Oral health indices
I- Introduction:
periodontal health was considered good, average or insufficient, resulting in the impossibility of comparing between studies, due to the subjectivity of the assessments, hence the interest in periodontal indices.
These indices will also be useful in epidemiological studies on periodontal and carious diseases as well as for the evaluation of oral hygiene.
II- the index:
1- Definition of an index: it is a number used to highlight the existence of a characteristic or to express quantitatively the value of the characteristic (according to BAUME 1969).
It is a numerical expression of defined diagnostic criteria, it is intended to systematically quantify and qualify the observations collected.
2- Required characteristics of an index:
– Easy to use by a large number of investigators for a large number of sites with minimal time and cost.
– Rapid, clear and sufficient observation allowing a diagnosis to be made.
– Possibility of using the results for statistical purposes.
– Have high reliability and easy quantification of results regardless of the degree of achievement.
III- clues in periodontaology:
1- Irreversible indices:
Based on bone loss, loss of attachment, loss of teeth, they allow to assess the irreversible damage of the disease, they translate a result which cannot return to stage zero even if the lesion disappears or heals.
a- Periodontal indices:
→ Radiological index according to ENGELBERG: it allows the degree of bone destruction to be estimated by measuring the distance separating the enamel-cement junction from the limit of the bone destruction zone.
But it has some drawbacks:
– The enamel-cement junction is not always visible on X-rays.
– The extent of bone destruction is not always evident at the level of multirooted cells.
– The height of the alveolar bone is not always measurable, due to dental malpositions (25% of cases)
The views are only a snapshot reflecting the past of the disease, no prognosis is possible.
→ GLICKMAN furcation index:
It remains one of the most common furcation indices and adopted the following ratings:
0: no furcation involvement
1: Alveolysis reaches the furcation area but does not pass under the common root trunk.
2: bone resorption under the furcation is partial, the probe penetrates the interadicular space but does not cross it.
3: the furcation attentitis is complete, the probe passes from both sides.
4: complete damage is accompanied by significant resorption of the intradicular bone, the entrance to the furcation is no longer hidden by the gum.
→ STAHL and MORRIS recession index:
The proportion of teeth with uncovered ECG in relation to the total number of teeth is established.
Simple and quick to establish, this index can be used on isolated subjects as well as groups, but it lacks rigor, because gingival recession can result from excessive brushing in a subject with healthy periodontium, but thin, poorly vascularized gums.
On the other hand, the presence of tartar makes the survey difficult and its removal is sometimes sufficient to completely eliminate the gingival recession, which biases the statistics.
→ MILLER recession index:
This classification was described in 1985 and has the advantage of being able to anticipate the possibilities of therapeutic recovery.
This author distinguishes four classes:
Class 1: the lesion does not extend beyond the mucogingival junction
Class 2: the lesion reaches or exceeds the mucogingival junction
→ These first two classes actually correspond to gingival recessions.
Class 3: the lesion reaches or exceeds the mucogingival junction, in addition, there is a loss of the interdental papillae and the underlying bone, but always in a coronal situation of the general recession.
Class 4: the lesion reaches or exceeds the JMG, the loss of papillae and interdental bone reaches the same level as that of the recession.
→ These last two classes = in fact periodontal retraction situations.
b- Indices of occlusal anomalies:
→ Abrasion index according to AGUEL:
This is a complementary indicator of occlusal anomaly:
0: no abrasion
1: abrasion at the enamel level
2: abrasion at the enamel level + appearance of dentin islands
3: abrasion at the enamel level + appearance of dentin surface
4: significant abrasion where the pulp is seen through transparency
5: Exposing the pulp
→ Mobility index according to ARPA:
0: physiological state
1: horizontal mobility less than one mm perceptible to the finger
2: horizontal mobility less than one mm perceptible to the eye
3: horizontal mobility greater than one mm
4: horizontal and axial mobility
2- Reversible indices:
Oral health indices
a- Gingival indices:
→ PMA according to SCHOUR and MASSLER:
Published in 1947, according to them the inflammation first affects the papilla, then the marginal gingiva and finally the attached gingiva, in each region the degree of inflammation is rated from 0 to 5.
This index allows us to compare the prevalence and severity of scores from different population samples.
0: no inflammation
1: mild inflammation
2: medium inflammation
3: strong inflammation
4: very intense inflammation
5: loss of papilla
Currently this index is evaluated from 0 to 3 of the gingival papillae, marginal gingiva and attached gingiva.
→ GI of LOË and SILNESS 1963:
This is an indication of gingival inflammation, we will note;
0: no signs of inflammation
1: there is a slight change in color, slight edema, a sign of mild inflammation
2: there is a change in color, moderate edema indicating moderate inflammation with bleeding caused by probing
3: There are signs of severe inflammation; color change, significant edema, spontaneous ulceration and bleeding
* This index is evaluated for each tooth at four sites (V, L, M, D) then the average of the 4 scores is taken for each site and the sum of the average scores per tooth divided by the number of teeth examined.
→ SBI of MUHLEMAN and SON 1971:
Derived from the previous one, it holds back the bleeding, but we also appreciate the shape and the gingival coloration, it is established using a periodontal probe introduced into the sulcus.
0: normal gum, no bleeding on probing.
1: bleeding on probing, no change in color or contour.
2: bleeding on probing, erythema.
3: bleeding on probing, erythema, moderate edema.
4: bleeding on probing, erythema, significant edema.
5: bleeding on probing, spontaneous bleeding, significant edema with or without ulceration.
→ PBI by MUHLEMAN and SAXER 1975:
Derived from the previous one, it only retains the bleeding at the level of the papillae on the vestibular and lingual side; this bleeding is sought with a blunt-ended probe, sweeping with light pressure the sulcus from the base of the papilla to its summit along the mesial and distal surfaces of each tooth.
A clinical indicator of gingival inflammation, it allows us to judge the success of periodontal treatment, but above all serves to motivate the patient to practice oral hygiene.
Indeed, the regression of bleeding responds to the effectiveness of plaque removal measures.
0: no bleeding.
1: Only one bleeding point appears.
2: a bleeding edge that fills the sulcus.
3: profuse bleeding overflowing from the sulcus.
→ GBI AYNAMO and BAY 1975:
It is based and limited to the examination of bleeding, it is done using a periodontal probe introduced into the groove.
If bleeding appears within 10 seconds after probing, the site is positive, 4 sites (MV, V, DV, L) are examined for each tooth and the results are expressed as a percentage.
Oral health indices
Number of bleeding sites x 100
Number of sites observed
b- Oral hygiene indices:
→ PI de LOË and SILNESS 1964:
After drying the sites in the air, the thickness of the uncolored plaque is assessed from 0 to 3, at the cervical level, around each tooth, it completes the GI, we will note:
0: no plaque present on the teeth.
1: there is plaque invisible to the eye but visible when a probe passes over it.
2: there is plaque visible to the naked eye.
3: significant accumulation of plaque.
Data recording and index calculation are done in the same way as the GI.
→ IHO Index 1972:
It records the accumulation of plaque (after staining) on all dental surfaces, the practitioner notes on a sign sheet, with a + the presence of plaque or a – its absence, the index is equal to the percentage of faces covered with plaque.
→ Oral Health Index Simplified OHIS by GREEN and VERMILLON 1960:
Plaque and tartar are looked for on the vestibular surface of 11, 12 and the lingual surface of 37, 47.
The extent of the deposits is assessed by 1/3 of the face and the DI (debris index) and CI (calculus index) are rated from 0 to 3 and even if it does not affect all the teeth, its results are significant.
The index showed that apparent correlations with geographic area or other demographic differences were actually related to differences in hygiene levels.
→ RI of BJÖRBY and LOË:
This index first assesses plaque retention caused by the presence of caries and unsuitable coronal reconstructions rated from 0 to 3.
0: no tartar, caries or fillings.
1: cavity, tartar or filling near the gum.
2: caries, tartar or filling in contact with the marginal and slightly subgingival gum.
3: caries or filling under the marginal gum, abundant subgingival tartar.
→ CSI of ENNEVER et al 1961:
CSI: the lingual faces of the 4 lower inc are cut into 4 zones by their diagonal and the presence of tartar is rated at 1, the total index represents the sum of the individual indices.
Oral health indices
VM: on the 6 upper and lower teeth.
c- Mixed indices:
→ PI (Periodontal Index) by RUSSELL 1959:
This index is based on the signs of periodontitis and their chronology of appearance on the 4 sides of the teeth:
0: healthy gums.
1: Partially inflamed gum.
2: Inflamed gum around the entire tooth.
6: formation of a periodontal pocket.
8: loss of function due to dental mobility.
Do not require complex equipment, quick to evaluate, this index is widely used in epidemiological surveys to study the predisposition to periodontal disease, the analysis of the value of a treatment or a preventive method, but the subjectivity of the observations makes the comparison of studies difficult.
The high grades of the initial pockets/stages risk obscuring these and the slight nuance of rating between superficial and deep pockets does not allow them to be distinguished.
Oral health indices
→ Periodontal Deseass Index (RAMFJORD 1959):
Established for periodontal destruction, it estimates gingivitis and specifies attachment loss (instead of pocket depth, it is therefore not reversible and concerns 6 teeth; 16, 21, 24, 36, 41, 34, considered as the representatives of the arches and if one of these teeth is absent, its distal neighbor replaces it.
The value scale is identical to that of RUSSELL; it also includes a section assessing the level of oral hygiene.
→ PDR of SANDLER and STAHL:
The number of teeth affected from a periodontal point of view is counted and expressed as a percentage of the number of teeth of the subject, a tooth is considered to be affected by periodontal disease as soon as there is gingivitis, hyperplasia, necrosis or discharge of pus from the SGD.
We also note the deepening of the SGD of 3mm or more, the displacement of the tooth of more than 1mm, radiological signs of alveolysis over + 3mm.
Oral health indices
3- Assessment of periodontal care needs:
Despite current knowledge, it appears that many countries do not practice effective prevention or treatment of periodontal diseases. WHO has therefore initiated research into methods for assessing care needs, the PTNS, the PSE and the CPITN.
1- PTNS (Periodental treatment needs system of JOHANSON et al):
This system is based on the speed of examination, the dentition is divided into 4 quadrants, on each of them, the state of the tooth most affected by periodontitis is evaluated, from the angle of its therapeutic needs.
0: no special care needs
1: need for oral hygiene education
2: need oral hygiene education + scaling + removal of overflowing fillings
3: need for additional specialized complex treatment
Among other things, this index makes it possible to estimate the time required to provide care based on the severity of the injury.
2- PSE (Periodontal screening examination by DEVER):
This method involves measuring the depth of the pockets at the MV and DV angles of the remaining teeth, bleeding on probing and the depth of the pockets (0 to 3mm, 4 to 5mm or more) indicate the therapeutic needs.
0 to 3mm without bleeding: no special treatment.
0 to 3mm with bleeding: domain of the hygienist.
4 to 5mm: domain of the general dentist.
6 and above: area of the periodontologist specialist .
3- CPITN (Community periodontal index treatment need from AINAMO):
Developed to determine the distribution and severity of periodontal disease by AINAMO et al in 1982 and modified by CUTRUSS et al in 1987.
The clinician uses a specially designed periodontal probe with fixed markers assembled directly to the index scale.
The severity of the disease, as well as the treatment needs, are determined according to 2 clinical parameters; inflammation and the depth of the periodontal pockets.
This method is based on the PTNS and the division of the mouth into 6 segments, which must contain at least 2 functional teeth, if one of the sextants contains only one functional tooth, its value is added to that of the neighboring segment.
The WHO has developed a periodontal probe of 0.5 mm in diameter which ends in a small ball and has between 3.5 and 5 mm of black color, when this colored portion disappears under the gum, the sextant rating is 4 and a complex treatment is indicated.
When it is partially visible, the sextant is rated 3 and the treatment is scaling-surfacing with hygiene instruction.
If the colored portion remains completely visible, the rating is 2 and the treatment is identical to rating 3.
Rating 1 is assigned to the bleeding sextant during probing, free of tartar or overhang that could harbor PB and the treatment is limited to a motivation for HBD.
Only the highest value is retained, it is used to evaluate subjects in the maintenance period.
Oral health indices
IV- caries indices:
1-the CAO index: (Klein and Palmer 1937)
Allows the oral health status of an individual or a population sample to be measured qualitatively and quantitatively.
- Individual CAO = Number of decayed teeth (C) + number of missing teeth (A) + number of filled teeth (O)
- Average CAD = sum of individual values / number of subjects examined
- In permanent dentition this index is formulated in capital letters and relates to 28 teeth (COA/D) and 128 faces (CAO/F)
- In temporary dentition it is formulated in lower case letters and covers 20 (cod) teeth and 88 faces.
- When establishing this index on temporary teeth, missing teeth are not counted.
2- the Banting index:
- Criterion 1: soft, discolored, discrete and delimited surface
- Criterion 2: Penetration of the probe which catches
- Criterion 3: lesion located at the enamel-cement junction
- Criterion 4: restored lesion of carious origin
3- Root caries index RCI:
(Number of decayed and filled root surfaces/number of decayed and healthy root surfaces) x100.
V- Importance and use of indices:
These various indices are intended, once the results of the surveys have been analyzed, to guide public health officials in their choice of priorities to give to this or that particular aspect highlighted by this or that study.
Individuals will be led to learn lessons from the evaluation of the problems highlighted or the treatments implemented, either through their daily practice or in terms of health economics.
The choice of a periodontal index will depend mainly on the desired result.
VI- Conclusion:
Epidemiological surveys are constantly gaining in perfection and precision, improving the work of evaluating new preventive or therapeutic methods. The indices are therefore often revised and improved to keep pace with this perfection.
Dental crowns are used to restore the shape and function of a damaged tooth.
Bruxism, or teeth grinding, can cause premature wear and often requires wearing a retainer at night.
Dental abscesses are painful infections that require prompt treatment to avoid complications. Gum grafting is a surgical procedure that can treat gum recession. Dentists use composite materials for fillings because they match the natural color of the teeth.
A diet high in sugar increases the risk of developing tooth decay.
Pediatric dental care is essential to establish good hygiene habits from an early age.