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ORAL INDICES
By
DR. FAROOQ AHMAD CHAUDHARY
BDS, MPH, FRSPH, MDPH , PhD
Index
 Index is defined as a numeric value describing
the relative status of a population on a graduated
scale with definite upper and lower limits.
 It is designed to permit and facilitate comparison
with other populations classified by the same
criteria and methods.
Ideal Requisites of an Index
Simplicity: Should be easy to apply so that there is no
undue time lost during field examinations. No expensive
equipment should be needed.
Objectivity: Criteria for the index should be clear and
unambiguous, with mutually exclusive categories.
Precision:Ability to distinguish between small increments.
Cont.
 Validity: Must measure what it is intended to measure,
so it should correspond with the clinical stages of the
disease under study at each point.
2 components –
• Sensitivity : ability to detect the condition when it is
present.
• Specificity: ability to not detect the condition when it
is absent.
Cont.
 Reliability: Should measure consistently at different
times and under a variety of conditions.
2 components-
• Inter examiner reliability: different examiners record the
same result.
• Intra examiner reliability: same examiner records the
same result at repeated attempts.
Cont.
 Acceptability: Safe and not demeaning to the
subject.
 Quantifiability: The index should be amenable to
statistical analysis and interpretable.
Ideal Properties/Requisites of an ideal
index (Summary)
 Simplicity/cost effective
 Objectivity/unambiguous
 Validity components
 Reliability
 Precision
 Acceptability/safe
 Quantifiability, Easy for analysis
Specifity
Sensitivity
Intra-examiner
Inter-examiner
Objectives of an Index
• To increase understanding of the disease process along with
measurement of the disease prevalence and incidence,
thereby leading to methods of control and prevention.
• It attempts to discover populations at high and low risk, and
to define the specific problem under investigation.
• The results of different populations can be compared.
Uses of Index
• For individual patient
• In research
• In community health
For Individual Patient
• Provide individual assessment to help patient
recognize an oral problem.
• Reveal degree of effectiveness of present oral
hygiene practices.
• Motivation in preventive and professional care for
control and elimination of diseases.
In Research
 Determine base line data before experimental factors are
introduced.
 Measure the effectiveness of specific agents for prevention
control or treatment of oral condition.
 Measure the effectiveness of mechanical devices for
personal care.
 Determination of effect of an Intervention (in comparing
the groups).
In Community Health
• Shows prevalence and incidence of a condition.
• Base line data for existing dental practices.
• Assess the need of the community.
• Compare the effects of a community program
and evaluate the results.
Classification of indices
Based upon the:
A. Direction in which the scores can fluctuate:
• Irreversible index - DMFT index
(measures conditions that will not return to the normal state. Once
established cannot decrease in value on subsequent examinations)
• Reversible index - GI (Loe & Silness)
(Index that measures conditions that can be return to the normal
state and reversible index scores can decrease/increase in value on
subsequent examinations.
B. The extent to which areas of oral cavity are measured:
 Full mouth index - Dean’s fluorosis index, PI
(These indices measure the patient's entire dentition/periodontium.
 Simplified index - OHI-S (Greene & Vermillion)
(These indices measure only a representative sample of teeth)
C. The entity which they measure:
 Disease index - DMF (‘D’ exemplifies a disease index)
 Treatment index - DMF (‘F’ exemplifies a treatment index)
 Symptom index - PBI (papillary bleeding index)
D. The special categories:
 Simple index – dental caries severity index, Silness and loe
plaque index
(Index that measures the presence/absence of a condition)
 Cumulative index – D MFT index for dental caries
(Index that measures all the evidence of a condition, past
and present)
Types/categories of Index
General Categories
Simple
index
irreversible reversible
Cumulative
index
Irreversible reversible
Selection criteria for index
 Simple to calculate
 Cost-effective (time and equipment)
 Acceptable
 Understandable
 Easy to interpret
 Easy to reproduce
 Valid and reliable
DMFT & DMFS Index
 Was introduced by Henry Klien, Carrole
E.Palmer and Knutson J.W in 1938.
 D…………..decayed teeth
 M…………..missing due to caries
 F…………….previously filled teeth
 T…………….teeth
Method
Teeth Examined:
 All permanent teeth are examined.
 Previously 28 teeth were examined (Third molars were excluded, as
per WHO modifications (1986) third molars are included).
Teeth excluded
 Un-erupted teeth.
 Congenitally missing.
 Supernumerary.
 Deciduous teeth.
 Teeth removed for any other reason than caries.
 Teeth restored for any other reason other than caries
example…..trauma or cosmetic purposes.
Instruments used
Mouth mirror Explorer
Rules to follow
1. No tooth be counted more than once.
2. Decay, missing, filled to be recorded separately.
3. Teeth with recurrent Decay=Decay
4. Missing due to caries only considered.
5. Tooth with several restoration=single restoration
6. Deciduous teeth are not included
7. A tooth is considered to be erupted when the occlusal
surface or incisal edge is totally exposed or can be exposed
be gently reflecting the gingival tissue
D
 Indicates the no of permanent teeth that are decayed.
 Remember that a tooth can be counted only once.
 Cannot be counted as decayed and filled.
M
 Indicated the no of missing permanent teeth due to decay.
 The teeth which are badly decayed that they are advised for extraction
are counted as missing.
 History must be taken to identify that teeth have been lost due to
caries.
F
 Indicates the no of permanent teeth are restored fully and functionally
good.
 Tooth may have several fillings, but is counted as ONE.
Criteria for the Identification of Caries
 Lesion is clinically visible
 Explorer tip can penetrate deep into soft yielding material
 There is discoloration or loss of translucency
 The explorer tip in a pit or fissure catches or resists removal after
pressure on insertion
Calculation of DMFT index
 Individual DMFT
Identify each component separately, Add each component separately
than add all subgroups.
Then add them
D+M+F = DMFT
 Group Average
Total D, M ,F for each individual , then divide the total DMF by the no
of individuals in the group i.e
Average DMFT= total DMFT
total no of persons
DMFS
Applied only to permanent teeth
 D = Decayed teeth surfaces
 M = Missing teeth surfaces
 F = Filled teeth surfaces
DMFS
Advantages
 More sensitive
Disadvantages
 Takes longer time
 May require radiographs for accurate assessment.
Surfaces Examined
 For Posterior Teeth: Five Surfaces
Facial, Lingual, Mesial, Distal and Occlusal
 For Anterior Teeth: Four Surfaces
Facial, Lingual, Mesial, Distal
Calculations
If Third Molars are not included
16 posterior teeth= 80 surfaces
12 anterior teeth =48 surfaces
Total=128
Third Molar included
Total =148 surfaces
Def Index
Caries Indices for Primary Dentition, Was
Described by Gruebbel A.O in 1944.
d= Decayed Teeth
e= Extracted Teeth ( Due to Caries)
f= Filled Teeth
Calculations of def Index
 For Primary teeth maximum def score for an
individual would be 20.
 Defs score for a child can be 88 to maximum.
 Calculations are same as that of DMFT.
For Mixed Dentition
 Caries indices for primary and permanent teeth will be
calculated separately.
 DMFT and deft are never added together.
 Index for permanent teeth is calculated first ,followed
be deft index.
THANK
YOU

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Oral disease indices in dentistry. pptx

  • 1. ORAL INDICES By DR. FAROOQ AHMAD CHAUDHARY BDS, MPH, FRSPH, MDPH , PhD
  • 2. Index  Index is defined as a numeric value describing the relative status of a population on a graduated scale with definite upper and lower limits.  It is designed to permit and facilitate comparison with other populations classified by the same criteria and methods.
  • 3. Ideal Requisites of an Index Simplicity: Should be easy to apply so that there is no undue time lost during field examinations. No expensive equipment should be needed. Objectivity: Criteria for the index should be clear and unambiguous, with mutually exclusive categories. Precision:Ability to distinguish between small increments.
  • 4. Cont.  Validity: Must measure what it is intended to measure, so it should correspond with the clinical stages of the disease under study at each point. 2 components – • Sensitivity : ability to detect the condition when it is present. • Specificity: ability to not detect the condition when it is absent.
  • 5. Cont.  Reliability: Should measure consistently at different times and under a variety of conditions. 2 components- • Inter examiner reliability: different examiners record the same result. • Intra examiner reliability: same examiner records the same result at repeated attempts.
  • 6. Cont.  Acceptability: Safe and not demeaning to the subject.  Quantifiability: The index should be amenable to statistical analysis and interpretable.
  • 7. Ideal Properties/Requisites of an ideal index (Summary)  Simplicity/cost effective  Objectivity/unambiguous  Validity components  Reliability  Precision  Acceptability/safe  Quantifiability, Easy for analysis Specifity Sensitivity Intra-examiner Inter-examiner
  • 8.
  • 9. Objectives of an Index • To increase understanding of the disease process along with measurement of the disease prevalence and incidence, thereby leading to methods of control and prevention. • It attempts to discover populations at high and low risk, and to define the specific problem under investigation. • The results of different populations can be compared.
  • 10. Uses of Index • For individual patient • In research • In community health
  • 11. For Individual Patient • Provide individual assessment to help patient recognize an oral problem. • Reveal degree of effectiveness of present oral hygiene practices. • Motivation in preventive and professional care for control and elimination of diseases.
  • 12. In Research  Determine base line data before experimental factors are introduced.  Measure the effectiveness of specific agents for prevention control or treatment of oral condition.  Measure the effectiveness of mechanical devices for personal care.  Determination of effect of an Intervention (in comparing the groups).
  • 13. In Community Health • Shows prevalence and incidence of a condition. • Base line data for existing dental practices. • Assess the need of the community. • Compare the effects of a community program and evaluate the results.
  • 14. Classification of indices Based upon the: A. Direction in which the scores can fluctuate: • Irreversible index - DMFT index (measures conditions that will not return to the normal state. Once established cannot decrease in value on subsequent examinations) • Reversible index - GI (Loe & Silness) (Index that measures conditions that can be return to the normal state and reversible index scores can decrease/increase in value on subsequent examinations.
  • 15. B. The extent to which areas of oral cavity are measured:  Full mouth index - Dean’s fluorosis index, PI (These indices measure the patient's entire dentition/periodontium.  Simplified index - OHI-S (Greene & Vermillion) (These indices measure only a representative sample of teeth) C. The entity which they measure:  Disease index - DMF (‘D’ exemplifies a disease index)  Treatment index - DMF (‘F’ exemplifies a treatment index)  Symptom index - PBI (papillary bleeding index)
  • 16. D. The special categories:  Simple index – dental caries severity index, Silness and loe plaque index (Index that measures the presence/absence of a condition)  Cumulative index – D MFT index for dental caries (Index that measures all the evidence of a condition, past and present)
  • 17. Types/categories of Index General Categories Simple index irreversible reversible Cumulative index Irreversible reversible
  • 18. Selection criteria for index  Simple to calculate  Cost-effective (time and equipment)  Acceptable  Understandable  Easy to interpret  Easy to reproduce  Valid and reliable
  • 19. DMFT & DMFS Index  Was introduced by Henry Klien, Carrole E.Palmer and Knutson J.W in 1938.  D…………..decayed teeth  M…………..missing due to caries  F…………….previously filled teeth  T…………….teeth
  • 20. Method Teeth Examined:  All permanent teeth are examined.  Previously 28 teeth were examined (Third molars were excluded, as per WHO modifications (1986) third molars are included). Teeth excluded  Un-erupted teeth.  Congenitally missing.  Supernumerary.  Deciduous teeth.  Teeth removed for any other reason than caries.  Teeth restored for any other reason other than caries example…..trauma or cosmetic purposes.
  • 22. Rules to follow 1. No tooth be counted more than once. 2. Decay, missing, filled to be recorded separately. 3. Teeth with recurrent Decay=Decay 4. Missing due to caries only considered. 5. Tooth with several restoration=single restoration 6. Deciduous teeth are not included 7. A tooth is considered to be erupted when the occlusal surface or incisal edge is totally exposed or can be exposed be gently reflecting the gingival tissue
  • 23. D  Indicates the no of permanent teeth that are decayed.  Remember that a tooth can be counted only once.  Cannot be counted as decayed and filled. M  Indicated the no of missing permanent teeth due to decay.  The teeth which are badly decayed that they are advised for extraction are counted as missing.  History must be taken to identify that teeth have been lost due to caries. F  Indicates the no of permanent teeth are restored fully and functionally good.  Tooth may have several fillings, but is counted as ONE.
  • 24. Criteria for the Identification of Caries  Lesion is clinically visible  Explorer tip can penetrate deep into soft yielding material  There is discoloration or loss of translucency  The explorer tip in a pit or fissure catches or resists removal after pressure on insertion
  • 25.
  • 26. Calculation of DMFT index  Individual DMFT Identify each component separately, Add each component separately than add all subgroups. Then add them D+M+F = DMFT  Group Average Total D, M ,F for each individual , then divide the total DMF by the no of individuals in the group i.e Average DMFT= total DMFT total no of persons
  • 27.
  • 28. DMFS Applied only to permanent teeth  D = Decayed teeth surfaces  M = Missing teeth surfaces  F = Filled teeth surfaces
  • 29. DMFS Advantages  More sensitive Disadvantages  Takes longer time  May require radiographs for accurate assessment.
  • 30. Surfaces Examined  For Posterior Teeth: Five Surfaces Facial, Lingual, Mesial, Distal and Occlusal  For Anterior Teeth: Four Surfaces Facial, Lingual, Mesial, Distal
  • 31. Calculations If Third Molars are not included 16 posterior teeth= 80 surfaces 12 anterior teeth =48 surfaces Total=128 Third Molar included Total =148 surfaces
  • 32.
  • 33. Def Index Caries Indices for Primary Dentition, Was Described by Gruebbel A.O in 1944. d= Decayed Teeth e= Extracted Teeth ( Due to Caries) f= Filled Teeth
  • 34. Calculations of def Index  For Primary teeth maximum def score for an individual would be 20.  Defs score for a child can be 88 to maximum.  Calculations are same as that of DMFT.
  • 35. For Mixed Dentition  Caries indices for primary and permanent teeth will be calculated separately.  DMFT and deft are never added together.  Index for permanent teeth is calculated first ,followed be deft index.