SHICK AND ASH MODIFICATION OF PLAQUE CRITERIA

The original criteria of the plaque component of Ramfjord’s Periodontal Disease Index was modified by Shick R.A and Ash M.M in 1961.

The modified criteria consists of examining the six selected teeth by excluding consideration of the interproximal areas of the teeth and restricting the scoring of plaque to the gingival half of the facial and lingual surfaces of the index teeth.

SCORING SYSTEM:

Code Criteria

0 Absence of dental plaque1 Dental plaque in the interproximal areas or at the

gingival margin covering less than one third of the gingival half of the facial or lingual surface of the tooth

2 Dental plaque covering more than 1/3rd but less than 2/3rd of the gingival half of the facial or lingual surface of the tooth

3 Dental plaque covering 2/3rd or more of the gingival half of the facial and lingual surface of the tooth.

Calculation:

The plaque score per person is obtained by totalling all of the individual tooth scores and dividing by number of teeth examined.

i.e. Total Score

Number of teeth examined.

TURESKY-GILMORE-GLICKMAN MODIFICATION OF THE QUIGLEY HEIN PLAQUE INDEX

Quigley G. and Hein J in 1962, reported a plaque measurement that focussed on the gingival third of the tooth surface. They examined only the facial surfaces of the anterior teeth, using a basic fuschin mouthwash as a disclosing agent. A numerical scoring system of ‘0’ to ‘5’ was used.Turesky S., Gilmore N.D and Glickman I modified the Quigley Hein plaque index in 1970.

This modification of the Quigley Hein Plaque Index was done by strengthening the objectivity of Quigley Hein Plaque Index criteria by redefining the scores of the gingival third area. Plaque was assessed on the labial, buccal and lingual surfaces of all the teeth after using a disclosing agent.

The modified technique of scoring plaque on the labial, buccal and lingual surfaces provides as comprehensive method for evaluating anti plaque procedures such as tooth brush and flossing as well as chemical anti plaque agents. This index emphasizes the differences in plaque accumulation in the gingival third of the tooth.

Scoring System

Code Criteria

0 No plaque.1 Separate flecks of plaque at the cervical margin of the tooth2 A thin continuous band of plaque (upto 1mm) at the

cervical margin.3 A band of plaque wider than 1 mm but covering less than

1/3rd of the crown of the tooth.4 Plaque covering atleast 1/3rd but less than 2/3rd of the crown5 Plaque covering 2/3rd or more of the crown.

UPPER

18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28

F

L

LOWER

F

L

48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38

Score =

CALCULUS SURFACE INDEX (CSI)

The Calculus Surface Index (CSI) was developed by Ennever J, Sturzenberger C.P and Radike A.W in 1961.

The CSI is one of the two indices that are used in short term (i.e. less than 6 weeks) clinical trials of calculus inhibitory agents. The objective of this study is to determine rapidly whether a specific agent has any effect on reducing or preventing supragingivak and subgingival calculus.

Method

The CSI assesses the presence or absence of supragingival and/or supragingival calculus on the four mandibular incisors. The index has also been applied to the six mandibular anterior teeth.

Each incisor is divided into four scoring units. The facial surface is considered one unit, and the lingual surface is divided longitudinally into three subsections, the distal-lingual third, the lingual third, and the mesial lingual third.

The total number of surfaces with calculus is considered the CSI score per person. The calculus surface index has been shown to have good intra examiner reproducibility and the examination can be performed in a relatively short period of time,

Hence, using a 1 to indicate the presence of calculus (and a ‘0’ the absence of calculus), the maximum number of surfaces (scoring four mandibular incisors) per person that could have calculus is 16.

F

L

42 41 31 32

CALCULUS SURFACE SEVERITY INDEX (CSSI)

The Calculus Surface Severity Index (CSSI) was developed by Ennever J et al in 1961 as a companion index to their Calculus Surface index (CSI).

The CSSI measures the quantity of calculus present on a scale of 0 to 3 on each of the surfaces examined for CSI.

The criteria for CSSI are as follows:

Code Criteria

0 No Calculus present1 Calculus observable but less than 0.5mm in width and/or thickness2 Calculus not exceeding 1.0mm in width and/or thickness3 Calculus exceeding 1.0mm in width and/or thickness

F

L

42 41 31 32

PERIODONTAL INDEX

The Periodontal Index (PI) was developed by Rusell A.L. in 1956. The PI was intended to estimate deeper periodontal disease by measuring the presence or absence of gingival inflammation and its severity, pocket formation and masticatory function.

The PI is probably the most widely used periodontal index in epidemiological surveys around the world. The PI is a composite index because it records both the reversible changes due to gingivitis and the more destructive and presumably irreversible changes brought by deeper periodontal disease.

Method:

All the teeth present are examined. All of the gingival tissue circumscribing each tooth (i.e. all of the tissue circumscribing a tooth is considered a scoring or gingival unit) is assessed for gingival inflammation and periodontal involvement.

Scoring Criteria:

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

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.

i.e PI Score per person = Sum of Individual Scores/ Number of teeth present

SCORE CRITERIA AND SCORING FOR FIELD STUDIES

0 NEGATIVE: there is neither overt inflammation in the investing tissues nor loss of function due to destruction of supporting tissues

1 MILD GINGIVITS: There is an overt area of inflammation in the free gingiva but this area does not circumscribe the tooth

2 GINGIVIIS: inflammation completely circumscribing the tooth, but there is no apparent break in the epithelial attachment

4 Used when radiographs are available

6 GINGIVITIS WITH POCKET FORMATION

8 ADVANCED DESTRUCTION WITH LOSS OF MASTICATORY FUNCTION

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

PI Score =

GINGIVAL INDEX

The Gingival Index (GI) was developed by Loe H and Silness J in 1963. It is developed for assessing the severity of gingivitis and its location in four possible areas.

Method:

The severity of gingivitis is scored on all surfaces of all teeth or selected teeth or on selected surfaces of all teeth or selected teeth.

The teeth selected as the index teeth are:

16- Maxillary Right First Molar

12- Maxillary Left Lateral Incisor

24- Maxillary Left First Premolar

36- Mandibular Left First Molar

32- Mandibular Left Lateral Incisor

44- Mandibular Right First Premolar

The tissues surrounding each tooth are divided into four gingival scoring units: distal facial papilla, facial margin, mesial facial papilla and entire lingual gingival margin.

Score Criteria

0 Absence of inflammation/normal gingiva

1 Mild inflammation, slight change in colour, slight edema, no bleeding on probing

2 Moderate Inflammation, Moderate glazing, redness, edema and hypertrophy, Bleeding on probing

3 Severe inflammation, marked redness and hypertrophy ulceration, spontaneous bleeding

Calculation of Index

If the scores around each tooth are totalled and divided by four, the gingival index score for the tooth is obtained. The numerical scores of the gingival index maybe associated with varying degrees of clinical gingivitis as follows:-

Gingival Scores Conditions

0.1-1.0 Mild Gingivitis

0.1-2.0 Moderate Gingivitis

2.1-3.0 Severe Gingivitis

D M

16 12 24

44 32 36

PAPILLARY-MARGINAL-ATTACHMENT INDEX (PMA INDEX)

The papillary-marginal-attachment index (PMA index) developed by Maury Massler and Schour I. in 1944 is probably the first successful attempt to design a numerical system for recording gingival health.

A gingival unit was divided into three component parts.

1. Papillary Gingivae (P)- The gingival portion between the teeth.2. Marginal Gingivae (M)- the marginal collar surrounding the teeth, and 3. Attached Gingivae (A)- the gingival portion overlying the bony alvedolar process.

The presence or absence of inflammation an each gingival unit is recorded respectively. The maxillary and mandibular incisors, canines and premolars are examined. The idea of using the PMA index is to express the degree of gingivitis for each gingival unit which is as follows:P- Involvement of the papillary gingival and its severity expressed in scores from 0 to5.M- Involvement of the marginal gingival and its severity expressed in scores from 0 to5.A- Involvement of the attached gingival and its severity to 3.

Mild gingivitis is confined to the papillary area (P)Moderate gingivitis means spread to marginal gingivae, (M)Severe gingivitis is identified by its spread to the attached gingival, (A)

Scoring Criteria :The degree of gingivitis for each gingival unit is scored as follows:‘P’ 0 Normal; no inflammation 1+ Mild papillary engorgement; slight increase in size. 2+ Obvious increase in size of gingival papilla; bleeding on pressure. 3+ Excessive increase in size with spontaneous bleeding . 4+ Necrotic papilla. 5+ Atrophy and loss of papilla ,(through inflammation)‘M’ 0 Normal; no inflammation visible. 1+ Engorgement; slight increase in size, nobleeding.

2+ Obvious engorgement; bleeding upon pressure.3+ Swollen collar ; spontaneous bleeding beginning infiltration into attached gingivae.4+ Necrotic gingivitis.5+ Recession of the free marginal gingivae below the CEJ due to inflammatory changes.

‘A’ 0 Normal; pale rose; stippled

1+ Slight engorgement with loss of stippling; changes in colour may or may not be present.2+ Obvious engorgement of attached gingivae with marked increase in redness. Pocket formation present.3+ Advanced periodontitis. Deep pockets evident.

Calculation of the Index:The number of affected Papillary, Marginal and Attached units are counted and the P,M and A numerical values are totalled separately, then added together and expressed numerically as the PMA index score per person.

15 14 13 12 11 21 22 23 24 25

MODIFIED GINGIVAL INDEX (MGI)

The Modified Gingival index (MGI, was developed by R.R. LOBENE, T. WEATHERFORD, N.M.ROSS, R.A. LAMM, AND L. MENAKER in 1986, as a modification of the Loe and Silness Gingival Index to assess the prevalence and severity of gingivitis.

Method :To obtain the MGI, the labial/facial and lingual surfaces of the gingival margins and the interdental papillae of all erupted teeth or selected teeth (same as in case of Gingival Index) are examined and scored using the following

Score Criteria

0 = Normal (absence of inflammation)

1 = Mild inflammation (slight change in color, little change in texture ) of any portion of the gingival unit

2 = Mild inflammation of the entire gingival unit

3 = Moderate inflammation (moderate glazing, redness, edema, and/or hypertrophy) of the gingival unit

4 = Severe inflammation (marked redness and edema /hypertrophy, spontaneous bleeding, or ulceration) of the gingival unit

The third molars are excluded. For a full mouth examination with 28 teeth, a maximum number of 108 gingival units (i.e, marginal and papillary) are examined and scored for gingivitis (i.e.56 marginal and 52 papillary).Again, for the MGI, the examination of gingivitis is strictly based on visual observation. There is no gentle probing or pressure to observe the presence or absence of bleeding.

Calculation :To calculate the MGI for an individual, the papillary and marginal scores are added and divided by the total number of sites (i.e, gingival units) examined.

17 16 15 14 13 12 11 21 22 23 24 25 26 27

47 46 45 44 43 42 41 31 32 33 34 35 36 37

SULCUS BLEEDING INDEX (SBI)The Sulcus Bleeding Index (SBI) is on index for assessment of gingival bleeding by Muhlemann H.R. and Son S. in 1971. This index system is a modification of the Papillary-Marginal Index (Pm index) of Muhlemann & Mazor (1958).

Method :The SBI is based on the evaluation of gingival bleeding on probing, gingival contour and gingival colour changes. Four gingival units are scored systematically for each tooth: the labial and lingual marginal gingivae (M units), and the mesial and distal papillary gingivae (P units).

Scoring Criteria :The assessment of gingival bleeding is done on a scale of 0-5 according to the following criteria : Score Criteria

0 Healthy appearance of P and M, No bleeding upon sulcus probing.

1 Apparently healthy P and M, showing no colour or contour

changes and no swelling, but bleeding from sulcus on probing.

2 Bleeding on probing and colour change caused by

Inflammation (reddening).No swelling or macroscopic edema.

3 Bleeding, on probing, change in colour, slight edematous swelling.

4 (1) Bleeding on probing, colour change, obvious swelling.

(2) Bleeding on probing and obvious swelling.

5 Spontaneous bleeding on probing, colour change, marked swelling with or without ulceration.

Calculation : Each of the four gingival units (M and P) is scored from 0 to 5 to obtain the SBI of the area. The scores for the four units are totaled and divided by four to obtain the SBI for the tooth. By totalling scores for individual teeth and number of teeth, the SBI is determined.

17 16 15 14 13 12 11 21 22 23 24 25 26 27

47 46 45 44 43 42 41 31 32 33 34 35 36 37

PAPILLARY BLEEDING INDEX (PBI):

The papillary Bleeding Index (PBI) was developed by Muhlemann H.R.as a modification of the Sulcus Bleeding Index (SBI) of Muhlemann and Son. The PBI is based on bleeding following gentle probing of the interdental papilla.

Method :The mouth is divided into quadrants, with the maxillary right and mandibular left quadrants probed lingually and the maxillary left and mandibular right quadrants probed buccally. The intensity of any bleeding thus provoked was recorded on a scale of 0 to 4.

Scoring Criteria :

Score Criteria

0 No bleeding after probing.

1 A single discreet bleeding point appears after probing.

2 Several isolated bleeding points or a single fine line of blood appears.

3 The interdental triangle fills with blood shortly after probing.

4 Profuse bleeding occurs after probing; blood flows immediately into the marginal sulcus.

Calculation: The scores are totalled and divided by the number of papilla examined.

17 16 15 14 13 12 11 21 22 23 24 25 26 27

47 46 45 44 43 42 41 31 32 33 34 35 36 37

MODIFIED SULCULAR BLEEDING INDEX

The Modified Sulcular Bleeding Index (mSBI),also known as the Modified Sulcus Bleeding Index, was developed in 1987 by A. Moblelli, M.A.Van Oasten, E. Schurch, Jr., and N.P. Land to determine the severity of gingival bleeding, a sign of inflammation that is associated with periodontal disease.A periodontal probe is used and passed along the gingival margin to provoke bleeding, and the clinical findings are recorded according to the following scores and criteria.

Score Criteria

0 No bleeding when a periodontal probe is passed along the gingival margin.

1 Isolated bleeding spots visible .

2 Blood forms a confluent red line on margin.

3 Heavy or profuse bleeding.

17 16 15 14 13 12 11 21 22 23 24 25 26 27

47 46 45 44 43 42 41 31 32 33 34 35 36 37

EASTMAN INTERDENTAL BLEEDING INDEX (EIBI)

The Eastman Interdental Bleeding Index was developed by ABRAMS, K., CATON,J, and POLSON, A., in 1984, to assess the presence of inflammation in the interdental area by the presence or absence of bleeding.

Method:The examination is done on each interdental area around the entire dentition. A triangular wooden interdental cleaner is used for this index. The wooden interdental cleaner is inserted gently into each interdental area sand removed immediately in such a way as to depress the papilla about 1to 2 mm.

Scoring :The number of bleeding sites is totaled for an individual score for comporison with scores over a series of appointments.Caldualtion :The Index score is expressed as a percentage of the total number sites evaluated. The calculations can be made for total mouth, quadrants, or maxillary versus mandibular. The EIBI for and Individual can be calculated using the formula,

EIBI = Number of bleeding area x 100Total No. of areas

17 16 15 14 13 12 11 21 22 23 24 25 26 27

47 46 45 44 43 42 41 31 32 33 34 35 36 37

PLAQUE INDEX (PI)

The plaque index was described by SILNESS P. and LOE H. in 1964 and more fully describe by LOE H in 1967.

Method :-

The evaluation or scoring is done on entire dentition (whole mouth basis)or on selected teeth (selected mouth basis) .the surfaces examined are the 4 gingival areas of the tooth that is the distal facial, facial, mesial, facial and lingual surfaces. The mouth mirror, light source, dental explorer and air drying of the teeth an gingival are used in the scoring of this index .

The six teeth that are evaluated when this index is done on selected theeth basis are ;

- Maxillary right first molar (16)

- Maxillary right lateral incisor (12)

- Maxillary left first bicuspid (24)

- Mandibular left first molar (36)

- Mandibular left lateral incisor (32)

- Mandibular right first bicuspid (44)

Procedure

The tooth is dried and examined visually. When no plaque is visible and explorer is used to test the surface.

Scoring criteria

Score criteria

0 - no plaque

1 - a film of plaque adhering to the free gingival margin and adjacent area of area 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 diposits within the gingival pockets 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 ntooth and gingival margin.

Criteria for the plaque index(loe 1967)

score criteria

0 - no plaque

1 - a film of plaque adhering to the free gingival margin and adjacent area of the tooth. Then plaque may be recognized only by running a probe across the tooth surface.

2 - moderate accumulation of soft diposits within the gingival pocket , on the gingival margin and /or adjacent tooth surface which can be seen by the naked eye .

3 - abundance of soft matter within the gingival pocket and /or on the tooth and gingival margin.

Suggested nominal scale for patient evaluation:

Rating scores

Excellent 0

Good 0.1 to 0.9

Fair 1.0 to 1.9

Poor 2.0 to 3.0

17 16 15 14 13 12 11 21 22 23 24 25 26 27

47 46 45 44 43 42 41 31 32 33 34 35 36 37

OHI (ORAL HYGIENE INDEX)

The oral hygiene index was developed in 1960 by John C.Greene and Jack R. Vermillion to

classify and assess oral hygiene status.Published in 1960, the “Oral Hygiene Index” was

depicted as a sensitive,simple method for assessing group or individual oral hygiene

quantitatively. It has wide acceptance and usage in surveys for assessing tooth brushing

efficiency and frequency and evaluating community dental health practices. The OHI is

considered a simple, rapid, and sensitive measure.

Methodology:

OHI is composed of the combined Debris Index(DI) and Calculus Index(CI) ,each of these

index is in turn based on 12 numerical determinants representing the amount of debris or

calculus found on the buccal and lingual surfaces of each of the three segments of each dental

arch.

Upper right posterior:distal to the right cuspid on the maxillary arch.

Upper anterior:mesial to the right and left first bicuspids on the maxillary arch.

Upper left posterior:distal to the left cuspid on the maxillary arch.

Lower right posterior:distal to the right cuspid on the mandibular arch.

Lower anterior:mesial to the right and left first bicuspids on the mandibular arch.

Lower left posterior:distal to the left cuspid on the mandibular arch.

Each segment is examined for debris or calculus.From each segment one tooth is used for

calculating the individual index, for that particular segment.The tooth used for the

calculation must have the greatest area covered by either debris or calculus.

Debris index(DI)

Score

0- No debris or stain present

1- Soft debris covering not more than one third of the tooth surface,AND/OR presence

of extrinsic stains without other debris regardless of surface area covered.

2- Soft debris covering more than one third but not more than two thirds of the exposed

tooth surface.

3- Soft debris covering more than two thirds of the exposed tooth surface.

Calculus Index(CI)

Score

0-No calculus present

1- Supragingival calculus covering not more than one third of the exposed tooth

surface.

2- Supragingival calculus covering more than one third but not more than two thirds of

the exposed tooth surface AND/OR the presence of individual flecks of subgingival

calculus around the cervical portion of the tooth or both.

3- Supragingival calculus covering more than two third of the exposed tooth surface

AND/OR a continous band of subgingival calculus around the cervical portion of the

tooth or both.

Calculation Example:

Oral Hygiene Index: Debris Index + Calculus Index.

DEBRIS INDEX:

Right Anterior Left Total

Buccal Lingual Labial Lingual Buccal Lingual Buccal/Labial Lingual

Upper

Lower

Total

CALCULUS INDEX:

Right Anterior Left Total

Buccal Lingual Labial Lingual Buccal Lingual Buccal/Labial Lingual

Upper

Lower

Total

CALCULUS INDEX=

SIMPLIFIED ORAL HYGIENE INDEX:

The Oral Hygiene Index was developed in 1964 by John C. Greene and Jack

R.Vermillion, the developers of oral hygiene index(OHI).The simplified oral hygiene

index differs from the original OHI in the number of the tooth surfaces scored(6 rather

than 12), the method of selecting the surfaces to be scored,and the scores, which can be

obtained.

Surfaces and teeth to be examined:

16-upper right first molar buccal surface

11-upper right central incisor labial surface

26-upper left first molar buccal surface

36-lower left first molar lingual

31-lower left central incisor labial

46-lower right first molar lingual

Examination methods and scoring system

For the OHI-S , each surface,buccal or lingual, is considered half the tooth

significance .Also only fully erupted permanent teeth are scored.Atooth is considered

fully erupted when the occlusal or incisal plane has reached the occlusal plane.

Debris-index-Simplified

Score

0- No debris or stain present

1- Soft debris not covering more than one third of the tooth surface, or presence of

extrinsic stains without other debris regardless of surface area covered.

2- Soft debris covering more than one third, but not more than two thirds, of the exposed

tooth surfaces.

3- Soft debris covering more than two thirds of the exposed tooth surfaces.

Calculus Index –simplified

Score Criteria

0-No calculus present

1-Supragingival calculus covering not more than third of the exposed tooth surface.

2-Supragingival calculus covering more than two thirds of the exposed tooth surface or

the presence individual flecks of subgingival calculus around the cervical portion of the

tooth or both.

3-Supragingival calculus covering more than two third of the exposed tooth surface or a

continuous heavy band of subgingival calculus around the cervical portion of the tooth or

both.

Calculation of the Index:

For each individual,the debris and calculus scores are totaled and divided by the number

of tooth surfaces scored.For an individual score to be calculated,at least two of the six

possible tooth surfaces must have been examined.

Once the DI-S and CI-S are calculated separately,then they are combined or added

together for the OHI-S. the DI-S and CI-S values range from 0 to 3,which can be

interpreted as:

Good - 0.0 to 0.6

Fair - 0.7 to 1.8

Poor - 1.9 to 3.0

The OHI-S value ranges from 0 to 6, which can be interpreted as :

Good - 0.0 to 1.2

Fair - 1.3 to 3.0

Poor - 3.1 to 6.0

CALCULUS INDEX:

Right Anterior Left Total

Buccal Lingual Labial Lingual Buccal Lingual Buccal/Labial Lingual

Upper

Lower

Total

CALCULUS INDEX=

DEBRIS INDEX:

Right Anterior Left Total

Buccal Lingual Labial Lingual Buccal Lingual Buccal/Labial Lingual

Upper

Lower

Total

GLASS INDEX

The Glass Index system was developed by Glass R.L. in 1965. This index assesses the

presence and extent of debris accumulation, for evaluating tooth-brushing efficacy.

METHOD

All the teeth present are examined. The surfaces examined are the facial (buccal/labial) and

lingual surfaces which are scored as a unit. The criteria for scoring debris according to the

Glass Criteria are as to follows:

Code Criteria

0 No visible debris

1 Debris visible at gingival margin but discontinuous less than 1mm

in height

2 Debris continuous at gingival margin – greater than 1mm in height

3 Debris involving entire gingival third of tooth

4 Debris generally scattered over tooth surface

CALCULATION OF GLASS INDEX SCORE

The debris index score per person is obtained by totalling all the debris scores per tooth and

then, dividing by the number of teeth examined, i.e. Debris index score per person = Total

debris scores of all teeth examined total number of teeth examined.

The Glass Criteria for scoring debris, places more emphasis on the gingival third of the tooth

than does the OHI-S and so, this index is useful in clinical trials of preventive or therapeutic

agents.

17 16 15 14 13 12 11 21 22 23 24 25 26 27

47 46 45 44 43 42 41 31 32 33 34 35 36 37

NAVY PLAQUE INDEX (NPI)

The Navy Plaque Index was developed by GROSSMAN F.D. and FEDI P.F. in 1970.

This index was designed to assess the plaque control status among naval personnels and

to measure any subsequent changes.

METHOD

The Navy Plaque Index is obtained by scoring the amount of plaque found on six selected

teeth (Index Teeth) by using a disclosing solution. The teeth examined are

16 - Maxillary Right First Molar

21 - Maxillary Left Central Incisor

24 - Maxillary Left First Premolar

36 - Mandibular Left First Molar

41 - Mandibular Right Central Incisor

44 - Mandibular Right First Premolar

The surfaces examined are the facial and lingual surfaces of each of the six teeth. The

facial and lingual surfaces are divided into three major areas, as; Gingival Area (G),

Mesial Proximal Area (M) and Distal Proximal Area (D).

Area M (Mesial Proximal) = 3

Area G (Gingival) = 2

Area D (Distal Proximal) = 3

When plaque is found not in contact with gingival tissue but is found on any tooth

surface, one point is added to the facial or lingual score.

CALCULATION OF INDEX

The highest total for any of the six teeth scored is the patient’s Navy Plaque Index score.

Scores of all teeth are added to give the total NPI score.

16 21 24

44 41 36

COMMUNITY PERIODONTAL INDEX OF TREATMENT NEEDS (CPITN)

The “community Periodontal Index of Treatment Needs” (CPITN) was developed for the

“joint working committee” of the “World Health Organization” and “Federation Dentaire

Internationale” (WHO/FDI) by Jukka Ainamo., David Bares., George Beagrie., Terry

Cutress., Jean Martin., and Jennifer Sardo-Infirri in 1982.

Primarily the CPITN is a screening procedure for identifying actual and potential problem

posed by periodontal periodontal diseases both in a community and by the individual. With

this information appropriate oral care services can be planned for populations and for

individuals.

PROCEDURE OF CPITN

The dentition is divided into six parts (sextant), for assessment of periodontal treatment

needs. Each sextant is given a score. For epidemiological purposes, the score is identified by

examination of specified index teeth. For clinical practice, the highest score in each sextant is

identified after examining all teeth. Essentially the CPITN considers the periodontal

treatment needs of each sextant with respect to:

i) No need for care (score 0)

ii) Bleeding gingivae on gently probing (score 1)

iii) Presence of calculus and other plaque retentive factors (score 2)

iv) Presence of 4 or 5mm pockets (score 3)

v) Presence of 6mm or deeper pockets (score 4)

SEXTANT

The mouth is divided into six sextant defined by tooth numbers as shown below:

17-14 13-23 24-27

47-44 43-33 34-37

The third molars are not included, except where they are functioning in place of second

molars.

The treatment need in a sextant is recorded only if there are two or more teeth present and not

indicated for extraction. When only one tooth remains in a sextant, it is included in the

adjacent sextant.

INDEX TEETH

In epidemiological surveys assessing the periodontal treatment needs of a population, the

recording per sextant are based on findings form specified index teeth.

In epidemiological surveys for adults, aged 20 years or more, only tent teeth, known as the

‘Index Teeth’ are examined. These teeth have been identified as the best estimators of the

worst periodontal condition of the mouth. The specified index teeth are:

17 16 11 26 27

47 46 31 36 37

17 - Maxillary Right Second Molar

16 - Maxillary Right First Molar

11 - Maxillary Right Central Incisor

26 - Maxillary Left First Molar

27 - Maxillary Left Second Molar

37 - Mandibular Left Second Molar

36 - Mandibular Left First Molar

31 - Mandibular Left Central Incisor

46 - Mandibular Right First Molar

47 – Mandibular Right Second Molar

The molar are examined in pairs and only one score, the highest is recorded. Only one score

is recorded for each sextant.

For young people upto 19 ears only six ‘Index Teeth’ are examined. The second molars are

excluded as Index Teeth at these ages because of the high frequency of false (non-

inflammatory, associated with tooth eruption) pockets. The six ‘Index Teeth’ selected are:

16 11 26

46 31 36

For scoring and monitoring purposes in dental practice all teeth in a sextant are examined for

adults over age 19 years. Only one score, the highest is recorded for each sextant.

When examining children less than 15 years pockets are not recorded although probing for

bleeding and calculus are carried out as a routine.

For use in a clinical setting, all teeth are examined per sextant and the CPITN recording is

based on the worst finding from all teeth in that sextant. This method is also suitable for adult

populations with a history of high caries prevalence and extensive restorative treatment

(Ainamo, Barmes, Beagrie, Cutress, Martin and Sardo-Infirri, 1982). In contrast, research

states that full mouth examination based on sextant that full mouth examination based on

sextant has little advantage over partial examination of the index teeth for age groups up to 20

years (Ainamo, Barmes, Beagrie, Cutress, Martin and Sardo-Infirri, 1982).

The following ‘box chart’ is recommended as the epidemiological and dental office chart for

recording CPITN data