Periodontal Screening and Recording (PSR)

• Measurements for gingival and periodontal indices have evolved.
• Bleeding upon gentle probing is an initial symptom of gingival inflammation, preceding color changes in gingival tissues.
• Testing for bleeding is key in assessing periodontal disease progression and is important for treatment planning and maintenance appointments.

Periodontal Screening and Recording (PSR)

• Assesses an individual's periodontal health.
• Is a modified form of the Community Periodontal Index of Treatment Needs (CPITN).
• Designed for rapid periodontal status assessments, motivating patients to seek full evaluations and treatment.
• Used to determine the necessity of comprehensive periodontal evaluation.
• The dentition is divided into sextants with each tooth examined.
• Posterior sextants start distal to the canines.
• Uses a probe with markings at 3.5, 5.5, 8.5, and 11.5 mm from the tip.
• The probe is color-coded between 3.5 and 5.5 mm.
• The working tip features a 0.5 mm ball to aid in detecting calculus, overhangs, and to improve probing depth accuracy.
• Gentle probe insertion into the sulcus until resistance is felt.
• A circumferential walking stroke is applied systematically around each tooth within each sextant.
• Observe the color-coded area of the probe for identifying probing depths.
• Each sextant is assigned a single code number that corresponds to the deepest position of the color-coded probe section.
• Five codes and an asterisk are utilized, with each code possibly including conditions from preceding codes.
• When a Code 4 is found, remaining teeth in that sextant need not be probed.
• For codes 0, 1, 2, and 3, complete probing of the sextant is needed.
• A six-box form is used to record scores for each sextant.
• One score is marked per sextant; the highest code observed is recorded.
• An asterisk is added to the score when indicated.
• Patients are classified based on their highest coded PSR score.
• Codes 3 and 4 indicate a need for comprehensive periodontal examination.
• Asterisks may indicate furcation or mucogingival involvement.
• Counseling the patient is important for cooperation and compliance.
• Code 2 indicates calculus and overhanging restorations that should be removed.
• All restorations are checked for recurrent dental caries.
• Appointments for instruction in dental biofilm control are of primary concern.
• Asterisks may indicate notable clinical features like minimal attached gingiva.

Community Periodontal Index (CPI)

• Screens and monitors periodontal status in populations.
• Evolved from the CPITN index, now excluding the treatment needs portion.
• Is a component of a WHO oral health survey, assessing mucosal lesions, caries, fluorosis, prosthetic status, and dentofacial anomalies.
• Later modified into the PSR index for individual patient scoring.
• The dentition is divided into sextants.
• Posterior sextants start distal to canines.
• For adults (20+ years), a sextant is examined only if two or more teeth are present and not indicated for extraction.
• Ten index teeth are examined, including first and second molars in each posterior sextant and the maxillary right and mandibular left central incisors.
• If no index teeth are present in a sextant, all remaining teeth are examined and the highest score is recorded.
• For children/adolescents (7-19 years), six index teeth are examined: the first molar in each posterior quadrant and the maxillary right and mandibular left incisors.
• Pocket depth isn't recorded for those under 15 to avoid deepened sulci from erupting teeth.
• Only bleeding and calculus are considered for children.
• A specially designed probe is used.
• Codes record bleeding, calculus, and pocket depth.
• Criteria are similar to PSR.
• Loss of attachment (LOA) is recorded using the WHO probe with five codes.
• LOA is not recorded for those under 15 years.

Sulcus Bleeding Index (SBI)

• Locates areas of gingival sulcus bleeding and color changes, indicating early inflammatory gingival disease.
• Four gingival units are scored systematically for each tooth: labial and lingual marginal gingiva (M units) and mesial and distal papillary gingiva (P units).
• Standardized lighting while probing each of the four areas.
• Probe to the base of the sulcus, parallel to the tooth's long axis for M units, towards the col area for P units.
• Wait 30 seconds after probing before scoring apparently healthy gingival units.
• Gently dry the gingiva if necessary to observe color changes clearly.
• Score each of the four gingival units (M and P) from 0 to 5.
• To get the SBI for a tooth, total scores for the four units and divide by 4.
• To get the SBI for an individual, total scores for individual teeth and divide by the number of teeth.
• SBI scores range from 0 to 5.

Gingival Bleeding Index (GBI)

• Records the presence or absence of gingival inflammation, determined by bleeding from interproximal gingival sulci.
• Each interproximal area has two sulci, scored as one interdental unit or separately.
• Certain areas may be excluded due to accessibility, tooth position, diastemata, or other factors.
• A full complement of teeth has 30 proximal areas; original studies excluded third molars, recording 26 interdental units.
• Unwaxed dental floss is used.
• Pass floss interproximally on both sides of the papilla, curving around the adjacent tooth.
• Move floss up and down for one stroke, avoiding laceration.
• Use new floss for each area.
• Allow 30 seconds for reinspection of areas without immediate bleeding.
• Bleeding indicates the presence of disease.
• The numbers of bleeding areas and scorable units are recorded.

Eastman Interdental Bleeding Index (EIBI)

• Assesses inflammation in the interdental area.
• Each interdental area around the entire dentition is examined.
• A triangular wooden interdental cleaner is used.
• Gently insert the cleaner into each interdental area to depress the papilla 1–2 mm, then immediately remove.
• The path of insertion should be horizontal (parallel to the occlusal surface).
• Insert and remove four times, then move to the next interproximal area.
• Record the presence or absence of bleeding within 15 seconds for each area.
• The number of bleeding sites may be totaled for an individual score.
• The index is expressed as a percentage of the total number of sites evaluated.

Gingival Index (GI)

• Assesses the severity of gingivitis based on color, consistency, and bleeding on probing.
• A GI can be determined for selected teeth or the entire dentition.
• Four gingival areas (distal, facial, mesial, and lingual) are examined systematically for each tooth.
• The distal examination may be omitted, doubling the mesial area score and dividing the total by 4.
• Dry the teeth and gingiva, using a mouth mirror and probe under adequate light.
• Use the probe to press on the gingiva to assess firmness and evaluate bleeding.
• Each of the four gingival surfaces is given a score of 0–3.
• Scores for each area are totaled and divided by 4 for the tooth score.
• Scores for individual teeth are grouped, totaled, and divided by the number of teeth.
• A GI may be determined for specific teeth, groups, quadrants, or sides of the mouth.
• Scores for each tooth are added up and divided by the number of teeth examined; scores range from 0 to 3.
• Add the individual GI scores and divide by the number of individuals examined for a group score.

Modified Gingival Index (MGI)

• Is an adaptation of the original GI that eliminates probing in the sulcus.
• Since it only uses visual observation, it is a less sensitive measure of gingivitis.
• The removal of probing aims to reduce plaque biofilm disruption and potential trauma.
• Assesses the full mouth or gingiva of selected teeth.
• Gingiva is divided into marginal and papillary units.
• Scores the extent and severity of gingival inflammation using five ordinal numbers.
• Scoring of mild and moderate inflammation differs from the original GI.
• Mean scores are calculated for individuals and population groups.