Oral Health Indices

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Oral Health IndicesTeerawat Tu s anapirom DDS. MPA.



Objectiveมความร เก ยวกับคณลั กษณะของดั ชนพ นฐานท ใช ในการสารวจ

สภาวะสขภาพชองปาก!สามารถใช ดั ชน ในการบั นทกข อมลและสามารถแปรผลข อมลสภาวะสขภาพชองปากเพ อนาไปใช ได อยางเหมาะสม



What Is Index An index is defined as a numerical valuedescribing the relative status of a population

on a graduated scale with definite upper andlower limits, which is designed to permit andfacilitated comparison with other populationsclassified by the same criteria and method (AL

Russell).



Properties of an ideal index

Reliability ! Validity !Clarity, simplicity and objectivity !Quantifiability ! Acceptability



Selection CriteriaBe simple to use and calculate!Require minimal equipment and expense.!Require minimal amount of time to complete.!Not cause patient discomfort or otherwise be

un acceptable to a patient.



Selection CriteriaHave clear-cut criteria that are readily understandable.!Be as free as possible from subjectiveinterpretation.!Be reproducible by the same examiner or

deference examiner.!Be amenable statistical analysis; have validity andreliability.



Different Types of Examination ADA



Different Types of Examination

ADA type 1!Mouth mirror !Explorer!Good illumination!Full mouth radiographs! Additional diagnosis method




ADA type 2!Mouth mirror !Explorer!Good illumination!Bite-wing radiographs!Periapical radiographs if indicated.




ADA type 3!Mouth mirror !Explorer!Good illumination




ADA type 4!Tongue depressor!

Available illumination



Oral Hygiene Index(OHI)Greene and Vermi l ion 1960



PurposePurpose : To measure existing debris and

calculus as an indication of oral cleanliness.!

The OHI has two components!Debris Index !Calculus Index



Selection Teeth and SurfacesDevide the dentition into

sextants.!Score only fully erupt

permanent teeth.!Exclude third molar , teeth

with full crown

restorations, teeth reduced

in hight because of severe

dental caries or trauma.!Select the 12 tooth surface,

1 facial and 1 lingual or

palatal in each sextant.



ProcedureEvaluation: evaluation each sextant to recordfirst the debris and then the calculus.!Sequence: proceed in routine from maxillary right, anterior, and left sextants to mandibularleft, anterior, and right sextants.!Record 12 Debris Scores!Record 12 Calculus Scores



Record 12 Debris ScoreDefinition of Oral Debris: the soft foreignmatter on the surface of the teeth that consist

of bacterial plaque, material alba, and fooddebris.!Examination: Run the side of the tip of the

probe or explorer across the tooth surface toassist in estimating the surface area covered by debris.



Record 12 Debris ScoreCriteria !

0 = no debris or stain present !1 = soft debris covering not more than

one third of the tooth surface being examined, or the presence of extrinsicstains without debris, regardless of

surface area covered.!2 = soft debris covering more than onethird but not mor than two thirds of

the exposed tooth surface.!3 = soft debris covering more than twothirds of the exposed tooth surface.



Record 12 calculus scores

Definition of Calculus: a hard deposit of inorganic salts composed primarily of calcium

carbonate and phosphate mix with debris,microorganism, and desquamate epithelial cells.!Examination: Use an explorer to supplement

visual examination for supra-gingival calculusdeposits. Identify sub-gingival deposits by exploring and/or probing. Record only definitedeposits of hard calculus.



Criteria !0 = no calculus present !1= supragingival calculus covering not more

than one third of the exposed tooth surface

being examined.!2= supragingival calculus covering more than

one third but not more than two thirds of

exposed tooth surface, or the presence of

individual flecks of subgingival calculus

around the cervical portion of the tooth.!3= supragingival calculus covering more than

two thirds of the exposed tooth surface or a

continuous heavy band of subgingival calculus

around the cervical portion of the tooth.



Scoring OHI for an individual!

Determine Debris index(DI) and Calculus index(CI)!•

Divide total score by number of sextants.!

• Each selected surface has a severity score of 0 to 3.!• The total score for debris or calculus ranges from 0 to 36.!• Debris index(DI) or Calculus index(CI) ranges from 0 to 6.!

Oral Hygiene Index(OHI) = DI + CI !• The OHI ranges from 0 to 12.



Calculation example for individual OHI

Total debris scores

Number of sextants

DI =

= 21

6

= 3.5



Calculation example for individual OHI

Total calculus scores

Number of sextants

CI =

= 10

6

= 1.67

OHI = DI + CI = 3.50 + 1.67 = 5.17



Scoring OHI for a group !

Group debris index : Divide total DI scores by

number of individuals.!

Group calculus index : Divide total calculusscores by number of individuals.!Mean oral hygiene index : Divide total DI and CIscores for all individuals by number of individuals.



Suggested Nominal Scale

Rating Scores

Excellent 0

Good 0.1-1.2

Fair 1.3-3.0

Poor 3.1-6.0

Rating Scores

Excellent 0

Good 0.1-2.4

Fair 2.5-6.0

Poor 6.1-12

DI and CI OHI



Example



Simplified Oral Hygiene Index

(OHI-S)Greene and Vermi l ion, 1964



Purpose

Purpose: To assess oral cleanliness by estimating the tooth surface covered with

debris and/or calculus.!Components: The OHI-S has two components,the Simplified Debris Index(DI-S) and

Simplified Calculus Index (CI-S). The twoscores may be use separately or may becombined for the OHI-S.



Comparison with OHITooth selection. In the OHI the examiner has toselect the tooth with the most debris or calculusin each sextant. The OHI-S assesses 6 specificteeth, 1 in each sextant.!Number of surfaces. In the OHI, 12 surfaces areevaluated: only 6 surfaces are used in OHI-S. !Scoring. The OHI ranges from 0 to 12; the OHI-Sranges from 0 to 6.



Selection of teeth and surfaces.

Posterior: the first fully erupt tooth distal to each second

premolar, usually the first

molar but sometimes the

second or third molar is

examined.!The facial surfaces of the

maxillary molars and the

lingual surfaces of mandibular molars are used.



Selection of teeth and surfaces.

Anterior: The facialsurfaces of the

maxillary right and themandibular left centralincisors are used.

When either is missing,

the opposite centralincisor is scored.



Procedure

Qualification: At least two of the six possiblesurfaces must have been examined for anindividual score to be expressed.!Record Six Debris scores and Six Calculusscores: follow the routine and use the same

criteria as for the OHI.



Scoring OHI-S for individual

DI-S = total debris scoresnumber of sextants

CI-S = total calculus scores

number of sextants

OHI-S = DI-S + CI-S



Scoring

OHI-S group score!Compute the average of the individual scoresby totaling the scores and dividing by thenumber of the individual.



Suggested Nominal Scale

Rating Scores

Excellent 0

Good 0.1-0.6

Fair 0.7-1.8

Poor 1.9-3.0

Rating Scores

Excellent 0

Good 0.1-1.2

Fair 1.3-3.0

Poor 3.1-6.0

DI-S and CI-S OHI-S



Calculation example for an individual

2 1 3

2 2 3

DI-S = total debris scoresnumber of sextants

= 13 = 2.176




2 0 2

2 1 2

= 9 = 1.506

CI-S = total calculus scores

number of sextants




OHI-S = DI-S + CI-S

= 2.17 + 1.50 = 3.67

Rating Scores

Excellent 0

Good 0.1-1.2Fair 1.3-3.0

Poor 3.1-6.0



Example



Community Periodontal

Index (CPI)Federation Dentaire International (FDI), Ainamo 1982



Purpose

To screen and monitor individual or groupperiodontal treatment needs.



Procedure

Instrument: WHOPeriodontal Prob



Selection of Teeth

The mouth is dividedinto sextant definedby tooth number



Selection of Teeth

17 16 11 26 27

47 46 31 36 37

For Adults ages(20 years above)



Selection of Teeth

Children and Adolescents !(20 years below)



Substitution for excluded and missing

index teethPosterior portion: In the absence of this posteriorteeth, the other teeth is substituted and in theabsence of both of teeth, the highest score insextant is substituted. !

Anterior portion: In the absence of either of thisanterior teeth, the central incisor on the opposite

side of midline is substituted, and in the absenceof both of teeth the highest score in sextant issubstituted.



Criteria

Code 0 = Healthy periodontal tissue.!Code 1 = bleeding after gentle probing.!Code 2 = Supra or subgingival calculus or defective margin of filling or crown.(all black band visible)!Code 3 = 4- or 5- mm. Pocket.(gingival margin within the black band)!Code 4 = 6 mm. Or deeper pathologic pocket.(black band not visible)!Code X = excluded sextant !Code 9 = not record



CPI code



CPI: Lost of attachment codes

Code 0 = lose of attachment 0 to 3 mm.!Code 1 = lose of attachment 4 to 5 mm.!Code 2 = lose of attachment 6 to 8 mm.!Code 3 = lose of attachment 9 to 11 mm.!Code 4 = lose of attachment 12 mm or more.!Code X = excluded sextant !Code 9 = not record



CPI: Lost of attachment codes



Recording

Mark one score torepresent each sextant.Record only highest code

that corresponds with themost severe condition.!Do not examineremaining teeth in asextant after code 4 has

been record.!Place X for missing sextant.



Scoring Periodontal treatment need scale.!TN 0 = No need for treatment (code 0)!TN I = Oral hygiene instruction (code 1)

!TN II = Oral hygiene instruction plus scaling and root planning, including elimination of plaque retentive marginof filling and crown (code 2 and 3)!TN III = I+II + complex periodontal therapy that may include surgical intervention and/or deep scaling and root planning with local anesthesia (code 4)



CPI for Individual

Example for Adult patient !• Interpretation: two

sextants are mark formissing (X). Codes 2, 3,

and 4 indicate need for

thorough periodontal

examination, charting, anddetails treatment plan.

2 3

4 2



CPI for Individual

Example for Young patient !• Interpretation: Code 1

indicates need for improvedoral hygiene. Code 3indicates for scaling androot planing after completeperiodontal examination

and charting. The possibility of juvenile periodontitisshould be considered.

3 0 3

3 1 3



CPI for GroupThe recordings for group maybe presented in a variety of ways, such as following.!

1.Treatment need can be reported as the number or percent of subjects in each

treatment need category.!2.Mean number of sextants with bleeding, calculus, and moderate or deep pockets

for each ages group can be shown.!3.To identify high and low priorities for treatment in a community, calculations of

the number and percent of individuals with the following can be made:! A. No sextants scoring each code.!B. 1 to 2 sextants scoring code 1, 2, 3 or 4!C. 3 to 4 sextants scoring code 1, 2, 3 or 4!D. 5 to 6 sextants scoring code 1, 2, 3 or 4



Plaque Index (PI)Siln e s and Loe, 1964



Purpose

The PI as developed by Silness and Loeassesses the thickness of plaque at the cervical

margin of the tooth. Four area, distal, facial orbuccal, mesial, and lingual or palatal areexamined.



ProcedureEach tooth is dried and examined visually using amouth mirror, an explorer, and adequate light.!The explorer is passes over the cervical third to test

for the presence if plaque. A disclosing agent may be used to assist evaluation.!Missing teeth are not substituted.!Each of the four surface of the teeth(buccal, lingual,mesial and distal) is given a score from 0 to 3.



Selection of teeth

All of teeth or !Modified PI



Scoring Each of the four surfaces of the teeth (buccal, lingual, mesial and distal)

is given a score from 0-3. The scores from the four areas of the tooth are

added and divided by four in order to give the plaque index for the tooth

with the following scores and criteria:



PI for individual

The index for the patient is obtained by summing the indices for all six teeth anddividing by six.



Interpretation for PI scores

0 = excellent oral hygiene!0.1 - 0.9= good oral hygiene!1.0 - 1.9 = fair oral hygiene!2.0 - 3.0 = poor oral hygiene



Decayed Missing and

Filled Permanent Teeth(DMFT)

Klein, H. And Palmer 1938



Purpose

To determine total dental caries experience,past and present.



Selection of Teeth

DMFT based on 28 teeth!Teeth not counted!

Third molars.!Un-erupted teeth. A tooth is considered erupted when

any part projects through the gingiva. Certain type of

research may require differentiation between clinical

emergence, partial eruption, and full eruption.!Congenital missing and supernumerary teeth.



Selection of TeethDMFT based on 28 teeth!Teeth not counted!

Teeth remove for reasons other than dental caries, such asfor impaction or during orthodontic treatment. !Teeth restored for reasons other than dental caries, such as

trauma, cosmetic purposes, or for use as bridge abutment.!Primary tooth retained with the permanent successorerupted. The permanent tooth is evaluated because

primary tooth is never include in this index.



Procedures

Instruments!Each tooth is examined in a systematicsequence, using a mouth mirror andadequate light. Explorers with same designand with standardized dimensions of the

working ends are needed throughout a givensurvey.



Procedure

Examination!Use of explorer. Teeth should be observed by visual means as much as possible.Unnecessary discomfort for the patient canbe avoided by exploring only questionable

small lesions.



ProcedureCriteria for identification of dental caries.!

The lesion is clinically visible and obvious.!The explorer tip cam penetrate into soft yielding material.!Discoloration or loss of translucency typical of undermined or demineralized enamel is apparent.!The explorer tip in a pit or fissure catches or resistsremoval after moderate to firm pressure on insertion,and when softness occurs at the base of the area.



Criteria for Recoding

D

- when both dental caries and a restoration are

present.!- when crown is broken down as a result of

dentalcarise

M

- When tooth has been extracted because of

dental caries.!- When it is curious, non restorable, and

indicated for extraction.

F- Permanent filling !-A tooth with a defective filling but without

evidence of dental caries.



Scoring

Individual DMFT!1.Total each component separately.!2.Total D+M+F = DMF



Scoring Group average !1.Total the DMFs for each individual

examined.!2.Divide the total DMFs by the number of

individual in group.



Example



Decayed Missing andFilled permanent tooth

Surface (DMFS)



Purpose

To determine total dental caries experience,

past and present, by record tooth surfacesinvolved instead of teeth, as in the DMFTpreviously described.



Selection of teeth and surfaces

Teeth not Counted!The same as listed for the DMFT



Selection of teeth and surfaces

Surfaces!Posterior teeth. Each tooth has five surfacesexamined and record: facial, lingual, mesial,distal, and the occlusal.!

Anterior teeth. Each tooth has four surfaces forevaluation: facial, lingual, mesial, and distal.!Total surface count for DMFS = 128 surfaces.



Procedure

The same criteria for instruments and

examination apply as listed previously forDMFT. In all surveys, specific criteria must bepredetermined.



Scoring

Individual DMFS!

DMFS = D + M + S



Example



Scoring

Group DMFS!Example: A group of 20 individuals 15 to 18

years old lives in a community withfluoridated water. All have lived therecontinuously except 3 who move there fromnon fluoridated town after reaching 12 years

of ages.



ExampleThe following data show the distribution of DMFS.



Decayed, Indicated for

extraction, filled Teeth orSurfaces (deft, defs)



Purpose

To determine the dental caries experience as

show for the primary teeth present in the oralcavity by evaluating teeth or surfaces.



Selection of teeth or surface

deft: 20 teeth evaluated.!defs : 88 surfaces evaluated.!

Posterior Teeth: Each has 5 surfaces - facial,lingual or palatal, mesial, distal and occlusal.! Anterior Teeth: Each had 4 surfaces - facial,lingual or palatal, mesial and distal.



Selection of teeth or surface

Missing teeth including unerupted andcongenitally missing.!Supernumerary teeth.!Teeth restored for reason other than dentalcaries are not counted as f.



Procedure

Instruments and Examination - Same as forDMFT.!Criteria for identification of dental caries -Same as for DMFT.



ProcedureCriteria for def !

d = Number of primary teeth or surfaces with

dental caries but not restored.!

e = number of teeth indicated for extractionbecause of dental caries.!f = number of filled primary teeth onsurfaces that do not have dental caries.



Scoring

Same as DMFT,DMFS



Significant Caries Index



Significant Caries Index

DMFT describes the amount - the prevalence - of dental caries in an individual and is obtained by calculating the number of Decayed (D), Missing (M)

and Filled (F) teeth. The WHO goal thus indicatethat a maximum of three teeth as a mean may beaffected by caries at the age of 12. However, a lowmean caries level such as '3' does not exclude a

number of individuals with considerably higherDMFT values in the same population.



Significant Caries Index A detailed analysis of the caries situation in many

countries show that there is a skewed distributionof caries prevalence - meaning that a proportion of

12-year-olds still has high or even very high DMFT values even though a proportion is totally cariesfree. Clearly, the mean DMFT value does not accurately reflect this skewed distribution leading

to incorrect conclusion that the caries situation forthe whole population is controlled, while in reality,several individuals still have caries.



Calculation

Individuals are sorted according to theirDMFT values!One third of the population with the highest caries scores is selected!The mean DMFT for this subgroup is

calculated. This value is the SiC Index.



Example

Caries free 45%!

Mean DMFT 1.91!SiC 4.61



Example

DMFT !3,1,2,1,3,5,3,7,4,2,1,

1,2,8,1,2,4,3,1,3,2,Mean DMFT =

1,1,1,1,1,1,2,2,2,2,2,3,3,3,3,3,4,4,5,7,8 Si-C =



Dean's Fluorosis Index H.T. Dean 1934



Dental Fluorosis

Dental fluorosis is a developmental disturbance of

dental enamel caused by excessive exposure to highconcentrations of fluoride during tooth development.

The risk of fluoride overexposure occurs between theages of 3 months and 8 years. In its mild forms (whichare its most common), fluorosis often appears as

unnoticeable, tiny white streaks or specks in the enamel

of the tooth. In its most severe form, tooth appearanceis marred by discoloration or brown markings. The

enamel may be pitted, rough and hard to clean.

"Enamel fluoros $ ". Ame % can Academy of Pe & at % c Dent $ try. Ret % eved 2 ' 9-02-04.



Scoring

Dean 1942



Scoring



Dean's community fluorosis index(CFI)

Code Weight(W) Frequency (F) WxF

Normal 0! 0 61 0

Questionable 1 0.5 6 3

Very mild 2 1 13 13

Mild 3 2 11 22

Moderate 4 3 6 18

Severe

5 4 3 12N=100 68



Dean's community fluorosis index(CFI)

CFI score = W x FN

Oral Health survey basic method



Oral Health survey basic method,

Geneva 1997

Oral Health Indices

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