Periodontal indices

1. `
GOOD MORNING
1

2. 2
SUBMITTED BY:
SHEKHAR KUMAR MANDAL
Roll no: 26
BDS IV
GUIDED BY:
DR. NAVRAJ LAMDARI
DR. LAL BABU KAMAIT
DEPARTMENT OF PERIODONTICS
COLLEGE OF MEDICAL SCIENCES,
BHARATPUR NEPAL

3. CONTENTS
REFERENCES
CONCLUSION
RECENT ADVANCES IN PERIODONTAL INDICES
GINGIVAL AND PERIODONTAL DISEASE INDICES
ORAL HYGIENE AND PLAQUE INDEX
OBJECTIVES AND USES OF INDEX
IDEAL REQUISITES OF AN INDEX
CLASSIFICATION OF INDEX
DEFINITIONS
INTRODUCTION
3

4. INTRODUCTION
“UNLESS YOU CAN COUNT IT, WEIGH IT OR EXPRESS IT IN A
QUANTITATIVE FASHION, YOU HAVE SCARCELY BEGUN TO
THINK ABOUT THE DISEASE IN A SCIENTIFIC FASHION”
-LORD KELVIN 4

5. DEFINITIONS
• “Epidemiological indices are attempts to quantitate clinical
condition on graduated scale, thereby facilitating
comparison among populations examined by the same
criteria and methods”. – Irving Glickman
5
According to Russell A.L , 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”

6. “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
6

7. IDEAL REQUISITES OF AN INDEX
7

8. OBJECTIVES
FOR INDIVIDUAL PATIENT
• Recognize an oral problem
• Effectiveness of present
oral hygiene practices
• Motivation in preventive
and professional care for
control and elimination of
diseases 8
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 need of the
community
• Compare the effects of a
community program and
evaluate the results

9. Based on the direction in which their scores can
fluctuate:
• Measures condition that
can be changed e.g.
periodontal index
Reversible
index:
• Measures conditions that
will not change e.g. dental
caries
Irreversible
index:
9
CLASSIFICATION OF INDEX

10. •Depending upon the extent to which areas of oral
cavity are measured :
Full mouth
indices:
• Patient’s entire
periodontium or
dentition is
measured.
• e.g. OHI
Simplified indices:
• Measure only a
representative
sample of the
dental apparatus.
• e.g. OHI-S
10

11. According to the entity which they measure
• “d” decay portion of the dmf index is the
best example of disease index
Disease
index :
• Measuring gingival or sulcular bleeding are
essentially examples of symptom indices
Symptom
index :
• “f” filled portion of dmft index is the best
example for treatment index
Treatment
index :
11

12. General indices :
• Index that measures the
presence or absence of a
condition. e.g. plaque index
Simple
index:
• Index that measures all the
evidence of a condition, past
and present. e.g. DMF index
Cumulative
index:

13. INDICES USED FOR ORAL HYGIENE ASSESSMENT
• Oral hygiene index
• Simplified oral hygiene index
• Patient hygiene performance
• Turesky, Gilmore, Glickman modification of the Quigley Hein
plaque index
• O’leary index

14. ORAL HYGIENE INDEX (OHI)
• Developed in 1960 by John C. Green and Jack R. Vermillion
in order to classify and assess oral hygiene status.
• Simple and sensitive method for assessing group or
individual oral hygiene quantitatively.
• Composed of 2 components:
• Debris index (DI)
• Calculus index (CI)

15. RULES OF ORAL HYGIENE INDEX
1 Only fully erupted permanent teeth
are scored.
2 Third molars and incompletely
erupted teeth are not scored
because of the wide variations in
heights of clinical crowns.
3 The buccal and lingual debris
scores are both taken on the tooth
in a segment having the greatest
surface area covered by debris.
4 The buccal and lingual calculus
scores are both taken on the tooth
in a segment having the greatest
surface area covered by
supragingival and subgingival
calculus.

16. 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 covered2 – 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
DEBRIS INDEX CRITERIA

17. 17
SCORE 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.Supragingival
calculus
Subgingival
calculus
CALCULUS INDEX CRITERIA

18. CALCULATION
• Debris Index (DI) =( Buccal Score+ Lingual Score) / NO. OF SEG
• Calculus Index (CI) =( Buccal Score+ Lingual Score) / NO. OF SEG
• Oral Hygiene Index= DI+CI
• 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

19. SIMPLIFIED ORAL HYGIENE INDEX
• Developed by John C Greene and Jack R Vermillion in 1964
as OHI was time consuming and required more decision
making
• 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
• An alternate tooth is then examined if missing

20. 20
16 17,18
11 21
26 27,28
36 37,38
31 41
46 47,48
Surfaces and tooth to
examined
Substitution

21. 21
DI –S and CI-S
• Good -0.0-0.6
• Fair – 0.7-1.8
• Poor – 1.9 -3.0
OHI –S
•Good - 0.0-1.2
•Fair – 1.3- 3.0
•Poor – 3.0 -6.0
INTERPRETATIONCALCULATION
• DI –S = Total score/No of
surfaces
• CI-S = Total score/ No of
surfaces
• OHI -S= DI-S+ CI-S

22. USES
• Widely used in epidemiological studies of periodontal diseases.
• Useful in evaluation of dental health education programs
• Evaluating the efficacy of tooth brushes and practices.
• Evaluate an individual’s level of oral cleanliness.

23. 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.
23
16 Buccal
11 Labial
26 Buccal
36 Lingual
31 Labial
46 Lingual

24. • 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.
M
MI
D
M
O/I
G
Procedure:

25. • Debris score for individual tooth:
• Add the scores for each of the 5 subdivisions.
• PHP index for an individual= (Total score for all the teeth /the number
of teeth examined)
Debris score for 1 tooth = 4/5
= 0.8
1
1
1 1
0
Rating scores
Excellent : 0 (no debris)
Good : 0.1-1.7
Fair : 1.8 – 3.4
Poor : 3.5 – 5.0

26. PLAQUE INDEX
• Silness and Loe in 1964
• Assesses only thickness of plaque at the cervical
margin of the tooth closest to the gums
• All four surfaces are examined
• Distal
• Mesial
• Lingual
• Buccal
12
16
44
32

27. SCORING CRITERIA FOR PLAQUE INDEX
Score Criteria
0 No Plaque
1
A film of plaque adhering to the free
gingival margin and adjacent area of
tooth the plaque may be seen in situ only
after application of disclosing solution
or by using probe on tooth surface
2
Moderate accumulation of soft deposits
within the gingival pocket, or the tooth
and gingival margin which can be seen
with the naked eye
3
Abundance of soft matter within the
gingival pocket and/or on the tooth and

28. Rating Scores
Excellen
t
0
Good 0.1-0.9
Fair 1.0-1.9
Poor 2.0-3.0
CALCULATION
Plaque index for
area
0-3 for each surface
Plaque index for a
tooth
Scores added and then divided by four
Plaque index for
group of teeth
Scores for individual teeth are added
and then divided by number of teeth.
Plaque index for
the individual
Indices for each of the teeth are added
and then divided by the total number of
teeth examined
Plaque index for
group
All indices are taken and divided by
number of individual
INTERPRETATION

29. USES
• Reliable technique for evaluating both mechanical anti plaque
procedures and chemical agents
• Used in longitudinal studies and clinical trials

30. 30
ADVANTAGE
•Good validity and reproducibility
•Can be used as full mouth or simplified
DRAWBACK
•Subjectivity in estimating plaque

31. Turesky, Gilmore, Glickman modification of the
Quigley-Hein plaque index
• Quigley and Hein in 1962 reported a plaque measurement
that focused on the gingival third of the tooth surface.
• Only facial surfaces of the anterior teeth were examined
after using basic fuchsin mouthwash as a disclosing agent.
• Quigley - Hein plaque index was modified by Turesky,
Gilmore and Glickman in 1970.
31

32. • Plaque is assessed on the labial, buccal and lingual surfaces
of all the teeth after using a disclosing agent.
• The scores of the gingival 1/3rd area was also redefined.
• Provides a comprehensive method for evaluating anti
plaque procedures such as tooth brushing, flossing as well
as chemical anti plaque agents.
• The index is based on a numerical score of 0 to 5
32
METHOD

33. 33
SCOR
E
CRITERIA
0 No plaque
1 Separate flecks of plaque at the
cervical margin of tooth
2 Thin continuous band of plaque
( up to 1 mm)
3 Band of plaque wider than 1 mm
but covering less than 1/3rd of the
crown of the tooth.
4 Plaque covering at least 1/3rd but
less than 2/3rd of the crown of the
tooth
5 Plaque covering 2/3rd or more of
the crown of the tooth

34. O’LEARY INDEX
(plaque control record)
• O' leary T, Drake R, Naylor in1972
• Method of recording the presence of the plaque on
individual tooth surfaces
• Suitable disclosing solution such as Bismarck brown,
Diaplac or similar is painted on all exposed tooth
surfaces..
• The operator (using an explorer or a tip of a probe)
examines each stained surface for soft accumulations at
the dentogingival junction. When found, they are
recorded by making a dash/red colour in the appropriate
spaces on the record form

35. Calculation
PLAQUE INDEX =The number of plaque containing surfaces
The total number of available surfaces
• Since plaque is stained,
identification and record
making is easy
• Also aids in patient education
Drawback
Records only the presence or absence of plaque

36. GINGIVAL AND PERIODONTAL DISEASE
INDICES
• GINGIVAL INDEX
• PERIODONTAL INDEX
• CPITN
• COMMUNITY PERIODONTAL INDEX
36

37. GINGIVAL INDEX
• Developed by Loe and Silness in 1963.
• One of the most widely accepted and used gingival indices.
• Assess the severity of gingivitis and its location in 4 possible areas.
• Mesial
• Lingual
• Distal
• Facial
• 0nly qualitative changes are assessed.
37

38. :
• All surfaces of all teeth or selected teeth or selected surface of
all teeth or selected teeth are scored.
• The teeth and gingiva are first dried with a blast of air and/or
cotton rolls.
• The tissues are divided into 4 gingival scoring units: Disto facial
papilla, Facial margin, Mesio facial papilla and Entire lingual
margin.
• A blunt periodontal probe is used to assess the bleeding
potential of the tissues.
INDEX TEETH
METHOD

39. SCORE CRITERIA
0
Absence of
inflammation/normal gingiva
1
Mild inflammation, slight
change in color, slight edema,
no bleeding on probing
2
Moderate inflammation,
moderate glazing, redness,
edema and hypertrophy.
bleeding on probing
3
Severe inflammation, marked
redness and hypertrophy
ulceration. Tendency to
spontaneous bleeding.
39

40. CALCULATION AND INTERPRETATION
• If the scores around each tooth are totaled
and divided by the number of surfaces per
tooth examined (4), the gingival index score
for the tooth is obtained.
• Totaling all of the scores per tooth and
dividing by the number of teeth examined
provides the gingival index score for
individual.
INTERPRETATION:
0.1 - 1.0 : mild gingivitis
1.1 – 2.0 : moderate
gingivitis
2.1 – 3.0 : severe gingivitisRECORDING FORMAT

41. MODIFIED GINGIVAL INDEX
• Developed by Lobene, Weatherford, Ross, Lamm and Menaker in 1986.
• Assess the prevalence and severity of gingivitis.
• Strictly based on non invasive approach i.e. visual examination only
without any probing.
• 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.
41

42. 42
0
• Normal (absence of inflammation)
1
• Mild inflammation (slight change in color, little change in
texture) of any portion of the gingival unit
2
• Mild inflammation of the entire gingival unit
3
• Moderate inflammation (moderate glazing, redness, edema,
and/or hypertrophy) of the gingival unit.
4
• Severe inflammation (marked redness and
edema/hypertrophy, spontaneous bleeding, or ulceration) of
the gingival unit.
SCORE CRITERIA

43. RUSELL’S PERIODONTAL INDEX
• Developed by Rusell AI in 1956.
• It was once widely used in epidemiological surveys but not used much
now because of introduction of new periodontal indices and
refinement of criteria.
• The RPI is reported to be useful among large populations, but it is of
limited use for individuals or small groups.
43

44. • All the teeth are examined in this index.
• Rusell 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 lower
score.”
44
METHOD

45. FIELD STUDIES CLINICAL STUDIES /
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.
45

46. CALCULATION AND INTERPRETATION
• RPI score per person = Sum of individual scores
No of teeth present
46
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

47. 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.
47

48. 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.
• The treatment need in a sextant is recorded only if there are 2 or more
teeth present in a sextant and not indicated for extraction.
• If only one tooth remains in a sextant, then the tooth is included in the
adjoining sextant.
48
Procedure :

49. Probing depth is recorded either on all the teeth in a
sextant or only on certain indexed teeth as recommended
by who for epidemiological surveys.
For adults aged > 20 yrs:
• 10 index teeth are taken into account :17 16 11 26 37 47
46 31 36 37.
• The molars are examined in pairs and only one score the
highest score is recorded.
49

50. For young people up to 19 yrs:
• Only 6 index teeth are examined : 16 11 26 46 31 36
• The second molars are excluded at these ages because of
the high frequency of false pockets (non inflammatory
tooth eruption associated).
50

51. First described by WHO.
Designed for 2 purposes :
• measurement of pockets.
• detection of sub-gingival calculus.
Weighs : 5 gms
Working force: 20-25 gms
51
CPITN probe
CPITN-E
PROBE
CPITN-C
PROBE

52. CODE CRITERIA TREATMENT
NEEDS
0 Healthy periodontium TN-0 No need of
treatment
1 Bleeding observed
during / after probing
TN-1 Self care
2 Calculus or other
plaque retentive
factors seen or felt
during probing
TN-2 Professional care
3 Pathological pocket 4-5
mm. gingival margin
situated on black band
of the probe.
TN-2 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

53. ADVANTAGE
• Simplicity
• Speed
• International uniformity
LIMITATIONS
• Doesnot record the
position of gingiva
• Doesn’t provide
assessment of past
periodontal breakdown
53

54. COMMUNITY PERIODONTAL INDEX (CPI)
Based on modification of CPITN
Modification is done by including “loss of
attachment” and eliminating “treatment needs”
category.
CPI scoring criteria is same as CPITN and done with
CPITN-C probe

55. 55
Code Criteria
0 Loss of attachment 0-3 mm, CEJ not visible
1 Loss of attachment 4-5mm
2 Loss of attachment 6-8mm
3 Loss of attachment 9-11mm
4 Loss of attachment 12mm or more
X Excluded sextant
9 Not recorded
Codes and Criteria for Loss of attachment includes:

56. BY SCHOUR & MASSLER, (1944)
• To count number of gingival unit affected with gingivitis
that is correlated with severity of gingival inflammation.
• The facial surface of gingiva around a tooth divided into
three units:
Papillary gingiva (P),
Marginal gingiva (M), and
Attached gingiva (A).
• Usually central incisor to second premolars are
examined.
PAPILLARY MARGINAL ATTACHMENT INDEX(

57. PAPILLARY COMPONENT (P)
• 0= NORMAL; NO INFLAMMATION.
• 1+= MILD PAPILLARY ENGORGEMENT; SLIGHT INCREASE IN SIZE.
• 2+= OBVIOUS INCREASE IN SIZE OF GINGIVAL PAPILLA; HEMORRHAGE ON
PRESSURE.
• 3+= EXCESSIVE INCREASE IN SIZE WITH SPONTANEOUS HEMORRHAGE.
• 4+= NECROTIC PAPILLA.
• 5+= ATROPHY AND LOSS OF PAPILLA (THROUGH INFLAMMATION).

58. MARGINAL COMPONENT(M)
• 0= Normal; no inflammation visible.
• 1+= Engorgement; slight increase in size; no bleeding.
• 2+= Obvious engorgement; bleeding upon pressure.
• 3+= Swollen collar; spontaneous hemorrhage; beginning infiltration
into attached gingivae.
• 4+= Necrotic gingivitis.
• 5+= Recession of the free marginal gingiva below the CEJ due to
inflammatory changes.

59. ATTACHED COMPONENT(A)
0= Normal; pale rose; stippled.
1+= slight engorgement with loss of stippling; change in color
may or may not be present.
2+=obvious engorgement of attached gingivae with marked
increase in redness. Pocket formation present.
3+=advanced periodontitis. Deep pockets evident.

60. CALCULATION:
P M A INDEX SCORE PER PERSON = P +
M + A
60
USES:
On clinical trails
On individual patient
For epidemiological surveys

61. • 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 24
44 41 36
PERIODONTAL DISEASE INDEX
(PDI)

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

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

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

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

66. 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.

67. 67
SCOR
E
CRITERIA
0 Absence of signs of inflammation
1 Mild to moderate inflammatory gingival changes
not extending around the tooth
2 Mild to moderately severe gingivitis extending
all around the tooth
3 Severe gingivitis characterized by marked
redness, swelling, tendency to bleed, and
ulceration
4 Gingival crevice in any of 4 measured
areas(M,D,B,L) extending apically to CEJ but not
more than 3mm
5 Gingival crevice in any of 4 measured
areas(M,D,B,L) extending apically to CEJ

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

69. 69
RECENT ADVANCES IN PERIODONTAL
INDICES
• BASIC PERIODONTAL EXAMINATION (BPE) INDEX
• GENETIC SUSCEPTIBILITY INDEX FOR PERIODONTAL DIS
• PERIODONTAL SCREENING AND RECORDING (PSR) INDE
• BLEEDING POINT INDEX

70. • 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
70
BASIC PERIODONTAL EXAMINATION (BPE)
INDEX

71. 71

72. • Genetic markers denote susceptibility toward disease
manifestation and it would be useful to exploit the
information hidden into them and to derive a Genetic
Susceptibility Index (GSI)
• Single Nucleotide Polymorphisms (SNP’s) in genes
encoding molecules of the host defense system are
assessed and an association is established between
SNP and disease status
72
GENETIC SUSCEPTIBILITY INDEX FOR
PERIODONTAL DISEASE

73. • 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 73
PERIODONTAL SCREENING AND RECORDING
(PSR) INDEX

74. 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
74

75. ADVANTAGES
• Introducing a simplified screening method that met
legal dental recording requirements.
• Early detection of periodontal disease and it serves as
an aid in monitoring the periodontal status of patients
75
LIMITATIONS
• Limited use of the PSR system in children due to inability
to differentiate pseudo-pockets
• Does not measure epithelial attachment, the severity of
periodontal disease may be underestimated with its use

76. • Used to measure pocket depths.
• A pocket measuring probe/ Williams probe is
used.
• Main components to record:
- Pocket depth (mm)
- Mobility
- Recession (mm)
- Bleeding on probing
- Furcation
DPC – DETAILED PERIODONTAL
CHART

77. • Two blunt instruments are used to asses a tooth’s
mobility.
e.g end of mirror and probe
• To quantify mobility, Millers index of mobility is used:
MOBILITY
GRAD
E
MOBILITY
Grade 0 Normal physiological mobility (<1mm)
Grade 1 Movement up to 1mm in horizontal plane
Grade 2 Movement greater than 1mm in horizontal plane
Grade 3 Severe mobility greater than 2mm or vertical
mobility

78. • 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:
FURCATION
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

79. RECESSION
•To measure the recession of
a individual tooth, a pocket
measuring probe must be
used.
•The probe is placed onto the
tooth and the distance
between the cemento-enamel
junction and the gingival
margin is measured. This is
the amount of recession that
has occurred on that tooth.

80. • THE POCKET MEASURING PROBE IS INSERTED INTO THE
GINGIVAL CREVICE.
• THE DISTANCE FROM THE BASE OF THE POCKET AND
THE GINGIVAL MARGIN IS MEASURED.
• IN ADDITION, IF THE SITE BLEEDS ON PROBING, CIRCLE
THE SCORE IN RED AND IF THE SITE HAS SUPPURATION
(PUS) CIRCLE THE SCORE IN BLUE OR BLACK.
BASELINE POCKET DEPTH
BASELINE POCKET DEPTH + RECESSION = CAL

81. • The DPC allows the operator to find sites in the mouth
requiring attention.
• Sites with pockets greater than 5mm will require
immediate attention .
• Subsequent pocket depths and CAL can be measured after
treatment to assess the success of treatment.
MERITS AND RESULTS OF THE DPC

82. BLEEDING POINT INDEX
•Provides an evaluation of gingival inflammation
around each tooth in patient’s mouth
•Bleeding on probing recorded on distal ,facial
,mesial and gingival surface
•Calculation=(no of bleeding surface/total no of
tooth surface)*100
•Demonstrates gingival inflammation
characterized by gingival bleeding rather than
presence of microbial plaque

83. 83
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
CONCLUSION

84. REFERENCES
• Essentials of Public Health Dentistry 5E, Soben Peter
• Carranza's Clinical Periodontology, 12E (2015) , Newman,
Takei, Klokkevold, Carranza
• Https://www.mah.se/capp/methods-and-indices/oral-
hygiene-indices/simplified-oral-hygiene-index--ohi-s/
• Dhingra k, vandana k l; indices for measuring
periodontitis: a literature review. international dental
journal. 2011; 84

85. THANK
YOU
85