INDICES in denistry dmft ohis russels S.ppt

index

1. GOOD MORNING

2. SEMINAR ON
INDICES USED IN DENTISTRY

3. Oral hygiene is a basic factor for oral health.
Poor oral hygiene leads to dental plaque-
collections, which in turn can cause gingivitis
eventually leading to periodontal diseases. That
is why many clinical studies have been carried
out focusing on the role of oral hygiene in the
prevention and control of oral diseases.
A number of plaque indices has been developed
for assessing individual levels of plaque control
and are also been used in several
epidemiological studies. Some of the most well -
known indices, which have been used in
numerous studies, are listed below.
.

4. ORAL HYGEINE INDEX –
ORIGINAL (1960)
•John.C.Greene and Jack.R.Vermilion
•2 components – Debris index + Calculus index.
•Score for the debris and calculus on all the teeth

5. Exclusions
•Third molars
•Incompletely erupted teeth

6. •First the buccal, and second the lingual surfaces of
the teeth in the right posterior region beginning
from the second molars, are inspected and scored.
•Then the labial and lingual surfaces of the upper
anterior teeth are examined.
•Finally, the buccal and lingual surfaces of the
teeth in the upper left posterior region are
examined and scored.
•The lower arch inspection proceeds in the same
manner, but from left to right.

7. METHOD OF SCORING FOR
DEBRIS
•The surface area covered by debris is estimated
by running the side of a no. 5 explorer
(Shephard’s hook) along the buccal, labial and
the lingual surfaces and noting the occlusal or
incisal extent of the debris as it is removed from
the tooth surface.

8. Criteria for Classifying oral debris
•Oral debris is defined as the soft foreign matter
on the surface of the teeth, consisting of mucin,
bacteria and food and varying in colour from
greyish white to green or orange.

9. Criteria for classifying debris
Scores Criteria
0
No debris or stain present
1
Soft debris covering not more than one third of
the tooth surface, or presence of extrinsic stains
without other debris regardless of surface area
covered
2
Soft debris covering more than one third, but not
more than two thirds, of the exposed tooth
surface.
3
Soft debris covering more than two thirds of the
exposed tooth surface.

10. Criteria for classifying calculus
•Dental calculus is defined as a deposit of
inorganic salts composed primarily of calcium
carbonate and calcium phosphate mixed with
food debris, bacteria and desquamated epithelial
cells.

11. •Supragingival calculus – denotes deposits located
occlusal to the free gingival margin and is usually
white to yellowish brown in colour
•Subgingival calculus – denotes deposits located
apically to free gingival margin which are usually
light brown to black in colour because of inclusion
of blood pigments.

12. Criteria for classifying calculus
Scores Criteria
0
No calculus present
1
Supragingival calculus covering not
more than third of the exposed tooth
surface.
2
Supragingival calculus covering more
than one third but not more than two
thirds of the exposed tooth surface or
the presence of individual flecks of
subgingival calculus around the cervical
portion of the tooth or both.
3
Supragingival calculus covering more
than two third of the exposed tooth
surface or a continuous heavy band of
subgingival calculus around the cervical
portion of the tooth or both.

14. 17 16 15 14 13 12 11 21 22 23 24 25 26 27
47 46 45 44 43 42 41 31 32 33 34 35 36 37
DEBRIS SCORE

15. 47 46 45 44 43 42 41 31 32 33 34 35 36 37
17 16 15 14 13 12 11 21 22 23 24 25 26 27
CALCULUS SCORE

16. CALCULATION OF THE INDEXES
•The debris index for an individual is determined
by totaling the debris scores recorded and then
dividing by the number of teeth scored.
•An identical procedure is used for determining the
Calculus Index.
•The two of them are then combined and expressed
as the “Oral Hygiene Index”.

17. ORAL HYGEINE INDEX -
MODIFIED
•The Oral Hygiene Index is composed of the
combined Debris Index and Calculus index,
based on 12 numerical determinations
representing the amount of debris or calculus
found on the buccal and lingual surfaces of each
of three segments of each dental arch, namely

18. •The segment distal to the right cuspid (see
picture).
•The segment distal to the left cuspid.
•The segment mesial to the right and left first
bicuspids

20. The Maxillary and the Mandibular arches are
each composed of three segments (these are
illustrated above).
Each segment is examined for debris or calculus.
From each segment one tooth is used for
calculating the individual index, for that particular
segment. The tooth used for the calculation must
have the greatest area covered by either debris or
calculus.

21. B
P
L
B
DEBRIS / CALCULUS SCORE

22. Calculation
•Debris Index = The total of the upper and lower
buccal and lingual scores(whichever is
greatest) /The number of surfaces scored.
•Calculus Index = The total of the upper and
lower buccal and lingual scores(whichever is
greatest) / The number of surfaces scored.
•Oral Hygiene Index = Debris Index + Calculus
Index.

23. OHI-S (Simplified) -
(Greene and Vermillion, 1964)
•The Simplified Oral Hygiene Index (OHI-S)
differs from the OHI (The Oral Hygiene Index)
in the number of the tooth surfaces scored (6
rather than 12), the method of selecting the
surfaces to be scored, and the scores, which can
be obtained. The criteria used for assigning
scores to the tooth surfaces are the same as those
use for the OHI (The Oral Hygiene Index).

24. •The OHI-S, like the OHI, has two
components, the Debris Index-
Simplified and the Calculus Index-
Simplified. Each of these indexes, in
turn, is based on numerical
determinations representing the amount
of debris or calculus found on the
preselected tooth surfaces.

25. SELECTION OF TOOTH SURFACES
•In the posterior portion of the dentition, the
first fully erupted tooth distal to the second
bicuspid (15), usually the first molar (16)
but sometimes the second (17) or third
molar (18), is examined. The buccal
surfaces of the selected upper molars and
the lingual surfaces of the selected lower
molars are inspected.

26. •In the anterior portion of the mouth, the
labial surfaces of the upper right (11) and
the lower left central incisors (13) are
scored. In the absence of either of this
anterior teeth, the central incisor (21 or 41
respectively) on the opposite side of the
midline is substituted.

28. 16 11 26
36 31 46
B La B
Li
La Li
DEBRIS / CALCULUS SCORE

29. Calculation
•Debris Index - S = Total the debris score /
Number of surfaces examined
•Calculus Index - S = Total the calculus score /
Number of surfaces examined
•OHI – S = DI - S + CI - S

30. Interpretation of the scores
•DI-S scores / CI-S scores
Good = 0.0 - 0.6
Fair = 0.7 - 1.8
Poor = 1.9 - 3.0
OHI – S scores
Good = 0.0 –1.2
Fair = 1.3 - 3.0
Poor = 3.1- 6.0

31. USES OF OHI-S INDEX
•Has been widely used in studies of the
epidemiology of periodontal disease.
•As a standard companion of the Periodontal Index
in the world wide studies of the interdepartmental
Committee on Nutrition for National Defence
(ICNND)
•In evaluation of dental health education programs
in public school systems.

32. Advantages
•It is easy to use
•Requires less time and hence can be used in field studies.
•It is used in epidemiological studies of periodontal disease
and calculus.
•It determines the status of oral hygiene cleanliness in
groups.
•Useful in evaluating the effectiveness of tooth brushing.
•Useful in evaluation of dental health education
procedures.
•A high level of reproducibility is possible in a minimum
period of training session.

33. Disadvantages
•Lacks the degree of sensitivity as much as the
original version
•Under or overestimation of debris or calculus
•Not appropriate for certain types of clinical
studies including detailed investigation of plaque,
calculus formation.

34. DISCUSSION
•In studies of groups with relatively small
amounts of plaque, the criteria of this oral
hygiene index have usually proved too crude for
demonstration of significant differences
between study and control groups. When plaque
is evaluated in relation to prevalence and
severity of gingivitis, only the amount of plaque
in contact with the gingival margin is of critical
importance. This index offers poor
discrimination in gingival plaque area scores.

35. PATIENT HYGEINE
PERFORMANCE INDEX (PHP)
•Podshadley.A.G and Haley.J.V -1968.
•Purpose of PHP index.

36. SELECTION OF TEETH AND
SURFACES
•Same as OHI-S
16- Maxillary right first molar
11- Maxillary right central incisor
26- Maxillary left first molar
36- Mandibular left first molar
31- Mandibular left central incisor
46- Mandibular right central incisor

37. DISCLOSING SOLUTION
•Because plaque is colourless, it is usually
visualized by staining prior to scoring. Plaque is
then defined, in an operational sense, as “stainable
material” because it usually includes pellicle as
well as bacterial deposits. Traditionally, the plaque
disclosing solutions used is FD & C Red Dye = 3.
This dye, also known as Erythrosine. A new
formulation has been made available which uses
FD &C Red = 28.

38. PROCEDURE
•Disclosing agent
•Swish for 30 seconds.
•Each tooth surface to be evaluated is subdivided
into five sections
•Vertically-mesial, middle and distal
•Horizontally-gingival, middle and incisal /
occlusal thirds.

39. D M
G
M
I

40. DEBRIS SCORE
0 = No debris
1 = Debris definitely present
M = All three molars or both incisors missing
S = Substitute tooth is used.

41. NOMINAL SCALE FOR
EVALUATION OF SCORES
RATING SCORES
EXCELLENT 0
GOOD 0.1 - 1.7
FAIR 1.8 - 3.4
POOR 3.5 - 6.0

42. USES OF PHP INDEX
•To both document and assist in motivating
changes in oral health habits.
•To score the patient before and after oral hygiene
instruction and at follow up visits.
•To analyze and evaluate the effectiveness of
home care methods that are being used in the
program.
•For individual patient education.

44. PLAQUE INDEX(PlI)
•Based on the principle the desirability of
distinguishing clearly between the severity and
the location of the soft debris aggregates.
•Silness and Loe - 1964

45. Method
•Scoring done on the entire dentition or on
selected teeth.
•Surfaces examined – four gingival areas of the
tooth – distal-facial, mesial-facial, facial and
lingual surfaces.
•Mouth mirror, a light source, a explorer and
airdrying of the teeth and gingiva.

47. •Each of the four gingival areas of the tooth
is given a score from 0-3 this is the PlI for
the area.
•The scores from the four areas of the tooth
may be added and divided by four to give
the PlI for the tooth.

48. Scores Criteria
0
The gingival area of the tooth surface is literally free of plaque.
The surface is tested by running a pointed probe across the tooth
surface at the entrance of the gingival crevice after the tooth has
been perfectly dried. If no soft matter adheres to the point of probe,
the are is considered clean.
1
No plaque can be observed in situ by the naked eye. A film of
plaque adhering to the free gingival margin and adjacent area of the
tooth. The plaque may be seen in situ only after application of
disclosing solution or by using the probe on the tooth surface.
2
A thin to 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 the gingival pocket and/or on the
tooth surface and gingival margin. The interdental area is stuffed
with soft debris.

49. •The Plaque Index scores consider only
differences as to thickness of the soft deposit
in the gingival area of the tooth surfaces, and
no attention is paid to the coronal extension
of the plaque.
•If optimal conditions and chair side
assistance are provided and all teeth are to
be examined scoring takes approximately 5
minutes.

50. USES
•Reliable technique for evaluating both
mechanical anti-plaque procedures and
chemical agents.
•Longitudinal studies and clinical trials.

51. INDICES USED TO ASSESS
GINGIVAL INFLAMMATION
•GINGIVAL INDEX(GI)
•PAPILLARY MARGINAL
ATTACHMENT INDEX ( PMA) INDEX

52. GINGIVAL INDEX
•The Gingival Index(GI) was developed by Loe
H and Silness J in 1963. It was developed solely
for the purpose of assessing the severity of
gingivitis and its location in four possible areas.

53. Method
•The severity of gingivitis is scored on all surfaces
of all teeth or selected teeth.
•The teeth selected as the index teeth
•16 – Maxillary Right First Molar
•12 – maxillary Left Lateral Incisor
•24 – Maxillary Left First Premolar
•36 – Mandibular Left First Molar
•32 – Mandibular Left Lateral Incisor
•44 - Mandibular Right First Premolar

54. •The tissues surrounding each tooth are divided
into four gingival scoring units: distal-facial
papilla, facial margin, mesial-facial papilla and
the entire lingual gingival margin. Unlike the
facial surface, the lingual surface is not
subdivided in an effort to minimize examiner
variability in scoring, since it will most likely be
viewed indirectly with a mouth mirror.
•A blunt instrument, such as a periodontal pocket
probe, is used to assess the bleeding potential of
the tissues.

55. CODING CRITERIA
•Each of the four gingival areas of the tooth is given a score
from 0 to 3.
•GI=0 is given to the gingiva the colour of which is pale
pink to pink. The surface after drying is matt. The degree
of stippling may vary. The gingival margin may be located
on the enamel or at various levels apical to the cemento-
enamel junction. Although the margin should be thin, the
buccal and lingual gingiva may present a rounded
termination against the tooth thereby forming the entrance
or orifice of the gingival crevice. The form of the
interdental gingiva depends on the shape and size of the
interdental areas. The tip of the papilla should be the most
incisally or occlusally located part of the gingiva. On
palpation with blunt instrument the gingiva should be firm.

56. •GI = 1 is the score given when the gingiva
is subject to mild inflammation. The
gingival margin is slightly more reddish or
bluish-reddish than normal and there is
slight oedema of the margin. A colourless
gingival exudate may be observed or
collected at the entrance of the crevice.
Bleeding may be found when

57. •GI = 2 This is the score of a moderately
inflamed gingiva. The gingiva is red and
glazy. There is enlargement of the margin
due to oedema. Bleeding is provoked when
a blunt instrument is run along the soft
tissue wall of the entrance of the gingival
crevice.
•GI = 3 The score for severe inflammation.
The gingiva is markedly red or reddish blue
and enlarged. Tendency to spontaneous
bleeding. Ulceration.

58. Method of examination
•Requires 2-5 minutes
•Method -

59. Calculation of the Index
•Totalling the scores around each tooth obtains the
gingival index score for the area.
•If the scores around each tooth are totaled and divided by
four, the gingival index score for the tooth is obtained.
•Totalling all of the scores per tooth and dividing by the
number of teeth examined provides the gingival index
score per person. The gingival index may be used to
evaluate a segment of the mouth or a group of teeth in
the same way.

60. GINGIVAL SCORES CONDITION
0.1- 1.0 Mild Gingivitis
1.1- 2.0 Moderate Gingivitis
2.1-3.0  
          
Severe Gingivitis
 

61. MODIFIED GINGIVAL INDEX
•MGI is a modification of GI of Loe and Silness. -
Described by Lobene.R.R, Weatherford T,
N.M.Ross and Menaker.
•To eliminate the use of pressure to elicit bleeding
and redefine the scoring system for mild and
moderate inflammation.
•Relies entirely on the visual criteria of gingivitis
and eliminates use of probing or pressure to
establish the presence or absence of bleeding.

62. Criteria
•0 = Absence of inflammation
•1 = Mild inflammation; slight change in colour
little change in texture of any portion of gingiva
but not the entire marginal or papillary gingival
unit.
•2 = Mild inflammation; criteria as above but
involving the entire marginal or papillary gingival
unit.

63. •3 = Moderate inflammation; glazing,
redness edema and / or hypertrophy of
the marginal or papillary gingival unit.
•4 = Severe inflammation; marked
redness, edema and / or hypertrophy of
the marginal or papillary gingival unit,
spontaneous bleeding congestion or
ulceration.

64. PAPILLARY MARGINAL ATTACHMENT
INDEX (PMA) INDEX
•Developed by Maury Massler and Schour. –
1944 - 1947.
•Gingival unit was divided into three
component parts
1) Papillary gingivae (P)
2) Marginal gingivae (M)
3) Attached gingivae (A)

65. METHOD
•Facial surface of the gingiva around the tooth
was divided into three gingival units.
•Teeth selected – Either the entire dentition or the
mandibular anteriors.
•The idea is to express the degree of gingivitis for
each unit.
•Instruments – Good lighting, mouth mirror,
explorer and ball burnisher.

66. EXPRESSION OF SCORES
•P – Involvement of the Papillary gingiva and its
severity expressed in scores from 0 to 5.
•M – Involvement of the Marginal gingiva and its
severity expressed in scores from 0 to 5.
•A – Involvement of the Attached gingiva and its
severity expressed in scores from 0 to 3.

67. SCORING CRITERIA ‘P’
0Normal;no inflammation
1+ Mild papillary engorgement;slight increase in
size.
2+ Obvious increase in size of gingival
papilla;hemorrhage on pressure.
3+ Excessive increase in size with spontaneous
hemorrhage.
4+ Necrotic papilla.
5+ Atrophy and loss of papilla(through
inflammation)

68. SCORING CRITERIA ‘M’
0 Normal;no inflammation visible.
1+ Engorgement; slight increase in size , no
bleeding.
2+ Obvious engorgement; bleeding upon
pressure.
3+ Swollen collar;spontaneous
hemorrhage;beginning infiltration into attached
gingivitis.
4+ Necrotic gingivitis.
5+ Recession of the free marginal gingiva below
the CEJ due to inflammatory changes.

69. SCORING CRITERIA ‘A’
0Normal;pale rose in colour
1+ Slight engorgement with loss of
stippling;changes in colour may or may not be
present.
2+ Obvious engorgement of attached gingiva
with marked increase in redness. Pocket
formation present.
3+ Advanced periodontitis.Deep pockets
evident.

70. CALCULATION OF THE INDEX
•Count the number of affected Papillary,
Marginal and Attached units
•P, M and A numerical values are totalled
separately,
•Added together
•Expressed as PMA index score per person.

71. USES
•In clinical trials.
•On individual patients.
•For epidemiological surveys.

72. ADVANTAGES
•The number of the gingival units affected as well
their severity of inflammation is counted.

73. DISADVANTAGES
•No attempt was made to relate the inflammatory
process to such factors as eruption gingivitis,
crowding gingivitis, and plaque accumulation.

74. SULCUS BLEEDING INDEX
(SBI)
•The Sulcus Bleeding Index (SBI) is an index for
assessment of gingival bleeding, developed by
Muhlemann H.R and Son S. in 1971.
•This index system is a modification of the
Papillary – Marginal Index (PM index) of
Muhlemann & Mazor (1958)
•The SBI is based on the evaluation of gingival
bleeding on probing, gingival contour and
gingival colour changes.

75. SCORING CRITERIA
SCORE CRITERIA
0Normal-appearing gingiva,no bleeding upon probing.
1No colour or contour changes, but bleeding on probing.
2Bleeding on probing, colour change(reddening),no
edematous contour changes.
3Bleeding on probing, colour change, mild inflammatory
edema.
4Bleeding on probing, colour change, severe
inflammatory edema.
5Spontaneous bleeding on probing, colour change, very
severe inflammatory edema with or without ulceration.

76. PAPILLARY BLEEDING INDEX
(PBI)
•Introduced by Muhlemann.H.R in 1977.
•Based on bleeding following gentle probing of the
interdental papilla.
•Blunt periodontal probe is carefully inserted into the
gingival sulcus at the base of the papilla on the mesial
aspect, then moved coronally to the papillary tip.
•Intensity of any bleeding thus provoked was recorded on
a 0 - 4 scale.

77. SCORING CRITERIA
0 No bleeding
1 A single discreet bleeding point appears.
2 Several isolated bleeding points or a single
fine line of blood appears.
3 The interdental triangle fills with blood
shortly after probing.
4 Profuse bleeding occurs after probing, blood
flows immediately into the marginal
sulcus.

78. INDICES USED FOR ASSESSMENT OF
CALCULUS
•Calculus is defined as “a deposit of inorganic salts
composed primarily of calcium carbonate and
calcium phosphate mixed with food debris, bacteria
and desquamated epithelial cells.”
•There are two main types of dental calculus, which
are differentiated primarily by location on the tooth in
relation to the free gingival margins.

79. Supragingival calculus: denotes deposits usually white to
yellowish brown in colour, found occlusal to the free
gingival margin, and visible in the oral cavity. It has a
hard, clay like consistency and is easily attached from
the tooth surface.
 
 
Subgingival calculus: denotes deposits apical to the free
gingival margin, which are usually light brown to black
in colour. Usually found in periodical pockets and is not
visible on routine oral examination

80. CALCULUS SURFACE INDEX(CSI)
•The Calculus Surface Index (CSI) was developed
by Ennever.J, Sturzenberger.C.P. And Radike
A.W in 1961
•The CSI is one of the two indices that are used in
short-term (i.e. less than 6 weeks) clinical trails of
calculus inhibitory agents. The objective of this
type of study is to determine rapidly whether a
specific agent has any effect on reducing or
preventing supra gingival and sub gingival
calculus

81. Method
•The CSI assesses the presence or absence of supra
gingival and /or sub gingival calculus on the four
mandibular incisors. The index has also been
applied to the six mandibular anterior teeth.
•The presence or absence of calculus is determined
by visual examination or by tactile examination
using a mouth mirror and a sickle-type dental
explorer.

82. •Each incisor is divided into four scoring units.
The facial (buccal/labial) surface is considered
one unit, and the lingual surface is divided
longitudinally into three subsections, the disto-
lingual third, the lingual third, and the mesio-
lingual third.
•The total number of surfaces with calculus is
considered the CSI score per person.
•The Calculus Surface Index has been shown to
have good intra examiner reproducibility and the
examination can be performed in a relatively
short period of time.

83. •Hence, using a ‘1’ to indicate the presence of
calculus and a ‘0’ the absence of calculus,the
maximum number of surfaces (scoring four
mandibular incisors) per person that could have
calculus is 16.

84. CALCULUS SURFACE SEVERTIY
INDEX (CSSI)
•The Calculus Surface Severity Index (CSSI)
was developed by ENNEVER J, et al in 1961
as a companion index to their calculus surface
index (CSI)
•The CSSI measures the quantity of calculus
present on a scale of 0 to 3 on each of the
surfaces examined for CSI .

85. The criteria for CSSI are as follows:
 
0  
                       
 No calculus present
1 
 
 
                      
Calculus observable, but less than 0.5mm in width
and /or thickness.
2 
 
 
                   
Calculus not exceeding 1.0mm in width and/or
thickness.
3 
  
 
                
Calculus exceeding 1.0mm in width and /or
thickness.

86. MARGINAL LINE CALCULUS
INDEX
•Developed by Muhlemann.H.R and Villa.P.
– 1967.
•Used in short term clinical trials of
anticalculus agents.
•Assesses the accumulation of supra gingival
calculus on the gingival third of the tooth,
along the margin of the gingiva.

87. METHOD
•Examination done on four mandibular
incisors.
•Mouth mirror, drying the tooth surfaces
with air.
•Only the cervical areas on the lingual
surfaces of the mandibular teeth.

88. 1) Cervical third is divided into a distal half and
mesial half.
2) Each half is examined for the extent of
calculus covering the surface.
3) Score on a scale of percentage is assigned
as follows:- 0, 12.5, 25, 50, 75 and 100
percent.

89. REFERENCES
•BURT AND ERKLAND – Methods in Oral
Epidemiology.
•PARK -Textbook of Preventive and Social
Medicine.
•DUNNING - Textbook on Public Health.
•SOBEN PETER – Textbook on Community
Dentistry.