INDEX IN DENTISTRY

1. GOOD MORNING
1

2. 2
SUBMITTED BY:
SHEKHAR KUMAR MANDAL
Roll no: 26
BDS IV
GUIDED BY:
DR. NAVRAJ LAMDARI
DR. LAL BABU KAMAIT
DEPARTMENT OF PERIODONTICS
COLLEGE OF MEDICAL SCIENCES,
BHARATPUR NEPAL

3. CONTENTS
REFERENCES
CONCLUSION
RECENT ADVANCES IN PERIODONTAL INDICES
GINGIVAL AND PERIODONTAL DISEASE INDICES
ORAL HYGIENE AND PLAQUE INDEX
OBJECTIVES AND USES OF INDEX
IDEAL REQUISITES OF AN INDEX
CLASSIFICATION OF INDEX
DEFINITIONS
INTRODUCTION
3

4. INTRODUCTION
“UNLESS YOU CAN COUNT IT, WEIGH IT OR EXPRESS IT IN A QUANTITATIVE FASHION, YOU HAVE
SCARCELY BEGUN TO THINK ABOUT THE DISEASE IN A SCIENTIFIC FASHION”
-LORD KELVIN
4

5. DEFINITIONS
• “Epidemiological indices are attempts to quantitate clinical condition on
graduated scale, thereby facilitating comparison among populations examined
by the same criteria and methods”. – Irving Glickman 5
According to Russell A.L , an index is defined as ‘A numerical value describing the
relative status of the population on a graduated scale with definite upper and
lower limits which is designed to permit and facilitate comparison with other
population classified with the same criteria and the method”

6. “An index is an expression of clinical observation in numeric values. It is used to
describe the status of the individual or group with respect to a condition being
measured. The use of numeric scale and a standardized method for interpreting
observations of a condition results in an index score that is more consistent and
less subjective than a word description of that condition”. – Esther M Wilkins
6

7. IDEAL REQUISITES OF AN INDEX
7

8. OBJECTIVES
FOR INDIVIDUAL PATIENT
• Recognize an oral problem
• Effectiveness of present oral
hygiene practices
• Motivation in preventive and
professional care for control
and elimination of diseases 8
IN RESEARCH
• Determine base line data before
experimental factors are
introduced
• Measure the effectiveness of
specific agents for prevention
control or treatment of oral
condition
IN COMMUNITY
• Shows prevalence and incidence
of a condition
• Assess the need of the community
• Compare the effects of a
community program and evaluate
the results

9. Based on the direction in which their scores can
fluctuate:
• Measures condition that can be
changed e.g. periodontal index
Reversible index:
• Measures conditions that will not
change e.g. dental caries
Irreversible index:
9
CLASSIFICATION OF INDEX

10. •Depending upon the extent to which areas of oral
cavity are measured :
Full mouth
indices:
• Patient’s entire
periodontium or
dentition is
measured.
• e.g. OHI
Simplified indices:
• Measure only a
representative
sample of the
dental apparatus.
• e.g. OHI-S 10

11. According to the entity which they measure
• “d” decay portion of the dmf index is the
best example of disease index
Disease
index :
• Measuring gingival or sulcular bleeding are
essentially examples of symptom indices
Symptom
index :
• “f” filled portion of dmft index is the best
example for treatment index
Treatment
index : 11

12. General indices :
• index that measures the presence or
absence of a condition. e.g. plaque
index
Simple
index:
• index that measures all the evidence of
a condition, past and present. e.g. dmf
index
Cumulative
index:
12

13. INDICES USED FOR ORAL HYGIENE ASSESSMENT
• Oral hygiene index
• Simplified oral hygiene index
• Patient hygiene performance
• Turesky, Gilmore, Glickman modification of the Quigley Hein plaque index
13

14. ORAL HYGIENE INDEX (OHI)
• Developed in 1960 by John C. Green and Jack R. Vermillion in order to classify
and assess oral hygiene status.
• Simple and sensitive method for assessing group or individual oral hygiene
quantitatively.
• Composed of 2 components:
• Debris index (DI)
• Calculus index (CI)
14

15. 15
RULES OF ORAL HYGIENE INDEX
1 Only fully erupted permanent teeth are
scored.
2 Third molars and incompletely erupted
teeth are not scored because of the wide
variations in heights of clinical crowns.
3 The buccal and lingual debris scores are
both taken on the tooth in a segment
having the greatest surface area covered
by debris.
4 The buccal and lingual calculus scores
are both taken on the tooth in a segment
having the greatest surface area covered
by supragingival and subgingival
calculus.

16. 0 – No debris or stain
present
1 – Soft debris
covering
not more than 1/3rd the
tooth surface, or
presence
of extrinsic stains
without
other debris regardless
of the area covered
2 – Soft debris
covering
more than 1/3rd, but not
more than 2/3rd,of the
exposed tooth surface
3 – Soft debris
covering more
than 2/3rd of the
exposed
DEBRIS INDEX CRITERIA

17. 17
SCORE CRITERIA
0 No calculus present
1 Supragingival calculus covering not more than 1/3 of
the exposed tooth surface
2 Supragingival calculus covering more than 1/3 but not
more than 2/3 the exposed tooth surface or presence
of individual flecks of subgingival calculus around the
cervical portion of the tooth or both.
3 Supragingival calculus covering more than 2/3 the
exposed tooth surface or a continuous heavy band of
subgingival calculus around the cervical portion of
tooth or both.
Supragingival
calculus
Subgingival
calculus
CALCULUS INDEX CRITERIA

18. CALCULATION
• Debris Index (DI) =( Buccal Score+ Lingual Score) / NO. OF SEG
• Calculus Index (CI) =( Buccal Score+ Lingual Score) / NO. OF SEG
• Oral Hygiene Index= DI+CI
• DI and CI range from 0-6
• Maximum score for all segments can be 36 for debris or calculus
• OHI range from 0-12
• Higher the OHI, poorer is the oral hygiene of patient
18

19. SIMPLIFIED ORAL HYGIENE INDEX
• Developed by John C Greene and Jack R Vermillion in 1964 as OHI was time
consuming and required more decision making
• Only fully erupted permanent teeth are scored
• Natural teeth with full crown restorations and surfaces reduced in height by
caries or trauma are not scored
• An alternate tooth is then examined if missing
19

20. 20
16 17,18
11 21
26 27,28
36 37,38
31 41
46 47,48
Surfaces and tooth to
examined
Substitution

21. 21
DI –S and CI-S
• Good -0.0-0.6
• Fair – 0.7-1.8
• Poor – 1.9 -3.0
OHI –S
•Good - 0.0-1.2
•Fair – 1.3- 3.0
•Poor – 3.0 -6.0
INTERPRETATIONCALCULATION
• DI –S = Total score/No of
surfaces
• CI-S = Total score/ No of
surfaces
• OHI -S= DI-S+ CI-S

22. USES
• Widely used in epidemiological studies of periodontal diseases.
• Useful in evaluation of dental health education programs
• Evaluating the efficacy of tooth brushes.
• Evaluate an individual’s level of oral cleanliness.

23. PATIENT HYGIENE PERFORMANCE (PHP) INDEX
• Introduced by Podshadley A.G. and Haley JV in 1968.
• Assessments are based on 6 index teeth.
• The extent of plaque and debris over a tooth surface was determined.
23
16 Buccal
11 Labial
26 Buccal
36 Lingual
31 Labial
46 Lingual

24. • Apply a disclosing agent before scoring.
• Patient is asked to swish for 30 sec and then expectorate but not rinse.
• Examination is made by using a mouth mirror.
• Each of the 5 subdivisions is scored for presence of stained debris:
0= No debris(or questionable)
1= Debris definitely present.
24
M
MI
D
M
O/I
G
Procedure:

25. • Debris score for individual tooth:
• Add the scores for each of the 5 subdivisions.
• PHP index for an individual= (Total score for all the teeth /the number of teeth
examined)
Debris score for 1 tooth = 4/5
= 0.8
1
1
1 1
0
Rating scores
Excellent : 0 (no debris)
Good : 0.1-1.7
Fair : 1.8 – 3.4
Poor : 3.5 – 5.0

26. PLAQUE INDEX
• Silness and Loe in 1964
• Assesses only thickness of plaque at the cervical
margin of the tooth closest to the gums
• All four surfaces are examined
• Distal
• Mesial
• Lingual
• Buccal
12
24
16
44
32
36

27. SCORING CRITERIA
Score Criteria
0 No Plaque
1
A film of plaque adhering to the free gingival margin
and adjacent area of tooth the plaque may be seen in
situ only after application of disclosing solution or by
using probe on 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
27

28. CALCULATION
28
Plaque index for area 0-3 for each surface
Plaque index for a
tooth
Scores added and then divided by four
Plaque index for group
of teeth
Scores for individual teeth are added and then
divided by number of teeth.
Plaque index for the
individual
Indices for each of the teeth are added and then
divided by the total number of teeth examined
Plaque index for group All indices are taken and divided by number of
individual
Rating Scores
Excellent 0
Good 0.1-0.9
Fair 1.0-1.9
Poor 2.0-3.0
INTERPRETATION

29. USES
• Reliable technique for evaluating both mechanical anti plaque procedures and
chemical agents
• Used in longitudinal studies and clinical trials
29

30. 30
ADVANTAGE
•Good validity and reproducibility
•Can be used as full mouth or simplified
DRAWBACK
•Subjectivity in estimating plaque

31. Turesky, Gilmore, Glickman modification of the
Quigley-Hein plaque index
• Quigley and Hein in 1962 reported a plaque measurement that focused on the
gingival third of the tooth surface.
• Only facial surfaces of the anterior teeth were examined after using basic
fuchsin mouthwash as a disclosing agent.
• Quigley - Hein plaque index was modified by Turesky, Gilmore and Glickman in
1970. 31

32. 32
SCOR
E
CRITERIA
0 No plaque
1 Separate flecks of plaque at the cervical
margin of tooth
2 Thin continuous band of plaque ( up to 1
mm
3 Band of plaque wider than 1 mm but
covering less than 1/3rd of the crown of
the tooth.
4 Plaque covering at least 1/3rd but less
than 2/3rd of the crown of the tooth
5 Plaque covering 2/3rd or more of the
crown of the tooth

33. • Plaque is assessed on the labial, buccal and lingual surfaces of all the teeth after
using a disclosing agent.
• The scores of the gingival 1/3rd area was also redefined.
• Provides a comprehensive method for evaluating anti plaque procedures such
as tooth brushing, flossing as well as chemical anti plaque agents.
• The index is based on a numerical score of 0 to 5
33

34. O’LEARY INDEX
(plaque control record)
• O' leary T, Drake R, Naylor in1972
• Method of recording the presence of the plaque on individual
tooth surfaces
• Suitable disclosing solution such as Bismarck brown, Diaplac or
similar is painted on all exposed tooth surfaces..
• The operator (using an explorer or a tip of a probe) examines each
stained surface for soft accumulations at the dentogingival
junction. When found, they are recorded by making a dash/red
colour in the appropriate spaces on the record form

35. Calculation
PLAQUE INDEX =The number of plaque containing surfaces
The total number of available surfaces
Since plaque is stained ,identification and record
making is easy
Also aids in patient education
Drawback
Records only the presence or absence of plaque

36. BLEEDING POINT INDEX
• Provides an evaluation of gingival inflammation around
each tooth in patient’s mouth
• Bleeding on probing recorded on distal ,facial ,mesial and
gingival surface
• Calculation=(no of bleeding surface/total no of tooth
surface)*100
• Demonstrates gingival inflammation characterized by
gingival bleeding rather than presence of microbial plaque

37. GINGIVAL AND PERIODONTAL DISEASE INDICES
• GINGIVAL INDEX
• PERIODONTAL INDEX
• CPITN
• COMMUNITY PERIODONTAL INDEX
37

38. GINGIVAL INDEX
• Developed by Loe and Silness in 1963.
• One of the most widely accepted and used gingival indices.
• Assess the severity of gingivitis and its location in 4 possible areas.
• Mesial
• Lingual
• Distal
• Facial
• 0nly qualitative changes are assessed.
38

39. :
• All surfaces of all teeth or selected teeth or selected surface of all teeth or selected
teeth are scored.
• The selected teeth as the index teeth are 16,12,24,36,32,44.
• The teeth and gingiva are first dried with a blast of air and/or cotton rolls.
• The tissues are divided into 4 gingival scoring units: Disto facial papilla, Facial margin,
Mesio facial papilla and Entire lingual margin.
• A blunt periodontal probe is used to assess the bleeding potential of the tissues.
39
METHOD

40. SCORE CRITERIA
0
Absence of inflammation/normal
gingiva
1
Mild inflammation, slight change
in color, slight edema, no
bleeding on probing
2
Moderate inflammation,
moderate glazing, redness,
edema and hypertrophy.
bleeding on probing
3
Severe inflammation, marked
redness and hypertrophy
ulceration. Tendency to
spontaneous bleeding. 40

41. CALCULATION AND INTERPRETATION
• If the scores around each tooth are totaled
and divided by the number of surfaces per
tooth examined (4), the gingival index score
for the tooth is obtained.
• Totaling all of the scores per tooth and
dividing by the number of teeth examined
provides the gingival index score for
individual. 41
INTERPRETATION:
0.1 - 1.0 : mild gingivitis
1.1 – 2.0 : moderate gingivitis
2.1 – 3.0 : severe gingivitis

42. MODIFIED GINGIVAL INDEX
• Developed by Lobene, Weatherford, Ross, Lamm and Menaker in 1986.
• Assess the prevalence and severity of gingivitis.
• Strictly based on non invasive approach i.e. visual examination only without
any probing.
• To obtain MGI , labial and lingual surfaces of the gingival margins and the
interdental papilla of all erupted teeth except 3rd molars are examined and
scored.
42

43. 43
0
• Normal (absence of inflammation)
1
• Mild inflammation (slight change in color, little change in texture) of
any portion of the gingival unit
2
• Mild inflammation of the entire gingival unit
3
• Moderate inflammation (moderate glazing, redness, edema, and/or
hypertrophy) of the gingival unit.
4
• Severe inflammation (marked redness and edema/hypertrophy,
spontaneous bleeding, or ulceration) of the gingival unit.
SCORE CRITERIA

44. RUSELL’S PERIODONTAL INDEX
• Developed by Rusell AI in 1956.
• It was once widely used in epidemiological surveys but not used much now
because of introduction of new periodontal indices and refinement of criteria.
• The RPI is reported to be useful among large populations, but it is of limited use
for individuals or small groups.
44

45. • All the teeth are examined in this index.
• Russell chose the scoring values as 0,1,2,4,6,8 in order to relate the stage of
the disease in an epidemiological survey to the clinical conditions observed.
• The Russell’s rule states that “ when in doubt assign the lower score.”
45
METHOD

46. FIELD STUDIES CLINICAL STUDIES / RADIOGRAPHIC FINDINGS
0 Negative. Neither overt inflammation in the
investing tissues nor loss of function due to
destruction of supporting bone.
Radiographic appearance is essentially normal.
1 Mild gingivitis. An overt area of
inflammation in the free gingiva does not
circumscribe the tooth
2 Gingivitis. Inflammation completely
circumscribe the tooth, but there is no
apparent break in the epithelial attachment
4 Used only when radiographs are available. There is early notch like resorption of alveolar crest.
6 Gingivitis with pocket formation. The
epithelial attachment is broken and there is a
pocket. There is no interference with normal
masticatory function; the tooth is firm in its
socket and has not drifted.
There is horizontal bone loss involving the entire alveolar
crest, up to half of the length of the tooth root.
8 Advanced destruction with loss of
masticatory function. The tooth may be
loose, may have drifted, may sound dull on
percussion with metallic instrument, or may
be depressible in its socket.
There is advanced bone loss involving more than half of the
tooth root, or a definite intrabony pocket with widening of
periodontal ligament. There may be root resorption or
rarefaction at the apex.
46

47. CALCULATION AND INTERPRETATION
• RPI score per person = Sum of individual scores
No of teeth present
47
Clinical Condition Individual Scores
Clinical normally supportive
tissue
0.0-0.2
Simple gingivitis 0.3-0.9
Beginning destructive periodontal
diseases
1.0-1.9
Established destructive
periodontal disease
2.0-4.9
Terminal disease 5.0-8.0

48. COMMUNITY PERIODONTAL INDEX OF TREATMENT NEEDS
• The community periodontal index of treatment needs (CPITN) was introduced by
JUKKAAINAMO for joint working committee of the WHO and FDI in 1982.
• Developed primarily to survey and evaluate periodontal treatment needs rather than
determining past and present periodontal status i.e. recession of the gingival margin
and alveolar bone.
• Treatment needs implies that the CPITN assesses only those conditions potentially
responsive to treatment, but not non treatable or irreversible conditions. 48

49. The mouth is divided into sextants :
17- 14 13- 23 24- 27
47 – 44 43- 33 34 – 37
• The 3rd molars are not included, except where they are functioning in place of 2nd molars.
• The treatment need in a sextant is recorded only if there are 2 or more teeth present in a sextant
and not indicated for extraction.
• If only one tooth remains in a sextant, then the tooth is included in the adjoining sextant.
49
Procedure :

50. Probing depth is recorded either on all the teeth in a sextant or only on certain
indexed teeth as recommended by who for epidemiological surveys.
For adults aged > 20 yrs:
• 10 index teeth are taken into account :17 16 11 26 37 47 46 31 36 37.
• The molars are examined in pairs and only one score the highest score is
recorded.
50

51. For young people up to 19 yrs:
• Only 6 index teeth are examined : 16 11 26 46 31 36
• The second molars are excluded at these ages because of the high frequency
of false pockets (non inflammatory tooth eruption associated).
• When examining children less than 15 yrs, pockets are not recorded although
probing for bleeding and calculus are carried out as a routine.
51

52. First described by WHO.
Designed for 2 purposes :
• measurement of pockets.
• detection of sub-gingival calculus.
Weighs : 5 gms
Working force: 20-25 gms
52
CPITN probe
CPITN-E
PROBE
CPITN-C
PROBE

53. 53
COD
E
CRITERIA TREATMENT
NEEDS
0 Healthy periodontium TN-0 No need of
treatment
1 Bleeding observed
during / after probing
TN-1 Self care
2 Calculus or other plaque
retentive factors seen or
felt during probing
TN-2 Professional care
3 Pathological pocket 4-5
mm. gingival margin
situated on black band
of the probe.
TN-2 Scaling and root
planning
4 Pathological pocket
6mm or more. Black
band of the probe not
visible
TN-3 Complex therapy
by specially
trained
personnel

54. ADVANTAGE
• Simplicity
• Speed
• International uniformity
LIMITATIONS
• Doesnot record the position of
gingiva
• Doesn’t provide assessment of
past periodontal breakdown
54

55. COMMUNITY PERIODONTAL INDEX (CPI)
 Based on modification of CPITN
 Modification is done by including “loss of attachment” and
eliminating “treatment needs” category.
 CPI scoring criteria is same as CPITN and done with CPITN-C
probe

56. 56
Code Criteria
0 loss of attachment 0-3 mm, CEJ not visible
1 loss of attachment 4-5mm
2 loss of attachment 6-8mm
3 loss of attachment 9-11mm
4 loss of attachment 12mm or more
X excluded sextant
9 not recorded
Codes and Criteria for Loss of attachment includes:

57. BY SCHOUR & MASSLER, (1944)
• To count number of gingival unit affected with gingivitis that is correlated
with severity of gingival inflammation.
• The facial surface of gingiva around a tooth divided into three units:
Papillary gingiva (P),
Marginal gingiva (M), and
Attached gingiva (A).
• Usually central incisor to second premolars are examined.
PAPILLARY MARGINAL ATTACHMENT INDEX(PM

58. PAPILLARY COMPONENT (P)
• 0= NORMAL; NO INFLAMMATION.
• 1+= MILD PAPILLARY ENGORGEMENT; SLIGHT INCREASE IN SIZE.
• 2+= OBVIOUS INCREASE IN SIZE OF GINGIVAL PAPILLA; HEMORRHAGE ON PRESSURE.
• 3+= EXCESSIVE INCREASE IN SIZE WITH SPONTANEOUS HEMORRHAGE.
• 4+= NECROTIC PAPILLA.
• 5+= ATROPHY AND LOSS OF PAPILLA (THROUGH INFLAMMATION).

59. MARGINAL COMPONENT(M)
• 0= Normal; no inflammation visible.
• 1+= Engorgement; slight increase in size; no bleeding.
• 2+= Obvious engorgement; bleeding upon pressure.
• 3+= Swollen collar; spontaneous hemorrhage; beginning infiltration into
attached gingivae.
• 4+= Necrotic gingivitis.
• 5+= Recession of the free marginal gingiva below the CEJ due to
inflammatory changes.

60. ATTACHED COMPONENT(A)
0= Normal; pale rose; stippled.
1+= slight engorgement with loss of stippling; change in color may or may
not be present.
2+=obvious engorgement of attached gingivae with marked increase in
redness. Pocket formation present.
3+=advanced periodontitis. Deep pockets evident.

61. CALCULATION:
P M A INDEX SCORE PER PERSON = P +
M + A
61
USES:
On clinical trails
On individual patient
For epidemiological surveys

62. • FIRST INTRODUCED BY RAMFJORD IN 1959
• COMPOSED OF THREE COMPONENTS:
I. PLAQUE COMPONENT,
II. CALCULUS COMPONENT AND
III. GINGIVAL & PERIODONTAL COMPONENET.
• ALL THE THREE COMPONENTS WILL BE SCORED SEPARATELY USING SIX RAMFJORD SELECTED TEETH.
16 21 24
44 41 36
PERIODONTAL DISEASE INDEX (PDI)

63. PLAQUE COMPONENT:
Scoring is done after staining with Bismark Brown
solution.
Score Criteria
0 No plaque
1 Plaque present on some but not on all interproximal,
buccal, and lingual surfaces of the tooth
2 Plaque present on all interproximal, buccal, and lingual
surfaces,but covering less than one half of these surfaces
3 Plaque extending over all interproximal, buccal and lingual
surfaces, and covering more than one half of these surfaces

64. Plaque Score = Total scores
No. of teeth examined
CALCULATION:

65. CALCULUS COMPONENT:
SCORING CRITERIA:
SCO
RE
CRITERIA
0 No calculus
1 Supragingival calculus extending only slightly below the free
gingival margin (not more than 1 mm
2 Moderate amount of supragingival and sub gingival calculus or
sub- gingival calculus alone.
3 An abundance of supra gingival and sub gingival calculus

66. CALCULATION:
CALCULUS SCORE = TOTAL SCORES
NO. OF SURFACES EXAMINED

67. GINGIVAL AND PERIODONTAL COMPONENT.
• Gingival status is scored first.
• Gingival status and crevice depth is recorded in relation to CEJ
• All areas (m, d, b, l) is scored .
• Only fully erupted teeth are scored .
• There is no substitution for excluded teeth.

68. 68
SCORE CRITERIA
0 Absence of signs of inflammation
1 Mild to moderate inflammatory gingival changes not extending
around the tooth
2 Mild to moderately severe gingivitis extending all around the
tooth
3 severe gingivitis characterized by marked redness, swelling,
tendency to bleed, and ulceration
4 gingival crevice in any of 4 measured areas(M,D,B,L) extending
apically to CEJ but not more than 3mm
5 gingival crevice in any of 4 measured areas(M,D,B,L) extending
apically to CEJ between 3-6mm
6 gingival crevice in any of 4 measured areas(M,D,B,L) extending
apically more than 6mm from CEJ

69. CALCULATION
PDI score = Total of individual tooth scores (PS+CS+GPS)
Number of tooth examined

70. 70
RECENT ADVANCES IN PERIODONTAL
INDICES
• BASIC PERIODONTAL EXAMINATION (BPE) INDEX
• GENETIC SUSCEPTIBILITY INDEX FOR PERIODONTAL DISEAS
• PERIODONTAL SCREENING AND RECORDING (PSR) INDEX

71. • Developed by British Society of Periodontology in
1986
• Derived from the community periodontal index of
treatment needs (cpitn)
• Simple and rapid screening tool that is used to
indicate the level of examination needed and to
provide basic guidance on treatment need
• Not a diagnostic tool
71
BASIC PERIODONTAL EXAMINATION (BPE)
INDEX

72. 72

73. • Genetic markers denote susceptibility toward disease manifestation
and it would be useful to exploit the information hidden into them
and to derive a Genetic Susceptibility Index (GSI)
• Single Nucleotide Polymorphisms (SNP’s) in genes encoding
molecules of the host defense system are assessed and an
association is established between SNP and disease status
73
GENETIC SUSCEPTIBILITY INDEX FOR PERIODONTAL
DISEASE

74. • Introduced in 1992 by American Academy of Periodontology (AAP) and
American Dental Association(ADA)
• Endorsed by the World Health Organization (WHO)
• Adaptation of the Community Periodontal Index of Treatment needs
(CPITN)
• Used to measure gingival bleeding upon probing, calculus on a tooth,
and periodontal pocket depth in each sextant of the oral cavity
74
PERIODONTAL SCREENING AND RECORDING
(PSR) INDEX

75. CALCULATING PSR
• Highest score in a sextant is recorded as the PSR score for
the sextant.
• Only one score is recorded for each sextant of the oral
cavity.
• A WHO/CPITN/PSR probe is used to examine each tooth
individually
75

76. ADVANTAGES
• Introducing a simplified screening method that met
legal dental recording requirements.
• Early detection of periodontal disease and it serves
as an aid in monitoring the periodontal status of
patients
76

77. LIMITATIONS
• Limited use of the PSR system in children due to
inability to differentiate pseudo-pockets
• Does not measure epithelial attachment, the severity
of periodontal disease may be underestimated with
its use
77

78. • Used to measure pocket depths.
• A pocket measuring probe/ Williams probe is used.
• Main components to record:
- Pocket depth (mm)
- Mobility
- Recession (mm)
- Bleeding on probing
- Furcation
DPC – DETAILED PERIODONTAL CHART

79. • Two blunt instruments are used to asses a tooth’s mobility.
e.g end of mirror and probe
• To quantify mobility, Millers index of mobility is used:
MOBILITY
GRADE MOBILITY
Grade 0 Normal physiological mobility (<1mm)
Grade 1 Movement up to 1mm in horizontal plane
Grade 2 Movement greater than 1mm in horizontal
plane
Grade 4 Severe mobility greater than 2mm or vertical
mobility

80. • The furcation is the point at which the two roots divide.
• A pocket measuring probe is used (naber’s probe)
Ramfjord and Ash furcation index:
FURCATION
GRADE MOBILITY
Grade 0 No clinical furcation involved
Grade 1 Bone loss up to 1/3 width
Grade 2 Bone loss up to 2/3 width
Grade 4 Through and through defect

81. RECESSION
•To measure the recession of a individual
tooth, a pocket measuring probe must
be used.
•The probe is placed onto the tooth and
the distance between the cemento-
enamel junction and the gingival margin
is measured. This is the amount of
recession that has occurred on that
tooth.

82. • THE POCKET MEASURING PROBE IS INSERTED INTO THE
GINGIVAL CREVICE.
• THE DISTANCE FROM THE BASE OF THE POCKET AND THE
GINGIVAL MARGIN IS MEASURED.
• IN ADDITION, IF THE SITE BLEEDS ON PROBING, CIRCLE THE
SCORE IN RED AND IF THE SITE HAS SUPPURATION (PUS) CIRCLE
THE SCORE IN BLUE OR BLACK.
BASELINE POCKET DEPTH
BASELINE POCKET DEPTH + RECESSION = CAL

83. • The DPC allows the operator to find sites in the mouth requiring
attention.
• Sites with pockets greater than 5mm will require RSD.
• Subsequent pocket depths and cal can be measured after treatment
to assess the success of treatment.
WHAT HAPPENS FROM THE RESULTS OF
THE DPC??

84. 84
Dental diseases are the most prevalent and most neglected of all the
chronic diseases of mankind.
One of the major problems in studying dental diseases and its factors is the
development of a suitable and practicable method for recording and
classifying the occurrence and severity of the disease.
Dental indices and scoring methods are used in clinical practice and
community programs to determine and recoRd the state of health of
individual and group
CONCLUSION

85. REFERENCES
• Essentials of Public health dentistry 5E, Soben Peter
• Carranza's Clinical Periodontology, 12E (2015) , Newman, Takei,
Klokkevold, Carranza
• Https://www.mah.se/capp/methods-and-indices/oral-hygiene-
indices/simplified-oral-hygiene-index--ohi-s/
• Dhingra k, vandana k l; indices for measuring periodontitis: a
literature review. international dental journal. 2011;
85

86. THANK YOU
86