31. Indices for Oral Diseases-converted

Chapter #
17
Dr.Saira
Afridi
1
Oral health problems
We want to measure an oral health problem in a
defined
community e.g;
1.We want to see what are the levels of oral
hygiene in a community
2.We want to calculate the extent of caries
3.We want to estimate the extent of periodontal
disease in a community
4.We want to measure the prevalence of oral
cancers in a community of pan/betel chewers
5.We want to measure the extent of
orthodontic malocclusions in a school
2
 For each of these oral health problems
we have different means of achieving
our target question.
 The means is the use of a diagnostic tool

called an epidemiological index
 Diagnostic tools are used to test the

probability of disease and identify the
strength of evidence.
3
Index
Definition:
 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.
(Russel AL)
 An index is an expression of clinical observation of
numerical values with upper and lower limits with
scores corresponding to specific criteria.
 The index is usually on a graduated scale with definite

upper and lower limits.
4
Objective of an index
 The use of an index in a population helps
with the measurement of the disease
prevalence and incidence thereby leading to
methods of control and prevention.
 To identify populations at high and low

risk and to define the specific problem
under study.
5
Use of oral indices
Three main uses:
 Used for epidemiological surveys
 To determine the burden of oral

disease in a community
 A tool for screening
6
Properties of an ideal index
 Clarity,simplicity and
 objectivety
Validity Specificity
 Reliability Sensitivit
 Quantifiabili y Intra-
ty examiner
 Sensitivity Inter-
 Acceptablity examiner
7
Properties of an Index
 Clarity,simplicity and objectivity:The criteria for the
index should
be simple,clear , easy to carry out and should be cost
effective.
 Validity:The index must measure what it is intended
to measure,it should correspond with clinical stages
of the disease.
 Sensitivity of a diagnostic/screening test is the ability
to correctly identify disease from a diseased
population.
 Specificity of a diagnostic test is the ability to
identify healthy people from a healthy population.
 Reliability:The index should measure consistently
at different times and under variety of conditions.
 Intra-examiner;When the same examiner uses it at 8
 Quantifiability:The index should be
open to statistical analysis so that
the status can be expressed by a
number.
 Sensitivity:The index should be able

to detect small shifts in either
direction.
 Acceptability:The index should not be

9
Selection of an index
In selecting indices,the following points
should be considered:
 Be simple to use and calculate.
 Require minimal equipment and
expense.
 Require minimal amount of time to
complete.
 Not cause patient discomfort or
unacceptable to the
patient.
 Have clear-cut and understandable
criteria.
 Be reproducible by the same examiner or
1
0
Types of Indices
1.Plaque index(Silness-Loe plaque index)
2.Oral hygiene
index 3.Gingival
index
4.Periodontal
index
Periodontal Disease
Index(PDI) Russell,s
Periodontal Index
Community Periodontal Index and Treatment
Needs(CPITN) Community Periodontal Index(CPI)
5.Dental caries indices
DMF
T
DMF
S
def
t
def
s
Ro 1
1
PLAQUE INDEX:
Quigley-Hein plaque index
 In 1962 Quigley G,Hein G reported a system
based on the gingival third of the tooth.
 They examined only the facial surfaces of the

anterior teeth by using disclosing agents
which include iodine, gentian violet,
erythrosin, basic fuchsin, fast green, food
dyes, and flourescein.
 A numerical scoring system of 0 to 5 was

used.
1
2
PLAQUE INDEX:
1. Quigley Hein Index -
(Modified by Turesky et al, 1970)
⚫ This index is the same as the Quigley Hein Index except the
criteria has been modified. As Quigley Hein Index, a score
of 0 to 5 is assigned to each facial and lingual nonrestored
surface
molars, ofas all the teeth
follows : The except third
Plaque Index
System
Scores Criteria
0 No plaque
1 Separate flecks of plaque at the cervical
margin of the tooth.
2 A thin continuos band of plaque (up to one
mm) at the cervical margin of the tooth.
3 A band of plaque wider than one mm but
covering less than one-third of the crown
of the tooth.
4 Plaque covering at least one-third but less
than two- thirds of the crown of the tooth.
5 Plaque covering two-thirds or more of the 1
3
An index for the entire mouth is determined by
dividing the total score by the number
surfaces ( a maximum of 2 x 2 x 14 = 56
surfaces) examined.
1
4
Upper jaw Buccal surface score Lingual surface
score
25 2 2
22 1 3
21 3 2
11 0 1
12 0 0
13 1 2
14 1 3
15 2 2
17 5 3
Total 15 18
1
5
Lower jaw Buccal surface score Lingual surface
score
47 4 5
44 3 5
43 2 3
42 2 3
41 2 4
31 2 3
32 0 2
33 0 2
34 0 0
Total 15 27
Index = Total score /

The number
surfaces
examined
((15 + 18) + (15
+
The index for the entire mouth
27)) / 36 = 2.1
1
is 2.1. 6
2. Silness-Löe Index -
(Silness and Löe, 1964)
 The measurement of the state of oral

hygiene by Silness-Löe plaque index is
based on recording both soft debris and
mineralized deposits on the following teeth.
 Missing teeth are not substituted.
1
7
Each of the four surfaces of the teeth (buccal, lingual, mesial
and distal) is given a score from 0-3. The scores from the four
areas of the tooth are added and divided by four in order to
give the plaque index for the tooth with the following scores
and criteria:
1
8
The Plaque Index System
Scores Criteria
0 No plaque
1 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 Moderate accumulation of soft deposit s 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 and gingival margin. 1
9
Calculation example:
⚫ The following example shows how to calculate the scores
for the index.
⚫ Assuming a tooth with the following scores on the four
Surface Scores
surfaces
Buccal 2
Lingual 1
Mesial 1
Distal 2
Plaque Index = (2+1+1+2) / 4 = 1.5,

according to the plaque index system this
means the plaque index for the tooth is
moderate accumulation of soft deposit within
the gingival pocket, or the tooth and gingival
margin which can be seen with the naked eye. 2
0
The indices for the following six teeth may be
grouped to designate the index for the group
of teeth: 16, 12, 24, 36, 32, 44.
The index for the patient is obtained by

summing the indices for all six teeth and
dividing by six.
For instance, if you have the following indices

for the teeth :
2
1
Tooth Index
Maxillary right first molar (16) 1.5
Maxillary right lateral incisor (12) 1.3
Maxillary left first bicuspid (24) 1.2
Mandibular left first molar (36) 1
Mandibular left lateral incisor (32) 1.6
Mandibular right first bicuspid 1.3

(44)
The index for patient = (1.5 + 1.3 +1.2 + 1 + 1.6 +

1.3) / 6 = 1.4
2
2
THANK YOU
2
3

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Chapter #

 The means is the use of a diagnostic tool

 Diagnostic tools are used to test the

 The index is usually on a graduated scale with definite

 To identify populations at high and low

 To determine the burden of oral

 A tool for screening

 Sensitivity:The index should be able

 Acceptability:The index should not be

 They examined only the facial surfaces of the

 A numerical scoring system of 0 to 5 was

Index = Total score /

 The measurement of the state of oral

 Missing teeth are not substituted.

1 A film of plaque adhering to the free gingival margin and

Plaque Index = (2+1+1+2) / 4 = 1.5,

The index for the patient is obtained by

For instance, if you have the following indices

Maxillary right first molar (16) 1.5

Maxillary right lateral incisor (12) 1.3

Maxillary left first bicuspid (24) 1.2

Mandibular left first molar (36) 1

Mandibular left lateral incisor (32) 1.6

Mandibular right first bicuspid 1.3

The index for patient = (1.5 + 1.3 +1.2 + 1 + 1.6 +

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