score individual = Sum of indices of
teeth/no.of teeth examined
GI score for group = Sum of all member/Total
no of individuals
13. score Criteria
0 Absence of inflammation/normal gingiva
1 Mild inflammation, slight change in colour,
slight edema, no bleeding on probing
2 Moderate inflammation, moderate glazing,
redness, edema and hypertrophy. bleeding on
probing
3 Severe inflammation, marked redness and
hypertrophy ulceration. Tendency to
spontaneous bleeding.
15. MODIFIED GINGIVAL INDEX
+ LOBENE, WEATHER FORD, LAMM AND
MEENAKER in 1986.(no probing)
0 Normal
1 Mild inflammation, slight change in colour,
little change in texture of any portion of
gingival unit
2 Mild inflammation of entire gingival unit
3 Moderate inflammation of gingival unit
4 Severe inflammation of gingival unit
16. ASSESSMENT OF GINGIVAL
BLEEDING:
+ SULCUS BLEEDING INDEX
+ PAPILLARY BLEEDING INDEX
+ GINGIVAL BLEEDING INDEX
+ BLEEDING TIME INDEX
+ QUANTITATIVE GINGIVAL BLEEDING INDEX
+ EASTMAN INTERDENTAL BLEEDING INDEX
17. SULCUS BLEEDING INDEX:
+ MUHLEMAN H.R in 1971
+ Early inflammatory gingival response
+ Labial & lingual marginal gingiva
+ Mesial & distal papillary gingiva
+ Scores for these units are added and divided
by 4
18. 0 Healthy looking papillary and marginal gingiva,
no bleeding on probing
1 Healthy looking gingiva, bleeding on probing
present
2 Bleeding on probing present, changes in color, no
edema
3 Bleeding on probing present, changes in colour,
slight edema present
4 Bleeding on probing present, changes in colour,
obvious edema present
5 Spontaneous bleeding, changes in colour, marked
edema present
19. GINGIVAL BLEEDING INDEX:
+ CARTER and BARNES -1974
+ Presence or absence of inflammation
+ Unwaxed dental floss-sulcus
+ Six segments-upper right, upper anterior,
upper left, lower left, lower anterior, lower right
+ 30 sec
+ Present or absent
20. GINGIVAL BLEEDING INDEX:
+ AINAMO & BAY-1975
+ 10 sec –positive finding
+ Bleeding present +
+ Bleeding absent –
+ No. of positive sites is recorded & expressed
as percentage of no. of sites examined
+ Short term clinical trials
+ Routine individual basis.
21. PAPILLARY BLEEDING INDEX:
+ SAXER and MUHLEMANN(1975)
+ Immediate evaluation of patients gingival
condition
+ P. Probe –base of papilla –mesial aspect –
coronally to tip-same on distal aspect
+ Score0-no bleeding
+ Score 1 -a single discrete bleeding point
+ Score2- several bleeding points or a single line
of blood appears
22. + Score 3- the interdental triangle fills with blood
shortly after probing
+ Score 4 –profuse bleeding occurs after
probing: blood flows immediately into marginal
sulcus
23. BLEEDING TIME INDEX:
+ NOWICKI et al.-1981
+ Michigan ‘o’ probe- sulcus- resistance- gingiva
stroked back and forth (2mm)
+ Score 0-no bleeding within 15 seconds of
second probing
+ Score 1 –bleeding within 6 to 15 seconds of
second probing
+ Score 2 – bleeding within 11 to 15 seconds of
first probing or 5 sec after second probing
+ Score 3- bleeding within 10 sec of probing
+ Score 4 – spontaneous bleeding
24. EASTMAN INTERDENTAL BLEEDING
INDEX
+ CATON & POLSON-1985
+ Wooden interdental cleaner –b/w teeth-facial-
depressing interdental tissues 1 to 2 mm
+ 4 times repeated
+ 15 sec
+ Presence or absence of bleeding
+ Clinical trails or epidemiological studies
25. QUANTITATIVE GINGIVAL
BLEEDING INDEX
+ GARG & KAPOOR- 1985
+ Magnitude of blood stains covering tooth brush
bristles while brushing
+ 6 segments-30 sec
+ Score 0- no bleeding on brushing : bristles free
from blood stains
+ Score 1 – slight bleeding on brushing : bristle
tips stained with blood
26. + Score 2 –moderate bleeding on brushing:
about half of bristle length from tip downwards
stained with blood
+ Score 3- severe bleeding on brushing : entire
bristle length of all bristles including brush
head covered with blood.
27. ASSESSMENT OF PERIODONTAL
DISEASES
+ RUSSELL’S PERIODONTAL INDEX
+ CPITN
+ PERIODONTAL DISEASE INDEX
+ PERIODONTAL SCREENING AND RECORDING
+ NIDCR PROTOCOL FOR DISEASE ASSESSMENT
+ GINGIVAL PERIODONTAL INDEX
+ PERIODONTITIS SEVERITY INDEX
28. RUSSELL’S PERIODONTAL INDEX:
+ RUSSELL.A.L -1956
+ Composite index( reversible & irreversible
changes)
+ Mouth mirror and straight probe
+ It was once widely used in epidemiological
surveys but not used much now because of
introduction of new periodontal indices and
refinement of criteria
29.
30.
31. COMMUNITY PERIODONTAL INDEX
OF TREATMENT NEEDS :
+ Joint working committee of the WHO and FDI
in 1982
+ JUKKA AINAMO, TERRY CUTRESS, JEAN
MARTIN, DAVID BARMES, JENNIFER
SARDO
+ To evaluate periodontal treatment needs
+ Six sextants
+ For adults aged > 20 yrs :-10 index teeth are
taken into account :17 16 11 26 37 47 46 31 36
37.
32. + For young people up to 19 yrs:
Only 6 index teeth are examined : 16 11 26 46 31
36
+ The second molars are excluded at these ages
because of the high frequency of false pockets
When examining children less than 15 yrs,
pockets are not recorded although probing for
bleeding and calculus are carried out as a routine.
38. PDI score= total of individual tooth
scores(PS+CS+GPS)/number of tooth examined
39. PERIODONTAL SCREENING AND
RECORDING INDEX:
+ 1992 by AAP & ADA
+ 6 sextants- mesio buccal, mid buccal,
distobuccal and corresponding palatal and
lingual sites.
+ simplicity
40. Clinical Signs Treatment Plan
Code 0 Absence of clinical signs No treatment required
Code 1 Bleeding on probing Oral hygiene instructions
Code 2 Supra and/or subgingival calculus
and/or defective margins
Removal of calculus
Correction of plaque
retentive margins
Code 3 Periodontal pocket 4mm to 5.5 mm
deep
(coloured band on probe partially
visible)
Removal of calculus
Root planing
Detailed periodontal
examination of sextant or
entire mouth if more than
2 sextants receive a Code
3 score
Code 4 Periodontal pocket 6mm deep
(colored band no longer visible)
Detailed periodontal
examination of entire mouth
Complex treatment
Code • Periodontal abnormalities present Detailed periodontal
examination of affected
sextant
Code X Sextant absent or fewer than 2 teeth
43. PERIODONTITIS SEVERITY INDEX:
+ ADAMS & NYSTROM-1986
+ PSI=clinical inflammation score X bone loss
score
+ BLS- schei ruler
+ Drawbacks-radiographs are necessary
radiographs do not permit buccal or
lingual PSI calculations
Range :0 to 10
44. ORAL HYGIENE INDEX:
+ JOHN.C.GREEN &
JACK.R.VERMILLION-
1960
+ Fully erupted permanent
teeth
+ Third molars not included
+ The buccal & lingual
calculus scores are both
taken on the tooth in a
segment having the
greatest surface area
covered by supra and
subgingival calculus
47. CALCULATION
+ Debris Index (DI) =( Buccal Score+ Lingual
Score) / NO. OF SEG
+ Calculus Index (CI) =( Buccal Score+ Lingual
Score) / NO. OF SEG
+ DI and CI range from 0-6
+ Maximum score for all segments can be 36 for
debris or calculus
+ OHI range from 0-12
+ Higher the OHI, poorer is the oral hygiene of
patient
Oral Hygiene Index= DI+CI
48. 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
+ Only fully erupted permanent teeth are scored
+ Natural teeth with full crown restorations and
surfaces reduced in height by caries or trauma
are not scored
50. PATIENT HYGIENE PERFORMANCE
INDEX:
+ Podshadley A.G. and Haley JV in 1968.
+ 6 index teeth-16,11,26,36,31,46
+ Disclosing agent-30 sec
+ Each of the 5 subdivisions is
scored for presence of stained debris:
+ 0= No debris(or questionable)
+ 1= Debris definitely present.
51. + PHP index for an individual= (Total score for all
the teeth /the number of teeth examined)
Rating scores
+ Excellent : 0 (no debris)
+ Good : 0.1-1.7
+ Fair : 1.8 – 3.4
+ Poor :3.5 – 5.0
52. PLAQUE INDEX:
+ Silness and Loe in 1964
+ Assess only thickness of plaque at the cervical
margin of the tooth closest to the gums
+ All four surfaces are examined, 6 index teeth
+ Distal
+ Mesial
+ Lingual
+ Buccal
Excellent-0
Good-0.1-0.9
Fair:1.0-1.9
Poor:2.0-3.0
16,
12,
24,
36,
32,
44
53. score criteria
0 No plaque
1 A film of plaque adhering to the free gingival
margin and adjacent area of tooth the plaque
may be seen in situ only after application of
disclosing solution or by using probe on tooth
surface
2 Moderate accumulation of soft deposits within
the gingival pocket, or the tooth and gingival
margin which can be seen with the naked eye
3 Abundance of soft matter within gingival pocket
and/or on the tooth and gingival margin
54. CALCULATION
+ Plaque index 0-3 for each surface
+ Plaque index for a tooth -Scores added and
then divided by four
+ Plaque index for group of teeth -Scores for
individual teeth are added and then divided by
number of teeth.
+ Plaque index for the individual -Indices for
each of the teeth are added and then divided
by the total number of teeth examined
+ Plaque index for group -All indices are taken
and divided by number of individual
55. Turesky- Gilmore- Glickman
modification of the Quigley-Hein
plaque index+ Quigley –Hein=1962 -gingival third& facial
surfaces only
+ Modification-1970
+ labial, buccal and lingual surfaces are
assessed after using disclosing agent
57. PLAQUE CONTROL RECORD:
+ O’leary, Drake -1972
+ Suitable disclosing solution such as Bismarck
brown 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 dento gingival junction.
When found, they are recorded by making a
dash/red colour in the appropriate spaces on
the record form
58. Calculation :
+ PLAQUE INDEX =The number of plaque
containing surfaces/the total number of
available surfaces
59. DENTIN HYPERSENSITIVITY
INDEX:SCHIFF(1994)
Subject
responds to
air stimulus ,
considers
stimulus to be
painful and
requests
discontinuatio
n of the
stimulus
3
Subject
responds
to
stimulus
and
requests
discontin
uation or
moves
from
stimulus
2
Subject
responds to
air stimulus
but does
not request
discontinua
tion of
stimulus
1
Subject
does
not
respond
to air
stimulus
0
60. DEAN’S FLUOROSIS INDEX:
+ Trendley H Dean in 1934-presence and
severity of mottled enamel
+ Modified in 1942
Normal(0) The enamel represents usual translucent
semivitriform type of structure .the surface
is smooth, glossy and usually of pale
creamy white colour
Questionable(0.5
)
The enamel discloses slight aberrations from
translucency of normal enamel ranging from few
flecks to occasional white spots
61. Very mild(1) Small, opaque paper white
areas scattered irregularly
over the tooth ,but not
involving as much as
approximately 25% of tooth
surface
Mild(2) The white opaque areas in
enamel of teeth are more
extensive but do not involve as
much as 50% of tooth
Moderate (3) All enamel surfaces of teeth are
effected and surfaces subject to
attrition show wear. Brown stain
is frequently a disfiguiring feature
Severe(4) All enamel surfaces of tooth are
effected and hypoplasia is so
marked that the general form of
tooth may be effected
62. MELANIN PIGMENTATION INDEX
+ TAKASHI et al
SCORE CRITERIA
0 No pigmentation
1 Solitary units of pigmentation in papillary gingiva
without extension between neighbouring solitary
units
2 Formation of continuous ribbon extending from
neighbouring solitary units
63. GINGIVAL PIGMENTATION INDEX
SCORE CRITERIA
0 Absence of pigmentation
1 Spots of brown to black colour or pigments
2 Brown to black patches but not diffuse
pigmentation
3 Diffuse brown to black pigmentation, marginal
and attached
64. GINGIVAL ENLARGEMENT
INDICES
+ BOKEN KAMP & BOHN HORST -1994
No signs of gingival enlargementGrade 0
Enlargement confined to interdental papillaGrade 1
Enlargement involves IDP & MGGrade 2
Grade 3 Enlargement covers three quarters / more
of crown
65. GINGIVAL ENLARGEMENT
INDICDES:
+ Mc . GAW et al -1987
Grade 0 No overgrowth, feather edge gingival
margin
Grade 1 Blunting of gingival margin
Grade 2 Moderate gingival overgrowth(one third
crown length)
Grade 3 Marked gingival overgrowth( more than
1/3 rd of crown)
67. GINGIVAL RECESSION
INDEX(SMITH)+ First digit-horizontal component
+ Second digit-vertical component
+ Asterisk(*)-involvement of MGJ
+ Score 0 - No clinical evidence of root exposure
+ Score 1 - No clinical exposure of root exposure
plus a subjective awareness of dentinal
hypersensitivity is reported and/or there is
clinically detectable exposure of the CEJ not
extending more than 1 mm vertically to the
gingival margin
68. + Score 2–8 - Root exposure 2–8 mm extending
vertically from the CEJ to the base of the soft tissue
defect
+ Score 9 - Root exposure more than 8 mm from the
CEJ to the base of the soft tissue defect
+ Score * - An asterisk is present next to the second
digit whenever the vertical component of the soft
tissue defect encroaches into the MGJ or extends
beyond it into alveolar mucosa; the absence of an
asterisk implies either absence of MGJ involvement
at the indexed site or its noninvolvement in the soft
tissue defect.
69. •Score 0 - No clinical evidence of root exposure
•Score 1 - No clinical exposure of root exposure plus a
subjective awareness of dentinal hypersensitivity in
response to a 1 s air blast is reported, and/or there is
clinically detectable exposure of the CEJ for up to 10% of the
estimated mid-mesial to mid-distal distance
•Score 2 - Horizontal exposure of the CEJ more than 10% but
not exceeding 25% of the estimated mid-mesial to mid-
distal distance
•Score 3 - Exposure of the CEJ more than 25% of the mid-
mesial to mid-distal distance but not exceeding 50%
•Score 4 - Exposure of the CEJ more than 50% of the mid-
mesial to mid-distal distance but not exceeding 75%
•Score 5 - Exposure of the CEJ more than 75% of the mid-
mesial to mid-distal distanceupto100%.
70. TOOTH MOBILITY INDICES:
+ MILLER MOBILITY INDEX
+ Score 0- no detectable mobility
+ Score 1- distinguishable tooth mobility
+ Score 2-movement greater than 1mm in
horizontal plane
+ Score 3- movement of more than 1 mm in any
direction
71. TOOTH MOBILITY INDEX:
+ WASERMAN et al-1973
+ Score 1- normal
+ Score 2- slight >3/4 mm of buccolingual
movement
+ Score 3- moderate- up to approx. 2mm
movement buccolingually
+ Score 4- severe- more than 2 mm
74. IMPLANT MOBILITY SCALE:
+ MISCH
Score 0 Absence of clinical mobility with 500gm in
any direction
Score 1 Slight detectable horizontal mobility
Score 2 Moderate visible horizontal mobility up to
0.5mm
Score 3 Severe horizontal movement greater than
0.5mm
Score 4 Visible moderate to severe horizontal and any
visible vertical movement
75. PERI-IMPLANT PLAQUE
ASSESSMENT INDEX(MOMBELLI)
SCORE CRITERIA
0 No detection of plaque
1 Plaque only recognised by running a
probe across the smooth margin
2 Plaque which can be seen by the
naked eye
3 Abundance of soft matter
76. PERI-IMPLANT MARGINAL
MUCOSAL INDEX(APSE et al)
SCORE CRITERIA
0 Normal mucosa
1 Minimal inflammation along with color
change and minor edema
2 Moderate inflammation with redness,
edema , glazing
3 Severe inflammation with redness,
edema, ulceration, spontaneous bleeding
without probing
78. Early healing index :Wachtel et al
+ 1 – complete flap closure – no fibrin line in
interproximal area
+ 2 - complete flap closure – fine fibrin line in
interproximal area
+ 3 - complete flap closure – fibrin clot in
interproximal area
+ 4 – incomplete flap closure – partial necrosis of
interproximal tissue
+ 5 - incomplete flap closure – complete necrosis
of interproximal tissue
80. CURRENT TRENDS IN INDICES:
+ Dichotomous periodontal index
+ Genetic susceptibility index for periodontal
disease
81. CONCLUSION:
+ 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. Each of
these indices has its merits and limitations, so
an ideal index which detects the ongoing
progressive periodontal destruction and also
identifies the active and inactive sites of
disease is the need of the hour.
82. REFERENCES:
+ Landry, R .G.,& Jean, M.(2002).Periodontal
screening and Recording (PSR) Index:
precursors, utility and limitations in a clinical
setting. Int Dent J,52(1),35-40.
+ Dhingra K, Vandana K L. Indices for measuring
periodontitis: a literature review.Int Dent J.2011
Apr;61(2):76-84.
83. + Ramjford .S.P Indices for Prevalence and
Incidence of Periodontal Disease. J Periodontol
1959;30(1):50-59.
+ Francesco et al. Root coverage esthetic score :a
system to evaluate the esthetic outcome of the
treatment of gingival recession through
evaluation of clinical cases. J Periodontol
2009;80:705-710
