54e22973c93de5a7d23dc25a72f40d78911.pptx

dental indices

1. Dr Darpan Nenava a 4

2. Contents

1. Introduction 6. Oral hygiene and plaque index

2. Definitions ns ;

. HI-
3. Classification’of index pH

+ Patient Hygiene Performance

4. Ideal requisites of an index ;
+ Plaque index

5. Objectives and uses of index , Turesky, Gilmore, Glickman
modification of the Quigley Hein plaque

index 2

3. 7. Gingival and periodontal

disease indices

Gingival index
Periodontal ind

CPITN

8. Caries index

DMF

def

Stone’s Index

Caries severity index

Dental caries severity index for

primary teeth

Functional measure index

Tissue health index

Dental health index

Index by J Murray and A Shaw
UFA index

„Indices used in dental fluorosis

Deans fluorosis

Community fluorosis index

Thylstrup - Fejerskov Classification of
fluorosis

Developmental defects of index

4. 10. Malocclusi

12. Reference

6. The teeth and their surrounding structures are so definite, so easy to

observe, and en of their previous disease”

history, that the measurement of dental diseases is much easier than

the measurement of any other forms of the disease.

7. Definitions

* Index is a graduated scale having upper and lower limits , with scores

on the scale i ecific criteria which is designed to
ES “
permit and f i er populat assifi

on a graduated
populations examined by the same e and methods. - Irving
n

Glickman

8. An index is an expression of clinical observation in numeric values. It is

used to describe the status of the individual or group with respect to a

condition bein f numeric scale anda standardized
method for interpreting observations of a condition results in an index
score that is more consistent and less subjective than a word

description of that condition. - Esther M Wilkins

9. Oral indices are essentially set of values, usually numerical with
maximum and minimum limits, used to describe the variables or a
+ . : “
specific cond a’graduated scale, which use the same criteria
and method to compare a specific variable in individuals, samples or

populations with that same variables as is found in other individuals,

samples or populations. - George P Barnes

10. Classification of index

+ Based upon me“: scores can fluctuate. _
.
* Upon the extent'to Which the areas of oral cavity are measured

* According to the entity they measure

* General indices

11. Based on the direction in which their scores
can fluctuate:

* Reversible rn” that can be changed. e.g.

periodontal index

* Irreversible index: Index that measures conditions that will not

change e.g. dental caries

12. Depending upon the extent to which areas of
oral cavity are measured :

* Full ro periodöntium or dentition is

measured. e.g. OHI

« Simplified indices: Measure only a representative. sample of the

dental apparatus. e.g. OHI-S

13. www.»
According to the entity which they measure :

a

nid >

* Disease ‘re the DMF index is the best
example of disease index |

+ Treatment Index : “P' filed portion index is the best

example for treatment index Te

14. General Indices :

« Simple ind X es the presence or absence of a
condition. E.gyplaque index

+ Cumulative index: Index that measures all the evidence of a

condition, past and present. E.g. DMF index

15. Ideal Requisites of an Index

« Simplicity:

* Should AS is no undue time lost during *
field examinations.

+ No expensive,equipmentshould be needed.

* Objectivity:
* Criteria for the index should be clear and unambiguous, with
mutually exclusive categories.

16. + Validity:
* Must measure what it is intended to measure, so it should
v ' ‘
correspon cal 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.

17. * Reliability:
+ Should measure consistently at different times and under a variety
of conditio
+ . vw
* 2 compone
* Inter examiner reliability: different examiners record the same result.

* Intra examiner reliability: same examiner records the same result at

repeated attempts.
* Precision:

* Ability to distinguish between small increments. e

18. + Quantifia bil

* The index should be a

interpretable.

20. For Individual Patient

+ Provide 114444 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

21. In Research

* Determine rere 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

22. In Community Health

+ Shows eal ‘

+ Base line data for existingdental practices
+ Assess the need of the community

* Compare the effects of a community program and evaluate the

results

23. INDICES USED FOR ORAL HYGIENE
ASSESSMENT
+ ORAL HYGIE

+ SIMPLIFIED à HYGIENE INDEX

+ PATIENT HYGIENE PERFORMANCE

+ TURESKY, GILMORE, GLICKMAN MODIFICATION OF THE QUIGLEY HEIN
PLAQUE INDEX

24. ORAL HYGIENE INDEX (OHI)

* Developed in 1960

+ John C. Gree rmillion in order to classify and assess oral
” . cd .
hygiene statu

+ Simple and sensitive method for assessing group or individual oral

hygiene quantitatively.

* It is composed of 2 components:
+ Debris index (DI)

* Calculus index (Cl)

25. RULES OF ORAL HYGIENE INDEX

Only fully erupted permanent teeth are
scored.

hird molars and incompletely erupted
teeth are not scored because of the wide
variations in heights of clinical crowns,

in a segment
area covered by

e tooth in a segment
having the greatest surface area covered by
supragingival and subgingival calculus.

25

26. DEBRIS INDEX 0- no debris or stain

present

1-soft debris covering
not more than 1/3" the
tooth surface, or presence
of extrinsic stains without

e Je 2/3" of the
exposed tooth surface

3 - soft debris covering more
than 2/3" of the exposed
A tooth surface

27. 0 No calculus present
CALCULUS INDEX il Supragingival calculus covering not
more than 1/3 of the exposed tooth

surface

Supragingival calculus covering more
than 1/3 but not more than 2/3 the
exposed tooth surface or presence
of individual flecks of subgingival
calculus around the cervical portion

of the tooth or both.
| Supragingival calculus covering more
Supragingival subgingival than 2/3 the exposed tooth surface
CS calculus or a continuous heavy band of

subgingival calculus around the
cervical portion of tooth or both. 2

28. Calculation
+ DI =B.S+L.S/No. of seg

*ClEBS+ A"

+ OHI = DI + Cl

+ Dl and Cl 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

29. SIMPLIFIED ORAL HYGIENE INDEX

+ John C Greene and Jack R Vermillion in 1964.

* 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.

+ An alternate tooth is then examined.

30. co co © CO
+ — a an a] =
N N N N LE N
4 A m +
Lo 4 wo wo Sy Lo
a4 — N m m st

31. Calculation and Interpretation

no of surfaces

DI-S and Cl-S
+ CI-S= Total score/ No of surfaces

* Good -0.0-0.6

+ Fair—0.7-18
+ OHI -S= DI-S+ CI-S + Poor=1.9-3.0
+ DI-S and CI-S range from 0-3 * OHI-S

* Good - 0.0-1.2
+ OHI-S range from 0-6 + Fair-1.3-3.0

* Poor -3.0 -6.0

+ INTERPRETATION

32. Uses

+ Widely used imepidemiological studies of periodontal diseases.
me wi

+ Useful in evaluation of dental health education programs

« Evaluating the efficacy of tooth brushes.

+ Evaluate an individuals level of oral cleanliness.

33. PATIENT HYGIENE PERFORMANCE (PHP INDEX)

* Introduced by Podshadley A.G. and Haley JV in 1968.
* Assessments

+ The extent of plaque and debris overa tooth surface was determined.

16 buccal
11 labial
26 buccal
36 lingual
31 labial

46 lingual

34. + PROCEDURE:
+ Apply a disclosing agent before scoring.

+ Patient is asked to swish for 30 sec and then expectorate but not
rinse.

+ Each of the 5 subdivisions is scored for presence of stained debris:
+ 0= no debris(or questionable)
+ 1= debris definitely present.

35. * Debris score for individual tooth:
+ Add the scores for each of the 5 subdivisions.

+ PHP index for an indivi , : ;
* Total score fol ¡vided by the numberof teeth examined.

Debris score
for 1 tooth = 4/5
+ RATING SCORES: =08

+ Excellent : 0 (no debris) FR
* Good : 0.1-1.7 Gai

+ Fair : 1.8-3.4 Hi
* Poor :3.5-5.0

36. Plaque index E

1
+ Silness and Loe in 1964

* Assesses the EOS cervical margin of the tooth

closest to the gums
36

+ All four surfaces are examined 40,
+ Distal
+ Mesial
+ Lingual

* Buccal

37. Scoring Criteria

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

Moderate accumulation of soft deposits within the gingival
2 pocket, or the tooth and gingival margin which can be seen with
the naked eye

Abundance of soft matter within the gingival pocket and/or on
the tooth and gingival margin

38. Calculation

+ Plaque index for area : 0-3 for each surface.

* Plaque I 200040000 then divided by four. + +,
« Plaque index for group of teeth»; Scores are added

and then divided by the total

ha.
+ Plaque index for group : All indices are taken and divided by number of

individual

38

39. Interpretation of Plaque index

exellent * |

40. Uses

* Reliable tech

procedures

+ Used in longi

41. TURESKY, GILMORE, GLICKMAN et OF
THE QUIGLEY HEIN PLAQUE INDEX

* Quigley and Heinii ted a plaque measurement that
.
focused on th third of the tooth U

of the anteriont

Y
* The Quigley - Hein plaque index was modified by Turesky, Gilmore
and Glickman in 1970. |

42. 0-no plaque
1- separate flecks of plaque at the cervical margin of tooth.
2-thin continuous band of plaque (up to 1 mm)

3- band of plaque wider than 1 mm but covering less than 1/3rd of the crown of
the tooth.

4 - plaque covering at least 1/3rd but less than 2/3rd of the crown of the tooth.
5 - plaque covering 2/3rd or more of the crown of the tooth.

43. * Plaque is assessed on the labial, buccal and lingual surfaces of all the

teeth after using a disclosing agent.
* The scores of as also redefined.

* Provides a comprehensive method for evaluating anti plaque
procedures such as tooth brushing, flossing as well as chemical anti

plaque agents,

* The index is based on a numerical score of 0 to 5.

44. Gingival

45. Gingival Index

* Developed by Loe H and Silness J in 1963.

* One of the mos gingival indices.

+ Assess the severity of gingivitissand its location in 4 possible areas.
* Mesial
* Lingual
+ Distal

* Facial

* Only qualitative changes are assessed.

46. METHOD:

« All surfaces of all teeth or selected teeth or selected surface of all teeth or

selected teeth
y .
* The selected t index teeth are 16,12,24,36,32,44.

+ The teeth and gingiva are first dried with a blast of air and/or cotton rolls.

* The tissues are divided into 4 gingival scoring units: disto facial papilla,

facial margin, mesio facial papilla and entire lingual margin.

+ A blunt periodontal probe is used to assess the bleeding potential of the

tissues.

47. SCORE

CRITERIA

Absence of inflammation/normal
gingiva

Mild inflammation, slight change in
color, slight edema, no bleeding on
probing

Moderate inflammation, moderate
glazing, redness, edema and
hypertrophy. bleeding on probing

Severe inflammation, marked
redness and hypertrophy ulceration.
Tendency to spontaneous bleeding.

48. Calculation and Interpretation

+ If the scores around each tooth are totaled and divided by the number of

surfaces per t i he gingival index score for the tooth is
, ; ‘
obtained.

* Totaling all of the scores per tooth and dividing by the number of teeth

examined provides the gingival index score for individual.

* Interpretation:
+ 0.1- 1.0: Mild gingivitis
+ 1.1-2.0: Moderate gingivitis

+ 2.1-3.0 : Severe gingivitis

49. Modified Gingival Index

+ Developed by rford, Ross, Lamm and Menaker in 1986.

+ Assess the ee.

* Strictly based on noninvasive approach i.e. visual examination only
without any probing.

+ To obtain MGI , labial and lingual surfaces of the gingival margins and the

interdental papilla of all erupted teeth except 3rd molars are examined and

scored.

50. il 2 3 4

«Mild + Mild + Moderate + Severe
inflammat inflammat inflammat inflammat
ion (slight ion of the ion ion
change in entire (moderate (marked
color, little gingival glazing, redness
change in unit redness, and
texture) of edema, edema/hy
any and/or pertrophy,
portion of hypertrop spontaneo

the hy) of the us

gingival gingival bleeding,

unit unit. or

ulceration
) of the
gingival
unit.

50

51. Periodontal Index

* Developed we
+ : ‘
* It was once widely Used in epidemiological surveys but not used much

now because of introduction of new periodontal indices and

refinement of criteria.

* The Pl is reported to be useful among large populations, but it is of

limited use for individuals or small groups.

52. * All the teeth are examined in this index.

* Russell chose t ing v 1,2,6,8 in order to relate the .
stage of the disease in an epidemiological survey to the clinical

conditions observed.

« The Russell's rule states that “when in doubt assign the lower score.”

53. 0 Negative. Neither overt inflammation in the investing Radiographic appearance is essentially normal.
tissues nor loss of function due to destruction of

supporting bone.
I an
1 Mild gingivitis. An overt area of inflammation in the free
gingiva does not circut
. "ve
Y —
2 Gingivitis,

tooth, but there is ni
attachment

4 Used only when r:
Gingivitis with
attachment is br

interference with norı 1 t + >
is firm in its socket and has not dri 4 nm

8 Advanced destruction with loss of masticatory function. There is advanced bone loss involving more than half of
The tooth may be loose, may have drifted, may sound dull the tooth root, or a definite intrabony pocket with
on percussion with metallic instrument, or may be widening of periodontal ligament. There may be root
depressible in its socket. resorption or rarefaction at the apex.

53

54. Calculation and Interpretation

* PI score per person = sum of individual scores

Clinical Condition

Clinical normally supportive tissue
Simple gingivitis

Beginning destructive periodontal
diseases

Established destructive periodontal
disease

Terminal disease

Individual Scores

00-02
03-09
10-19

2.0-4.9

5.0-8.0

55. 4 } D
Community periodontal Index of Treatmen
Needs

* The community peri index of treatment needs was developed
+ .
by the joint committee of the WHO.and FDI ir

56. * Treatment needs implies that the CPITN assesses only those conditions
potentially responsive to treatment, but not non treatable or irreversible

conditions.

* Procedure :

* The mouth is divided into sextants :
17-14 13-239 24-27
47-44 43-33 34-37
* The 3rd molars are not included, except where they are functioning in place of 2nd
molars.
+ The treatment need in a sextant is recorded only if there are 2 or more teeth present in
a sextant and not indicated for extraction. If only one tooth remains in a sextant, then

the tooth is included in the adjoining sextant.
56

57. * Probing depth is recorded either on all the teeth in a sextant or only on
certain indexed teeth as recommended by WHO for epidemiological

surveys.

+ FOR ADULTS Al
+ 10 index teeth are taken into account :17:16 11 26 37 47 46 31 36 37.

+ The molars are examined in pairs and only one score the highest score is recorded.

+ 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 (non inflammatory tooth eruption associated).

58. « When examining children less than 15 yrs pockets are not recorded

although probing for bleeding and calculus are carried out as a routine.

ee
+ CPITN PROBE:

* First described by WHO,

* Designed for 2 purposes :
* Measurement of pockets.

* Detection of sub-gingival calculus.

59. Fig. 84.4: CPITN PROBE

60. Codes and Criteria

CODE CRITERIA TREATMENT NEEDS

0 Healthy periodontium. TN-0 No need of treatment

1 Bleeding observed during / after probing TN-1 Self care

2 Calculus or other plaque retentive factors TN-2 Professional care
seen or felt during probing

3 Pathological pocket 4-5 mm. gingival margin TN-2 Scaling and root planning
situated on black band of the probe.

4 Pathological pocket 6mm or more. Black TN-3 Complex therapy by specially

band of the probe not visible

trained personnel 60

61. Caries In

primary teeth

62. DMF Index

* Bodecker CF BE gave term.caries '

v +
* Henry Klein, Carrolé E Palmer and JW Knutson 1938 gave DMF index
* Only permanent teeth

+ 28 teeth are included

63. + Exclusion Crit
+ 3 molar
* Teeth extract

* Filled for an

caries
* Teeth re

+ Supernumera

64. Features of DMF

* Tooth is counted only once

* Decayed, miss d¡be recorded separately
+ Recurrent cari ounted as decay

+ Extraction indicated teeth are included in missing
+ Many restoration is counted as one score

+ Root stump is also scored

+ 1986 WHO modification includes 3 molars

* Cant be used in children

+ Not accurate

* Overestimate caries

65. | Coding Criteria for DMF Index

Calculation of the Index
Individual DMFT: Total each component, ie. DM and E

qn

Criterio separately, then sum it all(D+M+F).

SumofD+M+F

Excluded tooth or tooth space Group average:
5 5
Number of individuals in the group

Sound permanent tooth

Filled permanent tooth Total number of decayed tooth

Percent needing care: — -
Decayed permanent tooth 5 Total number examined

Missi m 3e
AU Total number of missing tooth

x|o |» |» [=] m

Percent of teeth lost: — >
Extracted permanent tooth 1 Total number examined

Total number of missing tooth

Percent of filled teeth: — 2
ff Totalnumber examined

66. Limitations

* DMFT values are not related to the number of teeth at risk

* Can be van wei can become,lost for
reasons otherithan Caries

« Can be misleading in.children whose teeth lost due to orthodontic

reasons

« Can overestimate caries experience in teeth in which preventive filling
have been placed

* Little use in root caries

67. def Index

* Gruebbel AD 1944 as an equivalent index to DMF for measuring pad
caries in cn r , .

+ d-Indicates the er of deciduous teeth decayed!

* e - Indicates deciduous teeth extracted due to caries & indicated for X"

* f- Indicates restored teeth without recurrent decay

68. Criteria
Excluded tooth

Sound deciduous tooth

Filled deciduous tooth

Decayed deciduous tooth

Missing tooth

Extracted deciduous tooth aan hex

Individual dmf: Total each component, ie. d, m, fseparately,

then sum it all (d + m+£)

Group average a __ ofd a f

er of individuals in the group

Total number of decayed tooth

Total number examined

Total number of missing tooth

Total number examined

Percent needir

Percent of teeth

Total number of missing tooth
Perce Alot toc {
ace led tet: Total number examined

69. Modifications

+ dmf index + df index
« For children + Exfoliation problem
11-12 yea + df is,used\missing are ignored
* Decayed, missing and filled * WHO in survey
primary molar ahd canines have + deiner

being used to determine dmft

* Mixed dentition
+ DMFT and deft are done separately and never added
+ Permanent teeth index is done first then deciduous separately

70. Stone’s Index

* Introduced by HH Stone, FE Lawton, ER Bransby and HO Hartley in
1949

71. Caries Severity Index

* Tank Certrude and Storvick Clara 1960

Criteria
enamel)
Moderate (caries in enamel and superficial dentine)
erately severe (enamel un nined)

| Severe (approaching pulp, enamel collapsed)
caries or by trauma

either by deep seated caries or by trauma

6 | Death of pulp (cause
| without caries)
Periapical infe on (cau! sither by deep seated caries or by
trauma without caries)

72. Dental Caries Severity Index for primary teeth

* Designed by Aubrey Chosack 1985 >

‘Vy

Occlusal surfac imal surfaces of molar .

1 Early pit and fissure caries ¡a Discontinuity of enamel

À Cavitation with breakdown of marginal ridge

2 Cavitation of Imm

3 Cavitation with breakdown of half tooth 3 Break down of marginal ridge to proximal
extensions of occlusal surface

Buccal-lingual and palatal smooth surface Proximal surfaces of Incisors

1 Discontinuity of enamel

2 Cavitation with breakdown of buccal and lingual

surface

3 Cavitation of 2 mm extending to both embrasures 7
3 Break down of incisal edge

1 White lesion not extending to embrasure

2 Cavitation of 1-2mm extending to one embrasure

73. Functional measure Index

+ Sheiham, Maizels A, Maizels J in 1987
* Filled and so hile decayed and missing teeth”
is given zero

FMI = (Filled + Sound) / 28

74. Tissue health Index

+ Sheiham, Maizels A, Maizels J in 1987

1-decayed y

2 - filled

4 - sound

Tissue health index (THI) = 4(1*decayed+2*filled+4*sound)/28

Third molars are excluded
Score ranges from 0-1

75. Dental health Index

+ JJ Carpay, FHM Nieman, KG Konig, AJA Felling and JGM Lammers in
1968 ye ' '

+ Sound teeth a score of +1 affected teeth a score of -1

DHI = sound teeth = (decayed + filled +missing teeth)/ sound teeth +

decayed + filled + missing teeth

Score ranges from - 1 to +1

76. Clinical and radiographic Index by J Murray
and A Shaw in 1975 ER

77. PUFA Index

* Jindal M and me
. : : .
+ Assess the presence of oral conditions resulting from untreated caries

both in primary and permanent dentition
+ Upper case for permanent and lower case for primary dentition

« Assessment is made visually without any instrument

78. Denotation

Criteria

P/p

U/u

F/f

Aa

mer" an opening of pulp chamberis 4
e

Ulceration.of soft tissue of tongue or mucosa by sharp edges of
dislocated decayed carious tooth

Fistula is recorded with pus releasing sinus in relation to exposed
tooth

Abscess is recorded with pus containing swelling in relation to
exposed tooth

79. Calculation and Interpretation

PUFA/pufa = (filled + sound)* 100 /D+d

Higher scores i

me neglected either dueto” "*
lack of knowledge, facility available, cost and importance of dentition.

Advantages
* Easy to use
* No instruments required

« Used for planning monitoring and implementing oral health

programs keeping in view cause of negligence

80. Dental Fluorosis Index

+ DENTAL FLU lasia or hypo-mineralisation of
tooth enamel or dentinesproduced by the chronic ingestion of
excessive amounts of fluoride during the period when teeth are

developing.

81. CLASSIFICATION OF FLUOROSIS MEASURING

| N D | C ES + DEVELOPMENTAL
DEFECTS OF ENAMEL
INDE!
| a
f

FERJESKOV

82. DEAN'S FLUOROSIS INDEX

» 1934; TRENDLEY H.DEAN devised
ani ing the

pres

enamel!

84. e Y
METHOD ( as implied by DEAN)

+ Examinations adi | good natural light with the subject
sitting facing

+ Mouth mirror and probes were utilized for examination.

85. CLASSIFICATION AND CRITERIA _

«The enamel represents the usual translucency semi-vitriform type of structure
+ The surface is smooth, glossy and usually of pale creamy white color

« Slight aberrations in translucency of normal enamel ranging from few white flecks to occasional white
spots, 1-2mm in diameter,

VERY MILD

+ Small, opaque, paper white areas are scattered irregularly or streaked over the tooth surface
+ Observed on labial and buccal surfaces ; <25% of teeth surface involved.

+ Small pitted white areas are frequently found on summits of cusps

+ No brown stain

86. MILD

+ White opaque areas involve half of tooth surface.

+ Surfaces of cuspids n bicuspids prone to attrition show thin white layers worn off and bluish
shades of normal enamel

+ Faint brown stains are apparent

MODERATE

+ No change in form of tooth but all surfaces are involved
+ Surfaces subjected to attrition are definitely marked
+ Minute pitting is present on buccal n labial surfaces

MODERATELY SEVERE

+ Smoky white appearance
+ Pitting is more frequent and generally seen on all surfaces
+ Brown stain if present has more hue and involves all surfaces

+ Form of teeth are affected.
+ Pits are deeper and confluent
+ Stains are widespread and range from chocolate brown to almost black

87. Based on this index, Dean. u Cohen(1935) HE
proposed that ic ion should determine a
mottled enamel 2 ofa community for Er
purpose

= ios 2

88. h ti
Characteristics

0 Normal The enamel shows the usual translucency. The

surface is smooth, shiny and usually of a pale,
= {creamy white to grey white color =

0.5 Questionable | The enamel shows slight aber ations ranging
from a few white flecks to occasional white

3 | [spots e

1 Very mild |Small, opaque, paper white areas scattered
irregularly over tooth but not involving more

mE El than 25 percent

2 | Mild Opaque, paper white areas that is more
extensive, involving more than 25 percent but
less than 50 percent |

3 Moderate |All enamel surfaces are affected and also show
attrition

4 | Severe |All enamel surfaces are affected and

hypoplasia is so marked that general form of
tooth is affected, Discrete or confluent pitting
_{with brown stains is a characteristic feature

89. USES

* Most widely used index to measure dental fluorosis.
* Helped to re eek: to severe fluorosis in
many communities'as

> Sweden by Forsman.in1974

> Austria by Binder in 1973

> England by Murray et al(1956), Forrest (1965), Goward (1976)
> USA by Galagan and Lamson (1953)

> India by Nanda et al (1974)

90. * The National Survey of Children's Dental Health in Ireland in 1984
measured flu ex to provide baseline data for
future referel

( Whelton HP;Ketley.CE;Mcsweeny F;O’Mullane DM;2004)

* National Fluorosis Survey in USA in 1986-87 to note baseline values
was done using Dean’s index.

91. LIMITATIONS

* Does not give sufficient information on aun of fluorosis ur
the dentition

* Isolated defe

* The distinction amongst the Categories is unclear, indistinct and
lacking sensitivity.

+ Even though Dean’s scale is ordinal , it involves averaging of the
scores which is inappropriate.

not recorded.

(A. Rizan Mohamed,W. Murray Thomson;Timothy D. Mackay, An epidemiological comparison of Dean's index and the Developmental Defects
of Enamel (DDE) index; JPHD ISSN 0022-4006)

92. COMMUNITY FLUOROSIS INDEX

* 1942 , based on the revised fluorosis index scale , he developed a
scoring anal FLUOROSIS INDEX .
* On basis of th ion of indi a

community index for de
formula

re

Fci = sum of no. of individuals * sta weights)/ no. of