Dental indices of the oral cavity in dentistry. Quantitative and qualitative assessment of dental plaque

Prevalence periodontal diseases, the need for their objective diagnosis and comparability of results obtained by different researchers and doctors have led to the emergence of a large number of indices.

Periodontal indices make it possible to monitor the dynamics of the disease over a long period of time, assess the depth and prevalence of the pathological process, compare the effectiveness of various treatment methods, and perform mathematical processing of the results obtained.

Periodontal indices are divided into reversible, irreversible and complex.

Using reversible indices, the dynamics of periodontal disease and the effectiveness of treatment measures are assessed. These indices characterize the severity of symptoms such as inflammation and bleeding of the gums, tooth mobility, and the depth of gingival and periodontal pockets. The most common of them are the PMA index, the Russell periodontal index, etc.

Hygienic indices (Fedorov-Volodkina, Green-Vermillion, Ramfjord, etc.) can be included in this group.

Irreversible indices characterize the severity of such symptoms of periodontal disease as alveolar bone resorption and gum atrophy. Examples include radiographic index, gingival recession index, etc.

Using complex periodontal indices, they provide a comprehensive assessment of the condition of periodontal tissues. For example, when calculating the Kotschke index, the PMA index, the depth of periodontal pockets, the degree of atrophy of the gingival margin, bleeding gums, the degree of tooth mobility, and Svrakov’s iodine number are taken into account.

Currently, about a hundred periodontal indices have been described. However, in our opinion, even the most advanced and informative indices do not provide an individual approach to the patient and do not replace the clinical experience and intuition of the doctor. Therefore, in clinical practice, we assign a secondary role to index assessment, limiting ourselves to only the minimum number of reversible indices that allow us to objectively assess the dynamics of the pathological process and the effectiveness of the treatment.

We consider it advisable to use the Fedorov-Volodkina hygienic index, PMA index, and peripheral circulation index when examining a patient.

For developed forms of periodontitis, it is possible to recommend determining the Russell index. In epidemiological studies, the CPITN index (Community Periodontal Index of Treatment Needs), reflecting the need for various types of treatment.

Determination of the oral hygiene index

The hygienic condition of the oral cavity is determined according to the method of Yu.A. Fedorova, V.V. Volodkina (1971). As a test for hygienic cleaning of teeth, coloring of the labial surface of six lower frontal teeth with an iodine-iodido-potassium solution (potassium iodide - 2.0; crystalline iodine - 1.0; distilled water - 40.0) is used.

Quantitative assessment is made using a five-point system: staining the entire surface of the tooth crown - 5 points; staining 3/4 of the surface of the tooth crown - 4 points; staining 1/2 of the surface of the tooth crown - 3 points; staining 1/4 of the surface of the tooth crown - 2 points; absence of staining of the surface of the tooth crown - 1 point. The calculation is carried out according to the formula:

IG =	Ki (sum of ratings for each tooth)
	n

Where:
IG - general purification index;
Ki - hygienic index of cleaning one tooth;
n is the number of teeth examined (usually 6).

By dividing the sum of points by the number of teeth examined, an indicator of oral hygiene (hygiene index) is obtained.

When determining the quality of oral hygiene, the studied indicator is interpreted as follows:

1.1-1.5 points - good hygiene index;
1.6-2.0 points - satisfactory;
2.1-2.5 points - unsatisfactory;
2.6-4.0 points - bad;
3.5-5.0 points - very poor hygiene index.

With regular and proper oral care, the hygiene index varies between 1.1-1.6 points. A hygiene index reaching 2.6 points or more indicates a lack of regular dental care.

Using the hygiene index, you can determine the quality of dental cleaning by the patient. This index is quite simple and accessible for use in any setting, including when conducting mass population surveys; it can also serve to illustrate the quality of teeth cleaning when teaching hygiene skills. Its calculation is carried out quickly with sufficient information content to draw conclusions about the quality of dental care.

Determination of the papillary-marginal-alveolar index (PMA)

The papillary-marginal-alveolar index (Massler M., Shur D., 1948) allows one to judge the extent and severity of gingivitis. The index can be expressed in absolute numbers or as a percentage (Parma S, 1960). The inflammatory process is assessed as follows:

inflammation of the papilla - 1 point;
inflammation of the gum edge - 2 points;
inflammation of the alveolar gum - 3 points.

The condition of the gums of each tooth is assessed. The index is calculated using the following formula:

where 3 is the averaging coefficient.

The number of teeth with the integrity of the dentition depends on the age of the subject:

6-11 years - 24 teeth;
12-14 years - 28 teeth;
15 years or more - 30 teeth.

When teeth are lost, they are based on their actual presence.

Index values with limited prevalence of the pathological process reach 25%; with pronounced prevalence and intensity of the pathological process, the indicators approach 50%, and with further spread of the pathological process and an increase in its severity - from 51% or more.

In practical work, the PMA index can be used in a number of cases:

during preventive examinations in order to detect the disease in the early stages of the development of the process;
when examining periodontal disease in dental patients;
when treating a patient with gingivitis or periodontitis - to assess the severity of the disease and the effectiveness of treatment.

Determination of the numerical value of the Schiller-Pisarev test (Svrakov iodine number)

The Schiller-Pisarev test for objectification can be expressed in numbers (points), assessing the color of the papillae as 2 points, the color of the gingival margin as 4 points and the color of the alveolar gum as 8 points. The resulting total score should then be divided by the number of teeth examined (usually 6):

In this way, the digital value of the Schiller-Pisarev test (Svrakov iodine number) is determined in points. Estimation of Svrakov iodine number values:

mild inflammation process - up to 2.3 points;
moderately expressed process of inflammation - 2.67-5.0 points;
intense inflammatory process - 5.33-8.0 points.

Determination of the peripheral circulation index (PCI)

The peripheral circulation index is assessed based on the ratio of indicators of resistance of gum capillaries and the time of resorption of vacuum hematomas (Dedova L.N., 1981).

The indicators of these tests are assessed in points, their ratio is expressed as a percentage. The index is calculated using the formula:

Based on the index indicators, the following assessment of the functional state of peripheral circulation can be carried out:

IPC = 0.8-1.0 (80-100%) - physiological norm;
IPC = 0.6-0.7(60-70%) - good, compensated condition;
IPC = 0.075-0.5 (7.5-50%) - satisfactory condition;
IPC = 0.01-0.074 (1-7.4%) - state of decompensation.

The scoring system used to calculate the IPC

Resistance of gum capillaries		Resorption time of vacuum hematomas
seconds	points	day	points
1-10	1	2,5	10
11-20	2	3,0	20
21-30	4	3,5	40
31-40	6	4,0	60
41-50	8	4,5	80
50 or more	10	5,0	100

Determination of periodontal index

The periodontal index (PI) (Russell A., 1956) makes it possible to take into account the presence of both gingivitis and other symptoms of periodontal pathology: tooth mobility, clinical pocket depth, etc.

The following estimates are used:

0 - no changes and inflammation;
1 - mild gingivitis (gum inflammation does not cover the entire tooth);
2 - gingivitis without damage to the attached epithelium (the clinical pocket is not determined);
4 - disappearance of the closing cortical plates at the apexes of the alveolar process according to the radiograph;
6 - gingivitis with the formation of a clinical pocket, no dysfunction, the tooth is not mobile;
8 - pronounced destruction of all periodontal tissues, the tooth is mobile and can be displaced.

The periodontal condition is assessed for each existing tooth. In doubtful cases, the highest possible rating is given.

To calculate the index, the resulting scores are added and divided by the number of teeth available using the formula:

The index value is evaluated as follows:

0.1-1.0 - initial and mild degree of periodontal pathology;
1.5-4.0 - moderate to severe degree of periodontal pathology;
4.0-8.0 - severe degree of periodontal pathology.

Index of Periodontal Treatment Need (CPITN)

To determine the CPITN index, it is necessary to examine the surrounding tissues in the area of the ten teeth presented below:

17 / 16	11	26 / 27
47 / 46	31	36 / 37

This group of teeth creates a complete picture of the condition of the periodontal tissues of both jaws.

The study is carried out by probing to detect bleeding, supra- and subgingival “tartar”, and a clinical pocket using a special (button) probe.

The CPITN index is assessed using the following codes:

0 - no signs of disease;
1 - gum bleeding after probing;
2 - the presence of supra- and subgingival “tartar”;
3 - clinical pocket 4-5 mm deep;
4 - clinical pocket with a depth of 6 mm or more.

In the corresponding cells, the condition of only six teeth is recorded. When examining teeth 17 and 16, 26 and 27, 36 and 37, 46 and 47, codes corresponding to a more severe condition are taken into account. For example, if bleeding is detected in area 17 of the tooth, and “tartar” is detected in area 16, then a code indicating “tartar” (i.e. 2) is entered in the cell.

If any of these teeth is missing, then examine the tooth next to it in the dentition. If there is no tooth nearby, the cell is crossed out with a diagonal line and does not participate in the summary results.

Diagnosis, treatment and prevention of periodontal diseases
L.M. Tsepov, A.I. Nikolaev, E.A. Mikheeva.

Indices used during dental examination. Indexes in dentistry

One of the main indices (KPU) reflects the intensity of dental caries damage. K means the number of carious teeth, P - the number of filled teeth, Y - the number of teeth removed or to be removed. The sum of these indicators gives an idea of the intensity of the caries process in a particular person.

There are three types of KPU index:

KPU of teeth (KPUz) - the number of carious and filled teeth of the subject;
KPU surfaces (KPUpov) - the number of tooth surfaces affected by caries;
KPUpol - the absolute number of carious cavities and fillings in the teeth.

For temporary teeth, the following indicators are used:

kp - the number of carious and filled teeth in the temporary occlusion;
kp - number of affected surfaces;
checkpoint - the number of carious cavities and fillings.

Teeth removed or lost as a result of physiological change are not taken into account in the temporary dentition. In children, when changing teeth, two indices are used at once: KP and KPU. To determine the overall intensity of the disease, both indicators are summed up. KPI from 6 to 10 indicates a high intensity of carious lesions, 3-5 - moderate, 1-2 - low.

These indices do not provide a sufficiently objective picture, as they have the following disadvantages:

both treated and extracted teeth are taken into account;
can only increase over time and with age begin to reflect the previous incidence of caries;
do not allow taking into account the very initial carious lesions.

Serious disadvantages of the KPUz and KPUp indices include their unreliability when tooth damage increases due to the formation of new cavities in treated teeth, the occurrence of secondary caries, loss of fillings, and the like.

The prevalence of caries is expressed as a percentage. To do this, the number of people who were found to have certain manifestations of dental caries (except for focal demineralization) is divided by the total number of people examined in this group and multiplied by 100.
In order to assess the prevalence of dental caries in a particular region or compare the value of this indicator in different regions, the following assessment criteria for the level of prevalence among 12-year-old children are used:
INTENSITY LEVEL
LOW - 0-30%
AVERAGE - 31 - 80%
HIGH - 81 - 100%
To assess the intensity of dental caries, the following indices are used:
a) intensity of caries of temporary (baby) teeth:
index kp (z) - the sum of teeth affected by untreated caries
and filled in one individual;
index kp (n) - the sum of surfaces affected by untreated
caries and fillings in one individual;
In order to calculate the average value of the indices kp(z) and kp(p) in a group of subjects, one should determine the index for each person examined, add up all the values and divide the resulting amount by the number of people in the group.
b) intensity of caries of permanent teeth:
index KPU(z) - the sum of carious, filled and removed
teeth in one individual;
index KPU (n) - the sum of all surfaces of the teeth on which
caries or filling was diagnosed in one individual. (If
the tooth is removed, then in this index it is considered to be 5 surfaces).
When determining these indices, early forms of dental caries in the form of white and pigmented spots are not taken into account.
In order to calculate the average value of indices for a group, you should find the sum of individual indices and divide it by the number of people examined in this group.
c) assessment of the intensity of dental caries among the population.
To compare the intensity of dental caries between different regions or countries, the average values of the KPU index are used.

The CPITN index is used in clinical practice to examine and monitor periodontal condition.. This index records only those clinical signs that may undergo reverse development (inflammatory changes in the gums, judged by bleeding, tartar), and does not take into account irreversible changes (gingival recession, tooth mobility, loss of epithelial attachment). CPITN "does not tell" about the activity of the process and cannot be used for treatment planning.

The main advantage of the CPITN index is its simplicity, speed of determination, information content and the ability to compare results. The need for treatment is determined based on the following criteria.

CODE 0 or X means that there is no need to treat this patient.
CODE 1 indicates that this patient needs to improve his oral hygiene.
CODE 2 indicates the need for professional hygiene and the elimination of factors that contribute to plaque retention.
CODE 3 indicates the need for oral hygiene and curettage, which usually reduces inflammation and reduces pocket depth to values equal to or less than 3 mm.
CODE 4 can sometimes be successfully treated with deep curettage and adequate oral hygiene. Complex treatment is required.

Papillary-marginal-alveolar index (PMA) used to assess the severity of gingivitis. There are several types of this index, but the most widespread is the PMA index in the Parma modification. The number of teeth (while maintaining the integrity of the dentition) is taken into account depending on age: 6 - 11 years - 24 teeth, 12 - 14 years - 28 teeth, 15 years and older - 30 teeth. Normally, the PMA index is zero.

How well a patient monitors oral hygiene is determined by the Fedorov-Volodkina Hygienic Index. The index is recommended to be used to assess the hygienic state of the oral cavity in children under 5-6 years of age. To determine the index, the labial surface of six teeth is examined. Teeth are stained using special solutions and the presence of plaque is assessed. Determination of supra- and subgingival tartar is carried out using a dental probe. The calculation of the index consists of the values obtained for each component of the index, divided by the number of surfaces examined, followed by the summation of both values.

Also common Oral Hygiene Performance Index (OHP). To quantify plaque, 6 teeth are stained. The index is calculated by determining the code for each tooth by adding the codes for each section. Then the codes for all examined teeth are summed up and the resulting sum is divided by the number of teeth:

To assess the state of occlusion it is used dental aesthetic index, which determines the position of the teeth and the state of the bite in the sagittal, vertical and transversal directions. It is used from the age of 12.

The examination is carried out visually and using a button probe. The index includes definitions of the following components:

lack of teeth;
crowding in the incisal segments;
gap in incisal segments;
diastema;
deviations in the anterior region of the upper jaw;
deviations in the anterior region of the lower jaw;
anterior maxillary overlap;
anterior mandibular overlap;
vertical anterior slit;
anterior-posterior relationship of molars.

The dental aesthetic index allows you to analyze each of the components of the index or group them by anomalies of the dentition and bite.

In order to assess the prevalence of dental caries in a particular region or compare the value of this indicator in different regions, the following assessment criteria for the level of prevalence among 12-year-old children are used:

Intensity level

LOW - 0-30% MEDIUM - 31 - 80% HIGH - 81 - 100%

To assess the intensity of dental caries, the following indices are used:

a) intensity of caries of temporary (baby) teeth:
index kp (z) - the sum of teeth affected by untreated caries and filled in one individual;

kp index (n) - the sum of surfaces affected by untreated caries and filled in one individual;

In order to calculate the average value of the indices bullpen) And kp(p) in a group of subjects, you should determine the index for each person examined, add up all the values and divide the resulting amount by the number of people in the group.

b) intensity of caries of permanent teeth:

index KPU(z) - the sum of carious, filled and extracted teeth in one individual;

KPU index (p) - the sum of all tooth surfaces on which caries or fillings are diagnosed in one individual. (If a tooth is removed, then in this index it is considered 5 surfaces).

When determining these indices, early forms of dental caries in the form of white and pigmented spots are not taken into account.
In order to calculate the average value of indices for a group, you should find the sum of individual indices and divide it by the number of people examined in this group.

c) assessment of the intensity of dental caries among the population.
To compare the intensity of dental caries between different regions or countries, the average values of the KPU index are used.

Methods for assessing oral hygiene. Oral Health Indices

Methods for assessing dental plaque

Fedorov-Volodkina Index(1968) was widely used in our country until recently.

The hygienic index is determined by the intensity of coloring of the labial surface of the six lower frontal teeth with an iodine-iodide-potassium solution, assessed using a five-point system and calculated using the formula: By Wed=(∑To u)/n

Where By Wed. - general hygienic cleaning index; To u- hygienic index of cleaning one tooth; n- number of teeth.

Staining the entire surface of the crown means 5 points; 3/4 - 4 points; 1/2 - 3 points; 1/4 - 2 points; absence of staining - 1 point. Normally, the hygiene index should not exceed 1.=

Green-Vermillion Index(Green, Vermillion, 1964). The Oral Hygiene Index Simplified (OHI-S) evaluates the area of tooth surface covered by plaque and/or tartar and does not require the use of special dyes. To determine OHI-S, examine the buccal surface 16 and 26, the labial surface 11 and 31, and the lingual surface 36 and 46, moving the tip of the probe from the cutting edge towards the gum.

The absence of dental plaque is indicated as 0 , dental plaque up to 1/3 of the tooth surface - 1 , dental plaque from 1/3 to 2/3 - 2 , dental plaque covers more than 2/3 of the enamel surface - 3 . Then tartar is determined according to the same principle.

Formula for calculating the index.OHI - S=∑(ZN/n)+∑(ZK/n)

Where n- number of teeth, ZN- dental plaque, ZK- tartar.

Silnes-Lowe Index(Silness, Loe, 1967) takes into account the thickness of plaque in the gingival region in 4 areas of the tooth surface: vestibular, lingual, distal and mesial. After drying the enamel, the tip of the probe is passed along its surface at the gingival sulcus. If a soft substance does not adhere to the tip of the probe, the plaque index on the tooth area is indicated as - 0. If the plaque is not visually determined, but becomes visible after moving the probe, the index is 1. A plaque with a thin to moderate layer thickness, visible to the naked eye, is assessed as 2 Intensive deposition of plaque in the area of the gingival sulcus and interdental space is designated as 3. For each tooth, the index is calculated by dividing the sum of the points of 4 surfaces by 4.

The general index is equal to the sum of the indicators of all examined teeth, divided by their number.

Tartar index(CSI)(ENNEVER et al., 1961). Supra- and subgingival tartar is determined on the incisors and canines of the lower jaw. The vestibular, distal-lingual, central-lingual and medial-lingual surfaces are differentially examined.

To determine the intensity of tartar, a scale from 0 to 3 is used for each surface examined:

0 - no tartar

1 - tartar is determined to be less than 0.5mm in width and/or thickness

2 - width and/or thickness of tartar from 0.5 to 1 mm

3 - width and/or thickness of tartar more than 1 mm.

Formula for calculating the index: ZK intensity = (∑codes_of_all_surfaces)/n_teeth

where n is the number of teeth.

Ramfjord index(S. Ramfjord, 1956) as part of the periodontal index involves the determination of dental plaque on the vestibular, lingual and palatal surfaces, as well as the proximal surfaces of the 11, 14, 26, 31, 34, 46 teeth. The method requires preliminary staining with a Bismarck brown solution. Scoring is done as follows:

0 - absence of dental plaque

1 - dental plaque is present on some tooth surfaces

2 - dental plaque is present on all surfaces, but covers more than half of the tooth

3 - dental plaque is present on all surfaces, but covers more than half.

The index is calculated by dividing the total score by the number of teeth examined.

Navi Index(I.M.Navy, E.Quiglty, I.Hein, 1962).Tissue color indices in the oral cavity limited by the labial surfaces of the front teeth are calculated. Before the examination, the mouth is rinsed with a 0.75% solution of basic fuchsin. The calculation is carried out as follows:

0 - no plaque

1 - the plaque was stained only at the gingival border

2 - pronounced plaque line at the gingival border

3 - the gingival third of the surface is covered with plaque

4 - 2/3 of the surface is covered with plaque

5 - more than 2/3 of the surface is covered with plaque.

The index was calculated in terms of the average number per tooth per subject.

Turesky Index(S. Turesky, 1970). The authors used the Quigley-Hein counting system on the labial and lingual surfaces of the entire row of teeth.

0 - no plaque

1 - individual spots of plaque in the cervical area of the tooth

2 - a thin continuous strip of plaque (up to 1 mm) in the cervical part of the tooth

3 - plaque strip is wider than 1 mm, but covers less than 1/3 of the tooth crown

4 - plaque covers more than 1/3, but less than 2/3 of the tooth crown

5 - plaque covers 2/3 of the tooth crown or more.

Arnim index(S. Arnim, 1963) when assessing the effectiveness of various oral hygiene procedures, determined the amount of plaque present on the labial surfaces of the four upper and lower incisors, stained with erythrosine. This area is photographed and developed at 4x magnification. The outlines of the corresponding teeth and colored masses are transferred to paper and these areas are determined with a planimer. The percentage of surface area covered by plaque is then calculated.

Hygiene Performance Index(Podshadley, Haby, 1968) requires the use of dye. Then a visual assessment of the buccal surfaces of 16 and 26, labial - 11 and 31, lingual - 36 and 46 teeth is carried out. The surveyed surface is conventionally divided into 5 sections: 1 - medial, 2 - distal 3 - mid-occlusal, 4 - central, 5 - mid-cervical.

0 - no staining

1 - staining of any intensity is available

The index is calculated using the formula:PHP=(∑codes)/n

Clinical methods for assessing gum health

PMA Index(Schour, Massler ). Inflammation of the gingival papilla (P) is assessed as 1, inflammation of the gingival margin (M) - 2, inflammation of the mucous membrane of the alveolar process of the jaw (A) - 3.

By summing up the gum condition assessments for each tooth, the PMA index is obtained. At the same time, the number of examined teeth of patients aged 6 to 11 years is 24, from 12 to 14 years old - 28, and from 15 years old - 30.

The PMA index is calculated as a percentage as follows:

RMA = (sum of indicators x 100): (3 x number of teeth)

In absolute numbers, PMA = sum of indicators: (number of teeth x 3).

Gingival index GI(Loe, Silence ) . For each tooth, four areas are differentially examined: vestibular-distal gingival papilla, vestibular marginal gingiva, vestibular-medial gingival papilla, lingual (or palatal) marginal gingiva.

0 - normal gum;

1 - mild inflammation, slight discoloration of the gum mucosa, slight swelling, no bleeding on palpation;

2 - moderate inflammation, redness, swelling, bleeding on palpation;

3 - pronounced inflammation with noticeable redness and swelling, ulceration, and a tendency to spontaneous bleeding.

Key teeth whose gums are examined: 16, 21, 24, 36, 41, 44.

To evaluate the examination results, the sum of points is divided by 4 and the number of teeth.

0.1 - 1.0 - mild gingivitis

1.1 - 2.0 - moderate gingivitis

2.1 - 3.0 - severe gingivitis.

IN periodontal index P.I. (Russell) the condition of the gums and alveolar bone is calculated individually for each tooth. For calculation, a scale is used in which a relatively low index is assigned to gum inflammation, and a relatively higher index to alveolar bone resorption. The indices of each tooth are summed up, and the result is divided by the number of teeth in the oral cavity. The result shows the patient's periodontal index, which reflects the relative status of periodontal disease in a given oral cavity without taking into account the type and causes of the disease. The arithmetic mean of the individual indices of the examined patients characterizes the group or population indicator.

Periodontal Disease Index - PDI (Ramfjord, 1959) includes an assessment of the condition of the gums and periodontium. The vestibular and oral surfaces of the 16th, 21st, 24th, 36th, 41st, and 44th teeth are examined. Plaque and tartar are taken into account. The depth of the periodontal pocket is measured with a graduated probe from the enamel-cement junction to the bottom of the pocket.

GINGIVITIS INDEX

0 - no signs of inflammation

1 - mild or moderate inflammation of the gums, not spreading around the tooth

2 - moderate inflammation of the gums, spreading around the tooth

3 - severe gingivitis, characterized by severe redness, swelling, bleeding and ulceration.

INDEX OF PERIODONTAL DISEASE

0-3 - the gingival groove is determined no deeper than the cemento-enamel junction

4 - gum pocket depth up to 3 mm

5 - gum pocket depth from 3 mm to 6 mm

6 - gum pocket depth more than 6 mm.

CPITN (WHO) - comprehensive periodontal index of treatment need used to assess the periodontal condition of the adult population, to plan prevention and treatment, determine the need for dental personnel, analyze and improve treatment and preventive programs.

To determine the indicator, a specially designed periodontal probe is used, which has a ball with a diameter of 0.5 mm at the end and a black stripe at a distance of 3.5 mm from the tip of the probe.

In persons over 20 years of age, the periodontium is examined in the area of six groups of teeth (17/16, 11, 26/27, 37/36, 31, 46/47) in the lower and upper jaws. If there is not a single index tooth in the named sextant, then all remaining teeth in that sextant are examined.

In young people under the age of 19, teeth 16, 11, 26, 36, 31, 46 are examined.

Registration of research results is carried out according to the following codes:

0 - healthy gums, no signs of pathology

1 - bleeding of the gums is observed after probing

2 - subgingival tartar is determined with a probe; the black strip of the probe does not sink into the gingival pocket

3 - a pocket of 4-5mm is determined; the black strip of the probe is partially immersed in the periodontal pocket

4 - a pocket of more than 6 mm is determined; the black strip of the probe is completely immersed in the gingival pocket.

Complex periodontal index - KPI (P.A. Leus). In adolescents and adults, teeth 17/16, 11, 26/27, 31, 36/37, 46/47 are examined.

The patient is examined in a dental chair under adequate artificial lighting. A standard set of dental instruments is used.

If several signs are present, a more severe lesion is recorded (higher score). In case of doubt, preference is given to underdiagnosis.

An individual’s KPI is calculated using the formula: KPI=(∑codes)/n

where n is the number of teeth examined.

Index for assessing dental plaque in young children (E.M. Kuzmina, 2000)

To assess the amount of plaque in a young child (from the eruption of primary teeth to 3 years), all teeth present in the oral cavity are examined. The assessment is carried out visually or using a dental probe.

The amount of plaque must be determined even if there are only 2-3 teeth in the child’s mouth.

Codes and evaluation criteria:

0 - no plaque
1 - plaque present

The individual index value is calculated using the formula:

Plaque = number of teeth with plaque / number of teeth in the mouth

Index interpretation

HYGIENE INDEX according to Fedorov-Volodkina (1971)

To determine the index, the labial surface of six teeth is examined: 43, 42, 41, 31, 32, 33

The indicated teeth are stained using special solutions (Schiller-Pisarev, fuchsin, erythrosine, and the presence of plaque is assessed using the following codes:

1 - no dental plaque was detected;

2 - staining one quarter of the surface of the tooth crown;

3 - staining half the surface of the tooth crown;

4 - staining three quarters of the surface of the tooth crown;

5 - staining the entire surface of the tooth crown.

To assess the plaque present in a given patient, add up the codes obtained from examining each of the stained teeth and divide the sum by 6.

To obtain the average value of the hygiene index in a group of children, add up the individual index values for each child and divide the sum by the number of children in the group.

ORAL HYGIENE INDEX SIMPLIFIED (IGR-U), (OHI-S), J.C. Green, J.R. Vermillion (1964)

The index allows you to separately assess the amount of plaque and tartar.

To determine the index, 6 teeth are examined:

16, 11, 26, 31 - vestibular surfaces

36, 46 - lingual surfaces

Assessment of dental plaque can be carried out visually or using staining solutions (Schiller-Pisarev, fuchsin, erythrosine).

0 - no dental plaque was detected;

1 - soft plaque covering no more than 1/3 of the tooth surface, or the presence of any amount of colored deposits (green, brown, etc.);

2 - soft plaque covering more than 1/3, but less than 2/3 of the tooth surface;

3 - soft plaque covering more than 2/3 of the tooth surface.

CODES AND CRITERIA FOR EVALUATING DENTAL CALCULUS

Determination of supra- and subgingival tartar is carried out using a dental probe.

0 - no tartar was detected;

1 - supragingival tartar, covering no more than 1/3 of the tooth surface;

2 - supragingival tartar, covering more than 1/3, but less than 2/3 of the tooth surface, or the presence of individual deposits of subgingival tartar in the cervical area of the tooth;

3 - supragingival calculus covering more than 2/3 of the tooth surface, or significant deposits of subgingival calculus around the cervical area of the tooth.

The calculation of the index consists of the values obtained for each component of the index, divided by the number of surfaces surveyed, and summing both values.

Formula for calculation:

IGR-U= SUM OF PLAQUE VALUES / NUMBER OF SURFACES + SUM OF STONE VALUES / NUMBER OF SURFACES

Index interpretation

Oral Hygiene Performance Index (OHP) Podshadley, Haley (1968)

To quantify dental plaque, 6 teeth are stained:

16, 26, 11, 31 - vestibular surfaces;

36, 46 - lingual surfaces.

If there is no index tooth, you can examine the adjacent one, but within the group of teeth of the same name. Artificial crowns and parts of fixed dentures are examined in the same way as teeth.

Examined surface of each tooth
conditionally divided into 5 sections

medial
distal
midocclusal
central
midcervical

CODES AND CRITERIA FOR ASSESSING DENTAL PLAQUE

0 - no staining

1 - staining detected

The index is calculated by determining the code for each tooth by adding the codes for each section. Then the codes for all examined teeth are summed up and the resulting sum is divided by the number of teeth.

The index is calculated using the following formula:

RNR = SUM OF ALL TEETH CODES / NUMBER OF TEETH EXAMINED

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There are reversible, irreversible and complex indices. At using invertible indexes evaluate the dynamics of periodontal disease and the effectiveness of therapeutic measures. These indices characterize the severity of symptoms such as inflammation and bleeding of the gums, tooth mobility, and the depth of gingival and periodontal pockets. The most common of them are the PMA index, Russell's periodontal index, etc. This group also includes hygienic indices (Fedorov-Volodkina, Green-Vermilion, Ramfjord, etc.).

Irreversible Indexes: radiographic index, gingival recession index, etc. – characterize the severity of symptoms of periodontal disease such as bone resorption of the alveolar process and gum atrophy.

Using complex periodontal indices, they provide a comprehensive assessment of the condition of periodontal tissues. For example, when calculating the Komrke index, the PMA index, the depth of periodontal pockets, the degree of atrophy of the gingival margin, bleeding gums, the degree of tooth mobility, and Svrakov’s iodine number are taken into account.

Oral Hygiene Index

To assess the hygienic condition of the oral cavity, the hygiene index is determined according to the method of Yu.A. Fedorov and V.V. Volodkina. As a test for hygienic cleaning of teeth, coloring of the labial surface of the six lower front teeth with an iodine-iodide-potassium solution (potassium iodide - 2 g; crystalline iodine - 1 g; distilled water - 40 ml) is used.

Quantitative assessment is made using a five-point system:

Staining the entire surface of the tooth crown – 5 points;

Coloring 3/4 of the surface of the tooth crown – 4 points;

Staining 1/2 of the surface of the tooth crown – 3 points;

Staining 1/4 of the surface of the tooth crown – 2 points;

Absence of staining of the surface of the tooth crown – 1 point.

By dividing the sum of points by the number of teeth examined, an indicator of oral hygiene is obtained (hygiene index - IG).

The calculation is made using the formula:

IG = Ki (sum of ratings for each tooth) / n

Where: IG – general purification index; Ki – hygienic index of cleaning one tooth;

N – number of teeth examined [usually 6].

The quality of oral hygiene is assessed as follows:

Good IG – 1.1 – 1.5 points;

Satisfactory IG – 1.6 – 2.0 points;

Unsatisfactory IG – 2.1 – 2.5 points;

Bad IG – 2.6 – 3.4 points;

Very bad IG – 3.5 – 5.0 points.

With regular and proper oral care, the hygiene index is within 1.1–1.6 points; an IG value of 2.6 or more points indicates a lack of regular dental care.

This index is quite simple and accessible for use in any conditions, including when conducting mass population surveys. It can also serve to illustrate the quality of tooth brushing when teaching hygiene skills. Its calculation is carried out quickly, with sufficient information to draw conclusions about the quality of dental care.

Simplified hygiene index OHI-s [Green, Vermilion, 1969]

6 adjacent teeth or 1–2 from different groups (large and small molars, incisors) of the lower and upper jaws are examined; their vestibular and oral surfaces.

1/3 of the surface of the tooth crown – 1

1/2 of the surface of the tooth crown – 2

2/3 of the surface of the tooth crown – 3

No plaque – 0

If the plaque on the surface of the teeth is uneven, then it is assessed by a larger volume or, for accuracy, the arithmetic average of 2 or 4 surfaces is taken.

OHI-s = Sum of indicators / 6

OHI-s = 1 reflects normal or ideal hygienic condition;

OHI-s > 1 – poor hygienic condition.

Papillary marginal alveolar index (PMA)

The papillary-marginal-alveolar index (PMA) allows one to judge the extent and severity of gingivitis. The index can be expressed in absolute numbers or as a percentage.

The inflammatory process is assessed as follows:

Inflammation of the papilla – 1 point;

Inflammation of the gum edge – 2 points;

Inflammation of the alveolar gum – 3 points.

The condition of the gums of each tooth is assessed.

The index is calculated using the following formula:

RMA = Sum of indicators in points x 100 / 3 x number of teeth of the subject

Where 3 is the averaging coefficient.

The number of teeth with the integrity of the dentition depends on the age of the subject: 6–11 years – 24 teeth; 12–14 years – 28 teeth; 15 years and older – 30 teeth. When teeth are lost, they are based on their actual presence.

The index value with limited prevalence of the pathological process reaches 25%; with pronounced prevalence and intensity of the pathological process, the indicators approach 50%, and with further spread of the pathological process and an increase in its severity - from 51% or more.

Determination of the numerical value of the Schiller–Pisarev test

To determine the depth of the inflammatory process, L. Svrakov and Yu. Pisarev proposed lubricating the mucous membrane with an iodine-iodide-potassium solution. Staining occurs in areas of deep connective tissue damage. This is due to the accumulation of large amounts of glycogen in areas of inflammation. The test is quite sensitive and objective. When the inflammatory process subsides or stops, the intensity of the color and its area decrease.

When examining the patient, lubricate the gums with the specified solution. The degree of coloring is determined and areas of intense darkening of the gums are recorded in the examination card; for objectification, they can be expressed in numbers (points): coloring of the gingival papillae - 2 points, coloring of the gingival margin - 4 points, coloring of the alveolar gum - 8 points. The total score is divided by the number of teeth in which the study was carried out (usually 6):

Iodine number = Sum of assessments for each tooth / Number of teeth examined

Mild inflammation process – up to 2.3 points;

Moderately expressed inflammation process – 2.3-5.0 points;

Intense inflammatory process – 5.1-8.0 points.

Schiller–Pisarev test

The Schiller-Pisarev test is based on the detection of glycogen in the gum, the content of which increases sharply during inflammation due to the lack of keratinization of the epithelium. In the epithelium of healthy gums, glycogen is either absent or there are traces of it. Depending on the intensity of inflammation, the color of the gums when lubricated with a modified Schiller-Pisarev solution changes from light brown to dark brown. In the presence of healthy periodontium, there is no difference in the color of the gums. The test can also serve as a criterion for the effectiveness of the treatment, since anti-inflammatory therapy reduces the amount of glycogen in the gums.

To characterize inflammation, the following gradation has been adopted:

– staining of the gums in a straw-yellow color – negative test;

– staining of the mucous membrane in a light brown color – weakly positive test;

– dark brown color – positive test.

In some cases, the test is used with the simultaneous use of a stomatoscope (20 times magnification). The Schiller-Pisarev test is performed for periodontal diseases before and after treatment; it is not specific, however, if it is impossible to use other tests, it can serve as a relative indicator of the dynamics of the inflammatory process during treatment.

Periodontal index

The periodontal index (PI) makes it possible to take into account the presence of gingivitis and other symptoms of periodontal pathology: tooth mobility, clinical pocket depth, etc.

The following estimates are used:

No changes and inflammation – 0;

Mild gingivitis (gum inflammation does not cover the tooth)

From all sides) – 1;

Gingivitis without damage to the attached epithelium (clinical

Pocket is not detected) – 2;

Gingivitis with clinical pocket formation, dysfunction

No, the tooth is immovable – 6;

Severe destruction of all periodontal tissues, the tooth is mobile,

Can be shifted – 8.

The periodontal condition of each existing tooth is assessed - from 0 to 8, taking into account the degree of gum inflammation, tooth mobility and the depth of the clinical pocket. In doubtful cases, the highest possible rating is given. If an X-ray examination of the periodontium is possible, a score of “4” is entered, in which the leading sign is the condition of the bone tissue, manifested by the disappearance of the closing cortical plates at the apexes of the alveolar process. X-ray examination is especially important for diagnosing the initial stage of development of periodontal pathology.

To calculate the index, the resulting scores are added and divided by the number of teeth available using the formula:

PI = Sum of ratings for each tooth / Number of teeth

The index values are as follows:

0.1–1.0 – initial and mild degree of periodontal pathology;

1.5–4.0 – moderate degree of periodontal pathology;

4.0–4.8 – severe degree of periodontal pathology.

Index of need for treatment of periodontal diseases

To determine the periodontal disease treatment need index (CPITN), it is necessary to examine the surrounding tissues in the area of 10 teeth (17, 16, 11, 26, 27 and 37, 36, 31, 46, 47).

This group of teeth creates the most complete picture of the condition of the periodontal tissues of both jaws.

The study is carried out using the probing method. Using a special (button) probe, bleeding gums, the presence of supra- and subgingival “tartar”, and a clinical pocket are detected.

The CPITN index is assessed using the following codes:

– no signs of disease;

– gingival bleeding after probing;

– the presence of supra- and subgingival “tartar”;

– clinical pocket 4–5 mm deep;

– clinical pocket with a depth of 6 mm or more.

The condition of only 6 teeth is recorded in the corresponding cells. When examining the periodontium of teeth 17 and 16, 26 and 27, 36 and 37, 46 and 47, codes corresponding to a more severe condition are taken into account. For example, if bleeding is detected in the area of tooth 17, and “tartar” is detected in area 16, then a code indicating “tartar” is entered in the cell, i.e. 2.

If any of these teeth is missing, then examine the tooth next to it in the dentition. In the absence of a nearby tooth, the cell is crossed out diagonally and is not included in the summary results.

Indices used in dental examination

Intensity level

LOW - 0-30% MEDIUM - 31 - 80% HIGH - 81 - 100%

To assess the intensity of dental caries, the following indices are used:

A) intensity of caries of temporary (baby) teeth:
index kp (z) - the sum of teeth affected by untreated caries and filled in one individual;

kp index (n) - the sum of surfaces affected by untreated caries and filled in one individual;

In order to calculate the average value of the indices bullpen) And kp(p) in a group of subjects, you should determine the index for each person examined, add up all the values and divide the resulting amount by the number of people in the group.

B) intensity of caries of permanent teeth:

index KPU(z) - the sum of carious, filled and extracted teeth in one individual;

KPU index (p) - the sum of all tooth surfaces on which caries or fillings are diagnosed in one individual. (If a tooth is removed, then in this index it is considered 5 surfaces).

C) assessment of the intensity of dental caries among the population.
To compare the intensity of dental caries between different regions or countries, the average values of the KPU index are used.

WHO distinguishes 5 levels of intensity of dental caries:

Periodontal indices. CPITN Index

To assess the prevalence and intensity of periodontal diseases, almost all countries use the index of need for the treatment of periodontal diseases - CPITN . This index was proposed by specialists of the WHO working group to assess the condition of periodontal tissues during epidemiological surveys of the population.
Currently, the scope of the index has expanded, and it is used to plan and evaluate the effectiveness of prevention programs, as well as calculate the required number of dental personnel. In addition, the CPITN index is currently used in clinical practice to examine and monitor the periodontal condition of individual patients.
In this regard, the CPITN index can be considered a screening test at both the population and individual levels.
This index registers only those clinical signs that may undergo reverse development: inflammatory changes in the gums, which are judged by bleeding, tartar. The index does not record irreversible changes (gingival recession, tooth mobility, loss of epithelial attachment), does not indicate the activity of the process and cannot be used to plan specific clinical treatment in patients with developed periodontitis.
The main advantages of the CPITN index are the simplicity and speed of its determination, information content and the ability to compare results.
To determine the CPITN index The dentition is conventionally divided into 6 parts (sextants), including the following teeth: 17/14 13/23 24/27 34/37 43/33 47/44.

The periodontium is examined in each sextant, and for epidemiological purposes only in the area of the so-called “index” teeth. When using the index for clinical practice, the periodontium is examined in the area of all teeth and the most severe lesion is identified.
It should be remembered that a sextant is examined if it contains two or more teeth that cannot be removed. If only one tooth remains in the sextant, it is included in the adjacent sextant, and this sextant is excluded from the examination.
In the adult population, starting from 20 years of age and older, 10 index teeth are examined, which are identified as the most informative: 17/16 11 26/27 47/46 31 36/37.

When examining each pair of molars, only one code characterizing the worst condition is taken into account and recorded.
For persons under 20 years of age, 6 index teeth are examined during an epidemiological survey: 16, 11, 26, 36, 31, 46

CODE 1: Bleeding observed during or after probing.
Note: bleeding may appear immediately or after 10-30 seconds. after probing.
CODE 2: Tartar or other plaque-retaining factors (overhanging edges of fillings, etc.) are visible or felt during probing.
CODE 3: pathological pocket 4 or 5 mm (the edge of the gum is in the black area of the probe or the 3.5 mm mark is hidden).
CODE 4: An abnormal pocket 6 mm or more deep (with the 5.5 mm mark or black area of the probe hidden in the pocket).
CODE X: When only one or no teeth are present in the sextant (third molars are excluded unless they are in place of second molars).

To determine the need for periodontal disease treatment, population groups or individual patients can be categorized based on the following criteria.
0: CODE 0(healthy) or X (excluded) for all 6 sextants means that there is no need to treat this patient.
1: CODE 1 or higher indicates that the patient's oral hygiene needs to be improved.
2: a) CODE 2 or higher indicates the need for professional hygiene and the elimination of factors that contribute to plaque retention. In addition, the patient needs training in oral hygiene.
b) CODE 3 indicates the need for oral hygiene and curettage, which usually reduces inflammation and reduces pocket depth to values equal to or less than 3 mm.
3: Sextant with CODE 4 can sometimes be successfully treated with deep curettage and adequate oral hygiene. In other cases, this treatment does not help, and then complex treatment is required, which includes deep curettage.
The prevalence and intensity of periodontal disease in the population is assessed based on the results of a survey of 15-year-old adolescents.

Gingivitis Index (GIA)

To assess the severity of gingivitis (and subsequently record the dynamics of the process) use papillary-marginal-alveolar index (PMA). Various modifications of this index have been proposed, but in practice the PMA index as modified by Parma (1960) is more often used.

RMA Index Assessment carried out according to the following codes and criteria:

0 - no inflammation;
1 - inflammation of only the gingival papilla (P);
2 - inflammation of the marginal gum (M);
3 - inflammation of the alveolar gum (A).

RMA Index calculated by the formula:
total points
RMA= - x 100%
3 x number of teeth
The number of teeth (while maintaining the integrity of the dentition) is taken into account depending on age:
6 – 11 years - 24 teeth,
12 – 14 years - 28 teeth,
15 years and older - 30 teeth.

Note: if there are missing teeth, then divide by the number of teeth present in the oral cavity.
Normal RMA index is equal to 0. The higher the digital value of the index, the higher the intensity of gingivitis.

Evaluation criteria for the RMA index:

30% or less - mild gingivitis;
31-60% - moderate severity;
61% and above - severe.

Oral hygiene assessment

Fedorov-Volodkina hygienic index (1971)

The index is recommended to be used to assess the hygienic state of the oral cavity in children under 5-6 years of age.
To determine the index, the labial surface of six teeth is examined:
43, 42, 41, 31, 32, 33
The indicated teeth are stained using special solutions (Schiller-Pisarev, fuchsin, erythrosine) and the presence of plaque is assessed using the following codes:
1 - no dental plaque was detected;
2 - staining one quarter of the surface of the tooth crown;
3 - staining half the surface of the tooth crown;
4 - staining three quarters of the surface of the tooth crown;
5 - staining the entire surface of the tooth crown.
Determination of supra- and subgingival tartar is carried out using a dental probe.
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INDICES OF ORAL CAVITY CONDITION

Methods for assessing dental plaque

Fedorov-Volodkina Index (1968) was widely used in our country until recently.

Where By Wed. – general hygienic cleaning index; To u– hygienic index of cleaning one tooth; n– number of teeth.

Staining the entire surface of the crown means 5 points; 3/4 – 4 points; 1/2 – 3 points; 1/4 – 2 points; absence of staining – 1 point.

Normally, the hygiene index should not exceed 1.

Green-Vermillion Index (Green, Vermillion, 1964) . The Oral Health Index Simplified (OHI-S) evaluates the area of tooth surface covered by plaque and/or tartar and does not require the use of special stains. To determine OHI-S, examine the buccal surface 16 and 26, the labial surface 11 and 31, and the lingual surface 36 and 46, moving the tip of the probe from the cutting edge towards the gum.

The absence of dental plaque is indicated as 0 , dental plaque up to 1/3 of the tooth surface – 1 , dental plaque from 1/3 to 2/3 – 2 , dental plaque covers more than 2/3 of the enamel surface – 3 . Then tartar is determined according to the same principle.

Formula for calculating the index.

Where n– number of teeth, ZN– dental plaque, ZK– tartar.

Silnes-Lowe Index (Silness, Loe, 1967) takes into account the thickness of plaque in the gingival region in 4 areas of the tooth surface: vestibular, lingual, distal and mesial. After drying the enamel, the tip of the probe is passed along its surface at the gingival sulcus. If no soft substance adheres to the tip of the probe, the plaque index on the tooth area is indicated as - 0 . If the plaque is not visually detected, but becomes visible after moving the probe, the index is equal to 1 . A plaque with a thin to moderate thickness, visible to the naked eye, is assessed by 2 . Intensive deposition of dental plaque in the area of the gingival sulcus and interdental space is designated as 3 . For each tooth, the index is calculated by dividing the sum of the points of 4 surfaces by 4.

The general index is equal to the sum of the indicators of all examined teeth, divided by their number.

Tartar index (CSI) (ENNEVER" et al., 1961). Supra- and subgingival tartar is determined on the incisors and canines of the lower jaw. The vestibular, distal-lingual, central-lingual and medial-lingual surfaces are differentially examined.

To determine the intensity of tartar, a scale from 0 to 3 is used for each surface examined:

0 - no tartar

1 - tartar is determined to be less than 0.5mm in width and/or thickness

2 - width and/or thickness of tartar from 0.5 to 1 mm

3 - width and/or thickness of tartar more than 1 mm.

Formula for calculating the index:

Ramfjord index (S. Ramfjord, 1956) as part of the periodontal index involves the determination of dental plaque on the vestibular, lingual and palatal surfaces, as well as the proximal surfaces of the 11, 14, 26, 31, 34, 46 teeth. The method requires preliminary staining with a Bismarck brown solution. Scoring is done as follows:

0 - absence of dental plaque

1 - dental plaque is present on some tooth surfaces

2 - dental plaque is present on all surfaces, but covers more than half of the tooth

3 - dental plaque is present on all surfaces, but covers more than half.

The index is calculated by dividing the total score by the number of teeth examined.

Navy index (I.M.Navy, E.Quiglty, I.Hein, 1962). The color indices of tissues in the oral cavity limited by the labial surfaces of the front teeth are calculated. Before the examination, the mouth is rinsed with a 0.75% solution of basic fuchsin. The calculation is carried out as follows:

0 - no plaque

1 - the plaque was stained only at the gingival border

2 - pronounced plaque line at the gingival border

3 - the gingival third of the surface is covered with plaque

4 - 2/3 of the surface is covered with plaque

5 - more than 2/3 of the surface is covered with plaque.

The index was calculated in terms of the average number per tooth per subject.

Turesky index (S.Turesky, 1970). The authors used the Quigley-Hein scoring system on the labial and lingual surfaces of the entire row of teeth.

0 - no plaque

1 - individual spots of plaque in the cervical area of the tooth

2 - a thin continuous strip of plaque (up to 1 mm) in the cervical part of the tooth

3 - plaque strip is wider than 1 mm, but covers less than 1/3 of the tooth crown

4 - plaque covers more than 1/3, but less than 2/3 of the tooth crown

5 - plaque covers 2/3 of the tooth crown or more.

Index Arnim (S. Arnim, 1963) in assessing the effectiveness of various oral hygiene procedures, determined the amount of plaque present on the labial surfaces of four upper and lower incisors stained with erythrosine. This area is photographed and developed at 4x magnification. The outlines of the corresponding teeth and colored masses are transferred to paper and these areas are determined with a planimer. The percentage of surface area covered by plaque is then calculated.

Hygiene Performance Index (Podshadley, Haby, 1968) requires the use of dye. Then a visual assessment of the buccal surfaces of 16 and 26 teeth, labial surfaces of 11 and 31 teeth, and lingual surfaces of 36 and 46 teeth is carried out. The surveyed surface is conventionally divided into 5 sections: 1 – medial, 2 - distal 3 - mid-occlusal, 4 – central, 5 - mid-cervical.

0 - no staining

1 - staining of any intensity is available

The index is calculated using the formula:

where n is the number of teeth examined.

CLINICAL METHODS FOR ASSESSING GINGUM CONDITION

PMA Index (Schour, Massler ). Inflammation of the gingival papilla (P) is assessed as 1, inflammation of the gingival margin (M) - 2, inflammation of the mucous membrane of the alveolar process of the jaw (A) - 3.

The PMA index is calculated as a percentage as follows:

RMA = (sum of indicators x 100): (3 x number of teeth)

In absolute numbers, PMA = sum of indicators: (number of teeth x 3).

Gingival index GI (Loe, Silence ). For each tooth, four areas are differentially examined: vestibular-distal gingival papilla, vestibular marginal gingiva, vestibular-medial gingival papilla, lingual (or palatal) marginal gingiva.

0 – normal gum;

1 – mild inflammation, slight discoloration of the gum mucosa, slight swelling, no bleeding on palpation;

2 – moderate inflammation, redness, swelling, bleeding on palpation;

3 – severe inflammation with noticeable redness and swelling, ulceration, and a tendency to spontaneous bleeding.

Key teeth whose gums are examined: 16, 21, 24, 36, 41, 44.

To evaluate the examination results, the sum of points is divided by 4 and the number of teeth.

0.1 – 1.0 – mild gingivitis

1.1 – 2.0 – moderate gingivitis

2.1 – 3.0 – severe gingivitis.

Periodontal Disease Index - PDI (Ramfjord, 1959) includes an assessment of the condition of the gums and periodontium. The vestibular and oral surfaces of the 16th, 21st, 24th, 36th, 41st, and 44th teeth are examined. Plaque and tartar are taken into account. The depth of the periodontal pocket is measured with a graduated probe from the enamel-cement junction to the bottom of the pocket.

GINGIVITIS INDEX

The dental index is a method for determining the effectiveness of hygiene procedures and the general condition of the oral cavity. The article discusses the main types of indices, evaluation criteria, and diagnostic procedures used.

What is the Dental Oral Health Index?

The hygiene index is indicators reflecting oral hygiene, the degree of contamination, determining the presence of signs of bacterial infection, indicating the number of teeth that are affected by caries.

The hygiene index allows a specialist to determine the reasons why tooth decay occurs, gum disease occurs, and also prescribe effective preventive measures.

With their help they determine:

The level of dental health of the patient;
The severity and stage of caries;
Number of teeth pulled out;
Quality of hygiene procedures;
Presence of malocclusion;
The degree of effectiveness of therapy.

Important to remember! Each diagnostic criterion for different types of lesions is reflected in an individual index.

KPU index

It is the most common indicator used in modern dentistry. The presented indicator reflects the nature of the course of caries. The index is used in the diagnosis of both temporary and molar teeth.

The KPU index reflects:

The combination of this data allows the dentist to determine the severity and intensity of caries.

There are the following types of KPU indexes:

KPU of teeth (reflects how many teeth are affected by caries or filled);
KPU of surfaces (reflects how many teeth the early stage of caries was found on);
KPU of cavities (reflects the number of cavities caused by softening of tissues due to caries or loss of fillings).

When examining baby teeth, the number of pulled out or fallen out units is not taken into account. The index includes only indicators K - the number of caries affected, and P - the number of filled teeth.

Using the KPU index, the prevalence of caries is assessed. The number of all patients with caries must be divided by the number of subjects, and then multiplied by 100. The result obtained will indicate the percentage of prevalence.

Prevalence levels:

1% – 30% – low;
31% – 80% – average;
81% – 100% -high.

The degree of caries intensity is calculated taking into account the number of diseased teeth:

Intensity of the pathological process	Grades for children (12 years old)	Estimates for adults (35 years old)
Very low	Below 1.1	Below 1.5
Low	1.2 – 2.6	1.6 – 6.2
Average	2.7 – 4.4	6.3 – 12.7
High	4.5 – 6.4	12.8 – 16.2
Very high	6.5 and higher	Over 16.2

Important to remember! The dental index KPU is very effective, but does not allow us to provide absolutely reliable information about the nature of the course of caries. This is due to the fact that the overall clinical picture is influenced by previously treated or extracted teeth.

Green-Vermillion (OHI-S)

The method is a simplified method of hygienic indexing, with which the volume of plaque is determined without the application of auxiliary dyes.

A dental examination is used to determine contamination. During the examination, the condition of 6 teeth is examined.

Teeth examined:

Vestibular surface: 11, 31;
Buccal surface: 16, 26;
Lingual surface: 36, 46.

The evaluation criteria for Green Vermillion (Vermilion) are presented in the table:

To calculate the index, the plaque and tartar scores are summed up and the resulting number is divided by 6.

A breakdown of the results is presented in the table:

Fedorova-Volodkina

The presented method is carried out to determine the level of plaque contamination. During the procedure, a solution containing potassium and iodine is applied to the vestibular surface of the lower front teeth. Drying from saliva is done first.

The index is determined based on the intensity of staining:

The Fedorov-Volodkin index is determined as follows: the sum of the indices of each stained tooth is divided by 6.

Interpretation of results:

Silnes Low

A method for assessing oral hygiene without the application of coloring materials.

The dentist examines the oral cavity using a probe to determine the amount of plaque.

Based on the amount of plaque detected, the appropriate assessment is made:

0 – no plaque;
1 – thin layer of deposits, invisible without the use of a probe;
2 – visually noticeable plaques;
3 – plaque covers the crown.

Using the Silnes-Low method, the hygiene index of an individual unit, a group of several teeth or the entire oral cavity is calculated.

Pakhomova

Involves applying Lugol's solution to the teeth being examined. The procedure involves 6 frontal teeth of the lower jaw, all 1st molars, 11 and 21 teeth.

The quality of hygiene is assessed according to the degree of staining:

Grade	Degree of staining
1	Lack of color upon application
2	Staining 1/4 crown
3	Staining 1/2 crown
4	Staining 3/4 crowns
5	Staining the entire surface of the tooth

The overall score is calculated by summing the scores for each tooth examined and dividing by 12.

Assessment of plaque in young children (Kuzmina index)

During the examination, the child is examined for erupted units.

An assessment of the hygienic condition of the oral cavity is carried out after the eruption of primary teeth.

During the examination, the child's erupted units are examined. Inspection is carried out visually or using a probe.

The condition of the oral cavity is assessed depending on the presence of plaque.

The absence of deposits corresponds to a score of 0, and any amount of plaque corresponds to a score of 1.

To assess the plaque index in children, it is necessary to divide the number of points by the number of all erupted teeth. This allows you to determine the quality of hygiene procedures.

Kuzmina plaque index indicators:

0 – optimal oral hygiene;
From 0.1 to 0.4 – hygiene is at a satisfactory level;
From 0.5 and above – unsatisfactory hygiene.

Important to remember! Children's teeth are more susceptible to bacteria and more often suffer from caries, which emphasizes the need to maintain a high level of hygiene standards.

Navi indicator

The method involves examining the anterior incisors from the lips. Before starting the procedure, the patient is required to rinse his mouth with a fuchsin solution. This substance colors soft deposits, allowing you to assess the degree of contamination.

Hygiene rating:

0 – no deposits;
1 – presence of deposits in the area between the gum and tooth;
2 – the presence of a noticeable strip of plaque above the border of the tooth and gum;
3 – 1/3 coating;
4 – 2/3 coating;
5 – the tooth is covered with deposits by more than 2/3.

To give an overall assessment, calculate the arithmetic mean for all examined teeth.

Tureski

When calculating the Turesky index, the entire dentition is examined. The procedure involves applying a fuchsin solution, after which the appearance of deposits on the lingual and labial surfaces of the teeth is analyzed.

The score is calculated as follows:

The Turesky Index is calculated by adding the scores for each individual tooth and dividing by the number of teeth examined.

Arnim

It is used primarily for research purposes. It is used extremely rarely in dental practice, since the calculation is a labor-intensive and time-consuming process. The procedure is aimed at determining the area covered by plaque.

Stages of calculating the Arnim index:

Application of a dye to the front incisors (erythrosine)
Taking photographs of teeth that have stained
Enlarging photos and transferring contours using a planimeter
Determination of contaminated surface area

CPITN indicator

The CPINT index is also called the periodontal therapy need index. The assessment method involves examining the gums in the area of 11, 16, 17, 26, 27, 36, 37, 46 and 47 teeth. The method allows you to determine the condition of the tissues on both jaws.

Using a probe, the degree of bleeding of the gums, the presence of a periodontal pocket, and tartar are determined.

The assessment is carried out as follows:

When determining the CPINT index, the condition of each of the above teeth is assessed.

After this, a general assessment is made, reflecting the condition of the soft tissues and the degree of need for therapeutic intervention.

The treatment need estimate is calculated by adding the results for each tooth and dividing the resulting number by the number of units examined.

CPINT ratings:

PMA indicator

Stands for papillary-marginal-alveolar index. Used to assess the condition of the oral cavity in case of gingivitis (inflammation of the gums).

The assessment is made depending on the location and extent of the lesion:

1 – gingival papilla;
2 – marginal area;
3 – alveolar area.

The PMA index is calculated using the formula: sum of points for each tooth * 100 divided by 3 * number of teeth.

PHP

Determines the effectiveness of hygiene measures, including the thoroughness of daily cleaning. During the procedure, 6 teeth are examined: 16, 26, 11, 31, 36 and 46. The patient rinses his mouth with a special solution containing a dye.

The rating is based on the presence of a reaction to the solution:

0 – no reaction
1 – tooth staining

If the indexed tooth is removed, the adjacent tooth is examined.

To calculate the result, the score of all examined teeth is combined, after which it is divided by 6. The code for an individual tooth is the score obtained from the examination of each area (medial, distal, occlusal, central, cervical).

Interpretation:

Oral Hygiene Performance Index (OHP) Podshadley, Haley, (1968)

CSI

Determining the CSI index allows you to find out the amount of tartar and accumulated plaque in the area where the teeth come into contact with the gums.

The condition of the anterior incisors is analyzed. Each tooth is examined from the lingual, medial and vestibular sides. The examination is carried out using a dental probe.

Each surface is scored by:

0 – no deposits;
1 – deposits 0.5 mm wide;
2 – deposits 1 mm wide;
3 – plaque more than 1 mm.

To determine the index, it is necessary to add up the sum of ratings for each examined surface and divide by the number of teeth. The maximum value is considered to be CSI 16.

Approximal Plaque Index (API)

The procedure involves applying a dye

The approximal surface is the area of contact of the enamel with the tooth located behind it.

The need to inspect the area presented is due to the fact that it requires careful care, which can be difficult to achieve through routine hygiene procedures.

If the amount of plaque exceeds the permissible level, the patient is prescribed professional cleaning.

The procedure involves applying a dye. After this, it is determined how many teeth the color changes.

The API index rating does not provide a pollution rating. The assessment is the presence of a reaction to the dye or its absence.

To determine the index, it is necessary to divide the number of stained teeth by the number of all teeth in the patient’s oral cavity. The resulting figure is multiplied by 100.

Evaluation of results:

Flying Rate by Quigey and Hein

Determining the plaque index involves applying a fuchsin solution to 12 front teeth on both jaws. The survey includes numbers 12, 13, 11, 21, 22, 23, 31, 32, 33, 41, 42, 43.

After applying the solution, the vestibular surface is examined. The plaque index depends on the degree of surface staining.

Results of the procedure:

0 – no changes when applying the solution;
1 – change in color in the cervical area;
2 – color within 1 mm;
3 – deposits occupy from 1 mm to 1/3 of the surface;
4 – 2/3 plaque;
5 – sediments cover more than 2/3.

To calculate the index, the totality of points is summed up, and the resulting number is divided by the number of teeth examined (12).

Gingivitis score PMA (Parma)

Used to determine the clinical condition of the periodontium and reflect the present symptoms of inflammation.

The score reflects the stage of the inflammatory process:

The difference between the Parma modification is the modified formula for calculating the index.

The indicator is calculated as follows: the sum of points is divided by 3* the number of teeth examined. The resulting result is multiplied by 100.

This is how the severity of gingivitis is assessed:

Less than 30% – light;
31% – 60% – average;
61% – 100% – severe.

Composite Periodontal Index (CPI)

It is used for a comprehensive assessment of the condition of the gums and periodontal canal. The procedure involves performing a standard dental examination using a probe and mirror.

During the examination, the dentist notes the presence of certain symptoms, each of which corresponds to a specific score reflecting the condition of the tissues.

Evaluation criteria:

0 – absence of pathological signs;
1 – soft deposits;
2 – bleeding;
3 – tartar;
4 – expansion of the periodontal canal;
5 – loosening of the tooth in the affected area.

The KPI index is determined by dividing the sum of indicators by the number of examined teeth. The method of examination depends on the age of the patient.

Interpretation of the CRPD:

From 0.1 to 1 – potential risk of developing periodontitis;
From 1.1 to 2 – mild form of periodontitis;
From 2.1 to 3.5 – moderate severity;
From 3.6 and above – severe form.

Ramfiord

Like the KPI, it reflects the condition of the periodontium and gums. During the procedure, the vestibular and lingual surfaces of 6 teeth are examined: 16th, 21st, 36th, 41st, 44th. The presence of plaque and tartar must be taken into account.

Inspection results:

0 – no pathological signs identified;
1 – inflammation of a small area of the gum;
2 – pronounced inflammatory process;
3 – aggravated inflammatory process.

Such symptoms are characteristic of periodontitis and gingivitis. Further assessment reflects the condition of the periodontal pocket.

In the presence of periodontitis, the following values are possible:

0-3 – normal sizes;
4 – formation of a pocket up to 3 mm;
5 – formation of a pocket up to 6 mm;
6 – pocket deeper than 6 mm.

PFRI

The indicator reflects the rate of plaque formation. Allows you to evaluate the conditions and factors that influence the formation of soft deposits. The diagnostic value of the method lies in the fact that it allows you to assess the risk of caries.

The rate of plaque formation is influenced by the following factors:

Before assessing the rate of plaque formation, professional cleaning is performed.

The diagnostic procedure is performed 24 hours after cleaning. To do this, a coloring solution is applied.

The following surfaces are examined:

Buccal;
Lingual;
Mesio-buccal;
Mesio-lingual;
Distobuccal;
Distal-lingual.

The appearance of color is assessed as 1 point, while the absence of reaction to the solution is 0 points.

To calculate the PFRI, the total score should be divided by the number of teeth and multiplied by 100. The PFRI results are expressed as a percentage.

Ratings:

From 0 to 10% – very low;
From 10% to 20% – low;
From 21% to 30% – average;
From 31% to 40% – high;
Over 40% is very high.

Examination stages

Determining dental indices is a complex procedure that includes several main stages.

Examination stages:

Dental indices of the oral cavity in dentistry. Quantitative and qualitative assessment of dental plaque

Methods for assessing oral hygiene. Oral Health Indices

Methods for assessing dental plaque

Clinical methods for assessing gum health

Index for assessing dental plaque in young children (E.M. Kuzmina, 2000)

CODES AND CRITERIA FOR EVALUATING DENTAL CALCULUS

Oral Hygiene Performance Index (OHP) Podshadley, Haley (1968)

CODES AND CRITERIA FOR ASSESSING DENTAL PLAQUE

What is the Dental Oral Health Index?

KPU index

Green-Vermillion (OHI-S)

Fedorova-Volodkina

Silnes Low

Pakhomova

Assessment of plaque in young children (Kuzmina index)

Navi indicator

Tureski

Arnim

CPITN indicator

PMA indicator

PHP

CSI

Approximal Plaque Index (API)

Flying Rate by Quigey and Hein

Gingivitis score PMA (Parma)

Composite Periodontal Index (CPI)

Ramfiord

PFRI

Examination stages

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