Recent advances in dental indices

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i have tried to include few of the recent indices in dentistry

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  • Indices used in WHO Oral Health Survey
  • Counts, proportion, rate,
  • Russell??Expression of clinical observation expressed in a numerical value. This numerical value permits comparison and is more consistent and less subjective than a word description of that condition
  • Unambiguous- having no uncertainity, mutually exclusive criteriaShould correspond with the clinical stages of disease under study
  • Intra- and inter- examiner reproducibility
  • Most extensively used caries measurement tool.it will not be easy to replace DMF index as epidemiologists had collected or still collecting lot of data based upon this indexNo idea on state of disease progresion
  • Field surveys can miss early lesions whereas practitioners can overtreat
  • In developed countries where caries cannot be attributed only to frank cavitations and detection of early lesions is important
  • With dmf, the caries incidence is found to be higher in occlusal surface due to higher chance of presence of cavitation; whereas, incidence of precavitated lesions in higher in facial surface with Nyvad’s CDC
  • By 1995, in industrialized European countries, majority of population had little or no decay, say 0, 1 or 2 DMFT whereas a minority of them still had considerable DMF-experience. DMFT could not explain this discrepancy
  • In 15 communities, 11 with 0 DMFT and 4 with 5,10,15,20. mean dmft=3.3; SIC=10(in 5)
  • Reduces the chances of underestimation of caries by DMFT
  • Shashidhar
  • This scoring pattern was based on Black‘s well-known classification of cavity preparation for operative dentistry that was based on morphological consideration. If caries involved two or more surface, then highest score was given.
  • This will ensure optimal utilization of scarce dental manpower as well as materials.
  • developed on the basis of insights gained from a systematic review of the literature on clinical caries detection systems
  • the ICDAS committee developed the ‘wardrobe’ concept where the users can decide at what stage (noncavitated or cavitated) and severity they wish to measure dental caries
  • Ordinal scale: lists conditions in order of severity w/o attempting to define any mathematical relation between the categoriesOthers---nominal scale, interval/ration
  • Before describing the codes, it is important to define the term ‘tooth surface’
  • The characteristics of the base of the discolored area on the root surface can be used to determine whether or not the root caries lesion is active or not.Whenever both a coronal and root surface are affected by a single carious lesion that extends at least 1 mm past the CEJ in both the incisal and apical directions, both surfaces should be scored as caries. However, for a lesion affecting both crown and root surfaces that does not meet the 1 mm or greater extent of involvement, only the coronal or root surface that involves the greater portion (more than 50%) of the lesion should be scored as caries. When it is impossible to invoke the 50% rule (i.e., when both coronal and root surfaces appear equally affected), both surfaces should be scored as caries.the most severe lesion is scored. Non-vital teeth are scored the same as vital teeth.
  • Correlational and discrimatory validity
  • Root caries>only face validitycode 1 was the code most scoredAs the DMF index has been used extensively by many for decades, the results obtained from the ICDAS II index should be convertible to the DMF index, thus allowing the use of the latter index for comparison purposes the chance that every person in the world is affected by dental caries becomes very high
  • Its importance is highlighted in developing countries, where access to oral health services is limited and teeth are often left untreated or are extracted because of pain or discomfort; such an index can provide useful information for researches and authorities.
  • Results are reported in line with the presentation of results according to the DMF index. They are presented alongside results for carious lesions without pulpal infection, excluding those in enamel, using the DMF index.
  • not proposed as just another caries assessment index
  • The CAST index follows the scoring instructions accompanying the use of the ICDAS II, save code 1 and combines codes 2 and 3, and 5 and 6; that of PUFA, save code ‘u’ and combines codes ‘f’ and ‘a’; that of the DMF-index (for the M- and F- component); and includes sealant. Excluding ICDAS II code 1 from the CAST index eliminates the need to dry the tooth surface with an air spray before assessing the enamel: this dental aid is often not available in field situations in many countries. Combining ICDAS II codes 5 and 6 reflect obvious cavities without pulpal involvement. The latter situation is reported in PUFA code ‘p’ and taken up in the CAST index as code 6. As the difference between an abscessed tooth and a tooth with a fistula is minimal, these situations are combined as CAST index code 7.
  • usefulness for analysis of the dental caries situation in the public oral health setting.However shift from visuo-tactile means to exclusively visual diagnosis
  • Includes systems that includes:use in clinical practice;use in large-scale epidemiologic surveys in more than one geographical region;promotion for use in clinical practice by one or more NDAs;inclusion of elements likely to enable a shift towards prevention
  • The proposed matrix does not offer a definitive solution to caries lesion classification and disease management, but it provides a springboard for a dynamic and integrated process in which experts can assess consistency and parallels between different systems. this will provide a more sensitive guide to care management than does a system based solely on visual inspection of the lesion’s site and size
  • Widespread use of CPITN has produced substantial contributions to WHO’s Global Oral Health Data BankCPITN/PSR not a research toolDigital Plaque Image Analysis
  • Simplified index -full mouth
  • Full mouth
  • An international panel of 97 orthodontists gave subjective judgments on treatment need, complexity, treatment improvement and acceptability based on diverse sample
  • Quality of life:An individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their personal goals, expectations, standards and concerns
  • Although philosophically, it is desirable to measure health rather than disease; in practice the epidemiology concerns with measuring disease as health is difficult to define in operational terms and hence difficult to measure.As we cannot measure all diseases…
  • pærədaɪm
  • The OHIP-49 is concerned with impairment and three functional status dimensions (social, psychological and physical) which represent four of the seven quality of life dimensions.The OHIP-14 (Oral Health Impact Profile) comprises 14 items that explore seven dimensions of impact (functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap) and participants respond to each item according to the frequency of impact on a 5-point Likert scale ranging from never to very often (never = 0, hardly ever = 1, occasionally = 2, fairly often = 3, very often = 4), using a twelve-months recall periodThe OHQoL-UK consists of a battery of 16 questions, which takes into account both 'effect' and 'impact' of oral health on life quality, incorporating dimensions and an individualised weighting system.The OIDP (Oral Impacts on Daily Performances) questionnaire assesses the impacts of oral conditions on the abilities of individuals to perform eight daily activities eating, speaking, hygiene, occupational activities, social relations, sleeping-relaxing, smiling, and emotional state; using a severity-based approach
  • The OHIP-49 is concerned with impairment and three functional status dimensions (social, psychological and physical) which represent four of the seven quality of life dimensions.The OHIP-14 (Oral Health Impact Profile) comprises 14 items that explore seven dimensions of impact (functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap) and participants respond to each item according to the frequency of impact on a 5-point Likert scale ranging from never to very often (never = 0, hardly ever = 1, occasionally = 2, fairly often = 3, very often = 4), using a twelve-months recall periodThe OHQoL-UK consists of a battery of 16 questions, which takes into account both 'effect' and 'impact' of oral health on life quality, incorporating dimensions and an individualised weighting system.The OIDP (Oral Impacts on Daily Performances) questionnaire assesses the impacts of oral conditions on the abilities of individuals to perform eight daily activities eating, speaking, hygiene, occupational activities, social relations, sleeping-relaxing, smiling, and emotional state; using a severity-based approach
  • Recent advances in dental indices

    1. 1. Recent Advances in Dental Indices Presented by: Ujwal Gautam Roll no. 431 BDS 4th year (batch 2009)
    2. 2. Contents • • • • • • • Dental Indices- an Introduction Measuring Dental Caries Measuring Periodontal Diseases Measuring tooth erosion Measuring Dental Fluorosis and Enamel Defects Measuring Malocclusion Measuring OHRQoL 2
    3. 3. Measuring Diseases • A prerequisite for any epidemiological investigation is the ability to quantify the occurrence and severity of the disease. • Measurement is a process of assigning values to characteristics according to a set of rules. This is facilitated through indices: certain methodology and criteria 3
    4. 4. “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 same criteria and methods.” -Russell A. L. 4
    5. 5. Ideal Requisites of an Index  CLARITY: The examiner should be able to remember the rules of the index clearly in his mind  SIMPLICITY: The index should be simple and easy to apply so that there is no undue time lost during field examinations  OBJECTIVITY: The criteria for the index should be objective and unambiguous, with mutually exclusive criteria  VALIDITY: The index must measure what it is intended to measure 5
    6. 6. Ideal Requisites of an Index (contd)  RELIABILITY: The index should measure consistently at different times and at variety of conditions  QUANTIFIABILITY: The index should be amenable to statistical analysis  SENSITIVITY: The index should be able to detect reasonably small shifts, in either direction in group condition  ACCEPTABILITY: The use of index should not be painful or demeaning to the subject 6
    7. 7. Measuring Dental Caries Statistical measurement of dental caries serves 3 broad purposes: – For epidemiological investigation on characteristics of dental caries in population groups – For public health programme planning and evaluation – For testing prevention and control procedures 7
    8. 8. Prevalence of Dental caries is measured in terms of: – – – – – percentage of persons affected Number of teeth attacked Number of tooth surface involved Number of discrete cavities Size and degree of severity of carious lesion 8
    9. 9. Shortcomings of DMF Index • DMF values are not related to the number of teeth at risk. It tends to equate desired state with treated condition • It assesses only cavitated lesion extended into dentin • DMF index is invalid in elderly population, as teeth can be lost for reasons other than caries • Reaches saturation level at particular point of time when all teeth are involved and prevents registration of caries attack even when caries activity is continuing 9
    10. 10. Shortcomings of DMF Index(contd) • Does not give account for treatment needs • DMF index gives equal weight to missing, untreated decayed and well restored teeth • Cannot be use to assess root caries • Rate of caries progression cannot be assessed 10
    11. 11. Inability of D component of DMF score to define treatment needs: – Criteria used to diagnose caries in a survey are not the same as those used by practitioners in forming patient’s treatment plan – Patient’s own perceived needs, level of interest in their dental conditions, and ability or willingness to pay all level of treatment – A practitioner has to judge whether a minor lesion will develop into a major lesion over time, and whether a lesion in primary tooth can safely remain untreated for the life of the tooth. A survey, whereas, scores a tooth by how it appears at the time of the survey. – Treatment philosophies change with time 11
    12. 12. Nyvad Caries Diagnostic Criteria • Proposed by Nyvad in 1999 • Includes manifestation of caries in the initial stages of the disease, even before a cavity exists. • Differentiates between active and inactive caries lesions at both the cavitated and non cavitated levels • It also measures the activity of the carious lesion, favoring the cost–benefit relationship when treatment plans are made. 12
    13. 13. Nyvad Caries Diagnostic Criteria 13
    14. 14. Nyvad Caries Diagnostic Criteria advantages – Can identify incipient caries lesion, hence can be used for planning prevention programmes – Underestimation of prevalence and severity of caries with def index can be omitted as it measures only cavitation state – Reduce the need of treatment on a long term basis because diagnosis of initial lesions can stop the progression of lesion 14
    15. 15. Nyvad Caries Diagnostic Criteria limitations – Difficult to make exact diagnosis of precavitated active lesion over occlusal surface than over facial surface. Physiological wear of occlusal surface during mastication can lead to disappearance of the lesions 15
    16. 16. Significant caries Index (SiC) • Proposed by Bratthall D in 2000 • using DMF and SiC together helps to highlight oral health inequalities more accurately among different population groups within the community in order to identify the need for special preventive oral health interventions 16
    17. 17. Significant caries Index (SiC) Calculating SiC Index SiC is calculated by sorting individuals according to their DMFT values, than one third of the population with the highest caries scores is selected and the mean DMFT for this subgroup is calculated. This value is the SiC Index 17
    18. 18. Significant caries Index (SiC) advantages – brings attention to the individuals with the highest caries values in each population under investigation – It tries to overcome limitation of the mean DMFT value in accurately assessing the skewed distribution of dental caries in a population especially in developed countries leading to incorrect conclusion that the caries situation for the whole population is controlled, while in reality, several individuals still have caries 18
    19. 19. Significant caries Index (SiC) limitations – It is just an extension of DMF index as it follows same criteria for assessing dental caries and will have same limitations in assessing caries in a population as DMF index – more of significance in population where caries prevalence is low and has a skewed distribution 19
    20. 20. Specific Caries Index • Proposed by Acharya S. in 2006 • To develop a reproducible surface-specific caries index that would provide qualitative and quantitative information about untreated dental caries, that could be used in conjunction with the DMFS index and would provide information on not only the caries prevalence but also the location and type of caries lesion in an individual based on clinical examination 20
    21. 21. Specific Caries Index 21
    22. 22. Specific Caries Index Calculating Specific Caries Index The SCI score for an individual is calculated by adding the individual tooth scores The SCI scores for an individual can range from 0 to 192 (for 32 teeth) 22
    23. 23. Specific Caries Index advantages – the future manpower and material requirements and also the type and level of training of manpower, required to treat the caries in a particular population might be assessed – The results from authors work showed the reproducibility and validity of this new index to be fair to good 23
    24. 24. Specific Caries Index limitations – in cases of large lesions, which cover more than one surface, only an assumption can be made regarding the originating lesion – inability of this index, if used alone, to capture information useful for treatment planning – lack of provision for assessing root caries – number of proximal lesions be underestimated in absence of bitewing radiograph 24
    25. 25. International Caries Detection and Assessment System (ICDAS) • Developed in the year 2001 by the effort of large group of researchers, epidemiologists and restorative dentists • two-digit system; evolved with the need to detect caries at the non cavitated stage • ICDAS is divided into sections covering – coronal caries (pits and fissures, mesial-distal, and buccal-lingual), – root caries, and – caries-associated-with-restorations-and-sealants (CARS) 25
    26. 26. International Caries Detection and Assessment System (ICDAS) The ‘D’ in ICDAS stands for detection of dental caries by (i) stage of the carious process; (ii) topography (pit-and-fissure or smooth surfaces); (iii) anatomy (crowns versus roots); (iv) restoration or sealant status The ‘A’ in ICDAS stands for assessment of the caries process by stage (noncavitated or cavitated) and activity (active or arrested) 26
    27. 27. International Caries Detection and Assessment System (ICDAS) The detection of dental caries on coronal tooth surfaces is a twostage process; 1) The first decision is to classify each tooth surface on whether it is sound, sealed, restored, crowned, or missing 2) The second decision that should be made for each tooth surface is the classification of the carious status on an ordinal scale 27
    28. 28. International Caries Detection and Assessment System (ICDAS) ICDAS-I was meant to include detection (D) of caries by stage of carious process, topography and anatomy, assessment (A) of caries process (whether cavitated or noncavitated and active or arrested caries). But the ultimate index included detection of coronal caries and the assessment of lesion activity and root caries were not included due to lack of consensus and need for further discussions. ICDAS coordinating committee came up with ICDAS-II in the year 2009 which describes both coronal caries and caries associated with restorations and sealants (CARS) and root caries. The advantages of the ICDAS-II is that it has found to be a valid and reliable caries assessment system especially for clinical trials assessing effectiveness of caries preventive/ control agents. 28
    29. 29. International Caries Detection and Assessment System (ICDAS) Decision 1 0 = Sound (use with the codes for primary caries) 1 = Sealant, partial 2 = Sealant, full 3 = Tooth colored restoration 4 = Amalgam restoration 5 = Stainless steel crown 6 = Porcelain or gold or PFM crown or veneer 7 = Lost or broken restoration 8 = Temporary restoration 9 = Used for the following conditions 97 = Tooth extracted because of caries (all tooth surfaces will be coded 97) 98 = Tooth extracted for reasons other than caries (all tooth surfaces coded 98) 99 = Unerupted (all tooth surfaces coded 99) 29
    30. 30. International Caries Detection and Assessment System (ICDAS) Decision 2 0 = Sound 1 = First visual change in enamel (whitespot seen after 5 seconds air drying). 2 = Distinct visual change in enamel (whitespot seen without air drying). 3 = Localized enamel breakdown due to caries with no visible dentin 4 = Non-cavitated surface with underlying dark shadow from dentin 5 = Distinct cavity with visible dentin 6 = Extensive distinct cavity with visible dentin. An extensive cavity involves at least half of a tooth surface and possibly reaching the pulp. 7 = Tooth extracted because of caries (tooth surfaces will be coded 97) 8 = Tooth extracted for reasons other than caries (tooth surfaces will be coded 98) 9 = Unerupted (tooth surfaces coded 99) 30
    31. 31. International Caries Detection and Assessment System (ICDAS) 31
    32. 32. International Caries Detection and Assessment System (ICDAS) 32
    33. 33. Root Caries International Caries Detection and Assessment System (ICDAS) E = Excluded root surfaces (no gingival recession) 0 = Sound (no caries or restoration) 1 = Non-cavitated carious root surface— soft or leathery 2 = Non-cavitated carious root surface— hard and glossy 3 = Cavitated (greater than 0.5mm in depth) carious root surface— soft or leathery 4 = Cavitated (greater than 0.5mm in depth) carious root surface— hard and glossy 6 = Extensive cavity: an extensive cavity involves at least half of a tooth surface and possibly reaching the pulp. 7 = Filled root with no caries 9 = Used for the following conditions 97 = Tooth extracted because of caries (tooth surfaces will be coded 97) 98 = Tooth extracted for reasons other than caries (all tooth surfaces coded 98) 99 = Unerupted (tooth surfaces coded 99) 33
    34. 34. International Caries Detection and Assessment System (ICDAS) advantages – Designed to detect 6 stages of carious process ranging from early clinical changes to extensive cavitation – the system meets the requirements of validity and reliability – reliable in permanent teeth and acceptable in primary teeth – Very suitable for use in clinical trials assessing the efficacy and/or effectiveness of caries control agents 34
    35. 35. International Caries Detection and Assessment System (ICDAS) Wardrobe concept The users can decide at what stage (noncavitated or cavitated) and severity they wish to measure dental caries. The only stipulation is the requirement that the ICDAS definitions are used for whatever stage of dental caries is chosen for a specific study. The configuration of surfaces chosen for use in any study and the stage used to measure dental caries may be determined for each study using the ‘wardrobe’ concept. For example, in a national study that aims to compare dental caries prevalence over time, the number and configuration of tooth surfaces may be selected to match previous surveys. Also, the stage of caries detection may be adjusted to match previous studies conducted in a country. 35
    36. 36. International Caries Detection and Assessment System (ICDAS) limitation – Root caries assessment criteria has not been tested in any epidemiological or clinical studies – Data obtained are unpragmatic, non-cohesive and difficult to read – May lead to overestimation of seriousness of Dental caries – results are difficult to compare against the widely-used DMF index – Does not assess the very advanced stages of carious lesion 36
    37. 37. PUFA (pulp-ulcer-fistula-abscess) Index • Assesses the presence of oral conditions resulting from untreated advance stages of cavitated carious lesions 37
    38. 38. PUFA (pulp-ulcer-fistula-abscess) Index 38
    39. 39. PUFA (pulp-ulcer-fistula-abscess) Index advantages – Applicable in low- and middle- income countries as the burden of untreated cavitated lesions leads to serious consequences at tooth and surrounding tissue – simple to record – can be used for primary and permanent teeth – results can be presented alongside with DMF index 39
    40. 40. PUFA (pulp-ulcer-fistula-abscess) Index limitations – stages of carious lesion progression in enamel are not being assessed – few subjects with score “u” (ulcer) – assessment of abscess and fistula can be combined into one code – reliability and validity of this index requires further discussion and research. 40
    41. 41. Caries Assessment Spectrum and Treatment (CAST) Index • developed by J. E. Frencken, Rodrigo G. de Amorim, Jorge Faber and Soraya C. Leal in 2011 • Combines elements of the ICDAS II and PUFA indices, and the M- and F-components of the DMF index 41
    42. 42. Caries Assessment Spectrum and Treatment (CAST) Index 42
    43. 43. Caries Assessment Spectrum and Treatment (CAST) Index advantages – A DMF score can easily be calculated from the CAST score, thereby enabling retention of the use of existing DMF scores – Used only for epidemiological surveys – Visual/tactile hierarchical one digit coding system – Includes the total spectrum of stages of caries lesion progression allows for easy communication among health professionals and policymakers – is built on the strength of the ICDAS, DMF and PUFA indices – provide a link to the widely used DMF index 43
    44. 44. Caries Assessment Spectrum and Treatment (CAST) Index limitations – – – – It does not record active and inactive carious lesions It has not been validated, nor has its reliability been tested It is not suggested for use in clinical trials it does not provide data on treatment or preventive measures required for each code 44
    45. 45. FDI World Dental Federation Caries Matrix • The World Health Organization’s Global Oral Health Programme has recognized the importance of promoting “a new paradigm among dental practitioners, shifting from a restorative to preventive/health promotion model.” • Developed by FDI Science Committee 45
    46. 46. FDI World Dental Federation Caries Matrix Objective The intent of this matrix was not to establish a new caries lesion classification system, but to integrate existing systems into a framework that could be used by clinicians, researchers, educators, public health workers and decision makers 46
    47. 47. FDI World Dental Federation Caries Matrix 47
    48. 48. Measuring Periodontal Disease “Periodontal disease” was viewed as a single entity that began with gingivitis and progressed to periodontitis and tooth loss. This view is now obsolete, so that indices based on it are now invalid. Separate clinical measures are now being used for gingivitis and periodontitis. 48
    49. 49. requires; o What depth of Clinical attachment loss(CAL) at any site constitutes evidence of disease processes? o How many such sites need to be present in a mouth to establish disease presence o How probing depth and Bleeding on probing are to be included in the case definition 49
    50. 50. Even the introduction of computerized, constant-force probes has little difference in the reliability of measurements. The problems inherent in the clinical measurement have led researchers to look for markers of periodontitis. 50
    51. 51. Role of Inflammatory cytokines as markers in measuring periodontitis The most promising candidates are inflammatory cytokines expressed in gingival crevicular fluid (GCF) as part of the host response to inflammation, a number of which has been associated with active disease. These cytokines include PGE2, TNF α, Interleukin-1α, interleukin-1β, and others. However, quantifying these associations and determining the sensitivity of the measures is proving difficult. To date, measurement of periodontitis by means of inflammatory cytokines in GCF is still experimental. 51
    52. 52. Shortcomings of CPITN • The hierarchical principles underlying its use are not universally valid. • The partial recording approach of the CPITN may grossly underestimate the prevalence of deep pockets • CPITN yields extensively distorted estimates of the prevalence and severity of periodontal destruction in a population • Measuring treatment need has become obsolete as the standard treatment for periodontal pocket has shifted considerably from surgical removal of pockets to scaling and root planing 52
    53. 53. Basic Periodontal Examination (BPE) Index • Developed by British Society of Periodontology in 1986 • derived from the Community Periodontal Index of Treatment Needs (CPITN) • simple and rapid screening tool that is used to indicate the level of examination needed and to provide basic guidance on treatment need • Not a diagnostic tool 53
    54. 54. Basic Periodontal Examination (BPE) Index  Both the number and the * should be recorded if a furcation is detected 54
    55. 55. Basic Periodontal Examination (BPE) Index • As a general rule, radiographs to assess alveolar bone levels should be obtained for teeth or sextants where BPE codes 3 or 4 are found. 55
    56. 56. Genetic Susceptibility Index for Periodontal disease Etiology of periodontitis is multifactorial and involves infectious components, environmental factors and genetic susceptibility. Genetic markers denote susceptibility toward disease manifestation and it would be useful to exploit the information hidden into them and to derive a genetic susceptibility index (GSI) 56
    57. 57. Genetic Susceptibility Index for Periodontal disease • shows direct and indirect association between the susceptibility index, selected microbial values and disease presence • Single nucleotide polymorphisms (SNP’s) in genes encoding molecules of the host defense system are assessed and an association is established between SNP and disease status 57
    58. 58. Periodontal Screening and Recording (PSR) Index • Introduced in 1992 by American Academy of Periodontology(AAP) and American Dental Association(ADA) • endorsed by the World Health Organization (WHO) • adaptation of the Community Periodontal Index of Treatment Needs (CPITN) • used to measure gingival bleeding upon probing, calculus on a tooth, and periodontal pocket depth in each sextant of the oral cavity 58
    59. 59. Periodontal Screening and Recording (PSR) Index Calculating PSR • highest score in a sextant is recorded as the PSR score for the sextant. • Only one score is recorded for each sextant of the oral cavity. • A WHO/CPITN/PSR probe is used to examine each tooth individually 59
    60. 60. Periodontal Screening and Recording (PSR) Index Score Criteria 0 pocket depth is < 3.5 mm, no bleeding upon probing, and no calculus 1 pocket depth is < 3.5 mm, bleeding on probing and no calculus 2 pocket depth is < 3.5 mm, bleeding on probing and calculus present 3 pocket is 3.5 – 5.5 mm in depth 4 pocket is > 5.5 mm in depth * clinical abnormalities such as furcation involvement, tooth mobility, mucogingival involvement, or 3.5 mm or more of recession in that sextant X edentulous sextant 60
    61. 61. Periodontal Screening and Recording (PSR) Index advantages – Introducing a simplified screening method that met legal dental recording requirements. – early detection of periodontal disease and it serves as an aid in monitoring the periodontal status of patients – fast method to screen patients as only six scores are recorded – Its documented use also assists with the record keeping of a patient’s periodontal history – Can be used with a large population during oral health screenings. 61
    62. 62. Periodontal Screening and Recording (PSR) Index limitations – not intended to replace a full-mouth periodontal examination. Those patients who have received treatment for periodontal diseases and/or are in a maintenance phase of care should receive comprehensive periodontal examinations – limited use of the PSR system in children due to inability to differentiate pseudo-pockets – does not measure epithelial attachment, the severity of periodontal disease may be underestimated with its use 62
    63. 63. Measuring Tooth Wear • The objective of tooth wear indices is to classify and record the severity of tooth wear or dental erosion in prevalence and incidence studies. • different researchers have developed indices which suit their own research needs but do not allow comparison to assess the prevalence of tooth wear between countries and regions. Therefore, a need of new scoring system is deemed necessary to allow existing and hopefully future indices to be collapsed and re-analysed 63
    64. 64. Basic Erosive Wear Examination (BEWE) • Developed by Bartlett, Ganss and Lussi in 2007 • The aim of the BEWE is to be a simple, reproducible and transferable scoring system for recording clinical findings and for assisting in the decision-making process for the management of erosive tooth wear that can be used with the diagnostic criteria of all existing indices 64
    65. 65. Basic Erosive Wear Examination (BEWE) The BEWE is a partial scoring system recording the most severely affected surface in a sextant and the cumulative score guides the management of the condition for the practitioner The result of the BEWE is not only a measure of the severity of the condition for scientific purposes but, when transferred into risk levels, also a possible guide towards management 65
    66. 66. Basic Erosive Wear Examination (BEWE) 66
    67. 67. Basic Erosive Wear Examination (BEWE) 67
    68. 68. Basic Erosive Wear Examination (BEWE) 68
    69. 69. Basic Erosive Wear Examination (BEWE) advantages – by removing the clear distinction between “enamel loss” and “dentine” exposed, it will not only evade diagnostic uncertainties but will open a broad applicability beyond the clinical situation – can be used with study models or photographs – particular value in cross-sectional and incidence studies as well as for the monitoring of individual cases – avoid an overestimate of the problem – as a model to increase awareness 69
    70. 70. Measuring Dental Fluorosis Two distinct groups of indexes have been proposed for measuring dental fluorosis: • Specific fluorosis indexes - specifically measures the fluoride induced enamel changes in order to reflect increasing severity of fluorosis of lesions • Descriptive indexes - including all types of defects. These indexes includes all defects of enamel are recorded based solely on descriptive criteria, regardless of causative factors. It is based on the principle that examiner should record what he sees and do not presume the etiology 70
    71. 71. Shortcoming of Dean’s Index • Single score is given to a tooth rather than, a separate score to each tooth surface. Hence differences in the severity of fluorosis in different tooth surfaces cannot be ascertained • An individual has been classified according to the tooth most affected by fluorosis which may be located in the mouth that has little cosmetic value • Questionable diagnostic category (score 0.5) in Dean’s Index is difficult to define and interpret precisely • The distinctions between some of the diagnostic categories in Dean’s system are unclear, imprecise or lack sensitivity. 71
    72. 72. Thylstrup and Fejerskov Index (TFI) • Developed by Thylstrup A. and Fejerskov O. in 1978 to assess the prevalence and severity of dental fluorosis • It was developed to refine, modify, and extend the original concepts established by Dean. The primary aim was to develop a more sensitive classification system for recording enamel changes associated, with increasing level of fluoride in water 72
    73. 73. Thylstrup and Fejerskov Index (TFI) advantages – more appropriate than Dean's Index for use in clinical trials or analytical epidemiologic studies – increased sensitivity because teeth are dried and fluorosis can be identified in its milder forms. – provides statistical and practical advantages from the possible detection of effects with smaller samples when potential fluoride effects are small, or when the exposure may be widespread 73
    74. 74. Fluorosis Risk Index (FRI) • Introduced by David G Pendrys in 1990 • to permit a more accurate identification of associations between age-specific exposures to fluoride sources and the development of enamel fluorosis • developed for use in analytical epidemiologic studies 74
    75. 75. Fluorosis Risk Index (FRI) FRI divides the enamel surfaces of the permanent dentition into two developmentally related groups of surface zones, designated either as – having begun formation during the first year of life (classification I) or – during the third through sixth years of life (classification II) Data are found to illustrate the high reliability of the index, its validity, and its unique utility for the identification of risk factors of enamel fluorosis. 75
    76. 76. Modified Developmental Defects of Dental Enamel Index (modified DDE) • Developed by Clarkson J.J. and O’Mullane D.M. in 1989 • Access developmental enamel defects without the need for diagnosing fluorosis before recording enamel opacities • Simple and flexible compared to DDE Index 76
    77. 77. Modified Developmental Defects of Dental Enamel Index (modified DDE) Scoring Criteria Normal Demarcated opacity Diffuse opacity Hypoplasia Other defects Demarcated and Diffuse Demarcated and Hypoplasia Diffuse and Hypoplasia All three defects : : : : : : : : : 0 1 2 3 4 5 6 7 8 77
    78. 78. Measuring malocclusion Recording or measuring malocclusion is important for documentation of prevalence and severity of malocclusion in population groups and provide a basis for planning orthodontic treatment. Methods of recording and measuring malocclusion can be divided as; Qualitative Quantitative 78
    79. 79. Index of Complexity, Outcome and Need (ICON) • Developed by Richmond and Daniels in 2000 • Assess treatment need, complexity, treatment improvement and outcome based on international orthodontic professional opinion, intended for use in the context of specialist practice • Intended to use in late mixed dentition onwards • Simple with relatively fewer trait to measure • Quick and takes approximately 1 minute for a case 79
    80. 80. Measuring Oral Health-Related Quality of Life (OHRQoL) The impact of oral diseases and disorders on aspects of everyday life that a patient or person values, that are of sufficient magnitude, in terms of frequency, severity or duration to affect their experience and perception of their life overall Locker and Allen, 2007 80
    81. 81. Why measure health?? Although philosophically, it is desirable to measure health rather than disease; in practice the epidemiology concerns with measuring disease as health is difficult to define in operational terms and hence difficult to measure. Due to limitations in measurements of the levels of dysfunction, discomfort and disability associated with oral disorders, measurement of the social impact of oral disorders seems justifiable. Empirical approach to develop an index for oral health. Though subjective assessment in done and correlated with clinical measures 81
    82. 82. • Paradigm shift – from biomedical to biopsychosocial model of oral health • Expanded understanding of oral disorders: functional and psychosocial consequences • Legitimacy of the patients’ perspective –needs for and outcomes of therapy 82
    83. 83. Involves measurement of: – Group differences for public health purposes. To do this we need instrument that are reliable and valid – Changes in OHRQoL as a time effect or in response to treatment and preventive procedures. To do this we need instruments where the sensitivity to change (responsiveness) is established 83
    84. 84. Instruments to measure OHRQoL The OHIP-14 (Oral Health Impact Profile) comprises 14 items that explore sevenis concerned of impact (functional limitation, pain, The OHIP-49 dimensions with impairment and three functional The OIDP (Oral Impacts onpsychological and physical) which psychological discomfort, physical disability, psychological status dimensions (social, Daily Performances) questionnaire assesses socialof the seven conditions 16 questions, which takes disability,the impacts of oral quality of life dimensions. of respond The OHQoL-UK consists ofand handicap) and participants represent four disability, a battery of on the abilities individuals toboth 'effect' and frequency of impact on a 5-point to each item accordingeight daily activities eating, speaking, into account perform to the 'impact' of oral health on life hygiene,incorporating dimensions and relations, sleeping-relaxing, Likert scale ranging from never to veryan individualised weighting quality, occupational activities, social often (never = 0, hardly smiling, occasionally = 2, fairly often = 3, very often = 4), using ever = 1,and emotional state; using a severity-based approach a system. twelve-months recall period 84
    85. 85. Instruments to measure OHRQoL 85
    86. 86. References  Peter S., Essentials of Preventive and Community Dentistry, 4/e, Arya(Medi) Publishing House, 2009  Frencken JE, De Amorim RG, Faber J, Leal SC. The caries assessment spectrum and treatment (CAST) index rational and development. Int Dent J. 2011;61:117-23.  ICDAS Coordinating Committee (ICDAS CC). Rationale and evidence for the international caries detection and assessment system (ICDAS-II). 2005. Available from: URL: http://www.icdas.org.  Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H et al. The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol. 2007;35:170-8.  Acharya S. Specific caries index: a new system for describing untreated dental caries experience in developing countries. J Public Health Dent. 2006;66(4):285-7. 86
    87. 87. References  Bratthall D. Introducing the Significant Caries Index together with a proposal for a new oral health goal for 12-year-olds. Int Dent J. 2000;50:378-84.  Mehta A. Comprehensive review of caries assessment systems developed over the last decade. RSBO. 2012 jul-sep;9(3):316-21  Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Research. 1999;33:252-260.  Sikri V, Sikri P. Community dentistry. CBS Publishers and Distributors; 1999  Moustakis VS, Laine ML, Koumakis L et al. Modeling genetic susceptibility: a case study in periodontitis. In: Combi C, Tucker A, editors. Proceedings of IDAMAP-2007: Intelligent Data Analysis in Biomedicine and Pharmacology. Amsterdam, The Netherlands: Artificial Intelligence  Fisher J, Glick M; A new model for caries classification and managementThe FDI World Dental Federation Caries Matrix. Journal of American Dental Association. Jun 2012; 143(6):546-51 87
    88. 88. References  Dhingra K, Vandana K L; Indices for measuring periodontitis: a literature review. International Dental Journal. 2011; 61:76-84  Burt BA, Eklund SA. Dentistry, Dental practice, and the Community; 5/e; WB Saunders; 2007  Locker D, Conceptual development of “oral health-related quality of life”; PEF Symposium: A critical review of oral health-related quality of life: Where are we now?; Sept 2008  Slade GD, ed. Measuring Oral Health and Quality of Life. Chapel Hill: University of North Carolina, Dental Ecology 1997  Agarwal A, Mathur R; An Overview of Orthodontic Indices. World Journal of Dentistry. Jan-Mar 2012; 3(1):77-86 88

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