This document discusses various periodontal indices used to measure oral hygiene and periodontal disease. It begins by defining what an index is and its uses. It then describes several commonly used indices including: 1) The Oral Hygiene Index which measures debris and calculus to assess oral hygiene. 2) The Gingival Index which evaluates gingival inflammation visible to the naked eye. 3) The Plaque Index which scores the amount of plaque present on tooth surfaces. It provides the scoring criteria and calculations for each index. The document emphasizes that indices should be objective, reproducible and allow comparison across populations or studies.

1. PERIODONTAL
INDICES
DR BHAUMIK THAKKAR.
PART -1 P.G.
DEPT OF PERIODONTICS

2. 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.

3. 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

4. An index is an expression of clinical observation in numeric values. It is
used to describe the status of the individual or group with respect to a
condition being measured. The use of numeric scale and a
standardized method for interpreting observations of a condition
results in an index score that is more consistent and less subjective
than a word description of that condition. – ‘’Esther M Wilkins’’ - 1987

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

6. USES
6FOR INDIVIDUAL PATIENT
 Recognize an oral
problem
 Effectiveness of present
oral hygiene practices
 Motivation in preventive
and professional care for
control and elimination
of diseases
IN RESEARCH
• Determine base line data
before experimental
factors are introduced
• Measure the effectiveness
of specific agents for
prevention control or
treatment of oral condition
IN COMMUNITY
• Shows prevalence and
incidence of a condition
• Assess the needs of the
community.
• Compare the effects of
a community program
and evaluate the
results

7. CLASSIFICATION OF INDICES
Based on the direction in
which their scores can
fluctuate:
IRREVERSIBLE
INDEX
REVERSIBLE
INDEX
Depending upon the extent to
which areas of oral cavity are
measured :
FULL MOUTH
INDICES
SIMPLIFIED
INDICES

8. According to the entity
which they measure
DISEASE INDEX
SYMPTOM
INDEX
General indices :
SIMPLE
INDEX
CUMULATIVE
INDEX
TREATMENT
INDEX

9. 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.

10. Indices for assessing
oral hygiene & plaque

11. ORAL HYGIENE INDEX
RULES OF ORAL HYGIENE
INDEX
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.
Developed in 1960 by John C.
Green and Jack R. Vermillion
R

12. 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.

13. CALCULUS SCORING CRITERIA
SCO
RE
CRITERIA
0 No calculus present
1 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

14. Calculation
 Debris Index (DI) =( Buccal Score+ Lingual Score) / NO. OF SEG
 Calculus Index (CI) =( Buccal Score+ Lingual Score) / NO. OF SEG
 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
OHI=D.I+C.I

15. 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
16 17,18
11 21
26 27,28
36 37,38
31 41
46 47,48
SURFACES TO BE EXAMINED
SUBSTITUTION

16.  DI –S/CI-S = Total score/No of surfaces
OHI -S=
DI-S+ CI-S
CALCULATION INTERPRETATION
DI –S and CI-S
1. Good -0.0-0.6
2. Fair – 0.7-1.8
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

17. 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 BUCCAL
11 LABIAL
26 BUCCAL
36 LINGUAL
31 LABIAL
46 LINGUAL

18. 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.

19.  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 : 1.8 – 3.4
 Poor : 3.5 – 5.0

20. 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.

21. 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.

22. TURESKY – GILMORE- GLICKMAN MODIFICATION OF THE
QUIGLEY – HEIN PLAQUE INDEX
 Quigley G. Hein . J in 1962, plaque measurement that
focused on the gingival third of the tooth surface. They
examined only the facial surfaces of the anterior teeth,
using basic fuchsin mouthwash as a disclosing agent.
 The Quigley-Hein plaque index was modified by
Turesky S, Gilmore N.D and Glickman I in 1970..
Method:
 Labial, Buccal and lingual surfaces are assessed after
using disclosing agent.
INDEX SCORE= Total Score/ No of surfaces examined
 0-1 = low
 >2 = High

23. SCORING CRITERIA:
SCORE CRITERIA
0 No plaque
1
Separate flecks of plaque at the
cervical margin of the tooth
2
A thin continuous band of
plaque at the cervical margin of
the tooth
3
A band of plaque wider then
1mm covering less than 1/3rd of
the crown of the tooth
4
Plaque covering at least 1/3rd
but less then 2/3rd of the crown
of the tooth
5 Plaque covering 2/3rd or more of
the crown of the tooth
Score Criteria
0 no plaque
1
flecks of stain of the
gingival margin
2
Definitive line of plaque on
gingival margin
3 Gingival third of surface
4 Two- thirds of surface
5
Greater then 2/3rd of the
surface
QUIGLEY AND
HEIN
TURESKY et al

24. GINGIVAL INDICES

25. 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

26. 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

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

28. 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.

29. SCORING CRITERIA
Calculation:
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
SCOR
E
CRITERIA
0 Normal
1 Mild inflammation, slight change in color, little
change in texture of any portion of gingival unit
2 Mild inflammation of entire gingival unit
3 Moderate inflammation of gingival unit
4 Severe inflammation of gingival unit

30. 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.

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

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

33. 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

34. 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.

35. 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

36. ORAL PIGMENTATION INDEX
(DUMMET 1966)
CALCULATION:
Maxillary DOPI/number of teeth examined
 Mandibular DOPI/number of teeth examined.
 MEAN=maxillary DOPI + mandibular DOPI/2
SCORE CRITERIA
0 PINK TISSUE(no pigmentation)
1 Mild brown(light) tissue(mild pigmentation)
2 Moderate brown/mixed pink and brown tissue(moderate
clinical pigmentation)
3 Deep brown/blue/black tissue(heavy clinical pigmentation)

37. INTERPRETATION:
 0 - NO PIGMENTATION
 0.03-1.0 - MILD PIGMENTATION
 1.O3-2.0 - MODERATE PIGMENTATION
 2.03-3.0 - SEVERE PIGMENTATION

38. GINGIVAL PIGMENTATION INDEX
BY PEERAN ET AL 2014
CLASS CRITERIA OF CLASSIFICATION
I Coral pink/salmon pink colored gingiva
II Localized/isolated spots/areas of gingival melanin pigmentation
which does not involve all the three parts of gingiva,that is
attached,free and papillary gingiva
 Mild to moderate pigmentation
 Severe/intense pigmentation
III Localized/isolated unit/of melanin pigmentation which involve all
the three parts of gingiva
 Mild to moderate pigmentation
 Severe/intense pigmentation
IV Generalized diffuse pigmentation
 Mild to moderate pigmentation
 Severe/intense pigmentation.
V Tobacco associated pigmentation like smoker’s melanosis

39. VI
Gingival pigmentation due to exogenous pigments eg:-Amalgam tattoos, Cultural
gingival tattooing, Drinks, Food colors, Habitual betelnut/khat chewing, Lead-
Burtonian line, Mercury, Silver, Arsenic, Bismuth, Graphite, Other foreign bodies,
Topical medications, Idiopathic.
VII Gingival pigmentation due to endogenous pigments like Bilirubin, Blood breakdown
products, Ecchymosis, Petechiae, Hemochromatosis, Hemosiderin.
VIII Drug-induced gingival pigmentation like ACTH, Antimalarial drugs,
Chemotherapeutic agentbusulfan and doxorubicin, Minocycline, Oral
contraceptives, Phenothiazines.
IX Gingival pigmentation associated with systemic diseases and syndromes like
Addison’s disease, Albright’s syndrome, Basilar melanosis with incontinence, Beta
thalassemia; Healed mucocutaneous lesions-Lichen planus, Pemphigus,
Pemphigoid; Hereditary hemorrhagic telangiectasia; HIV-associated melanosis,
Neurofibromatosis, Peutz-Jeghers and other familial hamartoma syndromes,
Pyogenic granuloma/Granulomatous epulis.
X Pigmented benign and malignant lesions involving the gingival like Angiosarcoma,
Hemangioma, Kaposi’s sarcoma, Malignant melanoma, Melanocytic nevus,
Pigmented macule.

40. PERIODONTAL INDICES

41. 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.”

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

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

44. 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.

45.  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.

46. 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

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

48. ASSESSMENT OF TOOTH MOBILITY
MILLER(1985) – has described the most common clinical method in
which tooth is held between handles of the two instruments & moved
back and forth or with metallic instrument and one finger.
Criteria:
 SCORE 0- no detectable mobility
 SCORE 1- distinguishable tooth mobility
 SCORE 2- crown of tooth moves more than 1mm in any direction
 SCORE 3 – movement of more than 1mm in any direction
 GLICKMAN/ CARRANZA F.A (1972)–
 GRADE 1- slightly more then normal
 GRADE 2- moderately more than normal
 GRADE 3 – severe mobility faciolingually and or mesiodistally
combined with vertical displacement.

49. WASERMAN ET.AL 1973
 1- normal
 2- slight- > ¾ mm of bucco-lingual movement
 3- moderate- up to approximately 2mm movement bucco-
lingually
 4- severe- more than 2 mm.
LINDHE 1997:
 Degree 1 – movability of crown of tooth less than 1mm in
horizontal direction
 Degree 2 – movability of crown of tooth more than 1mm
in horizontal direction
 Degree 3 – movability of crown of tooth in vertical as well.

50. FURCATION
 The furcation is the point at which the two roots divide.
 A pocket measuring probe is used (naber’s probe).
 RAMFJORD AND ASH FURCATION INDEX:
GRADE MOBILITY
Grade 0 No clinical furcation involved
Grade 1 Bone loss up to 1/3 width
Grade 2 Bone loss up to 2/3 width
Grade 3 Through and through defect

51. DEANS FLUOROSIS INDEX-MODIFIED
 By TRENDLEY H DEAN 1942
 To obtain index,examiner’s recording is based on two teeth
most affected.
CLASSIFICATION CRITERIA
NORMAL(0) The enamel represents the usual
translucent semivitriform type of
structure.the surface is smooth,glossy and
usually of a pale,creamy white colour.
QUESTIONABLE(0.5) The enamel discloses slight abberations
from the translucency of normal
enamel,ranging from few white flecks to
occasional white spots.
VERY MILD(1) Small,opaque paper white areas scattered
irregularly over the tooth,but not involving
as much as 25% of tooth surface.usually
1-2mm of opacity at the tips cusps of

52. MILD(2) White opaque areas in enamel are more extensive,but
do not involve as much as 50% of tooth.
MODERATOR(3
)
All enamel surfaces of the teeth are affected and surfaces
subject to attrition show wear.brown stain is frequently a
disfiguring feature.
SEVERE(4) All enamel surfaces of the tooth are affected and
hypoplasia is so marked that the general form of the tooth
may be affected.major diagnostic sign is discrete or
confluent pitting.brown stains are wide spread and teeth
often present a corroded like appearance.

53. TRAUMA FROM OCCLUSION
 BY JIM AND CAO 1992
0 No tooth mobility during habitual centric closure and
excessive mandibular movements.
1 Tooth mobility detected only in centric closure or
excessive movements.
2 Significant tooth mobility detected during centric closure
and excessive movements.

54. WOUND HEALING INDEX
 BY HUANG et.al 2005
SCORE DESCRIPTION
1 Uneventful wound healing with no gingival
edema,erythema,suppuration,patient
discomfort or flap dehiscence.
2 Uneventful wound healing with slight gingival
edema,erythema,patient discomfort,or flap
dehiscence,but no suppuration
3 Poor wound healing with significant gingival
edema,erythema,patient discomfort,flap
dehiscence or any suppuration

55. CONCLUSION
 Dental diseases are the most prevalent and most neglected of all the chronic
diseases of mankind.
 One of the major problems in studying dental diseases and its factors is the
development of a suitable and practicable method for recording and
classifying the occurrence and severity of the disease.
 Dental indices and scoring methods are used in clinical practice and
community programs to determine and record the state of health of individual
and group.

56. THANK YOU