PREVENTION Lecture:1 Oral Health assessment (Dental caries) Clinical examinations are conducted by using plane mouth dental mirror and sharp explorer. A systemic approach of the examination for dental caries should be performed starting from the upper right second molar 17 proceeding in an orderly manner from one tooth or space to the adjacent tooth or space reach upper left second molar 27 and passing to the lower left second molar 37 ending with the lower right second molar 47. Examinations starts with the mesial surface followed by occlusal, distal, buccal and lingual surface of all teeth examined. A tooth is considered present in the mouth when any part of it is visible or can be touched with the tip of the explorer without displacing soft tissue, if the same space was occupied by both primary and permanent tooth, permanent tooth status were recorded. Measurement of dental caries: The best known dentai index that is used in measuring dental caries and received a universal acceptance is; Decayed- Missing- Filled teeth (surfaces) index DMFT and DMFS == for permanent dentition This index based on the fact that the dental hard tissue are not self healing so establishing caries on tooth either remains decayed or if treated either extracted or filled, therefore it measures total life-time caries experience.| | | In this index all teeth examined except: - Third molar. - Unerupted teeth. - Congenitally missing teeth. - Supernumerary teeth. - Teeth removed for reason other than dental caries. - Primary tooth when permanent tooth occupies the same space. Criteria for recording: Sound tooth: Recorded so, when there is no evidence of treated or untreated clinical caries (i.e, the stage of caries that precedes cavitations). In addition, teeth with the following defects in the absence of other positive criteria were recorded as sound too: = White or chalky spots. - Discolored or rough spots. - All questionable lesions were recorded as sound. Decayed tooth (surface): D, d recording in case of; - Caries that probe sticks - Temporary filling - Filled tooth with decay; when tooth (surface) contained one of permanent restorations and one or more area that are decayed. No distinction was between primary or secondary caries (whether or not the carious lesion was in physical association with the restoration). When a doubt exists, caries lesion was not recorded as present. Missing tooth due to caries (M,m): This score is used for teeth that have been extracted because of caries only. For primary tooth, it was recorded so, when normal exfoliation would not be a sufficient explanation for its absence. Differentiation between unerupted and extracted tooth was made by the;| | | Evaluation of the status of corresponding contralateral tooth. The appearance of the alveolar ridge in the area of the tooth space in question. The caries status of other teeth in the mouth. The cases that are not recorded as missing: when a tooth was missing because of; Filled Trauma Unerupted tooth Normal exfoliation Orthodontic treatment tooth with no decay (F, f recording} Recording so when one or more permanent restorations were present and no area of the tooth was affected whether by primary or secondary (recurrent) caries. Cosmetic filling not recorded as filling in this index. Note: Surface examined in DMFS, dmfs index are; 5 surfaces for posterior teeth 4 surfaces for anterior teeth Example; Missing posterior tooth due to caries recorded as 5 surface missing while missing anterior tooth recorded as 4 surfaces missing. Crown restoration due to caries for posterior tooth recorded as 5 surfaces filling while for anterior tooth recorded as 4 surfaces filling. Retained root recorded as 5 surfaces decayed for posterior tooth and 4 surfaces decayed for anterior tooth.Calculation: Individual DMF; 1- Total each component separately D,M,F. 2- Total D+M+F= DMF The maximum score for dmft=20, minimum=0 The maximum score for dmfs=88, minimum= 0 The maximum score for DMFT= 28, molars) © (excluding third The maximum score for DMFS= 128, minimum= 0 (excluding third molars) In mixed dentition: Primary and permanent teeth are evaluated separately. DMF and drf index are never added together. Oral cleanliness and gingival health conditi Dental plaque thickness adjacent to gingival margin was assessed by using plaque index (PI 1) of Silness and Loe (this index measures the thickness of dental plaque not the distribution of plaque on the tooth surface). Ramfjord index teeth were examined to represent the whole dentition. Only fully erupted tooth (when the occlusal or incisal surface has reached the occlusal plane was involved). A fully erupted permanent tooth was always substituted a primary tooth, if the index tooth was missing or partially erupted, the area was excluded and not substituted by an adjacent tooth. The six index teeth for the permanent dentition were the upper right 1“ molar, upper left central incisor, upper left 1° premolar, lower left 1* molar, lower right central sor, and lower right 1* premolar. In case of primary dentition the six selected teeth are upper right second deciduous molar, upper leftcentral incisor, upper left 1° primary molar, lower left 2° primary molar, lower right central incisor, and lower right 1° primary molar. Each of the 4 areas of the selected teeth was scored (buccal, mesial, lingual and distal) the area of examination is the cervical area and free gingival margin. The criteria for plaque index are: - O:no plaque - 1: A film of plaque adhering to the free gingival margin and adjacent area of the tooth. The plaque may be recognized only running a probe across the tooth surface. - 2: Moderate accumulation of soft matter within the gingival pocket, on the gingival margin and/or adjacent tooth surface, which can be seen with the naked eye. - 3: Abundance of soft deposits within the gingival pocket and/ or the gingival margin and adjacent tooth surface. Gingival index: described by Loe and Silness was used, the Ramfjord teeth were examined and the sequence of examination was similar to that of oral cleanliness. The criteria for the gingival index are: - 0: Normal gingival - 1: Mild inflammation, slight change in color, slight edema, no bleeding on probing. - 2: Moderate inflammation: redness, edema and glazing, bleeding on probing. - 3: Severe inflammation: marked redness and edema, ulceration, tendency to spontaneous bleeding. Note: Excluding from the recording the eruption gingi inflammation caused by infection. Calculus: is assessed according to the method described by Green and Vermillion, in which simplified oral hygiene index was applied. The sequence of examination was the same as that selected in oral cleanliness assess, using Ramfjord index teeth, criteria for the calculus index:- 9:No calculus present. - 4; Supra gingival calculus covering not more than one third of the exposed tooth surface. - 2: Supra gingival calculus covering more than one third but not more than 2/3 of the exposed tooth surface or the presence of individual flecks of sub gingival calculus around the cervical portion of the tooth or both. 3: Supra gingival calculus covering more than 2/3 of the exposed tooth surface or a continuous heavy band of sub gingival calculus around the cervical portion of the tooth or both. Calculation: The plaque index, gingival index and calculus index for individual was measured by summation of individual scores and then divided by number of surface examined. The maximum score = 3 while the minimum score= 0. Note: When examine the patients, always start with oral cleanliness and gingival health condition assessments then caries status assessments.