Professional Documents
Culture Documents
Good Morning
6/5/12
subtitle
CONTENTS
1)INTRODUCTION 2)PERIODONTAL INDEX
(PI) 3)PERIODONTAL DISEASE INDEX (PDI) 4)GINGIVAL PERIODONTAL INDEX (GPI) 6/5/12 5)GINGIVAL BONE COUNT
7) COMMUNITY PERIODONTAL
INDEX (CPI)
9) PERIODONTAL SCREENING &
RECORDING (PSR)
10) CONCLUSION 11) REFERENCES
6/5/12
INTRODUCTION
Periodontal disease is a
Uses of EPIDEMIOLOGY
PERIODONTAL
6/5/12
indices :
Surveys on prevalence &
incidence. studies.
RUSSELL A.L.
Year :
1956
6/5/12
Type : Composite
reversible irreversible
6/5/12
Objective :
Intended to estimate
examined.
6/5/12
SCORING CRITERIA :
1 : Mild gingivitis.
An overt area of inflammation in the free gingiva does not circumscribe the tooth.
6/5/12
2 : Gingivitis
Inflammation completely circumscribes the tooth, but there is no apparent break in the epithelial attachment.
6/5/12
4 : Usually used
when radiographs are available. There is early notch like resorption of alveolar crest
6/5/12
6 : Gingivitis with
Pocket Formation. The epithelial attachment has been broken and there is a pocket (not merely a deepened gingival crevice due to swelling in free gingivae). There is no interference with masticatory function; the tooth is firm in socket and 6/5/12 has not drifted.
There is horizontal bone loss involving the entire alveolar crest, upto half of the length of the tooth root.
6/5/12
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.
6/5/12
loss involving more than half the tooth root, or a definite infrabony pocket with widening of periodontal ligament.
There may be root
RUSSELLS RULE :
6/5/12
48 35
47 36
46 37
45 38
44
43
42
41 31
32
33
34
PI SCORE 6/5/12 =
Calculation :
GROUP PERIODONTAL INDEX SCORE AND CLINICAL MANIFESTATIONS CLINICAL CONDITION GROUP PI STAGE OF
SCORES
Clinically normal supportive 0-0.2 tissues Simple gingivitis 0.3-0.9
DISEASE
Beginning destructive periodontal disease Established destructive periodontal disease Terminal disease
0.7-1.9
Reversible
1.6-5.0
Irreversible
3.8-8.0
Irreversible 6/5/12
INDIVIDUAL PERIODONTAL INDEX SCORE AND CLINICAL MANIFESTATIONS INDIVIDUAL PI SCORES CLINICAL CONDITION
Clinically normal supportive tissues Simple gingivitis 0-0.2
0.3-0.9
Beginning destructive periodontal 0.7-1.9 disease Established destructive periodontal disease Terminal disease 1.6-4.9
5.0-8.0 6/5/12
(Periodontology 2000)
Much information on the relative severity of periodontal destruction in the different populations of the world was generated through the 6/5/12 use of the
Uses :
Epidemiological surveys. More data can be assembled
using PI.
In National Health Survey
Sigurd P. Ramfjord
Year :
1959
Records the attachment level
PI v/s PDI
6/5/12
Index system as introduced by Ramfjord differed from the Periodontal Index system in several respects.
It described 3 degrees of
severity for gingivitis (scores 1, 2 and 3); it measured the distance from the cementoenamel junction with a 6/5/12 periodontal probe graduated in
Disease Index system relied on probing measurement, and thus offered much greater potential and quantifying periodontal destruction than the Periodontal Index system.
6/5/12
(Loe H.) as to whether the quality (of the gingiva) and quantity (of destruction or attachment loss) were compatible components in a single statistical entity.
6/5/12
6/5/12
COMPONENTS OF PDI : I.
Plaque Component
component
6/5/12
6/5/12
6/5/12
Score 0 1 2 3
Scoring criteria :
Absence of inflammation. Mild to moderate inflammatory gingival changes not extending all around the tooth. Mild to moderately severe gingivitis extending all around the tooth. Severe gingivitis, characterized by marked tendency to bleed, and ulceration. redness,
Criteria
Gingival crevice in any of the four measured areas (mesial, distal, buccal, lingual), extending apically to CEJ but not more than 3mm. Gingival crevice in any of the four measured areas extending apically 3-6mm from the CEJ. Gingival crevice in any of the four measured areas 6/5/12 extending apically more than 6mm from the CEJ.
6/5/12
6/5/12
6/5/12
: PDI =
6/5/12
one that used a numerical scale to assess the extent of plaque covering the surface area of the tooth.
SCORING CRITERIA
Score Criteria 0 No plaque present 1 Plaque present on some but not on all interproximal, Only fully buccal, and lingual erupted teeth surface of the tooth. should be scored. Missing teeth 2 Plaque present on all should not be interproximal, buccal and substituted. lingual surfaces, but covering less than one half of these surfaces. Plaque extending over all interproximal, buccal and
6/5/12
6/5/12
The facial (buccal/labial) and lingual surfaces of index teeth are examined.
6/5/12
Method : Evaluation is
done using a mouth mirror and a dental explorer and/or a periodontal probe.
Score 0 1 Criteria Absence of calculus. Supra gingival calculus extending only slightly below the free gingival margin (not more than 1mm) Moderate amount of supra gingival and sub gingival calculus or sub gingival calculus alone. An abundance of supra gingival 6/5/12 and sub gingival calculus
Calculation of the
reproducibility.
periodontal diseases.
6/5/12
modification)
F
16
21
L
24
L Score:
46
41
34
6/5/12
Calculus Component
16
21
L
24
L Score:
46
41
34
6/5/12
Component : 16 21 24
Score: 44 41 34
6/5/12
6/5/12
periodontal disease:
Gingival status Periodontal status (crevice
depth)
6/5/12
Segmentation of the
mouth : 18 to 14 13 to 23 24 to 28 38 to 34 33 to 43 44 to 48
6/5/12
Method :
To determine the tooth or its surrounding tissues, with the severest condition within each segment.
6/5/12
Score 0 1
Gingival Status :
Criteria Tissue tightly adapted to the teeth, firm consistency with physiologic architecture. Slight to moderate inflammation, as indicated by changes in gingival color, loss of normal consistency, blunting and slight enlargement of marginal or papillary gingiva, involving one or more teeth in the same segment, but not completely surrounding any one tooth. The above changes (Score 1) either singly or combined completely encircle one or more teeth in a segment. Marked inflammation, as indicated by loss of surface continuity (ulceration), spontaneous hemorrhage, loss of faciolingual continuity or any interdental, marked deviation from normal contour (such as gross thickening or enlargement covering more than onethird of the anatomic crown), recession, and clefts.
6/5/12
Area with the highest score determines the gingival score for the segment. Gingival status for mouth : Sum of gingival scores No. of segments
6/5/12
Periodontal status : Beginning in segment 1, the mesio-facial line angle of every tooth erupted to the occlusal plane is probed with a Merritt type probe.
6/5/12
Score
0
Criteria
The probe does not extend 1mm apical to the CEJ of any tooth in the segment and there is no exposure of the CEJ on any surface of any tooth in the segment. The probe extends up to 3mm apical to CEJ of any tooth in the segment. The probe extend from 3mm to 6mm, apical to the CEJ of any tooth in the segment.
The probe extends 6mm or more apical to the CEJ of any tooth in the segment.
The highest score on any tooth in the segment is the periodontal score for the segment.
6/5/12
GPI score = Sum of the highest scores for each dentulous segment The number of segments
6/5/12
Scoring criteria :
Gingival Score (Gingivitis): (One score is assigned to each tooth studied, and a mean is computed for the whole mouth)
6/5/12
Score Criteria 0 1 Negative (no gingivitis) Mild gingivitis involving free gingiva (margin, papilla or both). Moderate gingivitis involving both free and attached gingivae. Severe gingivitis with enlargement and easy hemorrhage.
6/5/12
* Maximum score = 3
(One score is assigned to each tooth studied visually or by xray, and a mean is computed for the whole mouth.)
6/5/12
Score 0
alveolar
Bone loss approximating one-fourth of root length or pocket formation one side not over one-half root length. Bone loss approximating one-half of root length or pocket formation one side not over three-fourths of root length; Mobility slight. Bone loss approximating three-fourths of root length or pocket formation one side to apex; Mobility moderate Bone loss complete; Mobility marked.
6/5/12
* Maximum score = 5
(G)score per person is added to the average bone (B) score per person to yield the GB count per person. Maximum possible GB count per person = 8
6/5/12
6/5/12
COMMTUNITY PERIODONTAL INDEX OF TREATMENT NEEDS Developed for the Joint (CPITN) working committee of the
W.H.O. & F.D.I. by : Jukka Ainamo., David Barmes., George Beagrie., Terry Cutress., Jean Martin., Jennifer SardoInfirri.
Year : 1982
6/5/12
Objective : To evaluate
1) Periodontal epidemiology. 2) In a promotional role in developing periodontal health problems. 3) For initial screening. 4) For monitoring changes in periodontal needs of individuals.
6/5/12
Advantages :
Treatment needs Procedure for CPITN Sextants Index teeth Recording data
6/5/12
Tip and shank, and shank and handle include angles of 90 and 30 respectively.
6/5/12
Codes CODE X
Criteria When only one tooth or no teeth are present in a sextant (third molars are excluded unless they function in place of second molars ) Pathological pocket of 6mm or more present i.e., the black area of CPITN probe is not visible.
CODE 4
CODE 3
Pathological pocket of 4mm or 5mm present i.e., when the gingival margin is on the black area of the probe. Calculus or other plaque retentive factors such as ill fitting crowns or poorly adapted edges of restorations are either seen or felt during probing. Bleeding observed during or after probing. Healthy tissue; No signs of disease.
6/5/12
CODE 2
CODE 1 CODE 0
Code 0 No Periodontal
Code 1 Bleeding
Code 2 Calculus or
Code 3 Pathological
pocket 4-5mm in depth. Gingival margin situated on black band of the probe
6/5/12
criteria.
6/5/12
the two index teeth are not present or has to be excluded, then the recording is based on examination of remaining index teeth.
If both index teeth in posterior
6/5/12 sextant are missing or excluded
If 11 is missing/excluded,
substitute 21. If 21 is also missing, identify the worst score for the remaining teeth. Similarly substitute 41 if tooth 31 is missing.
In subjects age < 20 yrs, if 1st
missing or only one functional 6/5/12 tooth remains the sextant is coded
Calculation of CPITN :
Step I - Count the number of charts obtained with different codes individually (i.e., codes 0,1,2,3,4). Step II To obtain the prevalence (percentage) of subjects with codes 0,1,2,3,4 as their score, divide the counts of codes respectively, by the total number of dentate subjects examined.
6/5/12
Recording (PSR).
6/5/12
indicators of periodontal status are used for this assessment: gingival bleeding calculus periodontal pockets
A specially designed
divided into sextants defined by tooth numbers: 18-14, 13-23, 24-28, 38-34, 33-43, and 44-48.
only if there are two or more teeth present and not indicated for extraction.
17 16 11 26 27 47 46 31 36 37
6/5/12
probed, using the probe as a sensing instrument to determine pocket depth and to detect subgingival calculus and bleeding response.
Score 0 1 2 3 4 X 9
Criteria Healthy. Bleeding observed, directly or by using mouth mirror, after probing. Calculus detected during probing, but all the black band on the probe visible. Pocket 4 - 5 mm (gingival margin within the black band on the probe). Pocket 6 mm or more (black band on the probe not visible). Excluded sextant (less than two teeth present). Not recorded.
6/5/12
6/5/12
of Attachment Scores
Score Criteria 0 Loss of attachment 0-3 mm (CEJ not visible and CPI score 0-3) If CEJ is not visible and the CPI score is 4, or if the CEJ is visible. Loss of attachment 4-5mm (CEJ within the 6/5/12 black band)
Score 3
Criteria Loss of attachment 9-12mm (CEJ between the 8.5 mm and 11.5 mm rings) Loss 12 mm or more (CEJ beyond the 11.5 mm rings) Excluded sextant (Less than two teeth present) Not recorded (CEJ neither visible nor 6/5/12 detectable)
Association and the American Academy of Periodontology recommend that PSR to be conducted by dentists for all patients as an integral part of oral examinations.
6/5/12
screening system is to examine every tooth individually. Implants are examined in the same manner as naturally occurring teeth. For screening, the dentition is divided into sextants.
The use of a periodontal
probe is mandatory. The recommended probe has a ball end 0.5mm in diameter. A 6/5/12 color-coded area extends from
inserted into the gingival crevice until resistance is met. The depth of insertion is read against the colorcoding. The total extent of the crevice should be explored by "walking" the probe around the crevice.
0.5 mm ball-tip
6/5/12
PSR CODES :
6/5/12
6/5/12
6/5/12
CODE * Example: Recession This sextant exhibits gingival recession and mucogingival problems and therefore should include the * symbol next to the sextant code.
CODE * Example: Recession This sextant exhibits gingival recession and mucogingival problems and therefore should include the * symbol next to the sextant code 6/5/12
CODE * Example: Mucogingival Problems This sextant exhibits mucogingival problems and calculus and therefore should include the * symbol next to the sextant code.
6/5/12
A special form is
box chart would look like the chart shown below, for a PSR completed on May 14, 2004.
6/5/12
Code 2
All above + debridement of supra- and subgingival calculus, and correction of plaque retentive margins of restorations. Code 3 If a single sextant scores Code 3, a comprehensive periodontal examination is indicated for that sextant. If two or more sextants score Code 3, a comprehensive periodontal examination is indicated for entire mouth. Code 4Comprehensive periodontal examination is indicated for entire mouth. 6/5/12 Code *If an abnormality is present in a sextant with a Code 0, 1, or 2 score note the
Benefits :
Early detection Speed Simplicity Cost-effectiveness Recording ease Risk management
6/5/12
CONCLUSION
References :
Preventive and Community Dentistry, 3rd edition Soben Peter. Clinical Periodontology, 10th edition Carranza. Fundamentals of Periodontal Instrumentation, 3rd edition. Jill S. Nield-Gehrig, Ginger A. Houseman. Methodological issues in epidemiological studies of periodontitis - how can it be improved? - Biomed Central Oral Health. Roos 6/5/12 Leroy, Kenneth A Eaton, Amir Savage.
www.Google.com www.pubmed.org PERIODONTAL PROBING, Critical Reviews in Oral Biology & Medicine.
Than k You !!
6/5/12
A doctor who cannot take a good history and a patient who cannot give one are in
6/5/12