RUSSELS PERIODONTAL INDEX- periodontology

An assessment tool, named after A. L. Russell, a contemporary American dentist, that estimates the degree of periodontal disease present by measuring gingival inflammation and bone loss. It is used for measuring periodontal disease in population surveys.

1. RUSSELL’S PERIODONTAL INDEX

2. SYNOPSIS Introduction Definition of Index Ideal Requisites of an Index How to Select an Index Indices for assessing Gingival and Periodontal Disease Russell’s Periodontal Index

3. INTRODUCTION Dental index or indices are devices used to find out the incidence, prevalence and severity of the disease, based on which preventive programs can be adopted or implemented. An index is an expression of the clinical observation in a numerical value. It helps to describe the status of the individual or group with respect to a condition being measured. An index score can be more consistent and less subjective than a word description of that condition.

4. DEFINTION OF INDEX

5. ‘ 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 the same criteria and methods”. - Russell. A.L ‘Epidemiologic indices are attempts to quantitate clinical conditions on a graduated scale, thereby facilitating comparison among populations examined by the same criteria and methods. - Irving Glickman

6. IDEAL REQUISITES OF AN INDEX

7. INDEX SIMPLICITY OBJECTIVITY CLARITY RELIABILITY QUANTIFIABILITY SENSITIVITY ACCEPTABILITY

8. HOW TO SELECT AN INDEX

9. Index should be simple to use and calculate Should require minimum armamentarium and expenditure It should be strongly related numerically to the clinical stages of the specific disease under investigation It should allow examination of maximum no. of people/ subjects in a short time period. Index should not cause discomfort to the patient It should be acceptable to the patient. It should define clinical conditions objectively.

10. USES OF AN INDEX

11. Provide individual assessment to help a patient recognize an oral problem Reveal the degree of effectiveness of present oral hygiene practices Motivate the person in preventive and professional care for the elimination and control of the oral disease Evaluate the success of individual and professional treatment over a period of time by comparing index scores.

12. INDICES USED FOR ASSESSING GINGIVAL AND PERIODONTAL DISEASE

13. PAPILLARY- MARGINAL ATTACHMENT INDEX (PMA INDEX) GINGIVAL INDEX (GI) RUSSELL’S PERIODONTAL INDEX (PI) PERIODONTAL DISEASE INDX (PDI) COMMUNITY PERIODONTAL INDEX OF TREATMENT NEEDS (CPITN) COMMUNITY PERIODONTAL INDEX (CPI)

14. INDICES OF PERIODONTAL DISEASE Indices of periodontal destruction measures factors beyond gingival changes, including bone loss around the teeth. Indices have been used to estimate the periodontal health for individuals, communities and populations.

15. RUSSELL’S PERIODONTAL INDEX (PI)

16. History of Development of Russell’s Index Who developed this index? Why was this index developed? Advantages Disadvantages Instruments Used Scoring Criteria Russell’s Rule Recording Format Calculation Interpretation

17. HISTORY OF DEVELOPMENT OF RUSSELL’S INDEX

18. The first attempts to measure periodontal diseases at the population level were made in the late 1950s, using Russell’s Periodontal Index, an innovative recording system that scored the presence and severity of both gingival bleeding and pocket depth , also known as ‘composite’ indices. Russell’s Periodontal Index was simple, had clear detection criteria for each score level, was developed and tested empirically and was able to detect differences between population groups. Russell recognized the need to train examiners to minimize between-examiner differences in scoring.

19. The Russell’s Periodontal Index (PI) is a scale that assigns a numeric score to each tooth. This scale is weighted more towards the bone loss than it is towards gingival inflammation The score for each tooth is added and averaged by all teeth examined in the individual, providing a score for each person Averaging the scores of individuals determines the population score.

20. This is one of most widely used periodontal index in epidemiological surveys around the world. The Scale value ranges from 0 to 8, with increasing severity and prevalence of the disease. This is a Full Mouth Index, as it measures the patient’s entire periodontium or dentition. Russell designed and tested the Periodontal Index as an epidemiological tool in which all teeth were examined and scored using five well-distinguished categories (0, 1, 2, 6 and 8) representing incremental degrees of disease severity.

21. WHO DEVELOPED THIS INDEX?

22. The Periodontal Index was developed by Russell A.L. in 1956, over a trial period of ten years. It took a period of 10 years to develop this index, due to lack of sophisticated methodologies to assess the prevalence and severity of gingivitis and destructive periodontal disease.

23. WHY WAS THIS INDEX DEVELOPED?

24. This Index was intended to estimate deeper periodontal disease by measuring the presence or absence of gingival inflammation and its severity, pocket formation and masticatory function.

25. ADVANTAGES

26. This Index is reported to be useful among large populations This is a composite index because it records both the reversible changes due to gingivitis and the more destructive and presumably irreversible changes brought about by deeper periodontal disease. Empirically derived first index to assess periodontal disease at the epidemiological level.

27. DISADVANTAGES

28. It is only of limited use for individuals or small groups. It doesn’t indicate the degree of periodontal tissue destruction Modern understanding has shown the PI to be invalid because it does not include evaluation of Clinical Attachment Loss (CAL), grades all pockets of 3 mm or more equally and scores gingivitis and Periodontitis on the same weighted scale. The number of periodontal pockets without obvious supragingival calculus is also underestimated in the periodontal index. Due to use of only a mouth mirror, and no use of calibrated probe, there might be an underestimation of the true level of periodontal disease.

29. INSTRUMENTS USED Mouth Mirror Probe

30. METHOD FOR ASSESSMENT All the teeth present are examined All of the gingival tissue circumscribing each tooth is assessed for gingival inflammation or periodontal involvement.

31. SCORING CRITERIA Russell chose the scoring values (0,1,2,4,6,8) in order to relate the stages of the disease in an epidemiological survey to clinical conditions observed.

32. RUSSELL’S RULE Russell stated a rule that “When in doubt assign the lesser score’’.

33. RECORDING FORMAT 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38

34. CALCULATION OF THE INDEX The Periodontal Index score (PI Score) per individual is obtained by adding all of the individual scores and dividing by the number of teeth present or examined. PI score per person = Sum of individual scores Number of teeth present

35. SCORE CRITERIA ADDITIONAL RADIOGRAPHIC FEATURES NEGATIVE : There is neither overt inflammation in the investing tissues nor loss of function due to destruction of supporting tissue. Radiographic features essentially normal 1 MILD GINGIVITIS : There is an overt area of inflammation in the free gingiva, which does not circumscribe the tooth. 2 GINGIVITIS : Inflammation completely circumscribes the tooth but there is no apparent break in the epithelial attachment. 4 Used only when radiographs are available. There is early notch like resorption of the alveolar crest 6 GINGIVITIS WITH POCKET FORMATION : The epithelial attachment has been broken and there is pocket. There is no interference with normal masticatory function, the tooth is firm in its socket and has not drifted. There is horizontal bone loss involving the entire alveolar crest up to half of the length of the root 8 ADVANCED DESTRUCTION WITH LOSS OF MASTICATORY FUNCTION : The tooth may be loose; may have drifted; may sound dull on percussion with a metallic instrument ; may be depressible in its socket Advanced bone loss involving more than half of the tooth root or a definite infrabony pocket with widening of periodontal ligament. There may be root resorption or rarefaction at the apex

36. INTERPRETATION CLINICAL CONDITION INDIVIDUAL PI SCORE Clinically normal supportive tissues – 0.2 Simple gingivitis 0.3 – 0.9 Beginning destructive periodontal disease 1.0 – 1.9 Established destructive periodontal disease 2.0 – 4.9 Terminal disease 5.0 – 8.0

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