Dental Indices: Dr. Ammar Rushdi Abdelfattah

Prepared by : Ammar Rushdi AbdelfattahB.D.S. , MSc.

Dental Indices

1• Plaque index

2• Oral Hygiene index

3• Dental Fluorosis index

4 • Dental Aesthetic index


1 • Plaque index


IntroductionOral Hygiene is a basic factor for oral health. Poor oral hygiene leads to dental plaque-collections, which in turn can cause gingivitis eventually leading to periodontal diseases, that is why many clinical studies have been carried out focusing on the role of oral hygiene in the prevention and control of oral diseases.

Dental plaque is defined as the soft adherent structured deposits, which forms on the tooth surface. It consists of a mixed bacterial flora, sometimes with desquamated epithelial cells and migrated polymorphonuclear leukocytes. It is not and should not be confused with food debris.

A number of plaque indices has been developed for assessing individual levels of plaque control and are also been used in several epidemiological studies. Some of the most well - known indices, which have been used in numerous studies, are listed below


1 • Plaque index

1) Quigley - Hein Index

3) Silness-Löe Index

(1964)

2) Quigley - Hein Index Modified by

Turesky,Glimor,Glickman (1970)

4) The Plaque Control Record

5) Plaque Formation

Rate Index Prepared by : Ammar Rushdi AbdelfattahB.D.S. , MSc.

Thy examined only the facial of the ant. Teeth,after using a basic fuchsine mouth wash.


(1962)

A numerical scoring system of 0 to 5 was used .


Thy examined only the facial of the ant. Teeth,after using a basic fuchsine mouth wash.


(1962)

A numerical scoring system of 0 to 5 was used .

2) Quigley Hein Index Modified by

Turesky,Gilmor,Glickman (1970)

plaque was assessed on the facial and lingual surfaces of all teeth except third molars, after using disclosing agent.

This system easy to use because of objective

definitions of each numerical score .All focused on gingival 1/3 of the tooth surface.Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

Scores

Criteria0 No plaque.


Scores


1 Separate flecks of plaque at the cervical margin of the tooth.


Scores



2 A thin continuous band of plaque (up to 1 mm) at the cervical margin of the tooth.


Scores




3 A band of plaque wider than 1 mm but covering less than one-third of the crown of the tooth.


Scores





4 Plaque covering at least one-third but less than two-thirds of the crown of the tooth.


Scores





4 Plaque covering at least one-third but less than two-thirds of the crown of the tooth.

5 Plaque covering two-thirds or more of the crown of the tooth.


Lingual surface score

Buccal surface score

Lower jaw

5 4 15 3 13 2 33 2 64 2 73 2 72 0 52 0 30 0 4

27 15 Total

Lingual

surface

score

Buccal surface score

Upper jaw

2 2 43 1 32 3 11 0 10 0 22 1 53 1 72 2 63 5 6

18 15 TotalIndex=Total score / The number surfaces examined

(15+18) + (15+27) / 36 = 2.1The index for the entire mouth is

2.1.

Scoring method


This modification technique provides a comprehensive method for evaluating anti plaque procedure such us :Tooth Brushing FlossingWater PikChemical anti plaque agents (0 – 5)Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

http://shopwithmemama.com/wp-content/uploads/2010/11/listerineee.jpg

3) Silness-Löe Index( 1964)

R L


3) Silness-Löe Index(1964)

Missing teethare not substituted.

Proposed by silness and loe 1964

Areas examined :Four gingival areas ( D, F , M , L ) are examined systematically for each tooth

Purposes:To assess the thickness of plaque at the gingival area .To measure of the state of oral hygiene bossed on recording both soft debris and mineralized deposit on the following teeth .


3) Silness-Löe Index(1964)

Procedure:* Dry the teeth and examine

visually using adequate light ,mouth probe or explorer

When the Plaque Index is used in conjunction with GI , the GI must be completed first. *Evaluation according to the following criteria.


Scores



Scores


1 A film of plaque adhering to the free gingival margin and adjacent area of the tooth. The plaque may be seen in situ only after application of disclosing solution or by using the probe on the tooth surface.


Scores



2 Moderate accumulation of soft deposits within the gingival pocket, Orthe tooth and gingival margin which can be seen with the naked eye.


Scores



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 gingival margin.


= (1.5 + 1.3 +1.2 + 1 + 1.6 + 1.3) / 6 = 1.4

Scoring method

scor

e

surfaces

2 Buccal 1 Lingual1 Mesial2 Distal

Index Tooth

1.5 Maxillary right first molar (16)

1.3 Maxillary right lateral incisor (12)

1.2 Maxillary left first bicuspid (24)

1 Mandibular left first molar (36)

1.6 Mandibular left lateral incisor (32)

1.3 Mandibular right first bicuspid (44)

6\4 = 1.5

Then the index for the patient will be


= (1.5 + 1.3 +1.2 + 1 + 1.6 + 1.3) / 6 = 1.4

Scoring methodThen the index for the patient will be

The Plaque Index score values range from 0 to 3:

0 - < 1 Good Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

= (1.5 + 1.3 +1.2 + 1 + 1.6 + 1.3) / 6 = 1.4


The Plaque Index score values range from 0 to 3 :

1 - < 2 Moderate


= (1.5 + 1.3 +1.2 + 1 + 1.6 + 1.3) / 6 = 1.4


The Plaque Index score values range from 0 to 3 :

2 - 3 poor Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

AdvantagesThe index has the advantage of providing more data on self caring habits of the patient.It is visual and require only a mouth mirror.Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

4) The Plaque Control

Record (O'

Leary,Drake,Naylor,1972)

Name---------

Previous index --------

present index --------

Date ----------Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

4) The Plaque Control

Record (O'

Leary,Drake,Naylor,1972) Purpose :

The Plaque Control Record was developed to give the therapist, hygienist, or dental educator a simple method of recording the presence of the plaque. Selection of teeth and surfaces:on individual tooth surfaces.(M,D,B,L)Missing teeth are identified on record form by a single thick horizontal line.


Procedure : The Pt. is 1st asked to rinse vigorously with water to dislodge any loose food Debris. 2nd Appling a disclosing agent or solution.

3ed Mouth is again rinsed vigorously with water. 4th The operator then use the explorer or tip of periodontal probe to confirm the presence ofdisclosed accumulations of plaqueAt the DG J.Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

http://www.google.com.eg/imgres?imgurl=http://freehealthylife.com/wp-content/uploads/2010/11/mou_rinse.jpg&imgrefurl=http://freehealthylife.com/health-care/teeth-care/mouth-rinse-what-you-should-know-and-avoid/&usg=__ZotuISoLgrWC0sTVnV-kKH5YheE=&h=288&w=300&sz=75&hl=ar&start=12&sig2=31Hm8Tm6w7ONEQN8KIZUDQ&zoom=1&itbs=1&tbnid=jWF_i7MO-lG6tM:&tbnh=111&tbnw=116&prev=/images?q=rinsed+mouth+dental&hl=ar&gbv=2&tbs=isch:1&ei=JuscTeTpNMqy8gOLq92FBw

Scoring method

Upper jaw : 34 plaque containing surfaces.Lower Jaw : 36 plaque containing surfaces.

Upper jaw : 52 available surfaces.Lower Jaw : 48 available surfaces.


Plaque Index = (The number of plaque containing surfaces)

/ (The total number of available surfaces)

/100

PI= (34+36) / (52+48) = 70 /100

=0.7 %

The meaning that : the plaque index for this patient is 70% at initial control appointment. Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

Name---------

Previous index --------

present index 70 %

Date ----------Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

AdvantagesIs useful for monitoring pt.’s plaque control performance .Is easy to accomplish.

The complete chart indicate the location where plaque accumulate and where improving brushing and flossing technique are required.

Is reproducible. And is economical.


Proposed by Axelsson (1989, 1991).

He describes the accumulation of dental plaque within 24 hours after a professional dental cleaning.

This index can help in identifying pt.’s at increased risk of caries.

5) Plaque Formation Rate Index

Axelsson (1989, 1991).


Surfaces examined of each tooth : (6)Mesiobuccally ,Buccaly , Distobuccaly Lingually , distolinguallu ,mesiolingually

5) Plaque Formation Rate Index

Procedure :1 ) The teeth are cleaned by professional dental hygienist.2) The Pt. does not brush or clean the teeth for the next 24 hours. 3) Then examined for adherent plaque.


PFRI = (Total number of surfaces showing plaque)

/ (The total number of teeth surfaces examined)

*100

Interpretation:Minimum PFRI : 0%

Maximum PFRI : 100% score Level Percentage of surfaces

affected0 None 0% 1 Very low 1 – 10% 2 Low 11 – 20% 3 Moderate 21 – 30% 4 High 31 – 40% - 5 Very high >40% Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

Basic FactorsThe quantity of plaque that forms on clean tooth surfaces during a given time represents the net result of interactions among etiologic factors, many internal and external risk indicators and risk factors, and protective factors:

· The total oral bacterial population.· The quality of the oral bacterial flora.· The anatomy and surface morphology of the dentition.· The wet ability and surface tension of the tooth surfaces.· The salivary secretion rate and other properties of saliva.


Basic Factors· The intake of fermentable carbohydrates.· The mobility of the tongue and lips.· The exposure to chewing forces and abrasion from foods.· The eruption stage of the teeth.· The degree of gingival inflammation and volume of gingival exudate.· The individual oral hygiene habits.· The use of fluorides and other preventive products, such as chemical plaque control agents.Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

Possibly Related FactorsMany indicators and factors possibly related to PFRI were also evaluated, including : (1)caries prevalence and caries

incidence.(2) gingival inflammation.(3) Plaque Index.(4) dietary intake during the 24 hours of

free plaque accumulation.(5) salivary levels of Streptococcus

Mutans and Glucosyl Transferase.(6)agglutinin levels in resting saliva.(7) oral hygiene, dietary, and fluoride

habits.


Among observations from the study were: 1. Individuals with a PFRI score of 4 or 5

had considerably higher scores for gingival bleeding than had individuals with a PFRI score of 1 or 2.

2. An initially high Plaque Index usually correlated with PFRI scores 3 to 5.

3. There was no significant correlation between

different salivary S Mutans levels and PFRI scores.


Among observations from the study were:4. The level of salivary glucosyl

transferase was lower in individuals with a PFRI score of 4 or 5 than in those with a score of 1 or 2, probably because Glucosyl Transferase had already accumulated in the matrix of the plaque in the high and very high plaque formers.5. The scores for individuals with a very

low and low PFRI (scores 1 and 2, respectively) tended to remain constant over the 5-year period, while the scores of some individuals with PFRI scores of 3 to 5 tended to vary, increasing or decreasing by 1 unit.


2 • Oral Hygiene index


2 • Oral Hygiene index

1) (Greene and Vermillion, 1960) 2 ) OHI-S (Simplified) .(Greene and Vermillion,

1964) Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

1) (Greene and Vermillion, 1960)

The Oral Hygiene Index is composed of the combined Debris Index and Calculus index, each of these index is in turn based on 12 numerical determinations representing the amount of debris or calculus found on the Buccal and Lingual surfaces of each of three segments of each dental arch.

The Maxillary and the Mandibular arches are

each composed of three segments


Scores

Criteria for classifying debris

0 No debris or stain present.


Scores



1 Soft debris covering not more than one third of the tooth surface,

Or presence of extrinsic stains without other debris

regardless of surface area covered.Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

Scores



1 Soft debris covering not more than one third of the tooth surface, or presence of extrinsic stains without other debris regardless of surface area

covered.2 Soft debris covering more than one third, but not

more than two thirds, of the exposed tooth surface.Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

Scores

criteria for classifying debris




more than two thirds, of the exposed tooth surface.3 Soft debris covering more than two thirds of the

exposed tooth surface.Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

Scores

criteria for classifying calculus

0 No calculus present.


Scores



1 Supragingival calculus covering not more than third of the exposed tooth surface.


Scores




2 Supragingival calculus covering more than one third but not more than two thirds of the exposed tooth

surface or the presence of individual flecks of subgingival calculus around the cervical portion of

the tooth or both. Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

Scores

Criteria for classifying calculus

0 No calculus present




the tooth or both.

3 Supragingival calculus covering more than two third of the exposed tooth surface or a continuous heavy

band of subgingival calculus around the cervical portion of the tooth or both.


Scoring method

Total

Lt. Ant.

Rt .

Lingual

Buccal

Lingual

Buccal

Lingual

Labial

Lingual

Buccal

4 8 1 3 2 2 1 3 Upper5 4 2 1 1 1 2 2 Lower9 12 3 4 3 3 3 5 Total

Debris

The tooth used for the calculation must have the greatest area covered by debris.


Debris Index =

(The total of the upper and lower facial-scores) +

(The total of the upper and lower lingual-scores) /

(The number of segments scored).

Debris Index = (12+9) / 6= 3.5


Scoring method

Total

Lt. Ant

Rt .

Lingual

Buccal

Lingual

Buccal

Lingual

Labial

Lingual

Buccal

0 2 0 1 0 0 0 1 Upper5 0 2 0 2 0 1 0 Lower5 2 2 1 2 0 1 1 Total

Calculus

The method for scoring calculus is the same as that applied to debris,

but additional provisions are made for recording subgingival deposits.


Calculus Index =

(The total of the upper and lower facial-scores) +

(The total of the upper and lower lingual-scores) /

(The number of segments scored).

Debris Index = (2+5) / 6= 1.16


The average individual or group debris and calculus scores are combined to obtain Oral Hygiene Index,

as follows:

Oral Hygiene Index = Debris Index + Calculus Index 3.5 + 1.16 = 4.66


0 - < 2 Good

Scoring Range

The OH I score values range from 0 to 12:


Scoring Range

2 - < 4 Moderately Good


4- < 6 Fair

Scoring Range


6 - 12 Poor

Scoring Range


AdvantagesIs sensitive enough to reflect the cleansing efficiency of tooth brushing and the expected relation ship between cleanliness and periodontal disease.Is a simple , useful method for assessing a group of individual oral hygiene status quantitatively. Is a useful tool in programme evaluation ( in monitoring oral hygiene maintenance).


LimitationsExamination of all surfaces of all teeth present in The mouth.

Since it is tine consuming,It can not be used in epidemiological studies.


Limitations

Can not be used for mixed dentition.

Inter and Intra – ExaminerDifferences are more.


2 - OHI-S (Simplified) .(Greene and Vermillion,

1964) The Simplified Oral Hygiene Index (OHI-S) differs from the original OHI (The Oral Hygiene Index) in the number of the tooth surfaces scored (6 rather than 12), the method of selecting the surfaces to be scored, and the scores which can be obtained.The criteria used for assigning scores to the tooth surfaces are the same as those use for the OHI (The Oral Hygiene Index).

The six surfaces examined for the OHI-S

are selected from four posterior and two anterior teeth

In the absence of either of this anterior teeth, the central incisor (21 or 41 respectively) on the opposite side of the midline is substituted.sometimes the second (17) or third molar (18)

can be obtained. Prepared by : Ammar Rushdi AbdelfattahB.D.S. , MSc.

Scores





more than two thirds, of the exposed tooth surface.3 Soft debris covering more than two thirds of the

exposed tooth surface.Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

Scores

Criteria for classifying calculus





the tooth or both.

3 Supragingival calculus covering more than two third of the exposed tooth surface or a continuous heavy

band of subgingival calculus around the cervical portion of the tooth or both.


Scoring method

Total

Lt. Ant

Rt .

Lingual

Buccal

Lingual

Buccal

Labial Labial

Lingual

Buccal

- 8 - 3 - 2 - 3 Upper4 1 2 - 1 - 2 - Lower

Debris


Debris Index =

(The facial-scores) + (The lingual-scores) /

(Total number of examined facial and lingual surfaces).

Debris Index = (9+4) / 6= 2.2


Scoring method

Total

Lt. Ant

Rt .

Lingual

Buccal

Lingual

Buccal

Labial Labial

Lingul Buccal

- 2 - 1 - 0 - 1 Upper3 2 2 - 2 - 1 - Lower

calculus

The method for scoring calculus is the same as that applied to debris,

but additional provisions are made for recording subgingival deposits.


Calculus Index =

(The facial-scores) + (The lingual-scores) /

(Total number of examined facial and lingual surfaces).

Debris Index = (4+3) / 6= 1.2


The average individual or group debris and calculus scores are combined to obtain Oral Hygiene Index,

as follows.

Oral Hygiene Index = Debris Index + Calculus Index 2.2+ 1.2 = 3.4

0 - < 1 Good1 - < 2 Moderately good2 - < 3 Fair3 - 6 Poor


Advantages It is easy to use.

It may be used as an adjunct in epidemiological studies of periodontal disease.

It requires less time and hence can be used in field study , some times in selected clinical trials and program evaluation.


http://blog.flynirvana.in/wp-content/uploads/2009/03/2009-03-16-dental-camp-kamshet-053.jpg

AdvantagesIt determines the status of oral hygiene cleanliness in groups.

Useful in evaluation of dental health education procedure (immediate and long term effect ).Inter and Intra – ExaminerDifferences are less.Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

Limitations

Not appropriate for individual oral hygiene status evaluation.

Lack the degree of sensitivity as much as the original version.

Not appropriate for certain types of clinical studies ( clinical trials and research ) including detailed investigation of plaque or calculus formation.

Underestimation or overestimation of debris and calculus may occur.


3 • Dental fluorosis Index


3 • Dental fluorosis index

1) Deans’ fluorosis index

2) Community fluorosis index

3) TF (Thylstrup-Fejerskov) Index Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

symmetrical bilaterally opaque whit area in enamel (usually) .And tend to show (with level of F ingestion) a horizontal striated , mottled or pitted pattern across the tooth.

In severe fluorosis the opaque area may become stained yellow to dark brown.

Dental Fluorosis :


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Start of story

Frederick McKayLawrence, Massachusetts

1901 Phenomena1917 Etiology1931 Water


http://ar.wikipedia.org/wiki/%D9%85%D9%84%D9%81:Flag_of_Colorado.svg

http://upload.wikimedia.org/wikipedia/commons/5/55/Map_of_USA_CO.svg

Photo of Dr. G.V. Black's Greene_Vardiman_Black (left) 1909 visit of Dr. F. McKay (right) in Colorado Springs to

investigate the Colorado brown stain phenomenonPrepared by : Ammar Rushdi AbdelfattahB.D.S. , MSc.

http://upload.wikimedia.org/wikipedia/commons/a/ac/McKayandBlackCDC01.jpg


Dr. Frederick S. McKay Original caption: Dr. Frederick S. McKay's observations of the effects of fluoride in drinking water led to worldwide advances in dentistry. Dr. McKay's 1931 discovery that a high level of fluoride in the drinking water of the Colorado Springs area was causing brown stains, and resistance to tooth decay of tooth enamel among the native inhabitants, led to the modern fluoridation process.

After more than 25 years


H. Trendley Dean, D.D.S. (1893–1962).

Dean was a dental surgeon and epidemiologist who is associated with the

introduction of community water fluoridation.

Many systems are being used to describe dental fluorosis.The classification of mottled enamel developed by Dean in 1934 and later index of dental fluorosis in 1942 gained significant acceptance.Thus Dean’s index has been in use throughout the world and still being Used in many epidemiological studies since 1942

1) Deans’ fluorosis index


http://upload.wikimedia.org/wikipedia/commons/7/73/H-Trendley-Dean.jpeg

Objective : To asses the prevalence of dental fluorosis.

The criteria of dental fluorosis index / classification developed by Dean 1n 1934 was Based on 7 points ordinal scale ( Normal, questionable, very mild, mild, moderate,

moderately sever, sever ).

Six points ordinal scale came into existence in 1942and that is extensively used nowadays.

0 1 2 3

5

4

6


Code & Scoring criteria

for Dean's Fluorosis Index

0 Normal1 Questionable fluorosis2 Very mild fluorosis3 Mild fluorosis4 Moderate5 Severe fluorosis


Recommendation( W H O )

The recording is made on the basis of the two teeth that are most affected. If the two teeth are not equally affected, the score for the less affected of the two should be recorded.

When teeth are scored, the examiner should start at the higher end of the index, i.e. "severe", and eliminate each score until he or she arrives at the condition present.

If there is any doubt, the lower score should be given.


Scoring criteria

Includes teeth formerly classified as "moderately severe and severe." All enamel surfaces are affected and hypoplasia is so marked that the general form of the tooth may be affected. The diagnostic sign of this classification is discrete or confluent pitting . Brown stains are widespread and teeth often present a corroded-like appearance.

5 ) Severe

Major


http://www.fluoridealert.org/health/teeth/fluorosis/moderate-severe.html

http://upload.wikimedia.org/wikipedia/commons/1/1d/FluorosisFromNIH.jpg

All enamel surfaces of the teeth are affected, and the surfaces subject to attrition show wear. Brown stain is frequently a disfiguring feature.

4) ModerateMajo

r

Scoring criteria

NormalPrepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

http://www.fluoridealert.org/health/teeth/fluorosis/moderate-severe.html

The white opaque areas in the enamel of the teeth are more extensive but cover <

50% of the tooth.

Scoring criteria

MildMajo

r

Normal


http://www.fluoridealert.org/health/teeth/fluorosis/mild.html

Scoring criteria

Mild



http://upload.wikimedia.org/wikipedia/commons/f/ff/MildFluorosis02-24-09.jpg

Scoring criteria

Very MildSmall opaque, paper white areas

scattered irregularly over the tooth but < 25% of the tooth surface. Frequently included in this classification are teeth showing no more than about 1-2 mm of white opacity at the tip of the summit of the cusps of the bicuspids or second molars.Normal




Scoring criteria

Very Mild

Normal




Scoring criteria

Questionable

Normal

The enamel discloses slight aberrations from the translucency of normal enamel, ranging from a few white flecks to occasional white spots. This classification is utilized in those instances where a definite diagnosis of the mildest form of fluorosis is not warranted and a classification of "normal" is not justified.



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Questionable

Very Mild

MildPrepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.



Scoring criteria

NormalThe enamel represents the usual translucent semi - vitriform type of structure. The surface is smooth, glossy, and usually of a pale creamy white color.


http://upload.wikimedia.org/wikipedia/commons/1/11/Glass-of-water.jpg

NormalPrepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

*The scoring system ranged from 0 ( Normal enamel ) to 4 ( sever fluorosis )0.0 – 0.4 1-20.4 – 0.6 2-30.6 – 0.1 3-4

*Elimination of Moderately Sever Fluorosis . 5

moderately sever fluorosis

*Classification Questionable is often a baffling problem.

Limitations


2) Community fluorosis index

Purpose :To determine the severity of dental fluorosis as a public health concern and problem.

Proposed by : Dean also.

Calculation :CFI = (n*w) / N where:n = no of persons in each category.W = weight of scale (average score).N = the total population.


Scoring criteriaPublic health significant CFI

Negative 0.0 – 0.4Borderline 0.4 – 0.6

slight 0.6 – 1.0medium 1.0 – 2.0Marked 2.0 – 3.0

Very marked 3.0 – 4.0


AdvantagesCFI is widely used in epidemiological studies worldwide.

It is also used to asses the severity of fluorosis with level of fluoride in drinking water.

It is used to asses the correlation between caries and fluorosis.

It is of value while making comparisons between various studies.


The British Fluoridation Society; The UK Public Health Association; The

British Dental Association; The Faculty of Public Health (2004). “

The extent of water fluoridation”, One in a Million: The facts about water fluoridation

,

The extent of fluoridated water usage around the world. Colors indicate the percentage of population in each country that receives fluoridated water, where the fluoridation is to levels recommended for preventing tooth decay. This includes both artificially and naturally fluoridated water.


http://bfsweb.org/One%20in%20a%20million/7%20extent.pdf

http://bfsweb.org/onemillion/onemillion.htm

http://bfsweb.org/onemillion/onemillion.htm

1.5 mg / Lit considered as maximum permissible level for potable water.

Guidelines and Standards( W H O )

Ion MeterField Testing Kits

( SPANDS reagent method)


1

2

8

20

50

100

125

250

Water

Water

Water

Water or Food

Water or Food

Water or Food

Water or Food

Acute Dose

Source All values in mg/L

Death

Kidney Changes

Growth Retardation

Thyroid changes

Crippling skeletal fluorosis

10% osteosclerosis

Mottled enamel (dental fluorosis)Dental caries reduction

Fluoride concentration & health effects


0.421

P.pm

0.421

P.pm

Due to polluti

on

0.52

P.pm


Awareness creation of Fluorosis among Women


Limitations of Community fluorosis index

It does not provide information on distribution of fluorosis within the dentition.

Definition of pitting is necessary as the severe category is not clean in the 1942 diagnostic criteria.

It is not sufficiently sensitive in lower score.

Public health significant

CFI

Negative 0.0 –0.4

Borderline 0.4 –0.6

slight 0.6 –1.0

medium 1.0 –2.0

Marked 2.0 –3.0

Very marked 3.0 –4.0Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

Correlate

clinical appearance with

histo pathological changes

3) TF (Thylstrup-Fejerskov) Index

1978


Criteria Scor

eNormal translucency of enamel remains after prolonged air-drying.

0

Narrow white lines corresponding to the perikymata. 1

Smooth surfaces: More pronounced lines of opacity that follow the perikymata. Occasionally confluence of adjacent lines.Occlusal surfaces: Scattered areas of opacity <2 mm in diameter and pronounced opacity of cuspal ridges

2

Smooth surfaces: Merging and irregular cloudy areas of opacity. Accentuated drawing of perikymata often visible between opacities.Occlusal surfaces: Confluent areas of marked opacity. Worn areas appear almost normal but usually circumscribed by a rim of opaque enamel.

3

Smooth surfaces: The entire surface exhibits marked opacity or appears chalky white. Parts of surface exposed to attrition appear less affected.Occlusal surfaces: Entire surface exhibits marked opacity. Attrition is often pronounced shortly after eruption.

4

Clinical Criteria and Scoring


Criteria ScoreSmooth surfaces and occlusal surfaces: Entire surface displays marked opacity wtih focal loss of outermost enamel (pits) <2 mm in diameter

5

smooth surfaces: Pits are regularly arranged in horizontal bands <2 mm in vertical extension.Occlusal surfaces: Confluent areas <3 mm in diameter exhibit loss of enamel. Marked attrition

6

Smooth surfaces: Loss of outermost enamel in irregular areas involving <1/2 of entire surface.Occlusal surfaces: Changes in the morphology caused by merging pits and marked attrition

7

Smooth and occlusal surfaces: Loss of outermost enamel involving >1/2 of surface

8

Smooth and occlusal surfaces: Loss of main part of enamel with change in anatomic appearance of surface. Cervical rim of almost unafffected enamel is often noted

9


4 • Dental aesthetic Index


Designed by Cons NC , Jenny J , Kohont FJ with the aim of specifically measuring dental aesthetic using objective physical measurements .

Dental aesthetic index was initially based on dental record (study cast ) from Caucasian adolescent in the united states.

4 • Dental aesthetic index


http://www.whitehousedentaloptical.com/images/study_cast.jpg

Early :“It does not recognize any index rating classificationOr coding system as scientifically valid measure of need for orthodontic treatment.”



*Adopted by WHO *Simple*With high examiner reliability*Used in both epidemiological studies and small hospital based group.



http://blog.flynirvana.in/wp-content/uploads/2009/03/2009-03-16-dental-camp-kamshet-053.jpg

1 • Missing visible teeth

2 • Anterior crowding

3 • Anterior spacing

4 • Diastema

5• Largest anterior

irregularity on the maxilla


6• Largest anterior

irregularity on the mandible

7 • Anterior maxillary over jet

8 • Anterior mandibular overjet

9 • Vertical anterior open bite in mm

10 • Anteroposterior molar relation.


1) Missing visible teeth(With or without spacing)

Physical Measurements of Occlusal traits


2) Anterior crowding



3) Anterior spacing



4) Diastema



http://gotoknow.org/file/thanida018/diastema-closure-before.jpg

6) Largest anterior irregularity on the

mandible

5 ) Largest anterior irregularity on the

maxilla



7) Anterior maxillary overjet



8) Anterior mandibular over jet



9) Vertical anterior open bite in mm



10) Anteroposterior molar relation

physical measurements of

occlusal traits


procedure

Obtained from the study cast model or directly from individual .


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13 35 52

• Dental Aesthetic

index Range


Measuring of observation is the crux of science.

In studies of the oral disease , a true count of lesions in a population is almost never achieved .

Any one of count of disease in a group is , there , an estimate of condition rather than absolute truth.


Ideal index should posses certain criteria such as: Simplicity , Objectivity ,Validity , Reliability and Sensitivity.

Other terms such as reversible and irreversible are used in the literature to describe indices .

5.015.01

5.02



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Thus measurement of oral health is recognized as critical feature of numerous dental activities.

Describing normal biological process

Understanding the

nature history of

the disease

Planning and evaluation of oral health services

Planning and evaluation of oral health services

Describing normal biological

processUnderstanding

the nature

history of the

disease

References

*Greene JC, Vermillion JR. The oral hygiene index: a method for classifying oral hygiene status. J Amer Dent Ass 1960; 61: 29-35. *Greene JC, Vermillion JR. The simplified oral hygiene index. J Amer Dent Assoc 1964; 68: 7-13. *Silness J, Löe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964; 22: 121-135. *Turesky S, Gilmore ND, Glickman I. Reduced plaque formation by chloromethyl analogue of victamine C. J Periodontol 1970; 41: 41-43. O' Leary T, Drake R, Naylor. The plaque control record. J Periodontol 1972; 43: 38-39 Prepared by : Ammar Rushdi Abdelfattah

B.D.S. , MSc.

References

*dental.com/articles/rate_of_accumulation_plaque_formation_rate_index.html*"Oral Health Surveys - Basic methods", Geneva 1997.*Oral hygiene index a method for classifying Oral hygiene status *Text Bock of community and preventive dentistry (Jussive). * WHO website


AbbreviationsSlide No Meaning Abbreviation

31 D G J39 Plaque Formation

Rate IndexP F R I

63 Oral Hygiene Index O H I

70 Oral Hygiene Index(Simplified)

O H I - S

104 Community Fluorosis Index

CFI

109 Part per million P.pm116 (Thylstrup-

Fejerskov )IndexTFI


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Dental Indices: Dr. Ammar Rushdi Abdelfattah

Health & Medicine

Transcript of Dental Indices: Dr. Ammar Rushdi Abdelfattah