Indices of periodontal diseases
Many indicators has been used in research and clinical studies to measure the prevalence and severity of periodontal diseases.The most common or popular indices have evaluated the following parameters:
• Extent of supra-and sub- gingival plaque.• Gingival inflammation.
• Bleeding of gingiva.
• Supra- and sub-gingival calculi.
• Contour of gingiva.
• Color of gingiva.• Pocket depth.
• Tooth mobility.
• Loss of epithelial attachment measured from cemento-enamel junction.
There are four main categories in periodontal disease for which indices are needed:
Dental plaque: It is soft non mineralized, bacterial deposit formed on the tooth surface.Gingivitis: It is an inflammation of gingival tissue mainly caused by dental plaque.
Periodontitis: It is an inflammation of periodontal ligament which mainly followed untreated gingivitis.
Calculus: It is a hard deposit that forms by mineralization of dental plaque.
Indices used for plaque and debris assessment:
• Plaque Index by Löe and Silness (1964).This index measures plaque thickness.
• Six teeth are selected: 16, 12, 24, 36, 32, and 44 (FDI).• Each of the four surface of the tooth near the gingival margin is scored from “0” to “3”, then the mean score, first for each tooth, then the individual and finally the group, is calculated.
Selection of teeth and scoring:
Score criteria:
0: No plaque.1: A film of plaque adhering to the free gingival margin and adjacent area of the tooth, which cannot be seen with the naked eye. But the plaque only be recognized by using disclosing solution or by running a probe across the tooth surface.
2: Moderate accumulation of deposits within the gingival pocket, on the gingival margin and/ or adjacent tooth surface, which can be seen with the naked eye.
3: Heavy accumulation of soft matter within the gingival pocket and/ or on the tooth and gingival margin.
Calculation of plaque index
For Individual:
For Population:
II. Oral Hygiene Index (OHI) by Green and Vermillion (1960).
This index has 2 components: The debris index (DI) and the calculus index (CI).The scores for each are added to give the total score for the OHI.
Selection of teeth and scoring:
The mouth is scored in 6 segments: Anterior and right and left posterior in each jaw.The teeth are examined buccally and lingually in each segment, giving 12 scores in all.
The score for the buccal of an entire segment is the highest score for the buccal surface of an individual tooth in that segment.
The lingual surface scored similarly and not necessarily be on the same tooth.
Criteria of DI:
(debris is removed with the aid of the probe along the tooth).0 :No debris or stain.
1: Soft debris covering up to 1/3rd of the tooth surface or the presence of extrinsic stains without debris regardless of surface area covered.2: Soft debris covering 1/3rd - 2/3rd of the tooth surface.
3: Soft debris covering over 2/3rd of the tooth surface.III. Oral Hygiene Index simplified (OHI - S) by Green and Vermillion (1964):
This index was devised because the OHI was found to be very time consuming as all teeth to be examined .This index has 2 components:
the debris index simplified (DI-S) and the calculus index simplified (CI-S).
The scores for each added to give the total score for the OHI-S.
Selection of teeth and Scoring:
The surface examined are the buccal surface of 16, and 26, the lingual surface of 36 and 46, and the labial surface of 11 and 31 (FDI).
The DI-S for individual is calculated by dividing the total score by the number of surface examined which gives a range of 0-3.
Criteria of DI-S: The same as DI.
0: No debris or stain.
1: Soft debris covering up to 1/3rd of the tooth surface or the presence of extrinsic stains without debris regardless of surface area covered.
2: Soft debris covering 1/3rd – 2/3rd of the tooth surface.
3: Soft debris covering over 2/3rd of the tooth surface.
IV. Patients Hygiene Performance Index by Podshadley and Haley (1968).
This index was the first developed for the purpose of assessing an individual performance in removing debris after tooth brushing instruction.
Selection of teeth and Scoring:
Same as OHI-S index teeth. The surface examined are the buccal surface of 16, and 26, the lingual surface of 36 and 46, and the labial surface of 11 and 31.The scoring is preceded by use of a disclosing agent (tablet or solution).
The tooth is divided into five areas: Three longitudinal thirds (distal, middle, mesial) with the middle third subdivided horizontally into (incisal, middle, gingival thirds).
The assess of debris presence or absence is 1 or 0.
Calculation of score:The patient hygiene performance index score per person is obtained by totaling the five subdivision scores of each teeth surface and dividing the total by the number of tooth surface examined.
Advantages of Patients Hygiene Performance Index
• Patients Hygiene Performance Index is relatively more sensitive than OHI-S because it divides each tooth surface into five areas.
• It can be used in group studies of dental health education.
• Its chief value lies in its application as an education aid.
V. WHO System (1977):
This is a simple prevalence index. That teeth are not dried or stained, and no probe is used.Selection of teeth and scoring:
The mouth is divided into 6 segments: posterior right and left, and anterior, in each jaw.All surface are examined; each segment is scored as one unit. The maximum score for an individual is 6.
Criteria of WHO system:
0: no soft deposit visible
1: any soft deposit on any surface clearly visible by the naked eye.
Indices for measurement of calculus
I. Oral Hygiene index (OHI) by Greene and Vermillion (1960) Calculus index.Selection of teeth and scoring:
The same as DI.The mouth is scored in 6 segments: Anterior and right and left posterior in each jaw.
The teeth are examined buccally and lingually in each segment, giving 12 scores in all.
The score for the buccal of an entire segment is the highest score for the buccal surface of an individual tooth in that segment.
The lingual surface scored similarly and not necessarily be on the same tooth.
Criteria of CI:
0: no calculus.
1: supra gingival calculus covering not more than 1/3rd of surface.
2: supra gingival calculus covering 1/3rd – 2/3rd of surface or flecks of sub gingival calculus.
3: supra gingival calculus covering 2/3rd of surface or continuous heavy blend of sub gingival calculus.
II. Oral Hygiene Index-Simplified (OHI-S) by Greene and Vermillion (1964) Calculus index.
Selection of teeth and scoring:The same as DI-S. The surface examined are the buccal surface of 16, and 26, the lingual surface of 36 and 46, and the labial surface of 11 and 31.
Criteria of CI- S:
The same as CI.0: no calculus.
1: supra gingival calculus covering not more than 1/3rd of surface.
2: supra gingival calculus covering 1/3rd – 2/3rd of surface or flecks of subgingival calculus.
3: supra gingival calculus covering 2/3rd of surface or continuous heavy blend of sub gingival calculus.
III. Calculus Surface Index (CSI) BY Sturzenberger and Radike (1961).
Selection of teeth and scoring:Teeth selected are 31, 32, 41, 42 (FDI).
All surfaces of each tooth are examined, therefore the maximum score is 16.
Criteria:0: no calculus present on surface.
1: any calculus present on surface.
IV. Ramfjord periodontal disease index- calculus component (1959):
• Selection of teeth and scoring:Only six selected teeth are scored for assessment of the periodontal status of the mouth; 16, 21, 24, 36, 41 and 44 (FDI).
6 1 4
4 1 6
The score for an individual is the total score divided by number of teeth.
There is no substitution for missing teeth.Criteria
C 0: no calculusC 1: supra gingival calculus extending not more than 1 mm below gingival margin.
C 2: moderate amount of supra gingival and sub gingival calculus or sub gingival calculus alone.
C 3: heavy accumulation of both supra and sub gingival calculus.
V. WHO System (1977):
Selection of teeth and scoring :The mouth is divided into 6 segments posterior right and left, and anterior in each jaw.
All surfaces are examined each segment is scored as one unit. The maximum score for an individual is 6.
Criteria :
0: if the deposit is soft, or there is no suspected calculus.
1: if there is calculus clearly present on visual examination on at least one tooth in the segment .
If a deposit is suspected of being calcified, a probe may be used to confirm this.
VI. Calculus surface Severity index (CSSI) by Ennever et al. (1961).
Selection of teeth and scoring:
Same as Calculus Surface Index CSI.
Criteria:
0: no calculus.1: less than 0.5 mm width thickness of calculus.
2: 0.5-1mm width thickness of calculus.
3: over 1mm thickness of calculus.