Dental Indices and Oral Health

Dental Indices

• 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.

Types of Indices

• 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.

Selection Criteria for an Index

• A useful and effective index should:
  • Be simple to use and calculate.
  • Require minimal equipment and expense.
  • Use a minimal amount of time to complete.
  • Not cause patient discomfort or be unacceptable to patients.
  • Have clear-cut criteria that are readily understandable.
  • Be free from subjective interpretation.
  • Be reproducible by the same or different examiners.
  • Be amenable to statistical analysis with validity and reliability.

Biofilm Control Record

• Used to record the presence of dental biofilm on individual tooth surfaces.
• Helps patients visualize progress while learning biofilm control.
• Includes all teeth, with missing teeth identified on the record form.
• Four surfaces are recorded: facial, lingual, mesial, and distal.

Biofilm Index

• 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.

Simplified Oral Hygiene Index (OHI-S)

• 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.

Gingival and Periodontal Health

• 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.

Periodontal Screening and Recording (PSR)

• 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.

Sulcus Bleeding Index

• 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

Eastman Interdental Bleeding Index

• 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

Gingival Index

• 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

• 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

• 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

Primary Dentition

• 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

WHO Basic Screening Survey

• The WHO screening survey includes the CPI and the LOA indices
• The survey is suitable for adults and children
• Categories include:
  • Orofacial (intraoral and extraoral) lesions and anomalies
  • Temporomandibular joint status
  • Periodontal status
  • Dentition status and treatment need
  • Prosthetic status and need

ASTDD Basic Screening Survey

• 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