Dental Indices and Oral Health

Dental indices are used to measure and record various aspects of oral health, such as oral hygiene, gingivitis, and periodontal disease.
Indices can be used in clinical practice, epidemiologic surveys, and community oral health assessments.

Simple indices: measure the presence or absence of a condition, e.g. biofilm index.
Cumulative indices: measure all evidence of a condition, past and present, e.g. DMFT index for dental caries.
Irreversible indices: measure conditions that will not change, e.g. an index that measures dental caries experience.
Reversible indices: measure conditions that can be changed, e.g. indices that measure dental biofilm.

Measures oral hygiene status in a clinical setting to educate and motivate patients.
Can be used in a community setting to determine oral hygiene education programs.
Assesses the thickness of biofilm at the cervical margin of the tooth.

Assesses oral cleanliness by estimating tooth surfaces covered with debris and/or calculus.
Has two components: simplified debris index (DI-S) and simplified calculus index (CI-S).
Scores range from 0 to 3 for individual indices, and 0 to 6 for the combined OHI-S.

Various indices have been developed to assess gingival and periodontal health, including the papillary-marginal-attached index and the periodontal index of Russell.
Bleeding on probing (BOP) indicates gingival inflammation and progression of periodontal disease.

A modified form of the community periodontal index (CPI) used to assess periodontal health of individual patients.
Used to screen and monitor periodontal status of populations.
Includes the assessment of many oral health indicators, including mucosal lesions, dental caries, fluorosis, prosthetic status, and dentofacial anomalies.

Identifies areas of gingival sulcus bleeding and color changes to recognize early inflammatory gingival disease.
Scores range from 0 to 4, with 0 being healthy and 4 being bleeding on probing with obvious swelling.### Gingival Inflammation
Gingival inflammation is determined by bleeding from interproximal gingival sulci
Each interproximal area has two sulci, which can be scored as one interdental unit or scored separately
Certain areas may be excluded from scoring due to accessibility, tooth position, diastemata, or other factors
A full complement of teeth has 30 proximal areas
Third molars were excluded in the original studies, and 26 interdental units were recorded
Unwaxed dental floss is used for assessment
The Eastman Interdental Bleeding Index is used to assess the presence of inflammation in the interdental area

The index assesses the presence of inflammation in the interdental area as indicated by the presence or absence of bleeding
Each interdental area around the entire dentition is examined
The instrument used is a triangular wooden interdental cleaner
The presence or absence of bleeding is noted within a quadrant 15 seconds after final insertion
Bleeding indicates the presence of inflammation

The Gingival Index assesses the severity of gingivitis based on color, consistency, and bleeding on probing
The index is often used with the PI (Plaque Index)
Four gingival areas (distal, facial, mesial, and lingual) are examined systematically for each tooth
The index scores are:
- 0: Normal gingiva
- 1: Mild inflammation--slight change in color, slight edema. No bleeding on probing.
- 2: Moderate inflammation--redness, edema, and glazing. Bleeding on probing.
- 3: Severe inflammation--marked redness and edema. Ulceration. Tendency to spontaneous bleeding.

Dental caries experience data are most useful when measuring the prevalence of dental disease in groups rather than individuals
Population scores can document:
- Number of persons in any age group who are affected by dental caries
- Number of teeth needing treatment
- Proportion of teeth treated
The purpose of dental caries experience is to determine total dental caries experience, past and present, by recording either the number of affected teeth or tooth surfaces

DMF indices use a dichotomous scale (present or absent) to record decay
Decayed (D): Visible dental caries is present or both dental caries and a restoration are present
Missing (M): A tooth extracted because of dental caries or when it is carious, non-restorable, and indicated for extraction
Filled (F): Any permanent or temporary restoration is present or a defective restoration without evidence of dental caries is present

dmft: 12 teeth evaluated (8 primary molars; 4 primary canines)
dmfs: 56 surfaces evaluated
Decayed (d): Primary molars and canines (or surfaces) that are carious
Missing (m): Primary molars and canines (or surfaces) that are missing
Filled (f): Primary molars and canines (or surfaces) that have a restoration but are without caries

Developed by the ASTDD to provide oral screening for adult, school age, and/or preschool populations
Data levels are consistent with monitoring the U.S. Public Health Service national health objectives
Data collected can easily be compared with data collected by other communities and states using the data collection techniques
The system was designed to be used by screeners with or without dental background