PRESENTED BY - DR. KAVISHA KAPOOR GUIDED BY - DR. AMIT GOEL

1. INDICES IN
PERIODONTOLOGY
GUIDED BY PRESENTED BY
Dr. AMIT GOEL KAVISHA KAPOOR
MDS (PERIO) 2nd YR

2. CONTENTS
 INTRODUCTION
 DEFINITIONS
 OBJECTIVES OF AN INDEX
 IDEAL REQUISITS OF AN INDEX
 CRITERIA FOR SELECTING AN INDEX
 CLASSIFICATION OF INDICES
 PURPOSES AND USES OF AN INDEX
 INDICES USED FOR ASSESSING ORAL HYGIENE
 INDICES USED TO MEASURE PLAQUE AND DEBRIS
 INDICES USED FOR ASSESSMENT OF CALCULUS
 INDICES USED FOR ASSESSING GINGIVAL INFLAMMATION
 INDICES USED FOR ASSESSMENT OF GINGIVAL BLEEDING
 INDICES USED FOR ASSESSMENT OF PERIODONTAL DISEASES
 INDICES USED FOR ASSESSING TOOTH MOBILITY
 CONCLUSION
 REFERENCES 2/48

3. INTRODUCTION
Dental index or indices are devices to find out the
incidence, prevalence and severity of the disease, based on
which preventive programs can be adopted.
An index is an expression of the clinical observation in a
numerical value. It helps to describe the status of the
individual or a group with respect to a condition being
measured.
An index score can be more consistent and less subjective
than a word description of that condition.
3/48

4. DEFINITIONS

 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. ’ –
‘’Russell. A. l – 1956’’
‘’Epidemiological indices are attempts to quantitate clinical conditions on a
graduated scale, thereby facilitating comparison among populations examined by
same criteria and methods’’.
- ‘’ Irving Glickman – 1950’’
4/48
An index is an expression of clinical observation in numeric values. It is used to describe the
status of the individual or group with respect to a condition being measured. The use of
numeric scale and a standardized method for interpreting observations of a condition results
in an index score that is more consistent and less subjective than a word description of that
condition. – ‘’Esther M Wilkins’’ - 1987
Oral indices are essentially set of values, usually numerical with maximum and minimum
limits, used to describe the variables or a specific conditions on a graduated scale, which use
the same criteria and method to compare a specific variable in individuals, samples or
populations with that same variables as is found in other individuals, samples or
populations. – ‘’George P Barnes’’ - 1985

5. OBJECTIVES OF AN INDEX
 The main purpose or objective of using indices in
dental epidemiology is to increase understanding
of the disease process, thereby leading to method
of control and prevention.
 In addition it attempts to discover populations
at high and low risk and to define specific problem
under investigation.
5/48

6. IDEAL REQUISITES OF AN INDEX
 Clarity, simplicity and objectivity
 Validity
 Reliability
 Quantifiability
 Sensitivity
 Acceptability
6/48

7. CRITERIA FOR SELECTING AN INDEX
 Simple to use and calculate.
 Should permit the examination of many people in a short period of time.
 Should require minimum armamentarium and expenditure.
 Should be highly reproducible in assessing a clinical condition when used by one or
more examiners.
 Should not cause discomfort to the patient and should be acceptable to the patient.
 Should be free as possible from subjective interpretation
 Should be amenable to statistical analysis
 Should be strongly related numerically to the clinical stages of the specific disease
under investigation.
7/`48

8. CLASSIFICATION OF INDICES
 BASED ON THE DIRECTION IN WHICH THEIR SCORES
CAN FLUCTUATE
 IRREVERSIBLE INDICES
 REVERSIBLE INDICES
 DEPENDING UPON THE EXTENT TO WHICH AREAS OF
ORAL CAVITY ARE MEASURED
 FULL MOUTH INDICES
 SIMPLIFIED INDICES
8/48

9.  BASED ON DISEASE ENTITY WHICH THEY MEASURE
 Disease index
 Symptom index
 Treatment index
 SPECIAL CATEGORIES AS -
Simple index
Cumulative index
9/48

10. USES OF AN INDEX
 FOR INDIVIDUALS -
 Provide individual assessment to help patient recognize an oral problem.
 Reveal degree of effectiveness of present oral hygiene practices.
 Motivate the person in preventive and professional care for elimination
and control of oral disease.
 Evaluate the success of individual & professional treatment over a period
of time by comparing index scores.
 IN RESEARCH:
 Measure effectiveness of specific agents or devices for prevention/control/treatment
of oral conditions.
 IN COMMUNITY HEALTH :
 Show prevalence and trends of incidences.
 Assess needs of a community
10/48

11. INDICES FOR ASSESSING ORAL HYGIENE
AND PLAQUE
ORAL HYGIENE INDEX ( OHI)
 Developed in 1960 by John C Greene & Jack R vermillion.
 To classify and assess oral hygiene status.
 OHI comprises of 2 components
 DEBRIS INDEX(DI)
 CALCULUS INDEX(CI)
METHODOLOGY
 Mouth is divided into 6 segments:
11/48
Rules:
1. Only fully erupted permanent teeth scored
2. Third molars & incompletely erupted teeth are not scored
3. The Buccal & lingual debris scores are both taken on the tooth in a segment having the
greatest surface area covered by debris
4. Similarly calculus scores are taken on the tooth in a segment having the greatest surface area
covered by supra & sub-gingival calculus.
5. Using no.5 explorer(shepherds’ hook) debris & calculus are estimated by running on
Buccal/labial or lingual surface noting occlusal or incisal extent of the debris as it is removed
from the tooth surface.
6. Thus in this buccal/labial or lingual scores are not taken from same tooth

12.  PROCEDURE –
 Each segment examined for debris or calculus.
 From each segment one tooth is used for calculating the individual index for that segment.
 The tooth used for the calculation must have the greatest area covered by either debris or calculus.
 Buccal/labial and lingual surfaces.
 DI – no:23 explorer (shepherd’s hook)
 CI – no:5 explorer
CRITERIA OF SCORING (DI)AND (CI)
12/48

13. CALCULATION
 DI = Buccal total score + Lingual Total score
No: of segments
 CI = Buccal total score + Lingual Total score
No: of segments
OHI = DI+CI
 DI & CI = 1-6
 OHI = 0-12
 Higher the score poorer the oral hygiene
13/48

14. SIMPLIFIED ORAL HYGIENE INDEX (OHI-S)
 1964,John C Greene & Jack R vermillion.
 Oral hygiene index was determined to be simple and sensitive, it was time- consuming and required more decision –
making. So effort was made to make more simplified index with equal sensitivity.
DIFFERENCE
Number of tooth surfaces scored 16 rather 12
Method of selecting the surface
The scores, which can be obtained
SURFACES AND TEETH TO BE EXAMINED
14/48

15.  SUBSTITUTION –
16 -17 , 26 – 27, 36- 37 OR 38, 31-41, 46 – 47 OR 48 , 17 – 18. 11- 21
 EXCLUSIONS - Natural teeth with full crown restorations and surfaces reduced in height by
trauma/caries not scored.
 INSTRUMENTS: Mouth mirror,no:23 explorer(shepherd’s Crook)
 Scoring and method are same as that of OHI.
CALCULATION (DI-S AND CI-S)
 DI-S = Total score
No : of surfaces examined
 CI-S = Total score
No : of surfaces examined
OHI-S = DI-S + CI-S15/48

16. INTERPRETATION
 For DI-S & CI-S score –
 For OHI-S score -
 Study of epidemiology of periodontal diseases.
16/48

17. PLAQUE INDEX (PII)
 Described by Silness P and Loe H in 1964.
 This index measures the thickness of plaque on the gingival one third.
 Used as full mouth index/simplified index.
 Advantages –
 It is unique among indices used for the assessment of plaque because of the coronal extent of plaque on the
tooth surface area and assesses only the thickness of the plaque at the gingival area of the tooth
 Demonstrate good validity and reliability
 Drawback :
 One criticism is the subjectivity in estimating plaque. To overcome this, it is recommended that a single
examiner to be trained and used with each group of patients.
 INDEX TEETH:16,12,24,36,32,44
 No substitution if any one of the above teeth are missing.
 Areas examined: Distofacial , Facial, Mesio-facial and lingual surface of tooth.
 Instruments: Mouth mirror, Dental explorer.
17/48

18.  PROCEDURE –
 Tooth is dried and examined visually.
 Explorer Is passed across the tooth surface in the cervical third and near the entrance of gingival sulcus. When no
plaque adheres to the point of explorer, the area is considered to have a ‘0’ score. When plaque adheres, a score of ‘1’ is
assigned. Plaque that is on the surface of calculus deposits and on dental restorations of all types in cervical third is
evaluated and included.
 SCORING CRITERIA –
CALCULATION AND INTERPRETATION –
 PII for a tooth = Scores of 4 areas
4
 PII for individual = Total scores
no: of teeth examined
 PII for group = Total score
no: of individuals
18/48

19. TURESKY – GILMORE- GLICKMAN MODIFICATION OF
THE QUIGLEY – HEIN PLAQUE INDEX
 Quigley G. Hein . J in 1962, reported a plaque measurement that focused on the gingival third of the tooth
surface. They examined only the facial surfaces of the anterior teeth, using basic fuchcin mouthwash as a
disclosing agent.
 The Quigley – Hein plaque index was modified by Turesky S, Gilmore N.D and Glickman I in 1970.
 Modification was done by strengthening the objectivity of the original criteria. This system of scoring
plaque is relatively easy to use because of the objective definitions of each numerical score.
 Instruments used – Mouth mirror and Disclosing agent.
 Method – labial , buccal and lingual surfaces are assessed after using disclosing agent.
 Scoring criteria -
 Calculation and interpretation :
IS = TS/ No of surfaces examined
0-1 = low
>2 = High 19/48
Score Criteria
0 no plaque
1 flecks of stain of the
gingival margin
2 Definitive line of plaque
on gingival margin
3 Gingival third of surface
4 Two- thirds of surface
5 Greater then 2/3rd of the
surface
SCORE CRITERIA
0 No plaque
1 Separate flecks of plaque at
the cervical margin of the
tooth
2 A thin continuous band of
plaque at the cervical margin
of the tooth
3 A band of plaque wider then
1mm covering less than 1/3rd
of the crown of the tooth
4
5
Plaque covering at least 1/3rd
but less then 2/3rd of the
crown of the tooth
Plaque covering 2/3rd or more
of the crown of the tooth

20. GLASS INDEX
 It was developed by GLASS R.L in 1965.
 This index assesses the presence and extent of debris accumulation , for evaluating tooth – brushing
efficacy..
 CRITERIA –
 Code 0 – no visible debris
 Code 1 – debris visible at gingival margin but discontinuous less than1mm in height
 Code 2 – debris continuous at gingival margin – greater than 1mm in height.
 Code 3- debris involving entire gingival third of the tooth
 Code 4- debris generally scattered over tooth surface
 CALCULATION –
 Debris index score per person – total debris score of all the teeth examined / total no of teeth examined.
 Glass criteria of scoring places more emphasis on the gingival third of the tooth surface than does the
OHI- S, and so this index is useful in clinical trials of preventive and therapeutic agents.
20/48

21. SHICK AND ASH MODIFICATION OF
PLAQUE CRITERIA –
 The original criteria of plaque component of RAMFJORD’S periodontal disease was modified by SHICK
R.A and ASH M.M in 1961.
 Scoring criteria – only fully erupted teeth should be scored and missing teeth should not be substituted.
 Calculation – PS = TOTAL SCORE/ NO. OF TEETH EXAMINED
 Score Criteria
 0 Absence of dental plaque
 1 At the gingival margin covering less than 1/3rd of the gingival half of the facial or lingual surface
of
 2 Dental plaque covering more than 1/3rd but less than 2/3rd of the gingival half of the facial or
lingual surface of the tooth.
 3 Dental plaque covering 2/3rd or more of the gingival half of the facial or lingual surface of the
tooth
21/48

22. NAVY PLAQUE INDEX (NPI)
 The navy plaque index was developed by GROSSMAN F.D & FEDI P.F in 1970. This index was designed
to assess the plaque control status among naval personnels and to measure any subsequent changes.
 METHOD :
 The navy plaque index is obtained by scoring the amount of plaque found on six selected teeth (index teeth)
by using a disclosing solution. The teeth examined are.
 16, 21,24,36,41,44 and surfaces are – facial and lingual of the each six teeth, the facial surfaces are divided
into three major areas as – Gingival Area (G), Mesial Proximal Area (M) and Distal Proximal Area (D).
 The stained plaque in contact with the gingival is scored as follows-
 Area M = 3
 Area G = 2
 Area D = 3 when plaque is found not in contact with gingival tissue but is found on any tooth surface, one
point is added to the facial or lingual score.
 Calculation – the highest for any of the six teeth scored is the patient’s NAVY plaque index score. All teeth
scores are added to give the total NPI score.
22/48

23. INDICES USED FOR ASSESSMENT OF
CALCULUS
 CALCULUS SURFACE INDEX (CSI) - ENNEVER J, Sturzenberger C.P and Radike A.W in 1961.
 MARGINAL LINE CALCULUS INDEX (MLCI)- Muhlemann H.R and Villa P. in 1967.
 CALCULUS SURFACE SEVERITY INDEX (CSSI) - The calculus surface severity index was developed
by ENNEVER J , et al in 1961 as a companion index to their calculus surface index (CSI)
23/48

24. INDICES USED FOR ASSESSING GINGIVAL
INFLAMMATION
 PAPILLARY – MARGINALATTACHMENT INDEX (PMA)-
 MAURY MASSLER AND SCHOUR .L 1944.
 No. of gingival units effected were counted rather then the severity of inflammation.
METHOD
A gingival unit was divided into three compartments –
Papillary gingiva, Marginal gingiva, Attached gingiva
Presence or absence of inflammation on each gingival unit is recorded and usually only
maxillary and mandibular incisors, canines and premolars were examined.
SCORING CRITERIA
Papillary component (p) Marginal component (m) Attached component
score criteria
0 Normal
1 Might papillary
enlargement
2 Obvious increase in
size , BO Pressue
3 Excessive inc in
size, spontaneous
bleeding
4
5
Necrotic papilla
Atrophy and loss
score criteria
0 Normal
1 Engorgement, slight inc in
size, no bleeding
2 Obvious engorgement ,
bleeding on pressure
3 Swollen collar, spontaneous
bleeding , beginning
infiltration
4 Necrotic gingiva
5 Recession of the free
marginal gingiva below CEJ
due to inflammatory
changes.
score criteria
0 Normal
1 Slight engorgement with loss of
stippling, changes in color may
or may not be present
2
3
Obvious engorgement with
marked inc in redness and
pocket formation
Advanced periodontitis and
deep pockets.
24/48

25.  Calculation of the Index –
 USES –
 Clinical trials
 On individual patients
 Epidemiologic surveys
PMA = P+M+A
25/48

26. GINGIVAL INDEX
 Developed by Loe H and Silness P in 1963.
 For assessing severity of gingivitis.
 Instrument: MOUTH MIRROR , PERIODONTAL PROBE.
 METHOD – The severity of gingivitis is scored on all teeth or on selected index teeth.
 INDEX TEETH –
 Tissues surrounding each tooth divided into 4 gingival scoring units.
 DISTO-FACIAL PAPILLA
 FACIAL MARGIN
 MESIO-FACIAL PAPILLA
 LINGUAL GINGIVAL MARGIN
26/48
Advantage –
• The sensitivity and reproducibility is good
provided the examiner's knowledge of periodontal
biology and pathology is optimal

27.  SCORING CRITERIA –
 Calculation and interpretation –
 GI score for a tooth = Scores from 4 areas
4
 GI score individual = Sum of indices of teeth
No: of teeth examined
 GI score for group = Sum of all members
Total no of individuals
Use –
Severity of
gingivitis,
controlled
clinical trials of
preventive or
therapeutic
agents
27/48

28. MODIFIED GINIGVAL INDEX
 Lobene, Weatherford, Ross, Lamm and Menaker in 1986.
 Assess the prevalence and severity of gingivitis.
 Important changes in GI –
Elimination of gingival probing to assess the presence or absence of bleeding.
Redefinition of scoring system for mild and moderate inflammation.
Method -
To obtain MGI , labial and lingual surfaces of the gingival margins and the interdental papilla of all
erupted teeth except 3rd molars are examined and scored.
SCORING –
SCORE CRITERIA
0 Normal
1 Mild inflammation, slight change in color,
little change in texture of any portion of
gingival unit
2 Mild inflammation of entire gingival unit
3 Moderate inflammation of gingival unit
4 Severe inflammation of gingival unit
28/48

29. PAPILLARY MARGINAL INDEX (PM)
 Developed by MUHLEMANN H.R and MAZOR Z.S in 1958.
 SCORING CRITERIA
score criteria
0 normal
1 Bleeding from gingival sulcus on
gentle probing, tissue otherwise
become normal.
2 Bleeding on probing, change in
color due to inflammation, no
edema
3 BOP, color change, edematous
swelling
4 Ulceration with additional
symptoms
29/48

30. SULCUS BLEEDING INDEX (SBI)
 Developed by MUHLEMANN H.R AND SEN.S in 1971.
 Modification of PAPILLARY – MARGINAL INDEX of MUHLEMANN and MAZOR Z .S.
SCORING CRITERIA
 Score 0 – health looking papillary and marginal gingiva no bleeding on probing;
 Score 1 – healthy looking gingiva, bleeding on probing;
 Score 2 – bleeding on probing, change in color, no edema;
 Score 3 – bleeding on probing, change in color, slight edema;
 Score 4 –bleeding on probing, change in color, obvious edema;
 Score 5 –spontaneous bleeding, change in color, marked edema.
 Four gingival units are scored systematically for each tooth: the labial and lingual marginal
gingival (M units) and the mesial and distal papillary gingival (P units). Scores for these units
are added and divided by four gives the sulcus bleeding index.
30/48

31. GINGIVAL BLEEDING INDEX (GBI)
 In 1974, Carter and Barnes introduced a Gingival Bleeding Index, which records the presence or absence of
gingival inflammation.
 The mouth is divided into six segments and flossed in the following order; upper right, upper anterior, upper
left, lower left, lower anterior and lower right.
 Bleeding is generally immediately evident in the area or on the floss; however, thirty seconds is allowed for
re- inspection of each segment.
 Bleeding is recorded as present or absent. For each patient a Gingival Bleeding Score is obtained by noting
the total units of bleeding.
 Gingival Bleeding Index (GBI)-
 AINAMO & BAY (1975), is performed through gentle probing of the orifice of the gingival crevice.
31/48

32. PAPILLARY BLEEDING INDEX
 Introduced by Saxer and Muehlemann (1975), as cited by Muehlemann (1977).
 A periodontal probe is inserted into the gingival sulcus at the base of the papilla on the mesial
aspect, and then moved coronally to the papilla tip. This is repeated on the distal aspect of the
papilla.
The intensity of any bleeding is recorded as:
 Score 0 – no bleeding;
 Score 1 – A single discreet bleeding point;
 Score 2 – Several isolated bleeding points or a single line of blood appears;
 Score 3 – The interdental triangle fills with blood shortly after probing;
 Score 4 – Profuse bleeding occurs after probing; blood flows immediately into the marginal
sulcus.
32/48

33. EASTMAN INTERDENTAL BLEEDING INDEX
 Caton & Polson (1985) developed the Eastman Interdental Bleeding Index (EIB).
 A wooden interdental cleaner is inserted between the teeth from the facial aspect, depressing
the interdental tissues 1 to 2 mm. This is repeated four times and the presence or absence of
bleeding within 15 s is recorded.
 Path on insertion should be parallel to occlusal surface.
 Insertion and removal of interdental cleaner is done 4 times and then moved on to next
interproximal area.
 SCORE = no. of bleeding areas/total no. of areas Х 100
35/48

34. PERIODONTAL INDEX
 RUSSELL’S PERIODONTAL INDEX (RPI) –
 Developed by Russell A.L in 1956
 To estimate deeper periodontal diseases.
 All teeth present examined.
 Gingival tissue surrounding each tooth assessed for gingival inflammation and periodontal involvement.
 Instruments : Mouth Mirror, plain probe.
 SCORING CRITERIA
 CALCULATION AND INTERPRETATION
 PI score per person = Sum of individual scores
No: of teeth present
34/48

35. PERIODONTAL DISEASE INDEX (PDI)
 Developed by SIGURD P. RAMFJORD IN 1959.
 MOST IMPORTANT FEATURE OF PDI IS MEASUREMENT OF THE LEVEL OF THE
PERIODONTAL ATTACHMENT RELATED TO THE CEJ OF THE TEETH.
 COMPONENTS - SCORING METHODS -
PLAQUE,
CALCULUS,
GINGIVAL &
PERIODONTAL
16
21
24
36
41
44
35/48

36.  PLAQUE COMPONENT OF THE PDI –
 SURFACES – FACIAL, LINGUAL, MESIAL, DISTAL
 INSTRUMENTS- MOUTH MIRROR, DENTAL EXPLORER
 SCORING CRITERIA –
 SHICK AND ASH modification of plaque criteria –
 Consist of six teeth excluding the interproximal area and restricting the scoring of plaque to the gingival half, of
the facial and lingual surfaces of the index teeth. Selected teeth are same as that of plaque component
 Scoring criteria – only fully erupted teeth should be scored and missing teeth should not be
substituted.
 Calculation – PS = TOTAL SCORE/ NO.OF TEETH EXAMINED
SCORE CRITERIA
0 No plaque present
1 Plaque present but not on all
interproximal, buccal and lingual
surfaces of the tooth
2 Plaque present on all interproximal,
buccal and lingual surfaces of the
tooth , but covering half than one
half of these surfaces
3 Plaque extending over all
interproximal , buccal and lingual
surfaces, and covering more than one
half of these surfaces
Score Criteria
0 absence of dental plaque
1 At the gingival margin covering less
then 1/3rd of the gingival half of the
facial or lingual surface of the tooth
2
3
Dental plaque covering more than
1/3rd but less than 2/3rd of the
gingival half of the facial or lingual
surface of the tooth
Dental plaque covering 2/3rd or more
of the gingival half of the facial or
lingual surface of the tooth
36/48

37. CALCULUS, GINGIVALAND PLAQUE COMPONENT
(PDI)
 Calculus component – assess the presence and extent of calculus on the facial and lingual
surfaces of the six index teeth.
 Instruments – MOUTH MIRROR, DENTAL EXPLORER
 Scoring criteria –
Score 0 – Absence of calculus
Score 1 – Supragingival calculus extending only slightly below FGM
Score 2 – Moderate amount of supra and subgingival calculus or subgingival alone.
Score 3 – Abundance of supra and subgingival calculus
 Calculation – No of teeth examined/ total teeth.
37/48

38. GINGIVALAND PERIODONTAL COMPONENT
 Gingival status is scored first.
 Dried superficially by gently touching with absorbing cotton, and examined for color change, form ,
consistency and bleeding.
 Crevice depth is recorded in relation to CEJ.
 Instruments used – mouth mirror and university of Michigan probe number 0 probe.
Score 0 - Absence of signs of inflammation
Score 1 – mild to moderate inflammatory changes not extending around the tooth.
Score 2 - mild to moderately severe gingivitis extending around the tooth.
Score 3 – severe gingivitis characterized by marked redness , swelling , tendency to bleed , and
ulceration.
Score 4 – gingival crevice in any of the four areas , extending apically to CEJ but not more then 3 mm.
Score 5 - gingival crevice in any of the four areas , extending apically to CEJ between 3-6mm.
Score 6 - gingival crevice in any of the four areas , extending apically more then 6 mm from CEJ.
Calculation –
PDI – TOTAL OF INDIVIDUAL TOOTH SCORES/NUMBER OF TEETH
EXAMINED
SCORING CRITERIA
38/48

39. COMMUNITY PERIODONTAL INDEX OF
TREATMENT NEEDS (CPITN)
 Developed by “joint committee” of WHO & FDI in 1982.
 To survey and evaluate periodontal treatment needs.
 ADVANTAGES: PROCEDURE -
 Simplicity Dentition divided into sextants
 Speed Each sextant given a score
 International uniformity.
 INSTRUMENT USED - CPITN PROBE
39/48

40. CPITN PROBE
 WHO periodontal examination probe.
 Used for
 Measurement of pocket depth &
 Detection of subgingival calculus.
 Weight = 5gms
 2 types:
 CPITN-E(epidemiological probe)
 Pocket depth measured through color coding; black mark starting from 3.5mm - 5.5mm
 “Ball tip” diameter 0.5mm; easy detection of sub gingival calculus
 CPITN-C ( clinical probe)
 Variant probe basic probe
 2 additional markings
 8.5mm & 11.5 mm
 Detailed assessment & recording of deep pockets.
40/48

41.  Best estimators of the worst periodontal condition of the mouth.
 >20 years
 Molars examined in pairs & highest score recorded.
 Up to 19 years
 CODING CRITERIA-
41/48

42. COMMUNITY PERIODONTAL INDEX(CPI)
 This index is based on the modification of the earlier used community periodontal index of
treatment needs (CPITN).
 INCLUSION – MEASUREMENT OF ‘’LOSS OF ATTACHMENT ‘’AND ELIMINATION
OF THE ‘’TREATMENT NEEDS’’ category.
 INSTRUMENTS USED – MOUTH MIRROR , THE CPITN – C PROBE.
 SCORING CRITERIA –
Score 0 – healthy.
Score 1 – bleeding observed, directly or by using mouth mirror, after probing.
Score 2- calculus detected during probing, but all of the black band on the probe visible.
Score 3 – pocket 4 – 5 mm ( gingival margin within the black band on the probe)
Score 4 – pocket 6 mm or more ( black band on the probe not visible)
X- excluded sextant
9 – not recorded
Loss of attachment –
Criteria of scoring
Code o – loss of attachment 0-3mm (CEJ not visible and CPI score 0-3 ).
Code 1 – loss of attachment 4- 5 mm (CEJ within the black band).
Code 2 – loss of attachment 6- 8mm (CEJ between the upper limit of the black band and the
8.5mm ring )
Code 3 – loss of attachment 9- 11mm (CEJ between the 8.5mm and 11.5mm rings)
Code 4- loss of attachment 12mm or more(CEJ beyond the 11.5mm rings ).
X – excluded sextant (less than two teeth present )
9 – not recorded ( CEJ neither visible nor detectable )
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43. ASSESSMENT OF TOOTH MOBILITY
 MILLER(1985) – has described the most common clinical method in which tooth is held between handles of the
two instruments & moved back and forth or with metallic instrument and one finger.
 Criteria –
SCORE 0- no detectable mobility
SCORE 1- distinguishable tooth mobility
SCORE 2- crown of tooth moves more than 1mm in any direction
SCORE 3 – movement of more than 1mm in any direction.
 GLICKMAN/ CARRANZA F.A (1972)–
 GRADE 1- slightly more then normal
 GRADE 2- moderately more than normal
 GRADE 3 – severe mobility faciolingually and or mesiodistally combined with vertical displacement.
 GENCO R(1984).- assessed mobility as –
 DEGREE 1 – Horizontal mobility of crown is from detectable to 1mm.
 DEGREE 2 – mobility of crown ranges from 1-2 mm horizontally.
 DEGREE 3 – mobility of crown is observed in vertical or apical direction. 43/48
PRICHARD (1972):
1- slight mobility
2- Moderate
3- extensive movement in a lateral or mesiodistal direction combined with
vertical displacement in the alveolus.
WASERMAN ET AL (1973):
1- normal
2- slight- > ¾ mm of bucco-lingual movement
3- moderate- up to approximately 2mm movement bucco-lingually
4- severe- more than 2 mm
FLESZAR INDEX (1980) - devised a system for recording tooth
mobility, as follows:
M0 - Firm Tooth
M1 - Slight increased mobility
M2 – Definite to considerable increase in mobility but not impairment of
function.
M3 – Extreme mobility, a loose tooth that would be Incomparable in
function.

44.  LOVDAL’S INDEX(1994) –
 First degree – Teeth that were somewhat more mobile than normal.
 Second degree – Teeth showing conspicuous mobility in transverse but not axial direction.
 Third degree – Teeth being mobile in axial as well as on transverse direction.
 GRALES AND SHALES(1999) –
 GRADE 0 – No apparent mobility
 GRADE 1- Mobility less than 1mm buccolingually
 GRADE 2 – Mobility between 1- 2mm
 GRADE 3 – Mobility >2mm buccolingually
 LEONARD ABRANMS AND POTASHNICK’S(1999) –
 CLASS 1 – Mobility less than 1m
 Class 2 – mobility with in 1- 2mm
 Class 3 – mobility >2mm
Lindhe (1997) –
Degree 1 – movability of crown of tooth less than 1mm in horizontal
direction
Degree 2 – movability of crown of tooth more than 1mm in horizontal
direction
Degree 3 – movability of crown of tooth in vertical as well
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45.  NYMAN'S INDEX –
 Zero degree – Normal – less than 0.2 mm
 Degree 1 – Horizontal / Mesiodistal mobility of 0.2 – 1mm
 Degree 2 – Horizontal / Mesiodistal mobility of 1-2 mm.
 Degree 3 – Horizontal / Mesiodistal mobility exceeding 2mm and / or vertical mobility.
 KIESER(2001) –
 GRADE 0 – physiologic mobility
 GRADE 1 – Slight mobility
 GRADE 2 – Moderate mobility
 GRADE 3 – Marked mobility
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46. CONCLUSION
 Periodontal indices have contributed to identification, prevention and
treatment of periodontal disease over the years since their inception. These
indices are based on the prevailing understanding of the pathogenesis and
progression of periodontal disease. Thus, with the better understanding of the
periodontal disease process these indices have changed from the simple
Russell’s
 Periodontal Index to the current Moustakis’s Genetic Susceptibility Index.
Each of these indices has its merits and limitations, so, an ideal index which
detects the ongoing progressive periodontal destruction and also identifies the
active and inactive sites of disease, is the need of the hour
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47. REFERENCES
 Soben Peter. Indices in dental epidemiology,4th edition
 Soben Peter. Indices in dental epidemiology , 3rd edition
 Essentials Of Preventive and Community Dentistry 3ed.123-231.
 Kinane DF, Lindhe J. Pathogenesis of periodontitis.
 Kunaal Dhingra and Kharidhi Laxman Vandana. Indices for measuring
periodontitis : A literature review, International Dental Journal 2011; 61: 76–84
 In: Lindhe J, Karring T, Lang NP, Eds. Clinical Periodontology and Implant
Dentistry.
 Maria Augusta Bessa Rebelo and Adriana Corrêa de Queiroz, Federal
University of Amazonas Brazil. Gingival indices : state of art , Gingival
Diseases – Their Aetiology, Prevention and Treatment
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