Oral Health Indices

Teerawat Tussanapirom DDS. MPA.

Objective
!

What Is Index
An index is dened as a numerical value describing the relative status of a population on a graduated scale with denite upper and lower limits, which is designed to permit and facilitated comparison with other populations classied by the same criteria and method (AL Russell).

Properties of an ideal index

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

Selection Criteria
Be 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 Criteria
Have clear-cut criteria that are readily understandable.! Be as free as possible from subjective interpretation.! Be reproducible by the same examiner or deference examiner.! Be amenable statistical analysis; have validity and reliability.

Different Types of Examination

ADA

Different Types of Examination

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

Different Types of Examination

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

Different Types of Examination

ADA type 3! Mouth mirror ! Explorer! Good illumination

Different Types of Examination

ADA type 4! Tongue depressor! Available illumination

Oral Hygiene Index(OHI)

Greene and Vermillion 1960

Purpose
Purpose : To measure existing debris and calculus as an indication of oral cleanliness.! The OHI has two components! Debris Index! Calculus Index

Selection Teeth and Surfaces

Devide 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.

Procedure
Evaluation: evaluation each sextant to record rst the debris and then the calculus.! Sequence: proceed in routine from maxillary right, anterior, and left sextants to mandibular left, anterior, and right sextants.! Record 12 Debris Scores! Record 12 Calculus Scores

Record 12 Debris Score

Denition of Oral Debris: the soft foreign matter on the surface of the teeth that consist of bacterial plaque, material alba, and food debris.! Examination: Run the side of the tip of the probe or explorer across the tooth surface to assist in estimating the surface area covered by debris.

Record 12 Debris Score

Criteria ! 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 extrinsic stains without debris, regardless of surface area covered.! 2 = soft debris covering more than one third but not mor than two thirds of the exposed tooth surface.! 3 = soft debris covering more than two thirds of the exposed tooth surface.

Record 12 calculus scores

Denition 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 calculus deposits. Identify sub-gingival deposits by exploring and/or probing. Record only denite deposits 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 ecks 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 calculus scores by number of individuals.! Mean oral hygiene index : Divide total DI and CI scores for all individuals by number of individuals.

Suggested Nominal Scale

Rating Excellent Good Fair Poor Scores 0 0.1-1.2 1.3-3.0 3.1-6.0 Rating Excellent Good Fair Poor Scores 0 0.1-2.4 2.5-6.0 6.1-12

DI and CI

OHI

Example

Simplied Oral Hygiene Index (OHI-S)

Greene and Vermillion, 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 Simplied Debris Index(DI-S) and Simplied Calculus Index (CI-S). The two scores may be use separately or may be combined for the OHI-S.

Comparison with OHI

Tooth selection. In the OHI the examiner has to select the tooth with the most debris or calculus in each sextant. The OHI-S assesses 6 specic teeth, 1 in each sextant.! Number of surfaces. In the OHI, 12 surfaces are evaluated: only 6 surfaces are used in OHI-S. ! Scoring. The OHI ranges from 0 to 12; the OHI-S ranges from 0 to 6.

Selection of teeth and surfaces.

Posterior: the rst fully erupt tooth distal to each second premolar, usually the rst 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 facial surfaces of the maxillary right and the mandibular left central incisors are used. When either is missing, the opposite central incisor is scored.

Procedure
Qualication: At least two of the six possible surfaces must have been examined for an individual score to be expressed.! Record Six Debris scores and Six Calculus scores: follow the routine and use the same criteria as for the OHI.

Scoring
OHI-S for individual
DI-S = total debris scores number 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 scores by totaling the scores and dividing by the number of the individual.

Suggested Nominal Scale

Rating Excellent Good Fair Poor Scores 0 0.1-0.6 0.7-1.8 1.9-3.0 Rating Excellent Good Fair Poor Scores 0 0.1-1.2 1.3-3.0 3.1-6.0

DI-S and CI-S

OHI-S

Calculation example for an individual

1 2 3

2 2

1 2

3 3

DI-S =
2 2 3

total debris scores number of sextants 13 6 = 2.17

Calculation example for an individual

0 2 2

2 2

0 1

2 2

CI-S =
2 1 2

total calculus scores number of sextants 9 6 = 1.50

Calculation example for an individual

OHI-S = DI-S + CI-S = 2.17 + 1.50 = 3.67
Rating Excellent Good Fair Poor Scores 0 0.1-1.2 1.3-3.0 3.1-6.0

Example

Community Periodontal Index (CPI)

Federation Dentaire International (FDI), Ainamo 1982

Purpose
To screen and monitor individual or group periodontal treatment needs.

Procedure
Instrument: WHO Periodontal Prob

Selection of Teeth
The mouth is divided into sextant dened by 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 teeth

Posterior portion: In the absence of this posterior teeth, the other teeth is substituted and in the absence of both of teeth, the highest score in sextant is substituted. ! Anterior portion: In the absence of either of this anterior teeth, the central incisor on the opposite side of midline is substituted, and in the absence of both of teeth the highest score in sextant is substituted.

Criteria
Code 0 = Healthy periodontal tissue.! Code 1 = bleeding after gentle probing.! Code 2 = Supra or subgingival calculus or defective margin of lling 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 to represent each sextant. Record only highest code that corresponds with the most severe condition.! Do not examine remaining teeth in a sextant 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 margin of lling 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!

2 4 2

Interpretation: two sextants are mark for missing (X). Codes 2, 3, and 4 indicate need for thorough periodontal examination, charting, and details treatment plan.

CPI for Individual

Example for Young patient!

3 3

0 1

3 3

Interpretation: Code 1 indicates need for improved oral hygiene. Code 3 indicates for scaling and root planing after complete periodontal examination and charting. The possibility of juvenile periodontitis should be considered.

CPI for Group

The 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)

Silness and Loe, 1964

Purpose
The PI as developed by Silness and Loe assesses the thickness of plaque at the cervical margin of the tooth. Four area, distal, facial or buccal, mesial, and lingual or palatal are examined.

Procedure
Each tooth is dried and examined visually using a mouth 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 ! Modied 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 and dividing 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 Teeth
DMFT based on 28 teeth! Teeth not counted! Teeth remove for reasons other than dental caries, such as for 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 successor erupted. The permanent tooth is evaluated because primary tooth is never include in this index.

Procedures
Instruments! Each tooth is examined in a systematic sequence, using a mouth mirror and adequate light. Explorers with same design and with standardized dimensions of the working ends are needed throughout a given survey.

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

Procedure
Criteria for identication 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 ssure catches or resists removal after moderate to rm 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

- When tooth has been extracted because of dental caries.!

- When it is curious, non restorable, and

indicated for extraction.

- Permanent lling! -A tooth with a defective lling 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

Example

Decayed Missing and Filled permanent tooth Surface (DMFS)

Purpose
To determine total dental caries experience, past and present, by record tooth surfaces involved instead of teeth, as in the DMFT previously 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 ve surfaces examined and record: facial, lingual, mesial, distal, and the occlusal.! Anterior teeth. Each tooth has four surfaces for evaluation: facial, lingual, mesial, and distal.! Total surface count for DMFS = 128 surfaces.

Procedure
The same criteria for instruments and examination apply as listed previously for DMFT. In all surveys, specic criteria must be predetermined.

Scoring
Individual DMFS! DMFS = D + M + S

Example

Example

Scoring
Group DMFS! Example: A group of 20 individuals 15 to 18 years old lives in a community with uoridated water. All have lived there continuously except 3 who move there from non uoridated town after reaching 12 years of ages.

Example
The following data show the distribution of DMFS.

Decayed, Indicated for extraction, lled Teeth or Surfaces (deft, defs)

Purpose
To determine the dental caries experience as show for the primary teeth present in the oral cavity 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 and congenitally missing.! Supernumerary teeth.! Teeth restored for reason other than dental caries are not counted as f.

Procedure
Instruments and Examination - Same as for DMFT.! Criteria for identication of dental caries Same as for DMFT.

Procedure
Criteria for def! d = Number of primary teeth or surfaces with dental caries but not restored.! e = number of teeth indicated for extraction because of dental caries.! f = number of lled primary teeth on surfaces that do not have dental caries.

Scoring
Same as DMFT,DMFS

Signicant Caries Index

Signicant 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 indicate that a maximum of three teeth as a mean may be affected by caries at the age of 12. However, a low mean caries level such as '3' does not exclude a number of individuals with considerably higher DMFT values in the same population.

Signicant Caries Index

A detailed analysis of the caries situation in many countries show that there is a skewed distribution of 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 caries free. Clearly, the mean DMFT value does not accurately reect this skewed distribution leading to incorrect conclusion that the caries situation for the whole population is controlled, while in reality, several individuals still have caries.

Calculation
Individuals are sorted according to their DMFT 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 uorosis is a developmental disturbance of dental enamel caused by excessive exposure to high concentrations of uoride during tooth development. The risk of uoride overexposure occurs between the ages of 3 months and 8 years. In its mild forms (which are its most common), uorosis often appears as unnoticeable, tiny white streaks or specks in the enamel of the tooth. In its most severe form, tooth appearance is marred by discoloration or brown markings. The enamel may be pitted, rough and hard to clean.
"Enamel uoros$". Ame%can Academy of Pe&at %c Dent$try. Ret %eved 2'9-02-04.

Scoring

Dean 1942

Scoring

Dean's community uorosis index(CFI)

Code
Normal Questionable Very mild Mild Moderate Severe

Weight(W)

Frequency (F)

WxF 0 3 13 22 18 12 68

0! 1 2 3 4 5

0 0.5 1 2 3 4

61 6 13 11 6 3 N=100

Dean's community uorosis index(CFI)

CFI score = W x F
N

Oral Health survey basic method, Geneva 1997