Periodontal Indices

DRJAFFARRAZA
LECTURER KMUIDSKOHAT

INTRODUCTION
 Dental index or indices are devices to find out the incidence,
prevalence and severity of the disease, based on which
preventive programs can be adopted.
 An index is an expression of the clinical observation in a
numerical value. It helps to describe the status of the individual
or a group with respect to a condition being measured.

DEFINITION
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
Oral indices are essentially set of values, usually numerical with
maximum and minimum limits, used to describe the variables or a
specific conditions on a graduated scale, which use the same criteria
and method to compare a specific variable in individuals, samples or
populations with that same variables as is found in other individuals,
samples or populations. – ‘’George P Barnes’’ - 1985

IDEAL REQUISTIES OF AN INDEX
CLARITY
ACCEPTABILITY
SIMPLICITY
SENSITIVITY
INDEX OBJECTIVITY
VALIDITY
QUANTIFIBILITY
RELIABILITY

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

CRITERIA FOR SELECTING
INDEX
 Simple to use and calculate.
 Permit the examination of many people in a short period of time.
 Require minimum armamentarium and expenditure.
 Highly reproducible in assessing a clinical condition when used by one
or more examiners.
 Not cause discomfort to the patient and should be acceptable to the
patient.
 Amenable to statistical analysis
 Strongly related numerically to the clinical stages of the specific
disease under investigation.

Indices for assessing
oral hygiene & plaque

ORAL HYGIENE INDEX
Developed in 1960 by John C.
Green and Jack R. Vermillion RULES OF ORAL HYGIENE
INDEX
R
1 Only fully erupted permanent teeth
are scored.
2. Third molars are not included
3. The buccal & lingual calculus scores are
both taken on the tooth in a segment
having the greatest surface area covered
by supra and subgingival calculus.

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

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

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

SIMPLIFIED ORAL HYGIENE INDEX
 Developed by John C Greene and Jack R Vermillion in 1964
 Only fully erupted permanent teeth are scored.
 Natural teeth with full crown restorations and surfaces reduced
in height by caries or trauma are not scored SUBSTITUTION
16 17,18
21
SURFACES TO BE EXAMINED
11
26
36
31
46
27,28
37,38
41
47,48

CALCULATION INTERPRETATION
DI –S and CI-S
1. Good -0.0-0.6
2. Fair – 0.7-1.8
 DI –S/CI-S = Total score/No of surfaces
3. Poor – 1.9 -3.0
OHI-S
1. Good - 0.0-1.2
2. Fair – 1.3- 3.0
3. Poor – 3.0 -6.0
OHI -S=
DI-S+ CI-S

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

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

 Debris score for individual tooth:
 Add the scores for each of the 5 subdivisions.
 PHP index for an individual= (Sum of debris score/number of
debris score)
 SCORING CRITERIA
 Excellent : 0 (no debris)
 Good : 0.1-1.7
 Fair :
 Poor :
1.8 – 3.4
3.5 – 5.0

PLAQUE INDEX
• Described by Silness P and Loe H in 1964.
• This index measures the thickness of plaque on the gingival one third.
• Good validility and reliability.
• Draw back is subjectivity in estimating the amount of plaque.
• Used as full mouth index/simplified index.
•INDEX TEETH:
• 16,12,24,36,32,44.
•Areas examined:
• Distofacial
• Facial
• Mesio-facial&
• lingual surface of the tooth.

SCORING CRITERIA:
 PII for a tooth = Scores of 4 areas/4
 PII for individual = Total scores/no: of teeth examined
 PII for group = Total score/no: of individuals.

GINGIVAL INDEX
 Developed by Loe H and Silness P in 1963.
 For assessing severity of gingivitis,and its location by examining
qualitative changes of gingival tissues.
METHOD:
 The severity of gingivitis is scored on all teeth or on selected index
teeth.
INDEX TEETH:
16,36,12,32,24,44
Tissues surrounding each tooth divided into 4 gingival scoring units
 DISTO-FACIAL PAPILLA
 FACIAL MARGIN
 MESIO-FACIAL PAPILLA
 LINGUAL GINGIVAL MARGIN

SCORING CRITERIA
 Calculation and interpretation
 GI score for a tooth = Scores from 4 areas/4
 GI score individual = Sum of indices of teeth/no.of teeth examined
 GI score for group = Sum of all member/Total no of individuals

 Use:
 Severity of gingivitis, controlled clinical trials of
preventive or therapeutic agents

MODIFIED GINIGVAL INDEX
 Lobene, Weatherford, Ross, Lamm and Menaker in 1986.
 Assess the prevalence and severity of gingivitis.
IMPORTANT CHANGES IN GI:
 Elimination of gingival probing to assess the presence or
absence of bleeding.
 Redefinition of scoring system for mild and moderate
inflammation.
Method:
 To obtain MGI , labial and lingual surfaces of the gingival
margins and the interdental papilla of all erupted teeth
except 3rd molars are examined and scored.

SCORING CRITERIA
CRITERIA
SCOR
E
0
1
Normal
Mild inflammation, slight change in color, little
change in texture of any portion of gingival unit
2 Mild inflammation of entire gingival unit
Moderate inflammation of gingival unit
Severe inflammation of gingival unit
3
Calcula
4
tion:
Mesial and distal for papilla , labial and lingual for
marginal and then adding the two and then dividing with
no. Of teeth.
Uses:
Clinical trials of therapeutic agents

PAPILLARY – MARGINAL ATTACHMENT INDEX
(PMA)
 MAURY MASSLER AND SCHOUR .L 1944.
 No. of gingival units effected were counted rather
then the severity of inflammation
METHOD
 A gingival unit is divided into three compartments –
Papillary gingiva, Marginal gingiva, Attached gingiva
 Presence or absence of inflammation on each
gingival unit is recorded and usually only maxillary
and mandibular incisors, canines and premolars were
examined.

SCORING CRITERIA
PAPILLARY COMPONENT MARGINAL COMPONENT
score criteria
score criteria
Normal 0
1
Normal
0
1 Mild papillary
enlargement
Engorgement, slight inc in size,
no bleeding
2
3
Obvious increase in
size , BO Pressue
2
3
Obvious engorgement , bleeding
on pressure
Excessive inc in size,
spontaneous bleeding Swollen collar, spontaneous
bleeding , beginning infiltration
4
5
Necrotic papilla
4
5
Necrotic gingiva
Atrophy and loss of
papilla Recession of the free marginal
gingiva below CEJ due to
inflammatory changes.

ATTACHED COMPONENT
score criteria
0 Normal Calculation of the Index
1 Slight engorgement with loss of
stippling, changes in color may or
may not be present
PMA = P+M+A
2 Obvious engorgement with marked
inc in redness and pocket
formation.
3 Advanced periodontitis
USES:
 Clinical trials
 On individual patients
 Epidemiologic surveys

GINGIVAL BLEEDING INDEX
(AINAMO and BAY,1975)
 Gingival bleeding index is based on recordings from all four
tooth surfaces of all teeth.
 Recorded as
 Bleeding present +
 Bleeding absent -
 A minus recording is equivalent to gingival index scores 0 & 1
 A plus recording is equivalent to gingival index scores 2 & 3.
 Gingival bleeding index is calculated as a percentage of
affected sites.
USES:
 In Experimental Studies
 Routine Basis In Individual Patients

SULCUS BLEEDING INDEX
 Developed by MUHLEMANN H.R AND SON.S in 1971.
 Modification of PAPILLARY – MARGINAL INDEX of MUHLEMANN and MAZOR Z
SCORING CRITERIA
Score 0 – healthy looking papillary and marginal gingiva no bleeding on probing;
Score 1 – healthy looking gingiva, bleeding on probing;
Score 2 – bleeding on probing, change in color, no edema;
Score 3 – bleeding on probing, change in color, slight edema;
Score 4 –bleeding on probing, change in color, obvious edema;
Score 5 –spontaneous bleeding, change in color, marked edema.
Four gingival units are scored systematically for each tooth: the labial and lingual
marginal gingival (M units) and the mesial and distal papillary gingival (P units).
Scores for these units are added and divided by four gives the sulcus bleeding index.

MODIFIED SULCULAR BLEEDING INDEX
Developed by MOMBELLI,VAN OOSTEN & S.CHURCH ET.AL IN
1987.
Scoring criteria :
 SCORE 0 – No bleeding when probe is passed along the
gingival margin
 SCORE 1 – Isolated bleeding , spots visible
 SCORE 2 – Blood forms a confluent red line on margins
 SCORE 3 – Heavy or profuse bleeding

RUSELL’S PERIODONTAL INDEX
 Developed by Rusell AI in 1956.
METHOD:
 All the teeth are examined in this index.
 Russell chose the scoring values as 0,1,2,4,6,8 in order to relate the
stage of the disease in an epidemiological survey to the clinical
conditions observed.
 The Russell’s rule states that “ when in doubt assign the lesser
score.”

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

CALCULATION AND INTERPRETATION
PI score per person = Sum of individual scores
No of teeth present
CLINICAL CONDITION INDIVIDUAL
SCORES
Clinical normally supportive tissue
Simple gingivitis
0.0-0.2
0.3-0.9
Beginning destructive periodontal diseases
Established destructive periodontal disease
Terminal disease
1.0-1.9
2.0-4.9
5.0-8.0

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

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

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

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

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

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

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

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

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

 Procedure:
 The mouth is divided into sextants :
 17- 14 13- 23 24- 27
 47 – 44 43- 33 34 – 37
. The 3rd molars are not included, except where they are functioning in place of
2nd molars.
 For adults aged > 20 yrs:
• 10 index teeth are taken into account :17/16 11 26/27 47/46 31
36/37.

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

SCORING CRITERIA
CODE CRITERIA TREATMEN
T NEEDS
0 Healthy periodontium TN-0 No need of treatment
Self care
1 Bleeding observed during /
after probing
TN-1
2 Presence of supra or
subgingival calculus
TN-2
TN-2
Professional care
Scaling
3 Pathological pocket 4-5 mm.
gingival margin situated on
black band of the probe.
Scaling and root
planning
4 Pathological pocket 6mm or
more. Black band of the
probe not visible
TN-3 Complex therapy by
specially trained
personnel
X When only one tooth or no
teeth are present in sextant

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

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

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

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

Periodontal Indices

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