CS3-3. Dental Indices - Dr. Tağmaç Özberk .pdf

DENTAL INDICES ➢ Tağmaç Özberk PhD, DDS ➢ Department of Restorative Dentistry Learning Outcomes: At the end of this lecture; ✓ Students will be able to define properties of an ideal index. ✓ Students will be able to list type of dental indices and define dental caries indices. DENTAL INDICES An...

DENTAL INDICES ➢ Tağmaç Özberk PhD, DDS ➢ Department of Restorative Dentistry Learning Outcomes: At the end of this lecture; ✓ Students will be able to define properties of an ideal index. ✓ Students will be able to list type of dental indices and define dental caries indices. DENTAL INDICES An index has been defined as a numerical value describing the relative status of a population on a graduated scale with definite upper and lower limits, which is designed to permit and facilitate comparison with other populations classified by the same criteria and methods. OBJECTIVE OF A DENTAL INDEX ● For individual patient ● Provide individual assesment to help a patient recognize an oral problem ● Reveal the degree of effectiveness of present oral hygiene practices ● ● Motivate the person in preventive and professional care for elimination and control of oral disease. Evaluate the success of individual and professional treatment over a period of time by comparing index scores ● In research ● Determine baseline data before experimental factors are introduced ● ● Measure the effectiveness of specific agents for the prevention, control or treatment of oral conditions Measure the effectiveness of mechanical devices for personal care, such as toothbrushes, interdental cleaning devices or water irrigators ● ● In Community Health Show the prevelance and trends of incidence of a particular condition occuring within a given population ● Provide baseline data to show existing dental health practices ● Assess the needs of a community ● Compare the effects of a community programme and evaluate the results. PROPERTIES OF AN IDEAL INDEX • Validity: The index must measure what it is intended to measure, so it should correspond with clinical stages of the disease under study at each point • Reliability: The index should be able to measure consistently at different times and under a variety of conditions like the ability of the same or different examiners to interpret and use the index in the same way. • Clarity, Simplicity and Objectivity: The criteria should be clear and it shouldbe easily memorized by an examiner after some practice. • Quantifiability: The index must be liable to statistical analysis, so that the status of a group can be expressed by a distribution, mean, median, or other statistical measure. • Sensitivity: The index should be able to detect clinically relevant but small shifts, in either direction, in the condition. • Acceptability: The use of the index should not be unnecessarily painful or demeaning to the subject. TYPES OF INDICES • • • • • • • Plaque Index Oral Hygiene Index Gingival Index Periodontal Index Dental Caries Index Dental Fluorosis Index Dental Aesthetic Index TURESKY-GILMORE-GLICKMAN MODIFICATION OF THE QUIGLEY-HEIN PLAQUE INDEX ● ● This plaque index is mainly focusing on the gingival third of the tooth surface. After the application of a plaque disclosing agent (like basic fuchsin) to the tooth surfaces, gingival third of the labial, buccal and lingual surfaces are examined and scored between 0-5. • 0 No visible plaque. • 1 Separate flecks of plaque at the cervical margin of the tooth. • 2 A thin, continuous band of plaque (up to 1 mm wide) at the cervical margin. • 3 A band of plaque wider than 1 mm but covering less than one-third of crown. • 4 Plaque covering at least one-third but less than two-thirds of crown. • 5 Plaque covering two-thirds or more of crown. SILNESS-LÖE PLAQUE INDEX • By this plaque index it is purposed to determine the oral hygiene by recording both soft debris and mineralized deposits on the teeth. Rather than the other plaque indices, it is measuring the thickness of the plaque which is more valid than the amount of extension to the coronal surface. • Scoring is made for 6 teeth as showed in the figure. Each of the four surfaces of the teeth (buccal, lingual, mesial and distal) is given a score from 0- 3. Then the scores from the 4 areas of the tooth are added and divided by 4 in order to give the plaque index score for the tooth. • 0 No plaque • 1 A film of plaque adhering to the free gingival margin and adjacent area of the tooth. The plaque can be determined in situ only after application of disclosing solution or by using the probe on the tooth surface • 2 Moderate accumulation of soft deposits within the gingival pocket, or the tooth and gingival margin which can be seen with the naked eye • 3 Abundance of soft matter within the gingival pocket and/or on the tooth and gingival margin ORAL HYGIENE INDEX • For this index mouth is divided into 6 segments. • Oral Hygiene Index (OHI)= Debris Index +Calculus Index • Range of OHI: Min-0, Max-12 • 0 No debris or stain present • 1 Soft debris covering not more than 1/3rd of the tooth surface or the presence of extrinsic stains without the debris regardless of surface are covered • 2 Soft debris covering more than 1/3rd but not more than 2/3rds of the exposed tooth surface • 3 Soft debris covering more than 2/3rds of he exposed tooth surface • Debris Index (DI)= Total debris score recorded / Number of segments scored • Range of DI: Min-0, Max-6 • 0 No calculus present • 1 Supragingival calculus covering not more than 1/3rd of the exposed tooth surface • 2 Supragingival calculus covering more than 1/3rd but not more than 2/3rds of the exposed tooth surface or the presence of individual flecks of subgingival calculus around cervical portion of the tooth or both. • 3 Supragingival calculus covering more than 2/3rd of the exposed tooth surface or continuation of heavy band of subgingival calculus around the cervical portion of the tooth • Calculus Index (CI)= Total calculus score recorded / Number of segments scored • Range of CI: Min-0, Max-6 ORAL HYGIENE INDEX-SIMPLIFIED • Since the oral hygiene index defined before is time consuming and can not be used for epidemiological surveys and mixed dentition a simplified version (OHI-S) was improved in 1964. • For this index only the teeth showed in the figure is examined. • After scoring these teeth for debris index and calculus index, calculation of OHI-S is same as OHI. DENTAL CARIES INDICES ● ● ● ● Classification according to the caries morphology Classification according to dental surfaces Classification according to the developmental nature Classification according to treatment management AMERICAN DENTAL ASSOCIATION CARIES CLASSIFICATION SYSTEM-ADA CCS This is a simple index which is examining the activity and the cavitation appearance of the caries lesions. DENTAL INDEX DEVELOPED BY PITTS AND FYFF • This index is mainly classifying cavitation occurence of dental caries. It is a dental index accepted by WHO. • D1, Enamel Caries detected at intraoral examination, no cavitation • D2, Enamel caries with cavitation • D3, Detected dentin caries with or without cavitation • D4, Dental caries lesion reached to dental pulp DMF İNDEX • The mostly used dental index developed by Klein and Palmer (1937) and accepted by WHO especially to determine the prevelance and risk of dental caries. • While the DMF indices used for permanent teeth are DMFT and DMFS, dmft and dmfs are used for primary teeth. • These letters are refer to; • D and d: Dental caries with cavitation, • M and m: Missing tooth by cause of dental caries • F and f: Tooth with filling as a result of dental caries • T and t: Tooth • S and s: Surface • DMFT and dmft are obtained by the total number of the teeth scored as carious, missing or filled. • DMFS and dmfs are obtained by the total number of the dental surfaces scored as carious, missing or filled after the examination of all of the surfaces for each tooth. • Range of DMFT: Min-0, Max-28 or 32, DMFS: Min-0, Max-128 or 148 according to including of third molars or not dmft: Min-0, Max-20, dmfs: Min-0, Max-80 • Limitation: There is no scoring for the dental caries at early stages, secondary carieses, root carieses, fissur sealents, fillings related with trauma or esthetic reasons, missing tooth related any factor rather than dental caries (extraction, congenital deficiency). Additionaly it is not giving any idea about the stage of the caries, its progression and treatment needs Dental Index developed by Extrand et al. • Main purpose of this dental index is to determine the stage of dental caries. • 0 After well drying, there is no or minimal change at enamel translucency • 1 Opacity which can be detected after well drying while can not be detected at wet surfaces • 2 Opacity which can be detected at wet surfaces • 3 Destruction of opaque or discolored enamel or enamel reflecting discolored dentin • 4 Cavitation of opaque or discolored enamel where underlying dentin can be detected clinically. Dental Index developed by Mount et al. • This index simply defining the SIZE and LOCATION of the caries. • Location Scores: 1-Enamel surfaces, pit and fissures, 2-Aproximal surfaces especially at the servical area under the contact areas, 3-Servical thirds and exposed root surfaces • Size Scores: 0-Inıtıatıon phase, white spot lesion related with demineralisation, 1Superficial cavitation at dentin, 2- Procedeed cavitation but the left structure is still resistant against the occlusal forces, 3-Large cavity,weaked dental structures especially at insical and tubercules NYVAD SYSTEM • Main purpose of this dental index is to determine the activity of dental caries and it is especially examining the early stages of caries ICDAS SYSTEM • ICDAS indices are scored by two codes. First one mentions the present fissure sealents or restorations and the second one mentions the caries. ICDAS SYSTEM Although it is mainly developed from NYVAD system, there are some differences; • Severity and activity of the caries is coded by only one score at NYVAD. • While scoring at NYVAD is with the plaque, ICDAS is used after the scaling and polishing. • While at NYVAD, they prefer to use sharp ended probe, ICDAS is not prefering not to harm dental tissues and not to change the nature of the caries. • ICDAS-II SYSTEM • This index, firstly classify three types of caries as coronal caries (pit and fissure, mesial, distal, facial, lingual), root caries and caries related with the restorations including pit and fissure sealents. • All of the coronal surfaces are examined and scored seperately. First, the surfaces are scored as sound, restored, fissure and sealent applied or missing. If there are two or more restorations, the surface scored with the highest score. • At the second step each surface is score according to the observed caries. ICDAS AND ICCMS • Later the same commission developed a more detailed index called ICCMS (The international caries classification and management system). • The development of the ICCMS system has been based on a contemporary understanding of the evidence on and around cariology, international agreements on current caries terminology and how best to advance tooth preserving caries management pathways. PUFA INDEX • This is an index used to analyze the status of the diseases occured by the untreated and neglected caries lesions. • This index is examining the inclusion of the pulp, ulserations, root fractures, fistuls and abscesses. If these are not related with the caries,they are not recorded. • Examination is made only by visual inspection. It can be used for both decidious (range: 0- 20) and permanent teeth (range:0-32). ● ● ● ● P/p Pulpal involvement The exposure of the pulp chamber is visible or the coronal tooth structures have been destroyed by the carious process and only root fragments are left U/u Ulceration Sharp edges of a tooth with pulpal involvement or root fragments have caused traumatic ulceration of the surrounding soft tissues eg. tongue or buccal mucosa F/f Fistula Pus releasing sinus tract related to a tooth with pulpal involvement is present A/a Abscess Pus containing swelling related to a tootk with pulpal involvement is present UNIVISS This system is scoring the caries lesions at 3 steps and giving clue about the severity by the location and size, color and activity of the caries. CARIES ASSESMENT SPECTRUM-CAST • This system is including whole periods of the caries. • Rather than the other indices, tooth with restoration are accepted as healthy and functional and scored with smaller number. DENTAL FLUOROSIS INDICES ● ● ● Dean’s Index Thylstrup & Fejerskov Index Developmental Defects of Enamel (DDE) REFERENCES 1. İMREN, A., KORUYUCU, M., İNCE, E. B. T., & AKINCI, M. T. ÇÜRÜK AKTİVİTE TESTLERİ (DERLEME). Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi, 30(2), 330-336. 2. İLHAN, B., & ULUKAPI, İ. (2006). Çürük aktivite-risk belirleme yöntemlerinde son yenilikler. Journal of Istanbul University Faculty of Dentistry, 40(1-2), 33-40. 3. Tenovuo, J. (1997). Salivary parameters of relevance for assessing caries activity in individuals and populations. Community dentistry and oral epidemiology, 25(1), 82-86. 4. Sandhya, T., Avinash, T., & Satheesan, E. (2012). Caries activity indicators: guide for dental practitioners. International Journal of Oral & Maxillofacial Pathology, 4(1), 34-42. 5. Doifode, D., Godhane, A., Pattanshetti, K. S., Sanklecha, S., Kesri, R., & Jain, C. (2018). Dental caries indices used for detection, diagnosis, and assessment of dental caries. Int J Oral Care Res, 6(1), 77-81. 6. Keçeli Tİ, Özler CÖ, Tekçiçek M. Diş çürüğü durumunun değerlendirilmesinde kullanılan indeksler. Türkiye Klinikleri Çocuk Diş Hekimliği - Özel Konular 2015;1(3):19-28.