2. 1. An Index can be defined as a numerical value describing
the relative status of a population on a graduated scale with
definite upper and lower limits, which is designed to permit and
facilitate comparison with other populations classified by the same
criteria and methods. (Russal A. L) 2. An Index is an expression of
clinical observation in numerical values which is used to describe
the status of the individual or group with respect to a condition
being measured. (Wilkins Esther M.)
3. 3. Dental Index is an abbreviated measurement of the amount
or condition of disease in a population; a numerical scale with a
defined upper and lower limits designed to permit and facilitate
comparison with other population classified by the same criterion
and methods. (Zarkowski Pamela) 4. Epidemiologic Indices are
attempts to quantitate clinical conditions on a graduated scale,
thereby facilitating comparison among populations examined by the
same criterion and methods. (Glickman Irving)
4. 1. To increase understanding of the disease process. 2. To
discover populations at high and low risk. 3. To define specific
problem under investigation.
6. Measures the conditions that can be changed Indices for
periodontal conditions Reversible Measures the conditions that will
not change. Dental caries index Irreversible A. Depending upon the
directions in which the scores can fluctuate
7. Measures patients entire periodontium or dentition Russels
Periodontal index Full Mouth Measures only a representative sample
of dental apparatus Greene and Vermillions oral hygiene
index-Simplified Simplified B. Depending upon the extent to which
areas of oral cavity are measured
8. Disease Index Symptom Index Treatment Index C. Depending
upon the entity they measure
9. D. Special Category Indices Measures the presence or absence
of a condition. Index measuring presence of dental plaque without
an evaluation of its effect on gingiva. Simple Index Measures all
the evidence of a condition, past and present. DMF index for dental
caries Cumulative Index
10. INDICES FOR DENTAL
11. It is a dyanamic process of demineralisation due to
microbial metabolism resulting in net mineral loss which
subsequently may not always lead to cavitation Frejeskov 1997
DENTAL CARIES
12. Dental caries is an irreversible microbial disease of
calcified tissues of the teeth, characterised by demineraliasation
of the inorganic portion and destruction of the organic substance
of the tooth, which often leads to cavitation SHAFERS
13. HISTORICAL BACKGROUND OF CARIES INDICES. BODECKER CF and
BODECKER HWC described a Caries Index in 1931 Modified it later by
addition to counting of decayed surfaces. DEAN HT Counting carious
teeth visibly in the mouth MELLANBY M In 1934 described the carious
lesions depending upon the degree of severity 1 = Slight caries 2 =
Moderate caries 3 = Advanced caries
14. First systematic description - DMF index Attributed to
Knutson JW, Henry Klein and Carole Palmer in their studies of
dental caries in Hagerstown and Maryland (1930) FINALLY.
15. MOST COMMONLY USED OTHER MIXED DENTITION INDICES DMFT 1.
Primary Teeth (dmft & dmfs) 2. Permanent Teeth (DMFT &
DMFS) 1. Stones Index 2. Caries Severity Index 3. Czechoslovakian
Index 4. Caries Susceptibility Index 5. Modified DMFT Index 6.
Functional Measure Index 7. Tissue Health Index 8. Dental Health
Index 9. DMFS Percentage Index 10.Mollers Index 11.Restorative
Index INDICES FOR DENTAL CARIES
16. DIAGNOSING PIT AND FISSURE CARIES : -CRITERIA ANGLO-SAXON
SYSTEM {LIBERAL} By Horowitz H.S. In 1972 The pits and fissure on
the occlusal, vestibular and lingual surfaces are carious when- 1
The explorer catches after insertion with moderate to firm pressure
. 2. When the catch is accompanied by one or more of the following
signs of decay a) Softness at the base of the area. b) Opacity
adjacent to the area provides evidence of undermining or
demineralization. c) Softened enamel that can be scraped by
explorer. NOTE : - Areas should be diagnosed as soundwhen there is
apparent evidence of demineralisation but no evidence of
softness.
17. DIAGNOSING PIT AND FISSURE CARIES : -CRITERIA EUROPEAN
SYSTEM {CONSERVATIVE} By Backer-Dirks O., Houwink B., Kwant G.W. in
1961 Teeth are first dried and sharp new explorers are used Upper
molars : Mesio-occlusal and disto-occlusal-palative fissures are
assessed separately. Lower molars : Occlusal fissures and buccal
pits are assessed separately. C I - Minute black line at the base
of fissure C II - In addition, a white zone along margins of
fissure. C III - Smallest precipitable break in the continuity of
enamel. C IV - Large cavity, more than 3mm wide.
18. SOME OTHER IMPORTANT INDICES 1. Root Caries Index (RCI) 2.
Dental Caries Severity Index For Primary Teeth
19. Developed to determine the prevalence of coronal caries. Is
a simple, rapid, versatile, universally accepted and widely used
index for several decades. It is used to determine total dental
caries experience past and previous. The DMFT Index is an
irreversible index (meaning that it measures total lifetime caries
experience). The tooth either remains decayed or if treated it is
extracted or filled.
20. Procedure The DMFT Index is applied only to permanent teeth
is composed of three components.
21. Examination of DMFT Index has to be done with : - 1.
Favorable lighting conditions 2. A No. 3 plain mirror 3. A
Fine-pointed pig-tail explorer
22. Third molars and Unerupted teeth Congenitally, missing and
supernumerary teeth Teeth removed for reasons other than dental
caries Teeth restored for reasons other than dental caries Primary
tooth retained with permanent successor erupted. All 28 teeth are
examined. Teeth not to be included
23. Principles and Rules in recording DMFT:1. No tooth must be
counted more than once. It is either decayed, missing, filled or
sound. 2. Decayed, missing, and filled teeth should be recorded
separately since the components of DMF are of great interest. 3.
When counting the number of decayed teeth, also include those teeth
which have restorations with recurrent decay. 4. Care must be taken
to list as missing only those teeth which have been lost due to
decay. 5. Also included should be those teeth which are so badly,
decayed that they are indicated for extraction.
24. The following should not be counted as missing: a)
Unerupted teeth b) Missing teeth due to accident c) Congenitally
missing teeth d) Teeth that have been extracted for orthodontic
reasons. 6. A tooth may have several restorations but it is counted
as one tooth. 7. Deciduous teeth are not included in DMF count. 8.
A tooth is considered to be erupted when the occlusal surface or
incisal edge is totally, exposed or can be exposed by gently,
reflecting the overlying gingival tissue with the mirror or
explorer. 9. A tooth is considered to be present even though the
crown has been destroyed and only the roots are left.
25. WHO modification of DMF Index (1986)1. All third molars are
included. 2. Temporary restorations are considered as decayed 3.
Only, carious cavities are considered as D', the initial lesions
(Chalky spots. stained fissures, etc) are not considered as D'. The
DMF Index can be applied to denote the number of affected teeth
(DMFT) or to measure the surfaces affected by dental caries
(DMFS).
26. For tooth absent , O Missing Tooth - unerupted , impacted ,
congenitally missing. X Extracted permanent tooth. E Excluded tooth
or tooth space 1 Sound permanent tooth 2 Filled permanent tooth 3
Decayed permanent tooth
27. Calculation of the Index Individual DMFT: total D+M+F= DMF.
Group Average: Total DMF Total number of the subjects examined
Percent Needing Care Total number of decayed tooth Total number
examined Percentage of teeth lost: Total number of missing teeth
Total number examined Percent of filled teeth : Total number of
filled teeth Total DMFT
28. Missing permanent teeth/100 Total number of missing teeth X
100 Total number examined The maximum possible DMFT score is 32 (
if third molars are included ) DMFT score is 28 ( if third molars
are excluded)
29. Advantages of DMFT index 1. Because of its wide spread use
world wide over the past 60 years , it provides a reasonably
accurate historical account of changes in prevalence of dental
caries.
30. Limitations of DMFT Index: 1.DMFT values are not related to
the number of teeth at risk. 2. DMFT index can be invalid in older
adults because teeth can become lost for reasons other than caries.
3. DMFT index can be misleading in children whose teeth have been
lost due to the orthodontic reasons. 4. DMFT index can over
estimate caries experience in teeth in which "preventive fillings"
have been placed. 5. DMFT Index is of little use in studies of root
caries.
31. OTHER METHODS OF DMF EXMINATION Shorthand' Methods 1.
Intended for use in surveys where basic prevalence is assessed. 2.
Based on examination of selected teeth only 3. Objective is to
decrease the time taken for each examination and still provide
valid data.
32. I. WORLD HEALTH ORGANISATION (WHO) has described a
shorthand method 1. Recommends the use of "half-mouth" DMF in its
basic survey techniques. 2 Objective is to obtain assessments of
caries prevalence in a population which has not been previously
surveyed. 3. Half the upper arch only is scored. then the contra
lateral lower half arch and the results doubled. It is Quicker and
easier than full-mouth DMF Index.
33. More sensitive Usually the index of choice in a clinical
trial of caries preventive agent. Used to determine total dental
caries experience past and present by recording tooth surface
invloved instead of teeth.
34. Procedure
35. DMFS is a more detailed index than the DMFT by summing the
total number of decayed. missing and filled permanent tooth
surfaces. As in the case of the DMFT Index, the DMFS index is
simple and versatile and more sensitive, has practically, universal
acceptance. and is one of the best-known dental indices today.
36. DMFS Index - The Index of ChoiceThis is because relative
incidence is more likely to be detected over the limited time
period of a clinical trial. But a DMFS examination takes a longer
is more likely to produce inconsistencies in diagnosis and may
require the use of radiographs to be fully accurate
37. 1. For Posterior teeth: Five surfaces examined and
recorded: facial, lingual Mesial, distal and occlusal 2. For
Anterior teeth: Four surfaces examined and recorded: facial,
Lingual, mesial and distal.
38. Calculation of DMFS Index: 1. Individual DMFS Index : DMFS
score = D+M+F 2. Total surface count for a DMFS Index (If 28 teeth
are examined) 16 posterior teeth (16*5=80) 12 Anterior teeth
(12*4=48) Total= 128 surfaces 3. Total surface count for a DMFS
Index (If 32 teeth are examined) If third molars are included
(4*5)=20surfaces Total = 128 + 20 = 148 surfaces
39. Established modification: Procedural modifications can be
made to the DMFS index to allow for factors such as secondary
caries , crowned teeth , bridge pontics , and any other particular
attribute required for study . To save time in large surveys, the
DMFS can be used half-mouth , applied to opposite diagonal
quadrants and the score doubled an approach that assumes that
caries incidence is bilateral.
40. Disadvantages 1. DMFS examination takes a longer time and
is more likely to produce inconsistencies in diagnosis and may
require the use of radiographs to be fully accurate. To save time
in larger surveys, the DMFS can be used half- mouth , applied to
opposite diagonal quadrants and the score doubled . This is based
on the assumption that caries incidence is bilateral 2. A tooth
scores exactly the same under extremes of clinical conditions; a
tooth with small restoration in one pit rates the same as a tooth
that has been extracted. 3. Provides little or no additional
information in prevalence studies where the extent of caries is
being compared between groups.
41. 4. Has a wide range of possible values and hence a larger
standard deviation and standard error. 5. One of the difficulties
encountered in use of this surface index is the score to be
allocated to teeth indicated for extraction, which may have been
attacked on one surface only, although its extraction results in
the loss of four or five surfaces , according to the tooth. 6.
Another difficulty is the score to be given to two surface fillings
in posterior teeth, where the initial attack was probably on one
proximal surface and the occlusal surface was involved later, to
provide an adequate class II type of cavity or restoration.
42. CARIES INDICES FOR PRIMARY DENTITION def index GRUEBBEL
A.O. in 1944
43. The Caries Indices used for primary dentition are 'deft'
index and 'defs' index equivalent to the DMFT and DMFS indices used
for permanent dentition. The basic principles and rules for def
index are the same as that for DMF index.
44. d decayed Indicates the number of deciduous teeth that are
decayed. In counting the number of decayed deciduous teeth - a
tooth can only be counted once. It cannot be counted as filled and
decayed. If it has been restored and caries can be detected count
it as decayed. The explorer should fall into carious tooth
substance and not just in a deep groove before counting occlusal
caries.
45. 'e' extraction Indicates those deciduous teeth which have
been extracted due to caries or which are so badly, decayed that
they are indicated for extraction. Because of the wide variation in
the time of exfoliation of deciduous teeth. It is difficult to
determine whether a tooth missing from the deciduous dentition was
normal, exfoliated or was extracted because of advanced caries. If
it can be accurately established that a missing deciduous tooth has
been lost due to caries. include it with those indicated for
extraction
46. f filled Indicates the number of deciduous teeth that have
been attacked by caries but which have been restored without a
recurrent decay present. A tooth may have several fillings but it
is counted as one tooth. If a tooth has a filling but shows
evidence of recurrent decay. It is counted as a decayed tooth.
47. Modifications of def index dmf index For use in children
before ages of exfoliation i.e. children over 7 years and upto 11
or 12 years df index In this index the missing teeth are ignored.
df index can be applied to whole tooth as : decayed filled- tooth
(dft index) or to individual surfaces as : decayed filled surfaces
(dfs index)
48. Disadvantages (def and dmf indices) 1. It is difficult to
determine whether the primary tooth has been extracted or shed
naturally, by this index.
49. The D1-D3 Scale was first published by WHO in 1979 as an
aid to diagnosing coronal caries. Traditionally used among European
investigators who diagnose dental caries from the earliest
detectable non-cavitated lesion through to pulpal involvement ,said
to be of extreme value in research studies because it permits
identification of lesion progression as well as initiation.
Involves a lengthy & detailed examination, requires meticulous
examiner training DENTAL CARIES SEVERITY CLASSIFICATION SCALE
50. 0-surface sound : no evidence of treated or untreated
clinical caries. D1-initial caries : no clinically detectable loss
of substance For pits & fissures, there may be significant
staining, discolouration, rough spots in the enamel that do not
catch the explorer but loss of substance cannot be positively
diagnosed. D2-Enamel caries : demonstrable loss of tooth substance
in pits, fissures or on smooth surfaces, but no softened floor or
wall or undermined enamel. The texture of the material within the
cavity may be chalky or crumbly, but there is no evidence that
cavitation has penetrated the dentin.
51. D3-caries of dentin : detectably softened floor, undermined
enamel or a softened wall, or the tooth has a temporary filling. On
proximal surfaces, the explorer point must enter a lesion with
certainty D4-pulpal involvement : deep cavity with probable pulpal
involvement. pulp should not be probed (usually included with D3 in
data analysis)
52. Stone H. H, Lawton F. E, Bransby E. R. and Hartley H.O.
1949.
53. Score Criteria 1 One point to one or more cavities in the
same tooth detectable by sharp probe where the lesion has not
penetrated through the enamel to involve the dentine. 2 Two points
to one or more cavities in the same tooth where the dentine is
involved, where a total of less than a Quarter of the crown is
estimated to have been destroyed 3 Three points to one or more
cavities in the same tooth resulting in a total destruction of more
than a Quarter of the crown Scoring Criteria
54. CARIES SEVERITY INDEX Tank Certrude and Storvick Clara in
1960
55. a. This index was developed to study the depth and extent
of the caries surfaces and the extent of pulpal involvements. b.
The progress of the dental caries in stages as described by Massier
and Schour in 1952 were modified and this caries severity index was
devised to measure the extent and depth of decayed surfaces and
pulpal involvements based on clinical and radiographic
examinations.
56. Score Criteria 1 Superficial (caries in enamel) 2 Moderate
(caries in enamel and superficial dentine) 3 Moderately severe
(enamel undermined) 4 Severe (approaching pulp,enamel,collapsed) 5
Pulpitis(caused either by deep seated caries or by trauma without
caries) 6 Death of pulp (caused either by deep seated caries or by
trauma without caries) 7 Periapical infection (caused either by
deep seated caries or by trauma without caries) Scoring
Criteria
57. CZECHOSLOVAKIAN CARIES INDEX: Poncova, Novak and Matena in
1956.
58. This index is mainly used to compare caries experience in
one group with that of the other groups with a similar population
density but living in different environments. In this index the
"variables" seems to be controlled. In all examination studies and
tests in which this index is used, the average number of teeth,
tooth surfaces and tooth areas and the condition of previously
extracted or crowned teeth were considered.
59. The proposed formula can be applied as a basis for an
individual or a collective index. In individual examination. the
"Base" is given by the amount of teeth in adult dentition (32) and
in collective studies, the "Base" is the number of persons examined
multipled by 32 to establish the correct base figure. The average
index value will then be between 0 to I. The nearer, the index is
to 1 the higher the caries frequency. The following formula serves
as the basis for this caries index (in adults): 1- C - FC - 4/ 5 E
- 2 / 3 AT Base (C- Caries: FC - Fillings and Crowns; E
Extractions; and AT - Anchorage teeth).
60. CARIES SUSCEPTIBILITY INDEXRichardson A. in 1961
61. 1. This index is based on Bodecker and Mellanby caries
indices. 2. There are 2 factors involved in measuring caries
susceptibility using the dynamic survey, namely a) Amount of tooth
surface at risk. b) Amount of caries developing during the period
of observation.
62. Method: Each tooth is divided into various surfaces, to use
one caries tooth surface as the unit of measurement. Susceptible
surfaces are scored as follows: Incisors - Mesial. Distal. Lingual.
labial = 4 Canine - Mesial, Distal, lingual, labial = 4 Premolar -
Mesial, Distal, Lingual. Buccal Occlusal = 5 Molar - Mesial,
Distal, Lingual. Buccal, Occlusal = 5 Full permanent dentition thus
would have 148 susceptible surfaces and full deciduous dentition
would have 88 susceptible surfaces.
63. D-M-F SURFACE PERCENTAGE INDEX Jagger CL in 1963
64. Method : All the teeth are given surface values (SV) -The
incisors and canines are given four values. -The premolars and
molars are given five values. 1. Deciduous and permanent teeth are
treated alike and a mixed dentition does not upset this index. 2.
Caries teeth are allotted ONE carious surface value (CSV) for every
surface attacked by caries. 3. Missing teeth are allotted
equivalent to their total surface values (missing teeth lost other
than caries are not included). 4. Restored teeth are treated as
carious teeth. 5. Inter proximal cavities of incisors are given 3
(CSV) values and of premolars and molars are given 2 (CSV)
65. In the suggested DMFS percentage index: The age of the
subject is considered,since different numbers of surfaces are
present at different ages The simplified age factors for different
age groups are as follows: AGE AGE FACTOR 6 to 71/2 months 6 7 to 9
months 3 12 to 14 months 2 16 to 18 months 1.5 20 months to 5 years
1 6 to 11 years 0.9 12 to 16 years 0.8 17 years 0.7
66. Calculation: To determine the DMFS percentage caries index
of an individual, total the carious surface values and multiply by
the age factor for the particular individuals age group.
67. RESTORATIV E INDEX D. Jackson in 1973
68. a) RI=F/F+D b) Measures the proportion of attached
teeth(F+D) which are filled(F) c) Does not depend on DMF index
& hence can be used at all ages d) RI is not a weighted
index,it is a simple proportion with a definite meaning e) It is
the objective of the unmet restorative treatment needs (UTN) used
by Glick et al in 1972,which is D/F+D% f) The restorative index as
a community index: The RI can be used to measure the level of
restorative care in any community and for any subsection of a
community at any age
69. MODIFIED DMFT INDEX Joseph Z. Anaise in 1983.
70. DMFT index by Klein and Palmer Is simple and most widely
used in epidemiological surveys of dental caries It quantifies
dental health status based on the number of decayed missing and
filled teeth. Drawbacks of DMFT index Does not provide an accurate
description of previous dental care. Does not provide information
regarding severity of carious attack or the indicated treatment. To
overcome these drawbacks of DMFT index the modified DMFT index was
developed.
71. Basically this modified DMFT index involves the same
operational procedures as common DMFT index. The only difference is
in the scoring criteria for D component of index , which is divided
into 4 separate categories as follows : - C = Unfilled teeth that
are carious CF = Teeth that are carious around the margins of
restorations or primarily on a tooth surface other than restored
one. IX - Carious teeth either filled or unfilled that in the
examiners opinion are indicated for extraction IRC - Carious teeth
either filled or unfilled that in the examiners opinion are
indicated for pulp treatment or RCT.
72. Advantages 1. The index remains simple and yet provides
description of previous dental experience. 2. It further shows the
extent of dental services needed by the population, which can be
interpreted in terms of treatment hours and costs. 3. In addition
to these four categories, the remaining two categories of DMFT
index (F- filled teeth with no decay and M- Missing teeth) are
recorded as usual according to the WHO criteria. 4. The DMFT score
is then, the summation of all six categories and the calculation of
the individual components as well as sum remains essentially the
same as the original DMFT index.
73. DENTAL CARIES SEVERITY INDEX FOR PRIMARY TEETH Aubrey
Chosack in 1985.
74. METHOD Caries seen on the buccal,lingual and palatal
surfaces or proximal caries is only scored for these surfaces when
normal pits or fissures of these surfaces are affected or included,
or when the caries extends along atleast half the gingival third of
these surfaces
75. Only the largest caries involment is scored for any one
surface. Scores of two or more lesions on one surface are not
combined A filled surface is given a score of 1, secondary caries
at the margin of restoration is given a score of 2 A full crown
restoration gives a total score of 5 for that tooth and the total
tooth score of 6 is given to a tooth extracted because of caries.
These scores are based on the clinical experience of the earlier
levels of caries severity resulting in these types of
treatment
76. Score for each tooth is total of the scores of all the
surfaces Although a theoretical score of 15 is possible for molars
and 12 for canines and incisors, part of the tooth material loss
may have occurred because of fracture of unsupported surface,
rather than caries of that surface.
77. A ) Occlusal surfaces & pit and fissure caries on
buccal or palatal surfaces of molars: 1 - 2 - 3 - early pit and
fissure caries where explorer catches or resists removal with
moderate or firm pressure, and is accompanied by either a softness
at the base of the areas or an opacity adjacent to the pit or
fissure as evidence of undermining or demineralization or softened
enamel adjacent to the pit or fissure which may be scraped away
with the explorer. cavitation of atleast 1mm across the smallest
diameter at the tooth surface cavitation with breakdown or
undermining (as seen by obvious discolouration) of atleast half a
cusp
78. B) Buccal,lingual and palatal smooth caries 1 a white
lesion not extending to the embrasure areas,found to be soft and
sticky by penetration with the explorer 2 cavitation of atleast 1mm
but less than 2mm across the smallest diameter, or a soft sticky
white lesion extending into one embrassure 3 cavitation of atleast
2mm in the smallest diameter or a soft sticky white lesion
extending into both embrasures
79. C) Proximal surfaces of molars: 1 a discontinuity of the
enamel in which an explorer will catch and there is softness 2
cavitation with early breakdown of marginal ridge or obvious
discolouration indicating undermining of the ridge 3 breakdown of
the marginal ridge with cavitation extending to mesial or dental
extensions of occlusal fissures
80. D. Proximal surfaces on incisors and canine 1 a
discontinuity of the enamel in which an explorer will catch and if
there is softness 2 cavitation with breakdown or obvious
discolouration, indicating undermining for atleast 1mm on the
buccal or lingual surfaces 3 cavitation with breakdown of incisal
edge or undermining of the edge is indicated by obvious
discolouration
81. Thus a maximum of 12 is scored for molars and a maximum of
9 for canines and incisors If caries has resulted in complete
breakdown of the crown,leaving only roots,the maximum score is
recorded for this tooth The CSI for the population is the mean of
the scores for the caries teeth.Teeth free of caries are not
included in this calculation.
82. MOLLER S INDEX Moller IJ and Poulsens S 1966
83. Advantages 1. The basis for the development of this system
was to make available a system which could be used in many
different situations . 2. It is flexible in meeting the various
needs of different types of clinical studies on dental caries. 3.
The diagnostic criteria are specified for * pit and fissure
surfaces * smooth surfaces * radiographic evaluation of proximal
surfaces 4. Untreated carious lesions are divided into 4 types Type
1 ,2,3,4 which makes it possible to exclude certain types of
carious lesions in either diagnosis or during the analysis.
84. Disadvantages 1. It involves use of radiographs.
85. RECENT ADVANCES 1. Tissue Health Index 2. Dental Health
Index 3. Oral Health Status Index 4. Functional Measure Index
86. 1.Oral health status index Marcus M, Koch AL, Gershen JA in
1980. The index includes 3 component of DMFT and 15 other variables
such as Temperomandiular dysfunction, Degree of periodontal disease
and Tumors.
87. 2. Functional measure index Sheiham A, Maizels J, and
Maizels A in 1987 FIRST ALTERNATIVE TO DMFT Definition- Is defined
as the aggregate of healthy restored (i.e filled) teeth (otherwise
sound) and sound teeth with no decay. Was the first composite
indictor index to measure dental health and functional status
rather than disease. In FMI the filled and sound teeth are weighted
equally, while the decayed and the missing teeth are given zero
weight .
88. Formula- FMI = Filled + Sound 28 The FMI score ranges from
- 0 to 1 Advantage Disadvantage 1. More reliable indicator of
dental health status than conventional DMFT 2. More efficient at
revealing the antecedent and behavioural facts that are associated
with dental health status. 1. Very little research can be found
utilizing this index. 2. According to some it is a sound approach
to measuring dental health and function rather than the disease hat
probably deserves more attention.
89. 3. Tissue Health Index Was Sheiham A, Maizels J and Maizels
A in 1987 second alternative to DMFT index. Definition - defined as
the weighted average of decayed teeth, filled (other wise sound)
teeth and sound teeth. Purpose - To assess dental health status
rather than dental disease in relation to caries.
90. Principle The weights represents the relative amount of
sound tissue surrounding these three categories of teeth. that
means- Sound teeth contains- more sound tissue Filled tooth
contains more sound tissue compared to decayed tooth. Missing tooth
contains no sound tissue In THI selective weights are given to the
3 components as follows 1 Decayed 2- Filled 4- Sound
91. Formula to calculate THI THI = 1/4( 1X decayed + 2 X filled
+ 4X sound) 28 Third molars are not considered.
92. Advantages 1. More reliable indicator of dental health than
the conventional DMFT. 2. More efficient at revealing the
preliminary and behavioural factors that are associated with the
dental health status. For example- categories of decayed, filled
and missing teeth are each assigned equal weights to derive DMFT
score. 3. So the transformation of decayed tooth into a filled
tooth by restoration has no effect on the DMF value. 4. In
addition, the DMF value, specifically the number of filled teeth,
distorts the disease experience score of those who have regular
dental checkups and who observe a preventive approach to their
dental health.
93. 4. Dental Health Index (DHI) Carpay JJ , Nieman FHM, Konig
KJ, Felling AJ and Lammers JGM in 1988. This index uses selected
teeth for developing the index. Any number of teeth may be examined
and the denominator is adjusted accordingly. This index was
developed to minimize the difference between sound and affected (or
extracted )teeth .
94. Formula- DHI = (Sound teeth)- (decayed +filled+ missing
teeth) Sound+ decayed+ filled+ missing teeth DHI is the ratio of
sound teeth minus unsound teeth divided by the total number of
teeth examined. SCORE Sound teeth given score of +1 Affected
(extracted teeth) of - 1
95. ROOT CARIES INDEX (RCI) Ralph V Katz in 1979
96. 1. This was to make the simple prevalence measures for root
caries more specific by including the concept of teeth at risk for
root caries. 2. This index is specifically designed for analytical
epidemiological studies in which risk factors and causes of
diseases are being studied. 3. This index can be computed for an
individual, for a particular tooth types, or for a population at
large. 4. An RCI of 7% means that all of the teeth with gingival
recession, 7% were decayed or filed on the root surface.
97. Procedure: To obtain the RCI each of the four surfaces the
mesial, distal, buccal (labial), and lingual of a root are examined
for a single tooth. All teeth are examined in both the lower and
upper arch. It is the suggested rule that when multiple root
surfaces are exposed, the most severely affected root surface be
recorded for that tooth even though this occurrence is judged to be
rare.
98. A designation of missing (M) is made for the whole tooth
and not for a single surface. The root surfaces are characterized
and recorded as missing M Showing no association with gingival
recession NoR Recession present, surface decayed R-D Recession
present, surface filled R-F Recession present, surface normal or
sound R-N
99. Therefore, once a tooth is observed to be missing, all the
root surfaces are recorded as missing. A judgement of no recession
(NoR) is made if the cemento-enamel junction (CEJ) cannot be
observed. In addition, if calculus is present in the absence of any
other findings on a recessed root surface. a judgement of sound
(R-N) is made on the assumption that decay is not found underneath
the band of calculus. Once the above information is collected and
recorded, as illustrated in the following formula, the RCI is
obtained by adding the number of root lesions and restorations and
dividing that number by number of root surfaces with gingival
recession in decayed. filled, and sound teeth.
100. The data collected is entered on a format for each tooth
examined, as given below: M D B L R-N R-F R-D NOR
101. 108 The columns represent four surfaces: M Mesial.
D-Distal. B- Buccal. L- lingual. The rows represent the conditions
that could occur on the surfaces: R-N = Recession present; surface
normal Or sound R-D= Recession present: with a decayed root surface
R-F = Recession present; with a filled root surface NoR=No
association with gingival recession
102. Diagnostic conventions proposed for RCI Ralph V Katz in
1986 presented the following conventions for RCI Convention Number
1 : If the diagnosis of caries or of filled is uncertain, score the
surface as 'sound'. Convention Number 2 : All caries detected on
root surfaces near the Cemento- EnamelJunction (CEJ) shall be
scored as 'decayed' regardless of the adjacent enamel condition.
Convention Number 3 : For any coronal filling which extends on to a
root surface, the filling material must extend more than 3 mm,
beyond the CEJ in order to score that root
103. Convention Number 4 : In order to score a filling as
involving multiple surfaces, the filling must extend across at
least 1/3 rd of each additional surface. Convention Number 5a :
Recurrent decay associated with a fOot surface filling should be
recorded as an independent disease category called "Recurrent Root
Decay
104. Convention Number 5b : Recurrent decay associated with a
coronal filling (i.e. a coronal filling extending less than 3 mm
onto the root surface) or a crown should be recorded as an
independent disease category called "Root Decay Contiguous with
Coronal Filling". Convention Number 6 : For any root surface that
is decayed. the events of an additional but separate root lesion is
recorded as an independent disease category called" Additional Root
Caries Lesion".
105. REFRENCES Essentials of preventive & community
dentistry -Soben Peter. 3rd edition S.S Hiremath
106. In order to use the ICDAS criteria in epidemiological
surveys the following conditions are essential to enable examiners
to assess each of the caries codes accurately: overhead operating
light; cleaned teeth and compressed air. The ICDAS codes can be
used to examine cleaned teeth in other conditions but the data
recorded this way is unlikely to be comparable with other ICDAS
examinations. Variation from the ideal conditions detailed above
will compromise the sensitivity of the examination, e.g. without
compressed air many code 1 lesions cannot be detected and should be
omitted from the code list. It is suggested that if compressed air
is unavailable the following codes should be used: [insert new
ICDAS epi codes which use letters rather than numbers to highlight
that the codes are not comparable with full ICDAS]. Explanation to
the table Column 1: Terms of increasing severity stages of caries
for lay persons Column 2: Terms for the visual apperance for
increasing severity stages of caries for professionals Column 3
Related scores to coulmn 2 Column 4: Activity assessment
posibilities for the scores in column 3 and thus also columns 2 and
1 Column 5: Scores for radiographical classification of lesion
severity: 0=no radiolucency 1= radiolucency in outer of the enamel
2= radiolucency in inner of the enamel EDJ 3= radiolucency limited
to the outer 1/3 of dentine 4= radiolucency reaching the middle 1/3
of dentine
107. Column 6: Scores for Fibre-optic translumination (FOTI);
classification of lesion severity: Proximal and occlusal 0= no
shadow or stained area 1= Lesion stays the same width when
transilluminated/Thin grey shadow into enamel when transilluminated
2= Wide grey shadow into enamel when transilluminated 3= Wide grey
shadow into enamel with no evidence of dentine shadow 4=
Orange/brown or bluish/black shadow < 2mm in width 5= Shadow as
described above and/or transillumination light is blocked > 2mm
in width 6= Large area of frank cavitation with likely pulpal
involvemen
108. All sites were visually examined by two investigators
(doctoral student calibrated by an experienced investigator) using
the International Caries Detection and Assessment System (ICDAS-II)
[14] and a consensus score for each site was achieved. The chosen
sites were recorded as:0 = sound ( = 1 3);1 = first visible sign of
noncavitated lesion seen only when the tooth is dried;2 = visible
noncavitated lesion seen when wet and dry;3 = microcavitation in
enamel;4 = noncavitated lesion extending into dentine seen as an
undermining shadow;5 = small cavitated lesion with visible dentine:
less than 50% of surface;6 = large cavitated lesions with visible
dentine in more than 50% of the surface
109. EXAMINATION TYPESThe four different types of dental
examinations arediscussed in the paragraphs that follow. To
ensureunifo rmity in nomenclature and definitions,
dentalexaminations are classified by type. TYPE 1,
COMPREHENSIVEEXAMINATIONThis is the ideal examination, for it is
the mostextensive dental examination. The dentist wil l performa
comprehensive hard and soft tissue examination thatincludes: oral
cancer screening examination; mouth- mirror, explorer, and
periodontal probe examination;adequate natural or artificial
illuminati on; pano-graphic or full- mouth periapical, and
posteriorbitewing radiographs; blood pressure recording; andwhen
indicated, percussive, thermal and electrical
test,transillumination, and study models. Included arethose lengthy
clinical evaluations required to establisha complex clinical
diagnosis and the formulation of atotal treatment plan. For
example: treatment planningfor full- mouth reconstruction;
determination of theetiology or differential diagnosis of a
patient's c hiefcomplaint, such as temporomandibular joint
(TMJ)dysfunction and associated oral facial pain; or lengthyhistory
taking relative to determining a diagnosis, orin-processing
examination for officer candidates
110. TYPE 2, ORAL EXAMINATIONComprehensive hard and soft tissue
examination,which will include: oral cancer screeni ng
examination;mouth- mirror, explorer, and periodontal probeexa
mination; adequate natural or artificial ill u- mination;
appropriate panographic or intra oralradiographs as indicated by
the clinical examination;and blood pressure recording. An
appropriatetreatment plan will be rec orded. This type is
theroutine examination, which is normally done only onetime per
treatment regimen per patient, unlesscircumstances warrant another
complete examination
111. ..TYPE 3, OTHER EXAMINATIONThis examination consists of
diagnosticprocedures as ap propriate for: consultation betweenstaff
or st aff residents; observation where no formalco nsult is
prepared; certain categories of p hysica examinations; and
emergency oral examinati ons forevaluation of pain, infection,
traum a, or defectiverestorations.
112. TYPE 4, SCREENING EVALUATIONThis type of examination
consists of a mouth- mirror and explorer or tongue depressor
examinationwith whatever illumination is available. This
categoryincludes the initial dental processing of recruitswithout
necessarily being examined by a dentist orother screening
procedures. A qualified dentalassistant or dental hygienis t may
perform a type 4examination