Oral Indices

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Oral Epidemiology


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Community Periodontal

Treatment Needs Purpose : to provide an epidemiological measure of the treatmentrequired to control and reduce the prevalence of periodontaldisease.

Assessment is based on the evaluation of the specified indexteeth for:

1. gingival inflammation2. depth of periodontal pockets To determine the treatment need profile for a population , the

following age groups are considered:1. 15-19 yrs2. 20-29 yrs

3. 30-44 yrs4. 45-64 yrs


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Identification of

Priority GroupsThe age of the subject at the time of examination, togetherwith the CPI recording, should give sufficient information forclassification of the subject in an appropriate treatmentpriority group.

The order of priority might be, for example as follows;

1, Young patient with deep pockets

2. Young patient with moderate pockets

3. Adult patient with deep pockets

4. Young patient with gingival bleeding.5. Adult patient with moderate pockets.

6. Adult patient with dental calculus and gingival bleeding.


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CPITN Probes :

Two types :1. Epidemiological probe2. Clinical probe

Epidemiological Probe :

The probe has black band markings from 3.5mm to 5.5 mm and having a 0.5 mm diameterball at its tip.

0.5 mm diameter

3.5mm5.5mm


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CPITN Indicators Three indicators of periodontal status areused for this assessment:

1. Presence or absence of gingival bleeding.2. Supra or subgingival calculus.

3. Periodontal pockets subdivided into :

a. Shallow ( 4-5 mm )

b. Deep ( 6 mm or more )


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Principles 1. Last molar should not be included in CPITN. 2. The mouth is divided into sextant. 3. If second molar is removed and third molar is shifted to

second molars position then it can be included for

recording. 4. The teeth which are indicated for extraction should not

be included. 5. Vertical mobility of the tooth with discomfort due to

periodontal disease should not be included.

6. In one segment if only one tooth is there then it shouldbe included in the next segment. 7. Two or more teeth should be there in the segment for

the study purpose.


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Index Teeth For adults aged 20 years and over , the teeth to beexamined are :

17 16 11 26 2747 46 31 36 37

For young people up to the age of 19 years , only six teethare to be examined.16 11 2646 31 36

This modification is made in order to avoid classifying thedeepened crevices associated with eruption as periodontal

pockets. For the same reason, when examining childrenunder the age of 15 , recording for pocket should not beattempted , only bleeding and calculus should be considered.


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Probing Pockets :

The probing force should not be more than 20gms. A practical test for establishing this force isto place the probe point under the thumb nail andpress until blanching occur.

For sensing subgingival calculus , the lightest

possible force that will allow movement of theprobe ballpoint along the tooth surface should beused.

When inserting the probe , the ballpoint shouldfollow the anatomical configuration of the surface

of the tooth root. If the patient feels pain duringprobing , this indicates the use of too much force.


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Codes for Treatment

Needs Code 4 : pocket 6mm or more , when black area of the probecannot be seen.

Note : A recording of 4mm , theres no need to record thepresence or absence of calculus , and gingivalbleeding.

Code 3 : pocket 4 or 5 mm when gingival margin is on theblack area of the probe.Note : No need to examine for calculus and gingival bleeding.

Code 2 : calculus present , either seen or felt during theprobing.

Note : No need to examine for gingival bleeding. Code 1 : bleeding observed during or after probing.

Note : Gingivae of the designated tooth should be inspected forbleeding before the examinee is allowed to swallow or close hismouth. At times bleeding may occur only 10 -30 secs. after probing.

Code 0 : Healthy tissue


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UTILIZATION OF CPI RECORDINGThe CPI is designed for rapid recording of the level of

periodontal treatment needs in population surveys. Average severityscores would in most population be fairly well assessed by examination

of the designated index teeth.The CPI does not measure past periodontal disease experience.

For Example, recession of the gingival margin of the alveolar bone isin most cases the same after treatment and although of interest indetermination of periodontal status it does not indicate an actualtreatment need.

The time to complete a CPI assessment for the six segmentsshould not exceed 2-3 minutes. The following samples illustrate andexplain several assessments using the CPI.

Case No.1

4 2 3

2 2


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DENTAL FLUOROSIS

INDEXMottled enamel (Dental Fluorosis) is a defect of the crown portion of

the teeth brought about as a result of the ingestion of excessiveamount of fluoride in the dinking water during the early formative yearof a child, specifically during the process of tooth development.

GROSS MANIFESTATIONS OF FLOURISIS HAVE BEEN CLASSIFIED INTO:

Questionable- cases which may suggest some doubt as whether toclassify as normal early traces of mottling. These are represented byslight aberrations in the translucency of normal enamel, in the form ofwhite flecks or occasional white spots some 1 to 2 mm in diameter.


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Very mild- cases showing small opaque paper white areas scatteredirregular over less than 25% of the tooth surfaces. In addition,cusps tips of the 6 years molar show small pitted white areas.

Mild- cases where greater part of the tooth at least half of thetooth surfaces are involved. Generally, the surfaces of molars and

bicuspids show thin white layers worn off and the bluish shades ofunderlying normal enamel. Occasionally, light brown or yellowishbrown stains are apparent, generally on the upper incisors.

Moderate- cases which manifest characteristics of mild type; in

addition, however there is minute pitting on the labial and buccalsurfaces of the teeth. Stains are most often seen ranging from lightbrown to tan and chocolate color, or almost half of the labialsurfaces and buccal surfaces.


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Medium : When 50% or more, are mild or worse, but less than 35%

are moderate or worse.

RatherMarked : When 35% or more, but less than 50% are moderately

severe or worse.

Marked : When 50% or more moderate or worse, but less than 35%are moderately severe or worse.

Very

Marked : When 35% or worse are classified as moderately severeor worse.


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Dental Caries Index DMFT and DMFS Indexes

Scoring:1. Based on 28 permanent teeth only2. Not included are third molars , unerupted, congenitally missing ,

supernumerary or retained primary teeth.D Recordings :1. Used for restorable , decayed permanent teeth( or surfaces )

2. When both dental caries and a restoration are present , the toothis listed as D3. The D refers to the morbidity of the disease and represents

treatment needsM Recordings1. Teeth ( or surfaces) missing or indicated for extraction due to

caries only are assigned M

2. M refers to the mortality or fatality of the disease.F Recordings1. Restored ( filled) teeth (surfaces) are listed as F2. Used only for restorative work that is an outcome of carious

lesions.3. Tooth with a defective filling but without evidence of dental

caries is recorded as F.


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Prevalence of Dental caries/Periodontal disease

no. of persons w/ 1 or more DMF or w/periodontal disease._______________________________________________x 100

total number of persons examined

Dental caries DMFT = Total D,M, F

No. of persons examined

% component of D,M,F :D = D x100

DMF

M = M x100DMF

F = F x100DMF

COMPUTATION/ANALYSIS


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ra yg ene n ex- mp e(OHI-S) (Greene and

Vermillion) 2 Components :Debris IndexCalculus Index

Index teeth :16 /11/2646/31/36

In the posterior of the dentition, the first erupted tooth distal tothe second bicuspid, usually the first molar but sometimes thesecond or third molar , is examined if the first molar is missing.

In the anterior portion of the mouth , the labial surface of the upperright and the lower left central incisors are scored. In the

absence of either of these anterior teeth , the central incisor ofthe opposite side of the midline is substituted.


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Calculus Index Types of Calculus :

1. Supragingival calculus deposits usually white to yellowish brown in color coronal to free gingival margin.2. Subgingival calculus deposits apical to the free gingival margin. These

deposits usually are light brown to black in color because of theinclusion of blood pigments.

Scores and Criteria :0 No calculus.

1 Supra gingival calculus covering less than 1/3rd of the exposedtooth surface

2 Supra gingival calculus covering more than 1/3rd but less than2/3rd of the exposed tooth surface or individual isolated flakesof subgingival calculus or both.

3 Supra gingival calculus covering more than 2/3rd of the exposed

tooth surface , or subgingival continuous band of calculus aroundthe neck of the tooth or both.


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Debris Index Debris oral debris is the soft foreign matter loosely attached to the

teeth. It consists of mucin , bacteria and food and varies in color fromgrayish white to green orange. Scores and Criteria :

0 No soft debris1 - Soft debris covering less than 1/3rd of the exposed tooth surface or

presence of extrinsic stains regardless of the tooth surface areacovered or both.

2 - Soft debris covering more than 1/3rd

and less than 2/3rd

of the exposedtooth surface.3 - Soft debris covering more than 2/3rd of the exposed tooth surface.

Total Debris Scores of all surfacesDebris Index = No. of Surfaces Examined

Interpretation of the Debris Index :

Good - 0.0 - 0.6Fair - 0.7 - 1.8Poor - 1.9 - 3.0


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Oral Hygiene Index (OHI-S)

Individual OHI = CI + DI where CI = Total calculus score

total # of teeth examined DI = Total debris score total # of teeth examined

Community OHI = Total OHI scores total persons examined

Oral Hygiene Status : Good - 0.0 - 1.2 Fair - 1.3 - 3.0 Poor - 3.1 - 6.0


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Russells Periodontal

Index Purpose :1. To assess and score the periodontalstatus of population in epidemiologic

studies.2. It is best known for diagnosis andrecording of periodontal diseases. Gingivaltissues around each tooth , is scorednumerically according to the clinicalcondition.


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Scores and Criteria 0 Negative - there is neither overt norinflammation in the investing tissues nor lossof function due to destruction of supportingtissues.

1 - Very Mild - there is an overt area ofinflammation in the free gingiva , but thisarea does not circumscribe the tooth.

2 - Mild - Gingival inflammation completely

circumscribes the tooth , but there is noapparent break in the epithelial attachment, 6 - Early - With pocket formation. The

epithelial attachment has been broken andthere is pocket. There is no interferencewith normal mastication the tooth is firm andhas not drifted.

8 Advanced Destruction with loss ofmasticatory function . The tooth may beloose, drifted , may sound dull on percussion

with a metallic instrument or may bedepressible in its socket.

Radiographic appearance is essentiallynormal

There is horizontal periodontitis , bone lossinvolving up to of the length of the root.

Advanced bone loss involving more than ofthe length of the root or definite infra-bonypocket with widening of periodontal ligament.

there may be root resorption or rarefactionat the apex.


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Rule : if in doubt assign a lesser score.

Russell chose the scoring values (0,1,6,8) inorder to relate the stages of the diseasescore in an epidemiological survey to theclinical conditions observed , thus the jumpfrom 2-6 in the scale , to recognize the

changes in disease condition from severegingivitis to an overt destructiveperiodontal diseases with obvious loss ofattachment.


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Grading ( Russells ) 0.0 to 0.2 Clinically normal tissue reversible 0.1 to 1.0 Gingivitis Reversible 0.5 to 1.6 Incipient destructive periodontal disease

Reversible

1.6 to 5.0 Established destructive disease Irreversible 4.0 to 8.0 Terminal periodontal disease-

Irreversible.Total Scores

Periodontal Index = No. of teeth examined

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