DENTAL PUBLIC HEALTH 1 ● Assessments are based on 6 index teeth.

● The extent of plaque and debris over a tooth surface was

MODULE 9: DENTAL INDICES determined.
DENTAL INDEX 4. TURESKY, GILMORE, GLICKMAN MODIFICATION OF THE
● The main tool of epidemiological studies in dental diseases QUIGLEY HEIN PLAQUE INDEX
to measure incidence, prevalence, and severity. ● Quigley and Hein in 1962 reported a plaque measurement
● INDEX - A numerical value describing the relative status of that focused on the gingival third of the tooth surface. Only
a population on a graduated scale with definite upper and the facial surfaces of the anterior teeth were examined after
lower limits, which is designed to permit and facilitate fucshin mouthwash as a disclosing agent.
comparison with other populations classified by the same ● The Quigley - Hein plaque index was modified by Turesky,
criteria and methods. Gilmore and Glickman in 1970.
OBJECTIVES
*From the picture
1. To increase understanding of the disease process, leading
to methods of control and prevention. Most commonly used today for research
2. To discover populations at high and low risk. 0 = no plaque
3. To define the specific problem under investigation.
IDEAL PROPERTIES 1 = separate flecks of plaque
1. Clarify, simplicity and objectivity: The examiner should 2 = continuous band to 1 mm
be able to carry the rules of index in his mind. Index should
3 = >1mm and <1/3 of tooth surface
be easy to apply. The criteria should be clear and simple.
2. Validity: It should measure what it is intended to measure. 4 = >1/3 and <2/3
It should reflect the clinical stage of the disease, ex. the 5 = >2/3 of tooth covered with plaque
number of missing teeth in adults is not a valid measure of
caries activity.
3. Reliability: It should be able to measure consistently at
different times and under a variety of conditions. 5. PLAQUE INDEX
4. Reproducibility: Is the ability of the same or different ● Silness and Loe in 1964
person to use the index in the same way. ● Assesses the thickness of plaque at the cervical margin of
5. Quantifiability: The index should be amenable to the tooth closest to the gums.
statistical analysis. So that the study of groups can be ● All four surfaces are examined: distal, mesial, lingual,
expressed by a statistical measure, ex. mean and median. buccal
6. Sensitivity: The index should be able to detect reasonably Plaque Index System
small shifts, in either direction in the condition. This index is the same as the Quigley Hein Index except that the
7. Acceptability: The use of index should not be painful and criteria has been modified. As Quigley Hein Index, a score of 0 to 5
demeaning to the subject. is assigned to each facial and lingual non-restored surface of all the
USES OF DENTAL INDICES: teeth except third molars, as follows.
1. To study the oral health status of individuals and the Score Criteria
population.
2. To study prevalence and incidence of disease. 0 No plaque
3. To provide data for epidemiological studies.
1 Separate flecks of plaque at the cervical margin of the tooth
4. To provide data for research to find out etiological and
predisposing factors for the disease. 2 A thin continuous band of plaque (up to one mm) at the
5. For planning of oral health policy. cervical margin of the tooth.
6. To evaluate the effectiveness of oral health programs.
7. To evaluate the success of various preventive programs. 3 A band of plaque wider than one mm but covering less than
one-third of the crown of the tooth
INDICES USED FOR ORAL HYGIENE ASSESSMENT
1. ORAL HYGIENE INDEX 4 Plaque covering at least one-third but less than two-thirds of
● Developed in 1960 the crown of the tooth
● John C. Green and Jack R. Vermillion in order to classify
and assess oral hygiene status. 5 Plaque covering at least one-thirds or more of the crown of
the tooth
● Simple and sensitive method for assessing group or
individual oral hygiene quantitatively. *From the picture
● It is composed of 2 components: As the index for the entire mouth is determined by dividing the total
- Debris Index (DI) score by the number of surfaces (a maximum of 2 x 2 x 14 = 56
- Calculus Index (CI) surfaces) examined.
2. 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 examined
3. PATIENT HYGIENE PERFORMANCE
● Introduced by Podshadley A. G. and Haley J.V. in 1968
INDEX Interpretation:
Total score / The number of surfaces examined • minimum score: 0
((15 + 18) + (15 + 27)) / 36 = 2.1 • maximum score: 8
GINGIVAL AND PERIODONTAL DISEASE INDICES • The higher the score, the more marked the periodontal disease.
1. GINGIVAL INDEX
RUSSEL’S SCORE CRITERIA FOR FIELD STUDIES
Developed by Loe H and Silness J in 1963
● One of the most widely accepted and used gingival indices. 0 negative Obvious inflammation in the gingival
● Assess the severity of gingivitis and its location in 4 epithelium or loss of function
possible areas: mesial, lingual, distal, facial
1 mild gingivitis Obvious area if the inflammation in the free
● Only qualitative changes are assessed. gingiva, but this area does not circumscribe
Gingival Assesses severity of gingivitis based on Loe and the tooth
Index (GI) Silness (color + consistency + bleeding)
2 gingivitis Inflammation completely circumscribe the
0 Normal tooth there is no apparent break in the
epithelium attachment
1 Mild inflam, slight color change and edema, no bleeding
6 gingivitis with pocket Epithelial attachment has been broken and
formation there is a pocket. There is no interference in
2 Moderate inflam, redness, edema, bleeds on probing masticatory function

3 Severe inflam, marked redness and edema, ulceration, 8 advance destruction The tooth maybe loose, may have drifted,
spontaneous bleeding with loss of masticatory may sound dull on percussion with a
function metallic instrument, or maybe depressible in
its socket.
2. MODIFIED GINGIVAL INDEX
• Developed by Lobene, Weatherford. Ross, Lamm and
Menaker in 1986. 4. CPITN (Community Periodontal Index of Treatment Needs)
● Assess the prevalence and severity of gingivitis. The community periodontal Index of treatment needs was developed
● based on a non-invasive approach i.e. visual examination by the joint working committee of the WHO and FDI in 1982.
only without any probing. ● "Developed primarily to survey and evaluate periodontal
● To obtain MGI, labial and lingual surfaces of the gingival treatment needs rather than determining past and present
margins and the interdental papilla of all erupted teeth periodontal status i.e. recession of the gingival margin and
except 3rd molars are examined and scored alveolar bone.”
● Treatment needs implies that the CPITN assesses only
Modified Gingival Modified to be more sensitive in the portion
Index lower Index of the scale, and to be non-invasive, excludes
those conditions potentially responsive to treatment, but not
(MGI) Lobene bleeding non treatable or irreversible conditions.
CARIES INDICES
0 Normal, no inflammation 1. DMFT
● Developed to determine the prevalence of coronal carles.
1 Localized mild inflammation
● Is a simple, rapid,versatile, universally accepted and widely
2 Generalized mild inflammation used index for several decades.
● "It is used to determine total dental caries experience past
3 Moderate inflammation and previous.
● The DMFT Index is an irreversible index (meaning that it
4 Severe inflammation
measures total lifetime caries experience)
● "The tooth either remains decayed or if treated, it is
3. PERIODONTAL INDEX extracted or filled.
● Developed by Rusell Al in 1956. 2. DMF
● "It was once widely used in epidemiological surveys but not ● All third molars are included.
used much now because of the introduction of new ● Temporary restorations are considered as decayed
periodontal indices and refinement of criteria”. ● Only, carious cavities are considered as 'D', the initial
● The PI is reported to be useful among large populations, lesions (Chalky spots, stained fissures, etc.) are not
but it is of limited use for individuals or small groups. All the considered as 'D'.
teeth are examined in this index. ● The DMF Index can be applied to denote the number of
● Russell chose the scoring values as 0,1,2,6,8 in order to affected teeth (DMFT) or to measure the surfaces affected
relate the stage of the disease in an epidemiological survey by dental caries (DMFS).
to the clinical conditions observed. D+M+F
● The Russell's rule states that "when in doubt assign the --------------------------------------- x 100
lower score”. Total # of teeth present
Scoring: Where in:
(1) Each tooth is scored separately according to the following criteria. D = Decayed teeth indicates for extraction
(2) Rule: When in doubt, assign the lower score. M = Missing tooth
Individual score = AVERAGE (scores for all of the teeth in the F = Filled tooth
mouth)
Population score = AVERAGE(individual scores in population
Types Measurements Administr Recommendatio
examined)
 Teeth examined: 2 methods of selection:
of ations n and comment
Indices (1) sextants: 14 teeth on the maxilla and 14 teeth on the
mandible, divided into 3 segments on each
DMF Adult Decay, missing Intraoral - DMFS may be (1a) FDI notation maxilla:
(decay caries and filled teeth exam with more useful in (1) 17, 16, 15, 14;
missing mirror and some
field) explorer circumstances (2) 13, 12, 11, 21, 22, 23;
-Individuals (3) 24, 25, 26, 27
components can (1b) FDI notation mandible:
be manipulated
and provided (4) 47, 46, 45, 44;
insight into past (5) 43, 42, 41, 31, 32, 33;
and present caries (6) 34, 35, 36, 37
experience
(1c): Third molars are not used unless they function in place of the
RCI Root Attach rate of Intraoral More recent second molars
(root caries caries on exam and modifications
caries exposed root explorer include
index) surface classification for
recurrent decay

3. deft, defs
● The caries indices used for primary dentition are deft' index
and 'defs’ index equivalent to the DMFT and DMFS indices
used for permanent dentition
Formula:
d+e+f
—----------------------- x 100
Total # of teeth present
Where in:
d = decayed teeth indicated for extraction
(2) use of index teeth: 5 teeth on the maxilla and 5 teeth on the
e = exfoliation
mandible
f = filled tooth
(2a) FDI notation maxilla:
Community Periodontal Index and Treatment Needs
(1) 17, 16;
● "was introduced by WHO and FDI in 1982. In this procedure
(2) 11;
the mouth is divided into sextants and has one tooth
(3) 26, 27
representing the index tooth. The examination is done with
(2b) FDI notation mandible:
the use of periodontal probes and recorded readings.
(4) 47, 46;
Based on the readings there is a corresponding treatment.
(5) 31;
● Uses periodontal probe
(6) 36, 37
Link:
CODE INTERPRETATION
Basic technique: https://youtu.be/RVEn2zrtan4
Code 0:
The color of the probe remains completely visible in the deepest
crevice of the sextant. There is no calculus of defective margins
detected. The gingival tissues are healthy with no bleeding after
gentle probing.

RECORDING OF CPITN
● This is done for 16 years old and above using the four first
molars in the oral cavity and any of the two Incisors of upper
and lower arch and this are called as INDEX TOOTH. In
absence of first molar you can make use of the second Code 1:
molar The colored area of the probe remains completely visible in the
● Code 0-4 is use for adult patients ages 16 and above deepest probing depth in the sextant. There is no calculus or
● Code 0-2 is use for young patients ages 11-15 since defective margins detected. However, there is bleeding after
probing is not to be done at this age probing.
● Code 9 is use for young patients ages 10 and below
● Code X is use if there is only 2 or less than 2 teeth presentin
a sextant
CPITN PROBING
The Community Periodontal Index of Treatment Needs (CPITN) is
an epidemiologic tool developed by the World Health Organization Code 2:
(WHO) for the evaluation of periodontal disease in population The colored area of the probe remains completely visible in the
surveys. It can be used to recommend the kind of treatment needed deepest probing depth in the sextant. Supragingival or subgingival
to prevent periodontal disease. calculus and/or defective margins are detected.
 3 Shallow pockets up to 5mm OHI and debridement
Gingival margin is on black area of
probe

4 Deeper pockets from 6 mm OHI, calculus, and

Black area of probe not visible complex treatment
Code 3: Severe recession (3.5mm)
Furcation involvement
The colored area of the probe remains partly visible in the deepest Mobility
probing depth in the sextant. Mucogingival problems

Code 4:
The colored area of probe completely disappears indicating a
probing depth of greater than 5.5 mm

TREATMENT RECOMMENDATION:
maximum score 0: no need for additional treatment
maximum score 1: need to improve personal oral hygiene
maximum score 2: need for professional cleaning of teeth plus
improvement in personal oral hygiene
maximum score 3: need for professional cleaning of teeth, plus
improvement in personal oral hygiene
maximum score 4: need for more complex treatment to remove
infected tissue

ADVANTAGES OF CPITN
1. It is a universal index thereby allowing international comparison of
data collected.
2. It is easy to use
3. It is useful for describing the prevalence of needs for different
treatment
4. It is readily acceptable by the patient
DISADVANTAGES OF CPITN
1. Measures several parameters (ex. Gingival bleeding, calculus,
periodontal pocket) using the same index
2. Measures treatment needs and not diseases
3. Does not measure the effectiveness of treatment
4. Recession and mobility excluded
The PSR was adapted from the CPITN
Code Condition Treatment

l0 Healthy Preventive
No pickets - entire black area of
probe visible

1 Bleeding on probing Oral hygiene

No pockets - entire black area of instruction (OHI)
probe visible

2 Calculus or iatrogenic marginal OHI and debridement

irritation
No pockets - entire black area of
probe visible