5.Gingival and periodontal indices.pdf

D.Caroline Mohamed

07/07/2013 1 D Caroline Mohamed

Outline of lecture Description of normal gingiva

Gingival index by silness and loe

OHI index simplified

CPITN index


Remembering gingiva anathomy


Characteristics of normal gingiva


Characteristics of gingivitis


How do we know there is a problem?? DIAGNOSIS

Individual complaine

Clinical examinations

Radiographic examination


Individual complaine Bleeding gums Red gums

Blood on my pilow

Bad taste

Bad smell (halitosis)

Smokers ....less bleeding


Clinical examinations

Plaque index

Gingival index

Pocket measurment

Furcation

Tooth mobility


Gingival index of loe and silness The most frequently used index for evaluating

gingivitis.

It is possible to measure

bleeding tendencies

color, contour changes of the gingiva

alternations in the consistency of tissue

and the presence of ulcerations.


Steps..

The gingival condition around each tooth is examined, and a score for the mesial, distal, buccal, and lingual areas is recorded.

If desired, the gingival index can also be used on only selected teeth in the mouth.

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Bleeding is the most important criterion of inflammation in this index; however, the distinction between normal {0} and mild inflammation {l} is based on visual appearance of the tissues

The intensity of probing with a blunt instrument must be carefully controlled.

The basic intention of this index is not to assess the depth or extent of a pocket or to determine bone loss but only to evaluate the status of gingival health.


D Caroline Mohamed 19

Mesio-facial

Disto-facial

Buccal

Lingual

Buccal

Mesial Distal

Palatine or lingual

Gingival Index: GI

0 1 2 3


Appearance Bleeding Inflammation Points

normal no bleeding none 0

slight change in color

and mild edema with

slight change in

texture

no bleeding mild 1

redness,

hypertrophy, edema

and glazing

bleeding on

probing/pressu

re

moderate 2

marked redness,

hypertrophy, edema,

ulceration

spontaneous

bleeding

severe 3

Gingival Index Le & Silness 1963



Training What is the gingival index of this

tooth?

0 normal


2 bleeding on probing/pressure

moderate


marked redness, hypertrophy, edema, ulceration

spontaneous bleeding

3


2


3


Gingival Index Method

Six index teeth

16; 12; 24; 36; 32; 44


6 2 4

4 2 6

Gingival Index Calculation GI for a tooth:

Scores for the four areas of the tooth are added and then divided by four

GI for the individual:

Indices for each of the teeth are added & then divided by the total of number of teeth examined

GI for a group:

Indices for each member of a group is added up & then divided by the total number of individuals in the group.


GI FORMULA

GI ( tooth) = scores M+D+B+L

4

GI ( individual ) = GI each teeth added

N. of teeth

GI ( group) = GI each individual added

N. of individuals


Training Youve just assessed Omars gingival situation and filled

his chart now give me his gingival index.


Gingival Index Tooth

Sum of scores of each tooth divided for 4:

15 ( M=3; D=2;B=1; P=0) /4=

12 ( M=1; D=2; B=3; P=1) /4=

11 ( M=0; D=1; B=0;P=1) /4 =

21 ( M=0; D=1; B=3; P=0) /4=

24 ( M=1; D=2; B=3; P=1 ) /4=

33 ( M=1; D=2; B=3; L=2) /4=

GI individul= Scores each tooth added

N. Teeth

Training Youve just assessed Omars gingival situation and filled

his chart now give me his gingival index.


Gingival Index Tooth

Sum of scores of each tooth diveded for 4:

15 ( M=3; D=2;B=1; P=0) 6/4=1.5

12 ( M=1; D=2; B=3; P=1) 7/4= 1.75

11 ( M=0; D=1; B=0;P=1) 2/4 = 0.5

21 ( M=0; D=1; B=3; P=0) 4/4=1

24 ( M=1; D=2; B=3; P=1 ) 7/4=1.75

33 ( M=1; D=2; B=3; L=2) 8/4=2

GI individual= Scores each teeth

N. Teeth

Omars GI= =1.5+1.75+0.5+1+1.75+2 6

Omars GI= 8.5 = 1.4 6

Omars gingival index is = 1.4.

What does it mean?


Average

Gingival Index

Interpretation Patient

evaluation

< 0.1 no inflammation Healthy

0.1 - 1.0 mild inflammation Mild gingivitis

1.1 - 2.0 moderate

inflammation

Moderate gingivitis

2.1 - 3.0 severe

inflammation

Severe gingivitis

Gingival Index Le & Silness 1963


It means that Omar has moderate inflammation/ gingivitis ( 1.1 to 2.0)


Oral hygiene index (OHI) Greene, Vermillion, and Waggener,

The OHI of Greene and Vermillion has two components,

the debris index ( DI)

and the calculus index, ( CI)

It is an indication of

oral cleanliness.

The term oral debris include plaque, materia alba and food remnants.


The scores may be used singly or in combination.

For scoring, the clinician divides the dentition into sextants and selects the facial (or buccal) and lingual tooth surface in each sextant that is covered with the greatest amount of debris and calculus.

Twelve surfaces, therefore, will be evaluated.

For this index, a surface includes half the circumference of the tooth.


Debris Index


How to proceed? Each tooth is dried and examined visually using a mirror,

an explorer, and adequate light.

The explorer is passed over the cervical third to test for the presence of plaque.

A disclosing agent may be used to assist evaluation.


Criteria for classifying debris Silness and Loe

Score Criteria

0 No debris or stain present

1 A film of plaque covering the

tooth or soft debris covering

not more than 1/3 of the tooth

surface, or presence of

extrinsic stain without other

debris regardless of surface

area covered

2 Moderate accumulation of

soft deposits in the gingival

pocket or on the tooth. Soft

debris covering more than 1/3

but not more than 2/3 of the

exposed tooth surface

3 Soft debris covering more

than 2/3 of the exposed tooth

surface or abundance of soft

matter within the pocket 07/07/2013 47 D Caroline Mohamed

Training Give me the right debris score:


3


0


1

2


3


1 3

2


3

1


0


Criteria for classifying calculus

Scores Criteria

0 No calculus present

1 Supragingival calculus covering not more than 1/3

of the exposed tooth surface

2 Supragingival calculus covering more than 1/3 but

not more than 2/3 of the exposed tooth surface or

the presence of individual flecks of subgingival

calculus around the cervical portion of the tooth or

both

3 Supragingival calculus covering more than 2/3 of the exposed tooth surface or a continuous heavy

band of subgingival calculus around the cervical

portion of the tooth or both 07/07/2013 62 D Caroline Mohamed

Training


Training


3 1

3

0

0

2

3

1

To help to memorize....


ORAL HYGIENE INDEX SIMPLIFIED Greene and Vermilion

One of the most popular indicators for determining oral hygiene status in epidemiologic study

Greene and Vermillion have also developed a simplified OHI in which the clinician measures only one tooth surface in each sextant, equaling only six surfaces. ( 6 rather than 12)


Selection of tooth surfaces

Six Index surfaces are examined:

The buccal surface of the upper 1st molars ( 16, 26)

The lingual surfaces of the lower 1st molars ( 36, 46)

The labial surface of the upper right central incisor (11 )

The labial surface of the lower left central incisors ( 31)

16 11 26

46 31 36


Calculating OHI-Simplified DI-S = Buccal total score + Lingual total score

N. of segments scored

CI- S = Buccal total score + Lingual total score

N. of segments scored

Oral Hygiene Index (OHI-S) = D I-S + C I-S

OHI-S Value ranges from 0 to 6


Good 0.0 to 1.2

Fair 1.3 to 3.0

Poor 3.1 to6.0

Sign the worse score FOR debris

index and Calculus index (WHO, pathfinder methods, 1993).


Oral hygiene index-s

Advantages:

It takes less time to score.

It is easy to score.

It is useful in survey work

Disadvantages:

Results are biased

The index is not sensitive.

It is not ideal for clinical trials {Research}.


Community Periodontal Index of Treatment Needs (CPITN)

Developed by Russell, the PI determines the periodontal disease status of populations in epidemiologic studies. Each tooth is scored according to the condition of the surrounding tissues.

It can be based solely upon clinical examination, or it can make use of Xrays.


CPITN index

Indicators. Three indicators of periodontal status are used for this assessment:

presence or absence of gingival bleeding

supra- or subgingival calculus

periodontal pockets-subdivided into shallow (4-5mm) and deep (6mm or more).


CPITN probe

A specially designed light weight probe with a 0.5-mm ball tip is used, bearing a black band between a 3.5 and 5.5 mm from the ball tip.

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D Caroline Mohamed

Sextant The mouth is divided into

6 sextant defined by the teeth number

A sextant should be examined only if there are two or more teeth present and not indicated for extraction.

When only 1 tooth remain in a sextant it should be included in the adjacent sextant

Upper right

posterior

18-14

Upper

anterior

13-23

Upper left

posterior

24-28

lower right

posterior

44-48

Lower

anterior

33-43

lower left

posterior

38-34


Teeth to be examined For adults aged 20 years and over, the teeth to be examined are: The

2 molars in each posterior sextant are paired for recording, and if one is

missing, there is no replacement.

If no index teeth or tooth is present in a sextant qualifying for examination, all the remaining teeth in that sextant are examined

For young people up to the age of 19 years, only six teeth 16,11,26,36,31 and 46 are examined

For children under 15 recording for pocket should not be attempted. ie., only bleeding and calculus should be considered

If no index tooth is present in a sextant qualifying for examination, single fully erupted incisor or premolar may be substituted

17 16 11 26 27

47 46 31 36 37 07/07/2013 75 D Caroline Mohamed

Sensing gingival pocket The sensing force used should be no more than 20 gms

A practical test for establishing this force is to place the probe point under he thumb nail and press until blanching occurs

For sensing sub gingival calculus, the lightest force that will allow movement of the probe ball point along the tooth surface should be used

The depth of insertion read against the colour coding.

At least 6 point on each tooth should be examined: mesio-buccal, mid-buccal, disto-buccal, and the corresponding lingual sites.


When non-index teeth are examined, the highest score found in the sextant is recorded in the appropriate box.

If there are not at least two teeth remaining and not indicated for extraction in a sextant, the appropriate box should be cancelled by a cross ( x ).


Examination and recording. The incisor and either the first molars (up to 19 years) or the pairs of first and

second molars (above 19 years) should be sensed and

the highest score recorded in the appropriate box.


Scoring criteria for Russels ( CPTI) 0: normal

l: bleeding observed, directly or by using mouth mirror,

after sensing

2: calculus felt during probing but all the black area is

visible

3: pocket 4 or 5 mm (gingival margin situated on black

area of probe

4: pocket > 6 mm (black area of probe not visible)


CPTIN Score Criteria for field studies

Additional X ray criteria

Treatment Needs

0 Healthy. Neither overt inflammation nor loss of

function caused by the

destruction of supporting

tissue is noted

Radiographic appearance

normal

No need for treatment

1 Mild Gingivitis. Overt inflammation in the free

gingiva is present, but

does not circumscribe the

tooth.

-------------------------------- TN 1 .Need to improve individual OH. Require

OHI nstructions

2 Gingivitis. Inflammation surrounds the tooth, but

there is no apparent break

in the epithelial

attachment

--------------------------------- TN2. Patient needs OHI and Professional cleaning.

Pockets of 4 to 5 mm

needs Scaling an root

planning

6 Gingivitis with pocket formation. The tooth is not

mobile in the socket and

not drifted.

Horizontal bone lost

involving the entire

alveolar crest, up to half of

the length of the tooh root(

distance from apex to

cementoenamel junction)

TN 3. Needs of complex

treatment ( deep scaling,

efficient personal OH

measures)

8 Advanced destruction with loss of function. The tooth

may be loose or drifting. It

may sound dull on

percussion and may be

depressible in the socket.

Advanced bone loss,

involving more than half of

the length of the tooth root

or a definite intrabony

pocket with definite

widening of the

periodontal membranes.

Therre may be root

resorption, or rarefaction

of the apex.

. // 07/07/2013 D Caroline Mohamed 80

Scores for each tooth are added, and the total divided by the number of teeth examined. Scores can be interpreted

as follows:

0-0.2: Clinically normal supportive tissues.

0.3-0.9: Simple gingivitis.

0.7-1.9: Beginning destructive periodontal disease.

1.6-5.0: Established destructive periodontal disease.

3.8-8.0: Terminal periodontal disease.


Thank you


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5.Gingival and periodontal indices.pdf