Indices For Givgival and Periodontal Diseases and Malignancy

Indices for periodontal and
gingival disease, oral health

and oral malignancy
Contents
• Introduction
• Ideal requirements of an index
• Classification of an index
• Indices used for oral hygiene
• Indices used for gingival inflammation
• Indices used for gingival bleeding
• Indices used for periodontal diseases
• Indices used for oral health status
• Indices used for oral malignancy
• Conclusion
• References
Introduction
• Gingivitis and periodontitis - inflammatory diseases of

periodontal tissues
• Epidemiology – study of the distribution and determinants of

health-related states or events in a population and the
application of this study for the prevention and control of
health problems
• Dental index or indices are used to find out the incidence,
prevalence and severity of the disease, based on which
preventive programs can be adopted
• An expression of a clinical observation in a numerical value
• Describe a status of an individual or a group with respect to

condition being measured
Soben Peter. Essentials of Preventive and Community Dentistry. 4th edition

• 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’ – RUSSELL A.L

Ideal requirements of an index
Clarity,
simplicity and
objectivity
Acceptability Validity
Sensitivity Reliability
Quantifiability

Classification of indices
Direction Measures conditions

in which Irreversible whose scores will not
scores decrease on subsequent
can index examinations
fluctuate Eg: DMFT Index
Measures conditions
Reversible that can increase or
decrease on subsequent
index examinations Eg : Loe
and Silness
Gingiva/Index

Upon the Measure the patient's
extent to Full entire periodontium or
dentition
which
areas of Mouth Eg: Russell's
oral PeriodontaI Index (PI)
cavity Indices
are
measured Measure only a
Simplified representative sample
of the dental apparatus
Indices Eg: Greene &
Vermillion’s Oral
Hygiene Index-
Simplified (OHI-S)

According
'D' (decay)
to the
entity
Disease portion of the
which
they
Index DMFT Index
measure
Measuring
Symptom gingival /
Index sulcular bleeding
'F' (filled)
Treatment portion of the
Index DMFT Index

Special Measures the
categories Simple presence or
Index absence of a
condition
Eg: Silness and
Loe Plaque Index
Measures all the

Cumulative evidence of a
Index condition, past and
present
Eg: DMFT Index
for dental caries

Indices used for assessing
oral hygiene and plaque
• Oral Hygiene Index (OHI)
• Oral Hygiene Index – Simplified (OHI-S)
• Patient Hygiene Performance Index (PHP)
• Modified Patient Hygiene Index
• Plaque index (PlI)
• Turesky - Gilmore – Glickman modification of the Quigley - Hein
plaque index
Oral Hygiene Index (OHI)
• John. C. Green and Jack. R. Vermillion in 1960
• Developed as a plan to study variations in gingival

inflammation in relation to the degree of mental retardation
in children
• Sensitive, simple method for assessing group or individual

oral hygiene quantitatively
Green JC, Vermillion JR. The Oral Hygiene Index: A Method for Classifying Oral
Hygiene Status. J Am Dent Assoc. 1960; 61: 172-9.
• Debris Index and Calculus Index
• Based on 12 numerical determinations - amount of debris or

calculus found on the buccal and lingual surfaces of each of
the three segments of each dental arch
Segmental Division of the Oral Cavity

for Oral Hygiene Index
RULES
• Only fully erupted permanent teeth are scored
• Third molars and incompletely erupted teeth are not scored
• Two scores assigned to a segment are based on the buccal

surface and the lingual surface having the greatest surface
area covered by debris or calculus
• Buccal score and lingual score for a segment need not be

taken from the same tooth
Criteria for Classifying Oral Debris-
• Oral debris is defined as “the soft foreign matter on the

surface of the teeth, consisting of mucin, bacteria and food,
and varying in color from grayish white to green or orange”
Criteria for Classifying Calculus-
• Only definite deposits of hard calculus should be recorded
Calculation of indices:
Recording Form for Oral Hygiene Index
• Oral Hygiene Index = Debris index+ Calculus Index
Interpretation:
• Minimum number of points - debris or calculus - 0
• Maximum number of points - debris or calculus - 36
• Oral hygiene index is the sum of two indices, its value

ranges from 0-12
• Higher the score the poorer the oral hygiene
Advantage:
• Simple, rapid method
• 4 minutes per person were required to record oral hygiene scores
• Sensitive enough to reflect the cleansing efficiency of tooth

brushing
• Useful tool in program evaluation in monitoring oral hygiene

maintenance program
Disadvantages:
• Requires the user to spend more time in arriving at his
evaluations of an individual’s oral cleanliness
• Intra examiner and inter examiner errors are more
• Cannot be used in mixed dentition
Oral Hygiene Index – Simplified
(OHI-S)
• John. C. Green and Jack. R. Vermillion in 1964
The Oral Hygiene Index Simplified differs from the original

Oral Hygiene Index in -
• Number of tooth surfaces scored (6 rather than 12)
• Method of selecting the surfaces to be scored
• Scores which can be obtained
Green C. John, Vermillion R Jack. The Simplified Oral Hygiene Index. J Am Dent
Assoc. 1964; 68: 25-31.
Surfaces and Teeth to be
examined in permanent dentition:
16 – Buccal
11 – Labial
Teeth Examined for
26 – Buccal Oral Hygiene Index
Simplified
36 – Lingual
31 – Labial
46 - Lingual
Surfaces to be examined in
deciduous and mixed dentition:
For the ages 4-6 years
• 54 - buccal
• 61 - labial
• 82 - labial
• 75 – buccal
• For mixed dentition
• 26 - buccal
• 46 - lingual
Rodrigues CR, Ando T, Guimaraes LO. Simplified oral hygiene index for ages 4 to 6 and 7 to 10
(deciduous and mixed dentition). Revista de odontologia da Universidade de Sao Paulo.
1990;4(1):20-4.
Interpretation:
• For DI-S and CI-S score • For OHI-S score
Good – 0.0-0.6 Good – 0.0-1.2

Fair - 1.3-3.0
Fair – 0.7-1.8
Poor – 3.1-6.0
Poor – 1.9-3.0
Assoc. 1964; 68: 25-31.
Advantages:
• Sensitive method for assessing oral hygiene in population
groups
• Easy to use because the criteria are objective
• Examination - performed quickly
• High level of reproducibility is possible with a minimum of

training sessions
Assoc. 1964; 68: 25-31.
Patient Hygiene Performance
Index (PHP)
• Developed by Arlon G. Podshadley and John V. Haley in
1968
• The tooth surfaces assessed are the buccal of the maxillary

molars, the lingual of the mandibular molars, and the labial
of the maxillary and mandibular incisors – 16, 11, 26, 36,31,
46
Podshadley AG, Haley JV. A Method for Evaluating Oral Hygiene Performance.
Public Health Reports 1968; 83(3): 259-64.
Examination:
Patient will be given an erythrosine
disclosing wafer which stains the
oral debris as dark pink
Patient is instructed to chew the

disclosing wafer and to "swish" for
30 seconds
Patient can expectorate - but

permitted to rinse until after the
examination
Clinical crown -
Examiner mentally subdivided Mesial and distal thirds
divides the tooth into longitudinally into make up the first two
five sections mesial, middle, and subdivisions
distal thirds
Middle third -
Subdivisions is
subdivided horizontally
examined for the
into the gingival,
presence of the pink-
middle, and occlusal
stained oral debris
thirds
• No debris present
0
• Debris definitely present A- Five Subdivisions of a

1 Tooth in PHP Method
Calculation:
Calculation Score range
Debris score for Add the score for each 0-5
individual tooth five subdivisions
PHP index value for an Total the scores for 0-5

individual individual teeth and
divide by the number
of teeth examined
B- Debris Score 3
C- Debris Score 1
D- Debris Score 4
Interpretation:
• Excellent -0 (no debris)
• Good - 0.1-1.7
• Fair - 1.8- 3.4
• Poor - 3.5- 5.0
Advantages:
• Simple to use
• Can be performed quickly - Can be used for patient

education
• Recognizes the importance of, and scoring individually,

plaque accumulation at the gingival, and adjacent to the
dental papilla at the mesial and distal of the tooth
Disadvantages:
• It does not specifically label the five delineated areas to be
scored
• Decisions regarding substitutions must be employed when

the index teeth are missing
• Substitution rule becomes more complex with increasing

number of missing teeth
Modified Patient Hygiene
Performance Index
• Given by Leslie V. Martens and Lawrence H. Meskin in
1972
• Developed to measure plaque accumulation accurately in

each child in order to ascertain both individual and group
performance with respect to toothbrushing habits and skills
• Provides a means of making an objective measurement of

the plaque
Martens LV, Meskin LH. An Innovative Technique for assessing Oral Hygiene.
ASDC J Dent Child. 1972 Jan- Feb; 39(1): 12-4.
Surfaces to be examined:
Facial and lingual surfaces of the following teeth:
• Most posterior tooth erupted in the upper right quadrant
• 13/53
• 54/14
• Most posterior tooth in the lower left quadrant
• 73/33
• 84/44
Examination method:
Uses:
• Can be used as a tool in combination with personalized
instruction which results in a substantial improvement in oral
hygiene
• Can be used for patient education in private practice
Plaque Index
• Described by Silness P. and Loe H. in 1964
• Plaque thickness in given an important consideration
• Teeth examined – 16, 12, 24, 36, 32, 44
• No substitution and the index has to be done on a full mouth

basis
• Most widely used indices to measure plaque
Loe H. The Gingival Index, The Plaque Index and The Retention Index Systems. J
Periodontol. 1967 Nov- Dec; 38(6): Suppl: 610-6
Scoring criteria:
• Gingival area of the tooth surface is literally free of
0 • plaque.
• Plaque is made visible on the point of the probe after this has been
moved across the tooth surface at the entrance of the gingival
1 crevice. Disclosing solution has not been used
• Gingival area is covered with a thin to moderately thick

2 • layer of plaque. The deposit is visible to the naked eye
• Heavy accumulation of soft matter - interdental area is stuffed with

3 soft debris
Interpretation:
• Rating Scores
Excellent - 0
Good - 0.1- 0.9
Fair - 1.0- 1.9
Poor - 2.0- 3.0
Advantages:
• Most widely used – good validity and reliability
• Use of disclosing solution is very helpful especially for

inexperienced investigators
• Applied to studies in children as well as adults
• 5 minutes
Disadvantages:
• Ignores the coronal extent
Turesky – Gilmore - Glickman
modification of Quigley Hein
plaque index
• Quigley Hein plaque index was modified by Turesky S.,
Gilmore N.D., and Glickman I. in 1970
• Strengthening objectivity of Quigley- Hein Plaque
• Index criteria - redefining the scores of the gingival third

area
• Modification is recognized as a reliable index for measuring

plaque
Turesky S, Gilmore ND, Glickman I. Reduced Plaque Formation by the
Chloromethyl Analogue of Victamine C. J Periodontol 1970 Jan; 41(1): 41-3.
Method:
• Plaque is assessed on the labial, buccal and lingual surfaces
of all teeth except third molars after using a disclosing
solution for 15 seconds
• 10ml of 0.18 percent basic fuschin solution followed by a

five second rinse with 10 ml of tap water
Advantages:
• Comprehensive means of evaluating antiplaque agents or
procedures
• Relatively easy to use because of objective definitions
Turesky S, Gilmore ND, Glickman I. Reduced Plaque Formation by the

Chloromethyl Analogue of Victamine C. J Periodontol 1970 Jan; 41(1): 41-3.
Indices for detecting
calculus
• Calculus Surface Index (CSI)
• Calculus Surface Severity Index (CSSI)
• Marginal Line Calculus Index (MLCI)
• Volpe-Manhold Index (VMI)

Calculus surface Index
• Developed by Ennever J, Sturzenberger C.P and Radike A.W. in
1961
• Four surfaces of mandibular central and lateral incisors are

examined
• Each incisor is divided into four scoring units. The facial

(buccal/labial) surface is considered one unit, and the lingual
surface is divided longitudinally into three subsections, the distal-
lingual third, the lingual third, and the mesial-lingual third
Advantages:
• Good intra examiner reproducibility
• Relatively short period of time for examination
• Method is efficacious in detecting subgingival calculus
• Index can be used in short term (less than 6 weeks) clinical

trials of calculus inhibiting agents
Barnes GP, Parker WA, Lyon TC, Fultz RP. Indices to Evaluate Signs, Symptoms
and Etiologic Factors Associated with Diseases of the Periodontium. J Periodontal.
1986 Oct; 56(10): 643-51.
Calculus surface severity index
• Proposed by ENNEVER J, et al in 1961
• Measures the quantity of calculus present on a scale of 0 to 3
• No calculus present
0
• Calculus observable, but less than 0.5 mm in width and /or
1 thickness
• Calculus not exceeding 1.0 mm in width and / or thickness.

2
• Calculus exceeding 1.0mm in width and / or thickness.

3
Marginal Line Calculus Index
• Developed by Muhlemann, H.R., and Villa, P in the year 1967
• Index was developed to assess the accumulation of

supragingival calculus on the gingival third of a tooth or more
specifically, supragingival calculus along the margin of gingiva
• Results are reported in percentage of surface covered as

follows: 0, 12.5, 25, 50, 75 and 100 percent
Volpe Manhold Index
• Given by A. R. Volpe, J. H. Manhold and S. P. Hazen in
1962
• Measures calculus formation on the lingual surface of the

lower incisors by bisecting the surfaces with the periodontal
probe and recording the calculus heights in millimeters
Volpe AR, Manhold JH, Hazen SP. In Vivo Calculus Assessment: Part I A Method
and its Examiner Reproducibilty. J Periodontol. 1965; 36: 292-8
Recording Form for Volpe Manhold Diagonal Movement of the Probe to
Method for Calculus Assessment Measure Calculus
• Height of calculus is measured by a periodontal probe which

is graduated in millimeters and a tape colored at one end is
used to facilitate accurate readings
Volpe AR, Manhold JH, Hazen SP. In Vivo Calculus Assessment: Part I A Method
and its Examiner Reproducibilty. J Periodontol. 1965; 36: 292-8
Gingival Indices
Indices used to measure Gingival
Inflammation
• Papillary marginal attachment index
• Gingival Index
• Modified Gingival Index
• Gingival Tissue Index
• Gingival Pain Index

Papillary Marginal Attachment
Index
• Developed by Maury Massler and Schour I in 1944
• Oldest reversible index
• Number of gingival units affected are counted rather than the

severity of the inflammation
• Based on the premise that inflammation begins in the

interdental papilla spreads to the marginal area and continues
to the attached gingival in severe cases
Massler M. The PMA Index for the Assessment of Gingivitis. J Periodontol 1967;
38: 592
Method:
• Gingival unit is divided into three component parts -
Papillary gingival (P), Marginal gingival (M), Attached gingival

(A)
• Examination is carried from patient’s left posterior teeth (second
molar) to the last tooth on the right side. Shift to lower right and
then proceed to left in a continuous arc
• Third molars are omitted

Henry C. Sandler. Testing the Uniformity of the P-M-A Index as a Measurement of
Periodontal Disease. J Dent Res 1952; 31: 323
Scoring criteria:
• Each of the gingival units is assessed for the degree of gingivitis
• Normal; no inflammation
P 0
• Mild papillary engorgement; slight increase in size

1+
• Obvious increase in size of gingival papilla;
2+ haemorrhage on pressure
• Excessive increase in size with spontaneous
3+ haemorrhage
• Necrotic papilla
4+
• Atrophy and loss of papilla (through inflammation)

5+
M • Normal; no inflammation
0
• Engorgement; slight increase in size; no bleeding

1+
2+ • Obvious engorgement; bleeding on pressure
• Swollen collar; spontaneous hemorrhage; beginning

3+ infiltration into attached gingivae
• Necrotic gingivitis
4+
• Recession of the free marginal gingiva below the CEJ

5+ due to inflammatory changes
38: 592
A • Normal; pale rose; stippled
0
• Slight engorgement with loss of stippling; change in

1+ color may or may not be present
• Obvious engorgement of the attached gingiva with

2+ marked increase in redness; pocket formation
• Swollen collar; spontaneous hemorrhage; beginning

3+ infiltration into attached gingivae
• Advanced periodontitis; deep pockets evident

4+
38: 592
Interpretation:
Papillae Margins Degree of inflammation
1-4 0-2 Mild
4-8 2-4 Moderate
>9 >4 Severe
Recording Form for PMA Index

Advantages:
• Can be used in children
• Criteria to assess gingival inflammation served as a basis for the

development of many other indices
• Simple, accurate, quantitative, and reproducible
Disadvantages:
• Cannot be applied in older age groups
Gingival Index
• Developed by Loe. H and Silness J in 1964
• Introduced in a cross-sectional study of pregnancy gingivitis,

includes a bleeding component
• Severity of gingivitis is scored on all surfaces of all teeth or

on selected surfaces of all teeth or selected teeth
• Teeth examined – 16,12, 24, 36, 32, 44
Lobene RR et al. Correlations Among Gingival Indices: A Methodology Study. J

Periodontol 1989; 60: 159-62
Method:
• The tissue surrounding each tooth is divided into four gingival
scoring units-
1. Distofacial papilla
2. Facial margin
3. Mesiofacial papilla
4. Entire lingual gingival margin
• Periodontal probe is used to assess the bleeding potential of the

tissues

Scoring criteria:
• Normal gingiva
0
• Mild inflammation, slight change in

color, slight edema, no bleeding on
1 probing
• Moderate inflammation, redness,

2 edema, glazing, bleeding on probing
• Severe inflammation, marked redness

and edema, ulcerations, tendency to
3 spontaneous bleeding

Interpretation:
Scores Degree of
gingivitis
0.1 -1.0 Mild
1.1-2.0 Moderate
2.1-3.0 Severe
Recording Form for Gingival Index

(Selected Teeth)
Advantages:
• Records the severity of gingivitis within marginal and
interproximal tissues
• GI is one of the most widely accepted and used gingival

indices due to its documented validity, reliability and ease of
use
Disadvantages:
• Wide range of variability exists in the use of this index

Modified Gingival Index (MGI)
• Developed by Lobene, R.R., Weatherford, T., Ross, N.M.,
in the year 1986
• Non invasive method to assess the prevalence and severity of
gingivitis and to increase the sensitivity in the lower region
of the scoring scale

Method:
• Strictly based on visual observation
• No gentle probing or pressure to observe the presence or

absence of bleeding

Scoring criteria:
• Normal gingiva
0
• Mild inflammation (slight change in color, little change

1 in texture) of any portion of gingival unit
• Mild inflammation of entire gingival unit

2
• Moderate inflammation (moderate glazing, redness,

3 edema, and/ or hypertrophy) of the gingival unit.
• Severe inflammation (marked redness and edema/

4 hypertrophy, spontaneous bleeding, or ulceration)

Periodontol 1989; 60: 159-62.
Advantages:
• Non invasive - eliminates the concern about disruption of
soft tissue or plaque in the gingival region
• Index is simple - decision making is simplified if bleeding

considerations are not superimposed on visual
determinations
• Affords greater sensitivity in detecting therapeutic efficacy

Periodontol 1989; 60: 159-62.
Gingival Tissue Index
• Developed by Garg Subash, Kapoor K.K, Mehrotra K.K. and
Dixit Jaya in 1986
• Mainly based on inflammatory hyperplastic state and the
shape and consistency of gingival tissue units

Method:
• Each gingival unit included one interdental papillary or one
marginal gingiva from facial or oral aspect of a tooth and is
considered under three main compartments namely
i. Inflammatory- hyperplastic
ii. Non- inflammatory- hyperplastic
iii. Non inflammatory non-hyperplastic
• Every unit of the papilla is recorded to ascertain gross tissue

changes in each unit
Advantages:
• Reproducible
• Minimum equipment
• 5 minutes for complete assessment
• Good validity and reliability
• Allows registration of subtle changes in gingival tissue units
• Gives meaningful information for the prognosis during

various phases of improvement
Gingival Pain Index
• Developed by Garg Subash, Kapoor K.K, Mehrotra K.K. and
Dixit Jaya in 1986
• No pain
0
• Mild pain – within bearable limits

1
• Severe pain - unbearable

2
Gingival Bleeding
Indices
• Sulcus Bleeding Index (SBI)
• Modified Sulcus Bleeding Index (MSBI)
• Gingival Bleeding Index (GBI)
• Papillary Bleeding Index (PBI)
• Modifications of Papillary Bleeding Index
• Papillary Bleeding Score
• Bleeding Time Index
• Quantitative Gingival Bleeding
• Eastman Interdental Bleeding Index (EIBI)

Sulcus Bleeding Index
• Developed by Muhlemann H. R. and Son. S in 1971
• To locate areas of gingival sulcus bleeding upon gentle

probing
• Areas examined: labial and lingual marginal gingiva

(M units) and the mesial and distal papillary gingiva
(P units)
• Scoring is done 30 seconds
Esther M Wilkins. Textbook of Dental Hygieneist. Elsievers Publications. 9th edi. 2006
Scoring criteria:
• Healthy P and M, no bleeding on probing
0
• Bleeding on probing, no color change, no swelling of P and M

1
• Bleeding on probing, change in color, no swelling of P and M

2
• Bleeding on probing, change in color, slight swelling of P and

3 M
• Bleeding on probing, change in color, obvious swelling of P

4 and M
• Bleeding on probing, spontaneous bleeding, change in color,

5 marked swelling with or without ulceration
Newbrun E. Indices to Measure Gingival Bleeding. J Periodontol 1996; 67: 555-61.

Calculation:
• Sulcus Bleeding Index for tooth
• Sulcus Bleeding Index for area
• Sulcus Bleeding Index for Individual

Modified Sulcus Bleeding Index
(MSBI)
• Mombelli A, Van Oosten MAC, Schurch E, Lang NP. in
1987
• To reduce the number of grades in Sulcus Bleeding Index

Scoring criteria:
• No bleeding when a periodontal probe is passed along the
0 gingival margin
• Isolated bleeding spots visible

1
• Blood forms a confluent red line or margin

2
• Heavy or profuse bleeding

3

Gingival Bleeding Index
• Developed by Harlod G. Carter and George P. Barmes in the
year 1974
• Meaningful indication of disease activity
• Apparent misapplication of plaque staining indices
• Unwaxed dental floss is used as an index instrument
Carter HG, Barnes GP. The Gingival Bleeding Index. J Periodontol 1974 Nov; 11: 801-5
• 30 seconds is allowed for reinspection of each segment
• Bleeding is generally immediate and evident in the area or

on the floss
• Scored on the presence or absence of bleeding from the

gingival sulcus
1. Initial gingival bleeding score
2. Subsequent gingival bleeding score
Calculation:
• Mesial and distal sulcus components – risk
• Total units of bleeding and total areas at risk
Advantages:
• Dental floss – readily available, disposable
• Takes 3 minutes to evaluate
• Reversibility – definite observation
Disadvantages:
• Not immediately reproducible
• Creating new bleeding areas injudiciously
• Does not quantify gingival bleeding
Papillary Bleeding Index
• Developed by Muhlemann, H.R. in the year 1975
• Bleeding tendency of gingival papilla on gentle probing
• Insertion of the probe tip 2mm into the interproximal sulci,

or until resistance
• Angle of 450 to the long axis of the tooth
• Presence or absence of bleeding within 15 seconds is

recorded
Caton J et al. Associations Between Bleeding and Visual Signs of Interdental

Gingival Inflammation. J Periodontol 1988; 59: 722-7
Scoring criteria:
• No bleeding within 30 seconds of probing
0
• Bleeding within a few seconds of probing

1
• Immediate bleeding on probing

2
• Bleeding along gingival sulcus on slightest touch

3

Modifications of Papillary
Bleeding Index
I. Given by Barnett M, Ciancio S, Mather M in the
year1980
• Graded only on time
• Bleeding occurred between 3 to 30 seconds after

1 probing
• Bleeding occurred within 2 seconds after probing

2
• Bleeding occurred immediately upon probe placement

3
II. Given by Saxer U, Turconi B, Elsasser C. in the year 1977
• Both time and extent of bleeding were considered
• No bleeding
0
• Single bleeding point 20 to 30 seconds after probing

1
• Fine line of blood or several bleeding points

2
• Blood fills interdental triangle soon after probing

3
• Immediate profuse bleeding fills the interdental area and flows

4 over tooth and gingiva
Bleeding Time Index
• Given by Nowicki D, Vogel R, Melcer S, Deasy M in the
year 1981
Disadvantages:
• Has too many grades
• Takes too long to score
Newbrun E. Indices to Measure Gingival Bleeding. J Periodontol 1996; 67: 555-61

Scoring criteria:
• No bleeding within15 seconds of twice probing (i.e. 30
0 seconds total time)
• Bleeding within 6 to 15 seconds of second probing

1
• Bleeding within 11 to 15 seconds of first probing or 5

2 seconds after second probing
• Bleeding within 10 seconds after initial probing

3
• Spontaneous bleeding
4
Newbrun E. Indices to Measure Gingival Bleeding. J Periodontol 1996; 67: 555-61

The Quantitative Gingival
Bleeding Index
• Given by Garg Subash, Kapoor K.K. in 1985
• Magnitude of blood stains covering toothbrush bristles on

brushing and squeezing gingival tissues in one segment
• 30 secs for reinspection
Garg S, Kapoor KK. The Quantitative Gingival Bleeding Index. J Indian Dent
Assoc 1985; 57: 112-3
Scoring criteria:
• No bleeding on brushing; bristles free from blood stains
0
• Slight bleeding on brushing; bristle tips stained with

1 blood
• Moderate bleeding on brushing; about half of the bristle

2 length from tip downwards stained with blood
• Severe bleeding on brushing; entire bristle length of all

3 bristles including brush head covered with blood
• .
Advantages:
• Reproducible
• Simple, objective, good reliability
• Recording instrument - simple
• Recording is helpful as a part of treatment, instead of

unnecessary hurting the already inflamed and tensed tissue
• Effective from prognosis point of view
Garg S, Kapoor KK. The Quantitative Gingival Bleeding Index. J Indian Dent
Assoc 1985; 57: 112-3
Interdental Bleeding Index
• Known as Eastman Interdental Bleeding Index
• Developed by Caton J.G and Polson, A.M. in the year 1985
• Developed to assess the presence of

inflammation in the interdental area by
the presence or of bleeding

Method:
• Utilizes a triangle shaped toothpick made of soft, pliable
wood to stimulate the interproximal gingival tissue
• Interproximal cleaner is inserted horizontally between the

teeth from the facial surface, depressing the interproximal
papilla by upto 2mm
• Wooden cleaner is inserted and removed four times and the

presence of bleeding within 15 seconds is noted
Calculation:
• Number of bleeding sites
• Percentage of scores
Advantages:
• Uses a wooden interdental cleaner that fits into the
interproximal region, and is capable of stimulating across the
entire facial- lingual width
Disadvantages:
• Area beneath the contact point is not accessible for direct
visualization
to be continued….
Periodontal Indices
Indices for measuring
periodontal diseases
• Periodontal Index
• Gingival-bone Count
• Periodontal Disease Index
• Cohen Ship Procedure
• Gingival Periodontal Index
• Gingivitis, Periodontitis and Missing Teeth Index
• A Periodontitis Severity Index
• Extent and Severity Index
• CPI Index
Periodontal Index
• Given by A.L. Russell in 1956
• Measures the presence or absence of gingival inflammation

and its severity, pocket formation and masticatory function
• Known as a composite index
• Index of Biological Gradient
• Instruments - periodontal probe and mouth mirror is used
Russel AL. A System of Scoring for Prevalence Survey of Periodontal Disease. J

Dent Res 1956; 35: 350-9.
Scoring criteria:
Score Criteria X-ray criteria
0 - Negative There is neither overt Essentially normal
inflammation in the
investing tissues nor loss
of function due to
destruction of supporting
tissue
1 - Mild Gingivitis Overt area of inflammation
in the free gingiva which
does
not circumscribe the tooth
2 - Gingivitis Inflammation completely
circumscribes the tooth,
but there is no apparent
break in the epithelial
attachment
4 There is early, notchlike
resorption of the alveolar
crest
6 - Gingivitis with Pocket Epithelial attachment has There is horizontal bone
Formation been broken and loss involving the entire
there is a pocket (not alveolar crest, up to half
merely a deepened of the length of the tooth
gingival crevice due to root (distance from apex
swelling in the free to cemento-enamel
gingiva). No interference junction)
with normal masticatory
function, the tooth is firm
in the socket, and has not
been drifted
8 - Advanced Destruction Tooth has been loose; Advanced bone loss,
with Loss of may have drifted; may involving more than one-
Masticatory Function sound dull on percussion half of the length
with a metallic instrument; of the tooth root;or a
may definite intrabony pocket
be depressible in its with definite widening of
socket the periodontal
membrane. There may be
root resorption, or
rarefaction at the apex
• Mouth mirror and a periodontal probe
• Probe is placed inside the crevice and if pocket is present the

probe is walked along the tooth
Calculation:
• Individual Scores
• In epidemiological studies

Dent Res 1956; 35: 350-9.
Interpretation:
Clinical condition PI score Stage of disease
Clinically normal 0 - 0.2
Supportive tissues
Simple gingivitis 0.3 – 0.9
Beginning of 0.7 – 1.9 Reversible
periodontal
destructive disease
Established 1.6 – 5.0 Irreversible
destructive
periodontal disease
Terminal disease 3.8 – 8.0 Irreversible
Dent Res 1956; 35: 350-9.
Advantages:
• Requires minimum instruments
• Records both reversible and irreversible conditions
Disadvantages:
• Reproducibility - difficult
• Wide subjective variation
• Underestimating condition
• Overlapping of scores
Gingival-Bone Count
• Given by James M. Dunning and Leon B. Leach in the year
1960
• Developed to permit differential recording of gingival and

bone conditions
• Instruments – Mouth mirror, no. 17 explorer, 2 no. 3

posterior bitewing radiographs
Dunning J, Leach L. Gingival Bone Count: A Method for Epidemiological Study of

Periodontal Disease. J Dent Res 1960 May- Jun; 39(3): 506-13.
Gingival score:
• Negative
0
• Mild gingivitis involving the free gingiva (margin,

1 papilla, or both)
• Moderate gingivitis involving both free and attached

2 gingiva
• Severe gingivitis with hypertrophy and easy

3 hemorrhage

Bone score:
• No bone loss
0
• Incipient bone loss or notching of alveolar crest

1
• Bone loss approximating one-fourth of root length or pocket formation
2 one side not over one-half root length
• Bone loss approximating one-half of root length or pocket formation
3 one side not over three-fourths root length; mobility slight
• Bone loss approximating three-fourths of root length or pocket
4 formation one side to apex; mobility moderate
5 • Bone loss complete; mobility marked
8 • Maximum possible GB count per person

Recording Form for Gingival Bone Count Index
Calculation:
• Whole mouth means for gingiva and bone are separately
recorded
• Whole-mouth mean scores are then added together to obtain

what is called a "GB count."

Advantages:
• Simple subjective measurement of gingiva can be combined
with the bone loss count producing a composite score
Disadvantages:
• Mean clinical bone score (Bc) is only one-fourth to one-
sixth that obtained by X-ray (Bcr or Br)
• This is due to the difficulty in determining the loss of
interproximal alveolar bone by explorer alone
Periodontal Disease Index
• Given by Ramfjord P. Sigurd in 1967
• Primarily concerned with an accurate assessment of the

periodontal status of the individual person.
• Emphasis is placed on recording of the attachment level of

the periodontal tissues relative to the C-E junction
• 6 teeth selected – 16, 21, 24, 36, 41, 44
• University of Michigan #0 probe is used
Ramfjord SP. The Periodontal Disease Index. J Periodontol. 1967; 38: 602-10.
• Heavy deposits of supragingival calculus – removed first
• Distance from the free gingival margin to the cementum

enamel junction and the distance from the free gingival
margin to the bottom of the gingival crevice or pocket -
measured
• All the measurements are rounded off to the nearest mm;
• Anything close to half a mm is always rounded to the lower

whole number
• Only fully erupted teeth are scored and missing teeth are not
substituted
Score:
• The gingival crevice in none of the measured areas extends apically
to the CEJ, the recorded score for gingivitis is the PDI score for that
1 tooth
• The gingival crevice in any two measured areas extends apically to

the CEJ, but not more than 3mm (including 3mm in any area). The
4 gingivitis score is then disregarded in the PDI score for that tooth
• The gingival crevice in any of the two recorded areas extends

apically to from 3 to 6mm (including 6mm) in relation to the CEJ.
5 The gingivitis score is disregarded
• The gingival crevice extends more than 6mm apically to the CEJ.
6 The gingivitis score is disregarded
Advantages:
• Reproducibility – better, eye strain – less
• Omitting lingual and distal scores – makes it easier to

achieve reproducibility
• Provides measurable data regarding pocket formation
• Assessment of both – gingivitis and periodontitis
Disadvantages:
• Inter examiner bias
• It is more time consuming as compared to Russell’s Index
Cohen-Ship Procedure
• Developed by Irwin I. Ship, D. Walter Cohen and Larry
Laster in 1967
• Mouth mirror and periodontal pocket probes
• Complete set of 14 intraoral radiographs including posterior

bite-wing films using paralleling technique
• Radiographs examined for bone loss

Scoring criteria:
• Normal: Neither gingivitis nor periodontal disease on
clinical examination and neither horizontal or vertical bone
0 loss on radiographic examination
• Gingivitis: Evidence of gingival involvement according to

clinical examination findings, but neither "Horizontal" or
1 "Vertical" bone loss on radiographic evaluation
• Periodontitis: Evidence of periodontal involvement

according to clinical findings with or without adiographic
evidence of either "Horizontal" or "Vertical" bone loss
2 from the radiographs
Gingival Periodontal Index
• Given by Timothy O’ Leary in the year 1967
• Developed for use by general practitioners, to quickly and

effectively evaluate each tooth for gingival health, status of
the supporting alveolar bone, and the presence and extent of
local irritants
• Gingival and periodontal status is recorded
O’ Leary TJ. The Periodontal Screening Examination. J Periodontol 1967; 38: 617
Scoring criteria:
• Gingival status –
0 - The gingival tissue is tightly adapted to the teeth and is of firm

consistency with a physiologic architecture
1 - Slight to moderate inflammatory changes are present -
a. Involving one or more teeth in a segment, but not completely

surrounding any one tooth: The color of gingiva - normal pink to
varying shades of red
b. The loss of normal consistency (firmness) of the tissues as
evidenced by retraction of gingival margin from the tooth for more
than 1mm, when it is dried with a blast of compressed air
c. Blunting and slight enlargement ,of the marginal or papillary tissue

when associated with color change or loss of consistency (items I and
2)
2- If the above described changes, singly or in combination, are found

completely encircling one or more teeth in the 'segment.
3- If marked inflammatory changes are present including
a. Acute gingival inflammation.
b. Loss of surface continuity (ulceration)
c. Marked deviation from a normal gingival contour such as:
i. Gross thickening of the marginal, tissue (enlargement of

gingival tissue covering more than one-third of the anatomic
crown)
ii. A loss of continuity of any interdental papilla from the

buccal to lingual/ aspect (crater formation)
iii. Clefts of the gingival tissue

• Periodontal status –
0- The probe does not extend 1mm apical to the CEJ of any tooth
in the segment and there is no exposure of the CEJ on any
surface of any tooth in the segment
4- The probe extends up to 3mm apical to the CEJ of any tooth

in a segment
5- The probe extends from 3 to 6 mm apical to the CEJ of any

tooth in a segment
6- The probe extends 6mm or more apical to the CEJ of any

tooth in a segment
Gingivitis, Periodontitis and
Missing Teeth Index
• Developed by Peter Gaengler in the year 1984
• Developed to determine the distribution and the prevalence

of periodontal disease in adolescents and adults using the
WHO method Technical Report Series 621
• To propose a method of presenting the results by a simple

index system analogous to the DMFT index
• Instruments used – Standardized Morita probes

• Full mouth examination is carried for gingival bleeding,
periodontal pocketing, the presence of supra- or subgingival
calculus and for gingival recession
• Subject classified into one of three categories; healthy,

gingivitis, periodontitis
Gaengler P. Prevalence and Distribution of Gingivtis, Periodontitis and Missing

Teeth in Adolescents and Adults According to GPM/T Index. Community Dent Oral
Epidemiol. 1984; 12: 255-9
Scoring criteria:
Calculus Pocketing
0 - Absence of calculus 0 - Pocket depth less than 3.5 mm
1 - Supragingival calculus 1 - Pocket depth between 3.5 and 5.5 mm

2 - Pocket depth greater than 5.5 mm
2 - Subgingival calculus
Recession
Bleeding
0 - Recession less than 3.5 mm
0 - No bleeding
1 - Recession between 3.5 and 5.5 mm
1 — Bleeding on probing 2 Recession greater than 5.5 mm
Periodontitis Severity Index
• Given by R. A. Adams and G. P. Nystrom in the year 1985
• Full mouth series of periapical radiographs is taken using a

long-cone technique
• Modified Schei ruler was used to measure the radiographs
• The ruler acknowledged the typical 1.5-mm distance

between the alveolar crest and cemento-enamel junction in
ideal health and was divided into tenths, permitting analysis
of the percentage of bone
Adams RA, Nystrom GP. A Periodontitis Severity Index. J Periodontol 1986; 57(3): 176-9.
Scoring criteria:
Clinical Inflammation Score (CIS)
0- Absence of clinical signs of inflammation.
1- Inflammation determined.
Bone loss Score (BLS)
0- No bone loss.
1- Less than 10% bone loss
2- Bone loss between 10% and 20%.
Calculation:
• Periodontal Severity Index = Clinical Inflammation Score x Bone Loss
Score
Interpretation:
• No inflammation present (CIS = 0) the PSI - 0, regardless of the extent
of bone loss
• When inflammation was detected (CIS = 1), the PSI was directly
proportional to the BLS. No bone loss in the presence of inflammation
(gingivitis) resulted in a PSI of 0, because periodontitis severity alone
was being calculated
• Range from 0 to 10
Advantages:
• Arbitrary weighting is the assigning a 0 for health and a 1 for
overt Inflammation
Disadvantages:
• Use of radiographs appears to be a major drawback in the
application of the index
Extent and Severity Index
• Given by Carlos IF, Wolfe MD and Kingman A in 1986
• Data gathered from epidemiologic studies of periodontal

disease is regarded as a measurement vector [X1, X2, X3, ...
, XN] where xi is a measurement in (mm) of attachment
level, periodontal pocket depth or, of crestal bone loss as
estimated from radiographs
• N is the maximum number of sites diagnosed for each

individual examined
Carlos JP, Wolfe MD, Kingman A. Extent and Severity Index. A Simple Method
for Use in Epidemiologic Studies of Periodontal Disease. J Clin Periodontol 1986; 13: 500-5.
• Site is considered diseased only when attachment loss exceeds
1mm was considered
• Thus an additional vector [d.] was generated where
di= 1 if Xi> 1 and
di= 0, otherwise.
• Disease extent, E, is expressed as the % of those sites actually

examined which exhibit disease
E=( n Σ i= Idi X100)/n,
• This corrects for variation in the number of sites at risk when n

<N
• Disease severity, S-, is expressed as the mean loss of
attachment, in excess of 1 mm, for sites where di = 1,
S= nΣi=1 [di(xi-1)]/Σdi
• The extent and severity index is written as-
ESI=(E, S)
• where E is rounded to the nearest whole number
• ESI for a population or subset is the mean of the individual E

and S scores
Advantages:
• 2 components of the ESI measures different aspects of
periodontal disease - varying independently
• Reduces the time required for each examination
Disadvantages:
• Not intended for clinical diagnoses or descriptions of
individual subjects
• Information given by the index is retrospective
Community Periodontal Index
• Proposed by World Health Organization in 1997
• The three indicators of periodontal status used for this assessment

are-
• Gingival bleeding
• Calculus
• Periodontal pockets
• Sextants- The mouth is divided into sextants defined by tooth

numbers:
• 18-14, 13-23,24-28,38-34,33-43 and 44-48.
WHO: 1997, Oral Health Surveys Basic Methods. 4th Edition Geneva
• Index teeth – for 20 years and above
• 17,27; 16,26; 11; 37,47; 36,46; 31
• For subject under 20 years -six index teeth-16, 11, 26, 36, 31
and 46-are examined
• Modification is made in order to avoid scoring the deepened

sulci associated with eruption as periodontal pockets
• Sensing force used should not be more than 20 grams
Scoring criteria:
• Healthy
0
• Bleeding observed, directly or by using a mouth mirror, after probing

1
• Calculus detected during probing, but all of the black band on the probe
2 visible
• Pocket 4-5 mm (gingival margin within the black band on the probe)
3
• Pocket 6mm or more (black band on the probe not visible).

4
• Excluded sextant (less than two teeth present)

X
• Not recorded
9
Code 0 Code 2 Code 4
Code 1 Code 3
Loss of attachment:
• Recorded immediately after recording the CPI score for that
"particular sextant
• Highest scores for CPI and loss of attachment may not

necessarily be found on the same tooth in a sextant
• Loss of attachment should not be recorded for children under

the age 15 years
Scoring criteria for loss of attachment:
• Loss of attachment 0-3mm (CEJ not visible and CPI score 0-3).
0
• Loss of attachment 4-5 mm (CEJ within the black band).

1
• Loss of attachment 6-8 mm (CEJ between the upper limit of the black
2 band and the 8.5mm ring)
• Loss of attachment 9-11 mm (CEJ between the 8.5-mm and 11.5-mm

3 rings).
• 4- Loss of attachment 12mm or more (CEJ beyond the 11.5-mm ring)

4
• Excluded sextant (less than two teeth present)

X
• Not recorded(CEJ neither visible nor detectable).

9
Advantages:
• Provides a comprehensive measurement of periodontal
diseases
• Severity of the disease can be measured
Disadvantages:
• The index is time consuming
• Calibration is difficult as CPI involves many criteria
Papilla Presence Index
• Given by Daniele Cardaropoli, Stefania Re, and Giuseppe
Corrente in 2004
• Developed to facilitate communication between clinicians

regarding the surgical or non surgical periodontal techniques
of papilla regeneration and for standardization of
periodontic- orthodontic treatments
• Classification is based on the positional relationship among

papilla, cementoenamel junction (CEJ) and adjacent teeth
Scoring criteria:
• PPI score 1- The papilla is completely present and coronally
extends to the contact point to completely fill the interproximal
embrasure. This papilla is at the same level as the adjacent
papillae.
• PPI score 2- Describes a papilla that is no longer completely

present and lies apical to the contact point. This papilla is not at
the same level as the adjacent papilla, and the embrasure is no
longer completely filled, but the interproximal CEJ is still not
visble.
• PPI score 3- Refers to the situation in which the papilla is moved
more apical and the interproximal CEJ becomes visible. This
situation is compatible with a great amount of interdental soft
tissue recession.
• PPI score 4- Describes when the papilla lies apical to both the
interproximal CEJ and the buccal CEJ. Interproximal soft tissue
recession is present together with the buccal gingival recession
and the patient’s esthetic is dramatically compromised.
• Both PPI 1 and PPI 2 scores can be complicated by the presence

of buccal gingival recession, classified as PPI 1r and PPI 2r.
Cardaropoli D, Stefania Re, Corrente G. The Papilla Presence Index: A New

System to Assess Interproximal Papillary Levels. Int J Periodontics Restorative Dent
2004; 24: 488-92.
Advantages:
• Can be applied for measurements made in standard clinical
situation with teeth in alignment, and also for measurements on
dentitions showing flaring of the anterior teeth, open spaces and
presence of diastema
• Due to lack of an anatomic interdental contact point an ideal

contact should be assessed on interproximal surfaces and used as a
reference
• Can compare modifications of papillary levels between baseline

and end of treatment, eg. After orthodontic realignment
Indices to measure Oral health
Status
• Oral Health Status Index
• Children’s Oral Health Status Index
• Geriatric Oral Health Status Index

Oral Health Status Index
• Given by Marvin Marcus, Alma L. Koch and Jay A.
Gershen. in 1983
• The Paired Preference Program of subjective measurement

formed the basis of an innovative statistical approach
• Paired preference program - ranks the cases by assigning

scores
Marcus M, Koch A.L., Gershen J.A. A Proposed Index of Oral Health Status: A
Practical Applicator. J Am Dent Assoc. 1983 Nov; 107: 729-33.
• Dentist - compares successive pairs of cases for program to
generate - via a step wise multiple regression, the factors that
simulate their oral health preferences
• Most important factors can then be combined into a

composite oral health status index in which the components
can be examined individually
Application of Paired Preference
Technique:
• The Paired Preference Technique requires two sets of data to
quantify the oral health judgements
• Data abstracted from the simulated patient

cases that compromise the independent
1 variables for the regression
• Dependent variable each judge’s decision set

for the paired comparison
2
Each case consists –
Full mouth series of

periapical and Photographs of the
Study models of teeth bitewing radiographs, full face, profile, and
panoramic intraoral mouth
radiographs
Demographic data
including general Dental chart with
health and dental examination results
histories
• Each case simulates the presence of a dental patient with
complete records and yields a multitude of quantifiable
variables
Represents –
• negative aspects - of disease pathogenesis and prognosis
• positive aspects - of oral health and dental treatment
• Mix of statistically significant and practical variables along

with their respective coefficients = oral health index
• Software package makes it easy to calculate the large number
of multiple regression necessary to derive the index
coefficients
• Most noteworthy findings were moderate and severe

periodontal disease which can be represented by the degree
of bone loss or pocket depth
• Conditions requiring X rays for appraisal (benign tumors)

and those necessitating direct examination (occlusion) are
excluded
The eight variables :
1. Severe periodontal disease,
2. Moderate periodontal disease,
3. Mild periodontal disease
4. Missing teeth
5. Caries
6. Tumors (benign)
7. Occlusion
8. Replaced teeth
• Final Indirect Index
Variables Co-efficient
Severe Bone loss (no. teeth) -3.35
Moderate Bone loss (no. Teeth) -1.37
Missing Teeth/Free Ends -3.13

Caries or Fractured Teeth -2.17
Replaced Teeth +0.69
• Final Direct Index

Variable Co-efficient
Pockets 6+ mm (no. Teeth) -3.02
Pockets 4.0-5.9mm (no. Teeth) -0.73
Missing Teeth/Free ends -3.13
Decayed/Fractured Teeth -1.79
Replaced Teeth +0.61
Points to be considered:
• The negative scores - obtained when a patient has 21 or more
teeth - evidence of caries and periodontal diseases
• With each such tooth the index scores reduce by -5.52 in the
indirect version and by -4.81 in direct version
• The combination of these two active disease processes in one

tooth is considered far worse numerically than a missing
tooth
• For both versions of the index, the co-efficient for caries/
fractured teeth ranks third in importance and is between
moderate and severe periodontal disease in value
• If caries is present, the index number falls and if it is

restored, the index regains the same amount
• Missing variable accounts for 28 teeth, excluding third

molars and enumerates the presence of free ends
• Third molars are counted for decay and periodontal disease,

but not as missing teeth if extracted or unerupted
• For both versions of this index, the coefficient assigned to
this variable is -3.13, generating a score of zero for a patient
with all 32 teeth missing (28 teeth plus four free ends)
• Free ends which are composed of the molars in a quadrant

are included primarily because they impinge on the dentist’s
ability to replace the teeth that are missing
• As all molars are lacking, a free end obviates the possibility

of restoring teeth with a fixed partial denture.
Calculation:
Missing without
replacement (M), Teeth are examined
Shaded portions
replaced (R), severe for pocket depth
denote the adjacent
Caries or Fractured using a periodontal
molars comprising
(D), Normal (N), or probe calibrated in
free ends if missing
an orthodontic 2mm segments
space closure (C)
value for each

Any value entered Results are entered
variable is
other than zero, will in a tally box at the
multiplied by its
reduce the index lower right of the
negative or positive
from 100 form
coefficient
USES-
• Dental examinations are
administered directly and
the findings can be
recorded without X-rays
• Provides a point system
for outcome assessment by
allowing
computation of costs per
points in index
improvement
Recording Form for Oral Health Status Index
Children’s Oral Health Status
Index
• Given by Alma L. Koch, Jay A. Gershen and Marvin Marcus
in the year 1985

• For children aged 17 and younger
Koch A, Gershen J.A., Marcus M. A Children’s Oral Health Status Index Based on
Dentists’ Judgement. J Am Dent Assoc 1985 Jan; 110: 36-41
• The upper age limit for use of children’s index was
determined to be 17 years for anumber of reasons-
Access to
Periodontal dental
problems do treatment is
not occur in usually
children parent
induced
Orthodontic
treatment
predominates
during teenage
years
Calculation:
Five components of the occlusion variable are evaluated using
the top portion of the form
1. Crossbite
2. Overbite
3. Overjet
4. Profile
5. Lips
• Abnormal position assessed - according to three factors:
space loss; crowding in the primary dentition, and crowding
in the permanent dentition
• Teeth - in abnormal position when one or more of the

following circumstances exist:
• Displacement of at least 2mm
• Rotation of at least 450
• Tipping of at least 150
• Ankylosis
• Ectopic eruption
• Primary teeth are numbered A to T using standard
nomenclature
• Secondary teeth are labeled, but the third molars have been
excluded
• Examiner determines whether each tooth is missing (M),

decayed (D) or sound (S) and circles one for each tooth
number or letter on the form
• For each unerupted tooth, “M’ is circled and slashed
Advantages:
• Intended for direct appraisal of the patients and has a potential for
the evaluation of private practices, dental clinics and school
programs
• Good reliability
Disadvantages:
• Does not take into account the mild decay
• Total numerical effect of the occlusion variable on the index is

limited to count five, resulting in the loss of about 22 points
Geriatric Oral Health Assessment
Index
• Given by Atchison KA, Dolan TA. In 1990
• Geriatric Oral Health Assessment Instrument (GOHAI) was

designed specifically to assess the impact of oral disease in
elderly individuals and populations
• GOHAI was developed from the results of interviews with

patients and health care providers and literature reviews
Kressin N.R., Kathryn A., Miller D. Comparing the Impact of Oral Disease in Two
Populations of Older Adults: Application of the Geriatric Oral Health Assessment
Index. J Public Health Dent. 1997; 57(4): 224-32
• Twelve items reflecting three hypothesized dimensions, or
domains of impact, were included in the instrument:
Physical • Eating, speaking, swallowing

function • 1-4
• Satisfaction with appearance, worries or

Psychosocial concern about oral health, inhibition of social
function contacts due to such concerns
• 6,7,9-11
• With eating or with sensitivity to hot, cold, or

Pain or sweets
discomfort
• 5,8,12
GOHAI ITEMS:
In the past three months ...
• For function -
1. How often did you limit the kinds or amounts of food you
eat because of problems with your teeth or dentures?
2. How often did you have trouble biting or chewing any

kinds of food, such as firm meat or apples?
3. How often were you able to swallow comfortably?
4. How often have your teeth or dentures prevented you

from speaking the way you wanted?
• For pain/discomfort
5. How often were you able to eat anything without feeling

discomfort?
8. How often did you use medication to relieve pain or

discomfort from around your mouth?
12. How often were your teeth or gums sensitive to hot,

cold, or sweets?
• For physiological function-
6. How often did you limit contacts with people because of

the condition of your teeth and gums, or dentures?
7. How often were you pleased or happy with the looks of

your teeth and gums, or dentures?
9. How often were you worried or concerned about

problems with your teeth, gums, or dentures?
10. How often did you feel nervous or self-conscious

because of problems with your teeth, gums, or dentures?
11. How often did you feel uncomfortable eating in front of

people because of problems with your teeth or dentures?
Calculation:
• The GOHAI items had been scored on a six point scale
(always, very often, often, sometimes, seldom, never)
• The total GOHAI Score is derived by summing the scores on

each of the items
• Three items are reversed so that a higher total GOHAI score

reflects fewer impacts of oral conditions on functioning and
well-being
Advantages:
• Index provides a method for measuring patients' perceptions
of the impacts of oral conditions on functioning and well-
being
Indices for Oral Malignancy
• TNM Classification
TNM Classification of lip and
oral cavity carcinomas:
• Given by Pierre Denoix between 1943 and 1952
• Later the Union Internationale Contre le Cancer (UICC) i.e.
the International Union Against Cancer adopted the TNM
system in 1954
• The TNM System for describing the anatomical extent of
cancer is based on the assessment of three components.
N- The M- The
T- The absence or absence or
extent of presence and presence of
the primary extent of distant
tumor regional metastasis
lymph node
metastasis
• The addition of numbers to these three components indicates
the extent of malignant disease (i.e. Stages 0, I, II, III and
IV)
• TNM system has four classification schemes that are

denoted by prefix (i.e. c, p, r and a)
Shefer’s Hine Levy. Shafer’s Textbook of Oral Pathology. Elsiver’s Publication. 6th
edi. Philidelphia. 2006
cTNM Clinical classification
• initial diagnosis of cancer obtained during the first treatment and its
staging is used as a guide for selecting primary therapeutic
treatment
pTNM Pathologic classification
• additional evidence of cancer obtained via surgery and histological
examination of surgically removed tissue prior to the first treatment
rTNM Retreatment classification

• recurrent cancer after disease free interval
aTNM Autopsy
• symbolizes the diagnostic evidence of cancer obtained after the
death of a person by postmortem examination
• TNM system has staging classification for six major head
and neck sites:
• Lips and oral cavity; the pharynx including the base of

tongue, soft palate and uvula; the larynx; the paranasal
sinuses; the major salivary glands (i.e. parotid,
submandibular and sublingual) and the thyroid gland
• In the 1992 modification the classification applies only to

carcinomas of the vermillion surface of the lips and other
oral cavity, including those of minor salivary glands.
Anatomical sites and subsites:
Lip
• 1. External Upper Lip (Vermillion Border) (C00.0)
• 2. External Lower Lip (Vermillion Border) (C00.1)
• 3. Commissures (C00.6)
Oral Cavity
1. Buccal Mucosa
i. Mucosa of upper and lower lips (C00.3,4)
ii. Cheek mucosa (C06.0)
iii. Retromolar area (C06.2)
iv. Buccoalveolar sulci, upper and lower (vestibule of mouth)

(C06.1)
2. Upper Alveolus and Gingiva (Upper Gum) (C03.0)
3. Lower Alveolus and Gingiva (Lower Gum) (C03.1)

4. Hard Palate (C05.0)
5. Tongue
i. Dorsal surface and lateral borders anterior to the vallate

papilla (anterior twovthirds) (C02.0,1)
ii. Inferior (ventral) surface (C02.2)
6. Floor of the Mouth (C04)
Regional Lymph Nodes- The general lymph nodes are cervical

lymph nodes.
TNM Classification:
T- Primary Tumor
• TX Primary tumor cannot be assessed
• TO No evidence of primary tumor
• Tis Carcinoma in situ
• T1 Tumor 2cm or less in greatest dimension
• T2 Tumor more than 2cm but not more than 4cm in greatest
dimension
• T3 Tumor more than 4cm in greatest dimension
• T4 Lip: Tumor invades adjacent structures, eg through cortical
bone, tongue, skin of neck
• Oral cavity: Tumor invades adjacent structures, eg through
cortical bone into deep (extrinsic) muscle of tongue, maxillary
sinus, skin
• N- Regional Lymph Nodes
• NX Regional lymph nodes cannot be assessed
• NO No regional lymph node metastasis
• N1 Metastasis in a single ipsilateral lymph node, 3cm or less

in greatest diamension
• N2 Metastasis in a single ipsilateral lymph node, more than

3cm but not more than 6cm in greatest dimension, or in
multiple ipsilateral lymph nodes, none more than 6cm in
greatest dimension, or in bilateral or contralateral lymph
nodes, none more than 6cm in greatest dimension.
• N2a: Metastasis in a single ipsilateral lymph node, more than
3cm but not more than 6cm in greatest dimension.
• N2b: Metastasis in multiple ipsilateral lymph nodes, none

more than 6cm in greatest dimension
• N2c: Metastasis in bilateral or contralateral lymph nodes,

none more than 6cm in greatest dimension.
• N3 Metastasis in a lymph node, more than 6cm in greatest

dimension.
• Midline nodes are considered as ipsilateral nodes.
M- Distant Metastasis
• MX Presence of distant metastasis cannot be assessed.
• MO No distant metastasis
• M1 Distant metastasis
TNM PATHOLOGICAL CLASSIFICATION
Plasma DNA Integrity Index
• Analysis of the length of circulating DNA in plasma has been reported as a
marker for solid tumor detection
• Fifty-eight HNSCC patients with paired pre- and postoperative plasma and 47
plasma samples from control subjects were analyzed using quantitative PCR
to determine plasma DNA integrity index
• Results: Mean DNA integrity index was significantly greater in the plasma
from HNSCC patients, when compared to plasma from the control subjects
Jiang WW, Zahurak M, Goldenberg D, Milman Y, Park HL, Westra WH, Koch W, Sidransky D,
Califano J. Increased plasma DNA integrity index in head and neck cancer patients. International
journal of cancer. 2006 Dec 1;119(11):2673-6.
Micronucleus Index
• Characteristically seen in exfoliated cells in the buccal mucosa
and urinary bladder of during precancerous and cancerous
conditions in less and large proportions respectively
• 25 patients with varying stages of SCC of oral cavity and 25

patients with premalignant lesions were screened for the
presence of MN in epithelial scrapings obtained from the site of
the lesion
• Most of them were chronic tobacco chewers

• Results –
1. Micronucleus were found to be

two fold more in malignant cases
2. Significant number of
micronuclei in the premalignant
lesion – can be used in high risk
population in screening test
Pratheepa Sivasankari N, Kaur S, Reddy KS, Vivekanandam S. Micronucleus index: An early

diagnosis in oral carcinoma. J Anat Soc India. 2008;57:8-13.
Conclusion:

Indices For Givgival and Periodontal Diseases and Malignancy

Загружено:

Сведения о документе

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Indices For Givgival and Periodontal Diseases and Malignancy

Загружено:

Авторское право:

Доступные форматы

Indices for periodontal and

gingival disease, oral health

• Gingivitis and periodontitis - inflammatory diseases of

• Epidemiology – study of the distribution and determinants of

• An expression of a clinical observation in a numerical value

• Describe a status of an individual or a group with respect to

Soben Peter. Essentials of Preventive and Community Dentistry. 4th edition

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’ – RUSSELL A.L

Soben Peter. Essentials of Preventive and Community Dentistry. 4th edition

Soben Peter. Essentials of Preventive and Community Dentistry. 4th edition

Direction Measures conditions

Soben Peter. Essentials of Preventive and Community Dentistry. 4th edition

Soben Peter. Essentials of Preventive and Community Dentistry. 4th edition

Soben Peter. Essentials of Preventive and Community Dentistry. 4th edition

Measures all the

Soben Peter. Essentials of Preventive and Community Dentistry. 4th edition

• Oral Hygiene Index – Simplified (OHI-S)

• Patient Hygiene Performance Index (PHP)

• Modified Patient Hygiene Index

• Plaque index (PlI)

• Turesky - Gilmore – Glickman modification of the Quigley - Hein

• Developed as a plan to study variations in gingival

• Sensitive, simple method for assessing group or individual

• Based on 12 numerical determinations - amount of debris or

Segmental Division of the Oral Cavity

• Only fully erupted permanent teeth are scored

• Third molars and incompletely erupted teeth are not scored

• Two scores assigned to a segment are based on the buccal

• Buccal score and lingual score for a segment need not be

• Oral debris is defined as “the soft foreign matter on the

• Only definite deposits of hard calculus should be recorded

Recording Form for Oral Hygiene Index

• Oral Hygiene Index = Debris index+ Calculus Index

• Maximum number of points - debris or calculus - 36

• Oral hygiene index is the sum of two indices, its value

• Higher the score the poorer the oral hygiene

• 4 minutes per person were required to record oral hygiene scores

• Sensitive enough to reflect the cleansing efficiency of tooth

• Useful tool in program evaluation in monitoring oral hygiene

• Intra examiner and inter examiner errors are more

• Cannot be used in mixed dentition

The Oral Hygiene Index Simplified differs from the original

• Number of tooth surfaces scored (6 rather than 12)

• Method of selecting the surfaces to be scored

• Scores which can be obtained

• For mixed dentition

Good – 0.0-0.6 Good – 0.0-1.2

• Easy to use because the criteria are objective

• Examination - performed quickly

• High level of reproducibility is possible with a minimum of

• The tooth surfaces assessed are the buccal of the maxillary

Patient is instructed to chew the

Patient can expectorate - but

• Debris definitely present A- Five Subdivisions of a

PHP index value for an Total the scores for 0-5

• Fair - 1.8- 3.4

• Poor - 3.5- 5.0

• Can be performed quickly - Can be used for patient

• Recognizes the importance of, and scoring individually,

• Decisions regarding substitutions must be employed when