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Dental Indices

Used for recording oral diseases in children mainly dental caries, periodontal diseases, fluorosis and malocclusion
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Diagnosis of dental caries

According to WHO : ‘’diagnosis of dental caries should be made when a lesion in pit and fissure or on a free smooth surface has: detectably softened floor, undermined enamel or softened wall , or the tooth has a temporary filling. Where any doubt exists, caries should not be recorded as present ‘’

Diagnosis is made with a sharp sickle- shaped probe.

Another method of caries diagnosis is white or chalky spots , discolored or rough areas , and fissures or pits in enamel in which the probe sticks.

Methods used to detected dental caries :

• Visual.
• Tactile.
• Radiography.
• Transillumination(fiber-optic light).

Indices of Dental caries

the main dental caries indices may be divided into three groups:

• Indices which classify disease according to sites at risk.

• Indices which classify disease according to teeth at risk.
• Indices which classify disease according to severity.

Indices of Dental caries

the main dental indices used for measuring dental caries are:
• DMF Index of Klein and Palmer (1938).
• def Index of Gruebbel (1944).
• dmf Index of Jackson (1950).
• df index
• Index of Stones and Lauton (1948).
• Index of Slack et al (1958).
• PUFA caries index

DMFT Index

Also Known as Klein and Palmer index in 1938.
Measure the surface caries, incidence not severity.
Only permanent teeth ,28 teeth are included, 3rd molar excluded.
D=decayed, M=Missing, F=Filled.
For a community, Sum of D+M+F of individuals/ number of individual.


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Features of DMFT

Tooth is counted only once
Decayed, missing and filled teeth should be recorded separately
Recurrent caries is also counted as decay
Extraction indicated teeth are included in missing
Many restoration is counted as one score
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DMFT Index

The components are:
D component: Used to describe (Decayed teeth)which include:

1-Carious tooth.

2-Filled tooth with recurrent decay.
3-Only the root are left.
4-Defect filling with caries.
5-Temporary filling.
6-Filled tooth surface with other surface decayed.
7-Deciduous teeth are not included in DMFT count


DMFT Index

M component: Used to describe (missing teeth due to caries) other cases should be excluded these are:
1-Tooth that extracted for reasons other than caries
should be excluded, which include:
a-Orthodontic treatment.
b-Impaction.
c-Periodontal disease.
2- Unerupted teeth.
3- Congenitally missing
4- Avlsion teeth due to trauma or accident.

DMFT Index

F component: Used to describe (Filling teeth)which include:

• Filled teeth due to caries without recurrent caries.

• A tooth with a crown placed because of previous decay.
• Fissure sealant and other Preventive filling should be excluded.
• Composite filling or crown due to Trauma (fracture) should be excluded.



The maximum number for an individual
DMFT score is 28 or 32 , if the wisdom teeth are included.
The minimum score = Zero.

Calculation of DMFT :

1-For individual sum D,M,and F , DMF = D + M + F

2-For population Mean DMF =Total DMF / Total No. of the subjects examined.

For example for an individual has 3 decayed teeth , 2 teeth are missing & 5 teeth fillings.
DMFT score 3 + 2+ 5 =10

Limitations

DMFT values are not related to the number of teeth at risk
Can be invalid in older patients because teeth can become lost for reasons other than 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
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Decayed missing filled surface index (DMFS)

the DMFS index provides a finer measurement of caries of each tooth ( measure severity) . Each tooth was recorded scored as 4 surfaces for anterior teeth and 5 surfaces for posterior teeth.
Retained root was recorded as 4 D for anterior teeth, 5 D for posterior teeth.
Missing tooth was recorded as 4 M for anterior teeth, 5 M for posterior teeth.
Tooth with crown was recorded as 4 F for anterior teeth, 5 F for posterior teeth.


Total surface count for a DMFS Index
if 28 teeth are examined ( third molars are excluded ):
16 posterior teeth (16×5)=80 surfaces
12 anterior teeth (12×4)=48 surfaces
total = 128
if third molars are included : (4×5)=20surfaces
total = 148 surfaces

Individual DMFS Index:
Total number of decayed surfaces = D
Total number of missing surfaces =M
Total number of filled surfaces =F
DMFS score = D+M+F

Advantages of DMTS Index :

• The DMFS Index provides a finer measurement of caries of each tooth than DMFT index. Each tooth may score up to 5 points , one for each surface D,M,F.
• It is useful in clinical trail where detailed information is required .
• It is not as quickly saturated as that of DMFT.
Disadvantages of DMFS Index :
• It provides a little or no additional information in prevalence studies of caries extent in comparing between groups.
• Having a wider range of possible values and therefore the standard deviation and standard error of samples is greater than DMFT index.
• It is difficult to decide what score to assign to extracted teeth. Several examiners score “3” for each tooth extracted. Dunning score “4” as he thinks this is the best average (Dunning,1979).
• Proximal lesions often lead to a score of “2” as the occlusal surface is included in an adequate restoration.

Caries indices for primary teeth

def Index of Gruebbel
this index is a modification of DMFS index , it is for primary teeth.
d : decayed tooth indicated for filling
e : decayed tooth for extraction
f : filled tooth
missing tooth for any reason were not recorded ( because of difficulty for many children to distinguish between extracted teeth and naturally shed primary teeth) and because of this it may regarded as a measurement of observable dental caries prevalence .

def Index

Gruebbel AD 1944 as an equivalent index to DMF for measuring dental caries in primary dentition
d – deciduous teeth decayed indicated for filling.
e – deciduous teeth decayed indicated for extraction.
f – Indicates restored teeth without recurrent decay.

Missing teeth for any reasons are not recorded.

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dmf index by Jackson.

In order to count the number of teeth that are lost due to caries
Problem is to know whether the missing tooth is due to caries or normally exfoliated.
Jackson suggest:
For full mouth :3-5.
For molars : 3-8.
WHO recommended that missing teeth are disregarded after 9 years of age only recorded as missing under this age if normal shed would not be sufficient explanation for absence.
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Stone’s Index

Introduced by HH Stone, FE Lawton, ER Bransby and HO Hartley in 1949
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Caries Severity Index

Tank Certrude and Storvick Clara 1960
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Mixed dentition

in case of mixed dentition , the caries indices for the permanent teeth & deciduous teeth have to be done separately . A” DMFT” or “DMFS“ & “dmft” or “dmfs” are never added together . Each child is given a separate index for permanent teeth & another for primary teeth . The index for the permanent teeth is usually determined first , & then the index for the primary teeth separately ,

Index of Stones and Lauton

This is an index of severity .Each tooth grades as follows:
1 point: one or more cavities in the same tooth, in enamel only ,diagnosed with a probe or an x- ray.
2 points : a cavity extending into dentin, but involving less than 1/4th of the crown.
3 points : over 1/4th of the crown involved.


Index of Slack et al .
This is an index of severity:
D1 : the probe “catches” in a pit or fissure , but dose not extend into dentin.
D2 : a cavity extending into dentin , , but involving less than 1/4th of the crown.
D3 : a cavity extending into dentin , , but involving over 1/4th of the crown.

PUFA caries index

The new PUFA index records the presence of severely decayed teeth with visible pulpal involvement (P/p), ulceration caused by dislocated tooth fragments (U/u), fistula (F/f) and abscess (A/a); capital letters are for permanent and small letters are for deciduous teeth.

The PUFA ⁄ pufa score per person is calculated in the same cumulative way as for the DMFT ⁄ dmft and represents the number of teeth that meet the PUFA ⁄ pufa diagnostic criteria.
The PUFA for permanent teeth and pufa for primary teeth are reported separately. Thus, for an individual person the score can range from 0 to 20 pufa for the primary dentition and from 0 to 32 PUFA for the permanent dentition.

PUFA index

fistula

abscess
Pulp exposure