3. Measuring Diseases
• A prerequisite for any epidemiological investigation is
the ability to quantify the occurrence and severity of the
disease.
• Measurement is a process of assigning values to
characteristics according to a set of rules. This is
facilitated through indices: certain methodology and
criteria
3
4. “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 same
criteria and methods.”
-Russell A. L.
4
5. Ideal Requisites of an Index
CLARITY: The examiner should be able to remember
the rules of the index clearly in his mind
SIMPLICITY: The index should be simple and easy to
apply so that there is no undue time lost during field
examinations
OBJECTIVITY: The criteria for the index should be
objective and unambiguous, with mutually exclusive
criteria
VALIDITY: The index must measure what it is intended
to measure
5
6. Ideal Requisites of an Index
(contd)
RELIABILITY: The index should measure consistently at
different times and at variety of conditions
QUANTIFIABILITY: The index should be amenable to
statistical analysis
SENSITIVITY: The index should be able to detect
reasonably small shifts, in either direction in group
condition
ACCEPTABILITY: The use of index should not be painful
or demeaning to the subject
6
7. Measuring Dental Caries
Statistical measurement of dental caries serves 3 broad
purposes:
– For epidemiological investigation on characteristics of dental
caries in population groups
– For public health programme planning and evaluation
– For testing prevention and control procedures
7
8. Prevalence of Dental caries is measured in terms of:
–
–
–
–
–
percentage of persons affected
Number of teeth attacked
Number of tooth surface involved
Number of discrete cavities
Size and degree of severity of carious lesion
8
9. Shortcomings of DMF Index
• DMF values are not related to the number of teeth at risk.
It tends to equate desired state with treated condition
• It assesses only cavitated lesion extended into dentin
• DMF index is invalid in elderly population, as teeth can be
lost for reasons other than caries
• Reaches saturation level at particular point of time when
all teeth are involved and prevents registration of caries
attack even when caries activity is continuing
9
10. Shortcomings of DMF Index(contd)
• Does not give account for treatment needs
• DMF index gives equal weight to missing, untreated
decayed and well restored teeth
• Cannot be use to assess root caries
• Rate of caries progression cannot be assessed
10
11. Inability of D component of DMF score to define treatment needs:
– Criteria used to diagnose caries in a survey are not the same as
those used by practitioners in forming patient’s treatment plan
– Patient’s own perceived needs, level of interest in their dental
conditions, and ability or willingness to pay all level of treatment
– A practitioner has to judge whether a minor lesion will develop
into a major lesion over time, and whether a lesion in primary
tooth can safely remain untreated for the life of the tooth. A
survey, whereas, scores a tooth by how it appears at the time of
the survey.
– Treatment philosophies change with time
11
12. Nyvad Caries Diagnostic Criteria
• Proposed by Nyvad in 1999
• Includes manifestation of caries in the initial stages of
the disease, even before a cavity exists.
• Differentiates between active and inactive caries
lesions at both the cavitated and non cavitated levels
• It also measures the activity of the carious lesion,
favoring the cost–benefit relationship when treatment
plans are made.
12
14. Nyvad Caries Diagnostic Criteria
advantages
– Can identify incipient caries lesion, hence can be used
for planning prevention programmes
– Underestimation of prevalence and severity of caries
with def index can be omitted as it measures only
cavitation state
– Reduce the need of treatment on a long term basis
because diagnosis of initial lesions can stop the
progression of lesion
14
15. Nyvad Caries Diagnostic Criteria
limitations
– Difficult to make exact diagnosis of precavitated active
lesion over occlusal surface than over facial surface.
Physiological wear of occlusal surface during mastication
can lead to disappearance of the lesions
15
16. Significant caries Index (SiC)
• Proposed by Bratthall D in 2000
• using DMF and SiC together helps to highlight oral health
inequalities more accurately among different population
groups within the community in order to identify the
need for special preventive oral health interventions
16
17. Significant caries Index (SiC)
Calculating SiC Index
SiC is calculated by sorting individuals according to their DMFT
values, than one third of the population with the highest caries
scores is selected and the mean DMFT for this subgroup is
calculated. This value is the SiC Index
17
18. Significant caries Index (SiC)
advantages
– brings attention to the individuals with the highest caries
values in each population under investigation
– It tries to overcome limitation of the mean DMFT value in
accurately assessing the skewed distribution of dental
caries in a population especially in developed countries
leading to incorrect conclusion that the caries situation for
the whole population is controlled, while in reality, several
individuals still have caries
18
19. Significant caries Index (SiC)
limitations
– It is just an extension of DMF index as it follows same
criteria for assessing dental caries and will have same
limitations in assessing caries in a population as DMF index
– more of significance in population where caries prevalence
is low and has a skewed distribution
19
20. Specific Caries Index
• Proposed by Acharya S. in 2006
• To develop a reproducible surface-specific caries index
that would provide qualitative and quantitative
information about untreated dental caries, that could be
used in conjunction with the DMFS index and would
provide information on not only the caries prevalence but
also the location and type of caries lesion in an individual
based on clinical examination
20
22. Specific Caries Index
Calculating Specific Caries Index
The SCI score for an individual is calculated by adding the
individual tooth scores
The SCI scores for an individual can range from 0 to 192 (for
32 teeth)
22
23. Specific Caries Index
advantages
– the future manpower and material requirements and also
the type and level of training of manpower, required to
treat the caries in a particular population might be
assessed
– The results from authors work showed the reproducibility
and validity of this new index to be fair to good
23
24. Specific Caries Index
limitations
– in cases of large lesions, which cover more than one
surface, only an assumption can be made regarding the
originating lesion
– inability of this index, if used alone, to capture
information useful for treatment planning
– lack of provision for assessing root caries
– number of proximal lesions be underestimated in
absence of bitewing radiograph
24
25. International Caries Detection and Assessment System
(ICDAS)
• Developed in the year 2001 by the effort of large group
of researchers, epidemiologists and restorative dentists
• two-digit system; evolved with the need to detect
caries at the non cavitated stage
• ICDAS is divided into sections covering
– coronal caries (pits and fissures, mesial-distal, and
buccal-lingual),
– root caries, and
– caries-associated-with-restorations-and-sealants (CARS)
25
26. International Caries Detection and Assessment System (ICDAS)
The ‘D’ in ICDAS stands for detection of dental caries by
(i) stage of the carious process;
(ii) topography (pit-and-fissure or smooth surfaces);
(iii) anatomy (crowns versus roots);
(iv) restoration or sealant status
The ‘A’ in ICDAS stands for assessment of the caries
process by stage (noncavitated or cavitated) and activity
(active or arrested)
26
27. International Caries Detection and Assessment System (ICDAS)
The detection of dental caries on coronal tooth surfaces is a twostage process;
1) The first decision is to classify each tooth surface on
whether it is sound, sealed, restored, crowned, or
missing
2) The second decision that should be made for each tooth
surface is the classification of the carious status on an
ordinal scale
27
28. International Caries Detection and Assessment System (ICDAS)
ICDAS-I was meant to include
detection (D) of caries by stage of
carious process, topography and
anatomy, assessment (A) of caries
process (whether cavitated or noncavitated and active or arrested
caries). But the ultimate index
included detection of coronal caries
and the assessment of lesion activity
and root caries were not included due
to lack of consensus and need for
further discussions.
ICDAS coordinating committee came
up with ICDAS-II in the year 2009
which describes both coronal caries
and caries associated with restorations
and sealants (CARS) and root caries.
The advantages of the ICDAS-II is that
it has found to be a valid and reliable
caries assessment system especially
for clinical trials assessing
effectiveness of caries preventive/
control agents.
28
29. International Caries Detection and Assessment System (ICDAS)
Decision 1
0 = Sound (use with the codes for primary caries)
1 = Sealant, partial
2 = Sealant, full
3 = Tooth colored restoration
4 = Amalgam restoration
5 = Stainless steel crown
6 = Porcelain or gold or PFM crown or veneer
7 = Lost or broken restoration
8 = Temporary restoration
9 = Used for the following conditions
97 = Tooth extracted because of caries (all tooth
surfaces will be coded 97)
98 = Tooth extracted for reasons other than caries (all
tooth surfaces coded 98)
99 = Unerupted (all tooth surfaces coded 99)
29
30. International Caries Detection and Assessment System (ICDAS)
Decision 2
0 = Sound
1 = First visual change in enamel (whitespot seen after 5 seconds air
drying).
2 = Distinct visual change in enamel (whitespot seen without air drying).
3 = Localized enamel breakdown due to caries with no visible dentin
4 = Non-cavitated surface with underlying dark shadow from dentin
5 = Distinct cavity with visible dentin
6 = Extensive distinct cavity with visible dentin. An extensive cavity
involves at least half of a tooth surface and possibly reaching
the pulp.
7 = Tooth extracted because of caries (tooth surfaces will be coded
97)
8 = Tooth extracted for reasons other than caries (tooth surfaces will
be coded 98)
9 = Unerupted (tooth surfaces coded 99)
30
33. Root Caries
International Caries Detection and Assessment System (ICDAS)
E = Excluded root surfaces (no gingival recession)
0 = Sound (no caries or restoration)
1 = Non-cavitated carious root surface— soft or leathery
2 = Non-cavitated carious root surface— hard and glossy
3 = Cavitated (greater than 0.5mm in depth) carious root surface—
soft or leathery
4 = Cavitated (greater than 0.5mm in depth) carious root surface—
hard and glossy
6 = Extensive cavity: an extensive cavity involves at least half of a
tooth surface and possibly reaching the pulp.
7 = Filled root with no caries
9 = Used for the following conditions
97 = Tooth extracted because of caries (tooth surfaces will be
coded 97)
98 = Tooth extracted for reasons other than caries (all tooth surfaces
coded 98)
99 = Unerupted (tooth surfaces coded 99)
33
34. International Caries Detection and Assessment System (ICDAS)
advantages
– Designed to detect 6 stages of carious process ranging
from early clinical changes to extensive cavitation
– the system meets the requirements of validity and
reliability
– reliable in permanent teeth and acceptable in primary
teeth
– Very suitable for use in clinical trials assessing the efficacy
and/or effectiveness of caries control agents
34
35. International Caries Detection and Assessment System (ICDAS)
Wardrobe concept
The users can decide at what stage (noncavitated or cavitated) and
severity they wish to measure dental caries.
The only stipulation is the requirement that the ICDAS definitions are
used for whatever stage of dental caries is chosen for a specific study.
The configuration of surfaces chosen for use in any study and the
stage used to measure dental caries may be determined for each
study using the ‘wardrobe’ concept.
For example, in a national study that aims to compare dental caries
prevalence over time, the number and configuration of tooth
surfaces may be selected to match previous surveys. Also, the stage
of caries detection may be adjusted to match previous studies
conducted in a country.
35
36. International Caries Detection and Assessment System (ICDAS)
limitation
– Root caries assessment criteria has not been tested in any
epidemiological or clinical studies
– Data obtained are unpragmatic, non-cohesive and difficult
to read
– May lead to overestimation of seriousness of Dental caries
– results are difficult to compare against the widely-used
DMF index
– Does not assess the very advanced stages of carious lesion
36
39. PUFA (pulp-ulcer-fistula-abscess) Index
advantages
– Applicable in low- and middle- income countries as the
burden of untreated cavitated lesions leads to serious
consequences at tooth and surrounding tissue
– simple to record
– can be used for primary and permanent teeth
– results can be presented alongside with DMF index
39
40. PUFA (pulp-ulcer-fistula-abscess) Index
limitations
– stages of carious lesion progression in enamel are not
being assessed
– few subjects with score “u” (ulcer)
– assessment of abscess and fistula can be combined into
one code
– reliability and validity of this index requires further
discussion and research.
40
41. Caries Assessment Spectrum and Treatment (CAST) Index
• developed by J. E. Frencken, Rodrigo G. de Amorim,
Jorge Faber and Soraya C. Leal in 2011
• Combines elements of the ICDAS II and PUFA indices, and
the M- and F-components of the DMF index
41
43. Caries Assessment Spectrum and Treatment (CAST) Index
advantages
– A DMF score can easily be calculated from the CAST
score, thereby enabling retention of the use of existing DMF
scores
– Used only for epidemiological surveys
– Visual/tactile hierarchical one digit coding system
– Includes the total spectrum of stages of caries lesion
progression allows for easy communication among health
professionals and policymakers
– is built on the strength of the ICDAS, DMF and PUFA indices
– provide a link to the widely used DMF index
43
44. Caries Assessment Spectrum and Treatment (CAST) Index
limitations
–
–
–
–
It does not record active and inactive carious lesions
It has not been validated, nor has its reliability been tested
It is not suggested for use in clinical trials
it does not provide data on treatment or preventive
measures required for each code
44
45. FDI World Dental Federation Caries Matrix
• The World Health Organization’s Global Oral Health
Programme has recognized the importance of promoting
“a new paradigm among dental practitioners, shifting
from a restorative to preventive/health promotion
model.”
• Developed by FDI Science Committee
45
46. FDI World Dental Federation Caries Matrix
Objective
The intent of this matrix was not to establish a new caries
lesion classification system, but to integrate existing systems
into a framework that could be used by clinicians,
researchers, educators, public health workers and decision
makers
46
48. Measuring Periodontal Disease
“Periodontal disease” was viewed as a single entity that
began with gingivitis and progressed to periodontitis and
tooth loss. This view is now obsolete, so that indices based
on it are now invalid.
Separate clinical measures are now being used for gingivitis
and periodontitis.
48
49. requires;
o What depth of Clinical attachment loss(CAL) at any site
constitutes evidence of disease processes?
o How many such sites need to be present in a mouth to
establish disease presence
o How probing depth and Bleeding on probing are to be
included in the case definition
49
50. Even the introduction of computerized, constant-force
probes has little difference in the reliability of
measurements.
The problems inherent in the clinical measurement have led
researchers to look for markers of periodontitis.
50
51. Role of Inflammatory cytokines as markers
in measuring periodontitis
The most promising candidates are inflammatory cytokines expressed
in gingival crevicular fluid (GCF) as part of the host response to
inflammation, a number of which has been associated with active
disease. These cytokines include PGE2, TNF α, Interleukin-1α,
interleukin-1β, and others. However, quantifying these associations
and determining the sensitivity of the measures is proving difficult.
To date, measurement of periodontitis by means of inflammatory
cytokines in GCF is still experimental.
51
52. Shortcomings of CPITN
• The hierarchical principles underlying its use are not
universally valid.
• The partial recording approach of the CPITN may grossly
underestimate the prevalence of deep pockets
• CPITN yields extensively distorted estimates of the
prevalence and severity of periodontal destruction in a
population
• Measuring treatment need has become obsolete as the
standard treatment for periodontal pocket has shifted
considerably from surgical removal of pockets to scaling
and root planing
52
53. Basic Periodontal Examination (BPE) Index
• Developed by British Society of Periodontology in 1986
• derived from the Community Periodontal Index of Treatment
Needs (CPITN)
• simple and rapid screening tool that is used to indicate the
level of examination needed and to provide basic guidance on
treatment need
• Not a diagnostic tool
53
54. Basic Periodontal Examination (BPE) Index
Both the number and the * should be recorded if a furcation is detected
54
55. Basic Periodontal Examination (BPE) Index
•
As a general rule, radiographs to assess alveolar bone levels should be obtained for
teeth or sextants where BPE codes 3 or 4 are found.
55
56. Genetic Susceptibility Index for Periodontal disease
Etiology of periodontitis is multifactorial and involves
infectious components, environmental factors and genetic
susceptibility.
Genetic markers denote susceptibility toward disease
manifestation and it would be useful to exploit the
information hidden into them and to derive a genetic
susceptibility index (GSI)
56
57. Genetic Susceptibility Index for Periodontal disease
• shows direct and indirect association between the
susceptibility index, selected microbial values and disease
presence
• Single nucleotide polymorphisms (SNP’s) in genes encoding
molecules of the host defense system are assessed and an
association is established between SNP and disease status
57
58. Periodontal Screening and Recording (PSR) Index
• Introduced in 1992 by American Academy of
Periodontology(AAP) and American Dental
Association(ADA)
• endorsed by the World Health Organization (WHO)
• adaptation of the Community Periodontal Index of
Treatment Needs (CPITN)
• used to measure gingival bleeding upon probing, calculus
on a tooth, and periodontal pocket depth in each sextant
of the oral cavity
58
59. Periodontal Screening and Recording (PSR) Index
Calculating PSR
• highest score in a sextant is recorded as the PSR score for the
sextant.
• Only one score is recorded for each sextant of the oral cavity.
• A WHO/CPITN/PSR probe is used to examine each tooth
individually
59
60. Periodontal Screening and Recording (PSR) Index
Score
Criteria
0
pocket depth is < 3.5 mm, no bleeding upon probing, and no calculus
1
pocket depth is < 3.5 mm, bleeding on probing and no calculus
2
pocket depth is < 3.5 mm, bleeding on probing and calculus present
3
pocket is 3.5 – 5.5 mm in depth
4
pocket is > 5.5 mm in depth
*
clinical abnormalities
such as furcation involvement, tooth mobility, mucogingival
involvement, or 3.5 mm or more of recession in that sextant
X
edentulous sextant
60
61. Periodontal Screening and Recording (PSR) Index
advantages
– Introducing a simplified screening method that met legal
dental recording requirements.
– early detection of periodontal disease and it serves as an
aid in monitoring the periodontal status of patients
– fast method to screen patients as only six scores are
recorded
– Its documented use also assists with the record keeping
of a patient’s periodontal history
– Can be used with a large population during oral health
screenings.
61
62. Periodontal Screening and Recording (PSR) Index
limitations
– not intended to replace a full-mouth periodontal
examination. Those patients who have received
treatment for periodontal diseases and/or are in a
maintenance phase of care should receive
comprehensive periodontal examinations
– limited use of the PSR system in children due to inability
to differentiate pseudo-pockets
– does not measure epithelial attachment, the severity of
periodontal disease may be underestimated with its use
62
63. Measuring Tooth Wear
• The objective of tooth wear indices is to classify and
record the severity of tooth wear or dental erosion in
prevalence and incidence studies.
• different researchers have developed indices which suit
their own research needs but do not allow comparison
to assess the prevalence of tooth wear between
countries and regions. Therefore, a need of new scoring
system is deemed necessary to allow existing and
hopefully future indices to be collapsed and re-analysed
63
64. Basic Erosive Wear Examination (BEWE)
• Developed by Bartlett, Ganss and Lussi in 2007
• The aim of the BEWE is to be a simple, reproducible and
transferable scoring system for recording clinical findings
and for assisting in the decision-making process for the
management of erosive tooth wear that can be used
with the diagnostic criteria of all existing indices
64
65. Basic Erosive Wear Examination (BEWE)
The BEWE is a partial scoring system recording the most
severely affected surface in a sextant and the cumulative
score guides the management of the condition for the
practitioner
The result of the BEWE is not only a measure of the severity
of the condition for scientific purposes but, when transferred
into risk levels, also a possible guide towards management
65
69. Basic Erosive Wear Examination (BEWE)
advantages
– by removing the clear distinction between “enamel loss”
and “dentine” exposed, it will not only evade diagnostic
uncertainties but will open a broad applicability beyond
the clinical situation
– can be used with study models or photographs
– particular value in cross-sectional and incidence studies as
well as for the monitoring of individual cases
– avoid an overestimate of the problem
– as a model to increase awareness
69
70. Measuring Dental Fluorosis
Two distinct groups of indexes have been proposed for
measuring dental fluorosis:
• Specific fluorosis indexes - specifically measures the fluoride
induced enamel changes in order to reflect increasing severity
of fluorosis of lesions
• Descriptive indexes - including all types of defects. These
indexes includes all defects of enamel are recorded based
solely on descriptive criteria, regardless of causative factors. It
is based on the principle that examiner should record what he
sees and do not presume the etiology
70
71. Shortcoming of Dean’s Index
• Single score is given to a tooth rather than, a separate score to
each tooth surface. Hence differences in the severity of
fluorosis in different tooth surfaces cannot be ascertained
• An individual has been classified according to the tooth most
affected by fluorosis which may be located in the mouth that
has little cosmetic value
• Questionable diagnostic category (score 0.5) in Dean’s Index is
difficult to define and interpret precisely
• The distinctions between some of the diagnostic categories in
Dean’s system are unclear, imprecise or lack sensitivity.
71
72. Thylstrup and Fejerskov Index (TFI)
• Developed by Thylstrup A. and Fejerskov O. in 1978 to assess
the prevalence and severity of dental fluorosis
• It was developed to refine, modify, and extend the original
concepts established by Dean. The primary aim was to
develop a more sensitive classification system for recording
enamel changes associated, with increasing level of fluoride in
water
72
73. Thylstrup and Fejerskov Index (TFI)
advantages
– more appropriate than Dean's Index for use in clinical trials
or analytical epidemiologic studies
– increased sensitivity because teeth are dried and fluorosis
can be identified in its milder forms.
– provides statistical and practical advantages from the
possible detection of effects with smaller samples when
potential fluoride effects are small, or when the exposure
may be widespread
73
74. Fluorosis Risk Index (FRI)
• Introduced by David G Pendrys in 1990
• to permit a more accurate identification of associations
between age-specific exposures to fluoride sources and
the development of enamel fluorosis
• developed for use in analytical epidemiologic studies
74
75. Fluorosis Risk Index (FRI)
FRI divides the enamel surfaces of the permanent dentition into
two developmentally related groups of surface zones, designated
either as
– having begun formation during the first year of life (classification I) or
– during the third through sixth years of life (classification II)
Data are found to illustrate the high reliability of the index, its
validity, and its unique utility for the identification of risk factors
of enamel fluorosis.
75
76. Modified Developmental Defects of Dental Enamel Index
(modified DDE)
• Developed by Clarkson J.J. and O’Mullane D.M. in 1989
• Access developmental enamel defects without the need
for diagnosing fluorosis before recording enamel opacities
• Simple and flexible compared to DDE Index
76
77. Modified Developmental Defects of Dental Enamel Index (modified DDE)
Scoring Criteria
Normal
Demarcated opacity
Diffuse opacity
Hypoplasia
Other defects
Demarcated and Diffuse
Demarcated and Hypoplasia
Diffuse and Hypoplasia
All three defects
:
:
:
:
:
:
:
:
:
0
1
2
3
4
5
6
7
8
77
78. Measuring malocclusion
Recording or measuring malocclusion is important for
documentation of prevalence and severity of malocclusion in
population groups and provide a basis for planning orthodontic
treatment.
Methods of recording and measuring malocclusion can be
divided as;
Qualitative
Quantitative
78
79. Index of Complexity, Outcome and Need (ICON)
• Developed by Richmond and Daniels in 2000
• Assess treatment need, complexity, treatment
improvement and outcome based on international
orthodontic professional opinion, intended for use in the
context of specialist practice
• Intended to use in late mixed dentition onwards
• Simple with relatively fewer trait to measure
• Quick and takes approximately 1 minute for a case
79
80. Measuring
Oral Health-Related Quality of Life
(OHRQoL)
The impact of oral diseases and disorders on aspects of
everyday life that a patient or person values, that are of
sufficient magnitude, in terms of frequency, severity or
duration to affect their experience and perception of their life
overall
Locker and Allen, 2007
80
81. Why measure health??
Although philosophically, it is desirable to measure health rather than
disease; in practice the epidemiology concerns with measuring
disease as health is difficult to define in operational terms and hence
difficult to measure.
Due to limitations in measurements of the levels of
dysfunction, discomfort and disability associated with oral
disorders, measurement of the social impact of oral disorders seems
justifiable.
Empirical approach to develop an index for oral health. Though
subjective assessment in done and correlated with clinical measures
81
82. • Paradigm shift – from biomedical to biopsychosocial model
of oral health
• Expanded understanding of oral disorders: functional and
psychosocial consequences
• Legitimacy of the patients’ perspective –needs for and
outcomes of therapy
82
83. Involves measurement of:
– Group differences for public health purposes.
To do this we need instrument that are reliable and valid
– Changes in OHRQoL as a time effect or in response to
treatment and preventive procedures.
To do this we need instruments where the sensitivity to change
(responsiveness) is established
83
84. Instruments to measure OHRQoL
The OHIP-14 (Oral Health Impact Profile) comprises 14 items that
explore sevenis concerned of impact (functional limitation, pain,
The OHIP-49 dimensions with impairment and three functional
The OIDP (Oral Impacts onpsychological and physical) which
psychological discomfort, physical disability, psychological
status dimensions (social, Daily Performances) questionnaire
assesses socialof the seven conditions 16 questions, which takes
disability,the impacts of oral quality of life dimensions. of respond
The OHQoL-UK consists ofand handicap) and participants
represent four disability, a battery of on the abilities
individuals toboth 'effect' and frequency of impact on a 5-point
to each item accordingeight daily activities eating, speaking,
into account perform to the 'impact' of oral health on life
hygiene,incorporating dimensions and relations, sleeping-relaxing,
Likert scale ranging from never to veryan individualised weighting
quality, occupational activities, social often (never = 0, hardly
smiling, occasionally = 2, fairly often = 3, very often = 4), using
ever = 1,and emotional state; using a severity-based approach a
system.
twelve-months recall period
84
86. References
Peter S., Essentials of Preventive and Community
Dentistry, 4/e, Arya(Medi) Publishing House, 2009
Frencken JE, De Amorim RG, Faber J, Leal SC. The caries assessment
spectrum and treatment (CAST) index rational and development. Int
Dent J. 2011;61:117-23.
ICDAS Coordinating Committee (ICDAS CC). Rationale and evidence for
the international caries detection and assessment system (ICDAS-II).
2005. Available from: URL: http://www.icdas.org.
Ismail AI, Sohn W, Tellez M, Amaya A, Sen A, Hasson H et al. The
International Caries Detection and Assessment System (ICDAS): an
integrated system for measuring dental caries. Community Dent Oral
Epidemiol. 2007;35:170-8.
Acharya S. Specific caries index: a new system for describing untreated
dental caries experience in developing countries. J Public Health Dent.
2006;66(4):285-7.
86
87. References
Bratthall D. Introducing the Significant Caries Index together with a
proposal for a new oral health goal for 12-year-olds. Int Dent J.
2000;50:378-84.
Mehta A. Comprehensive review of caries assessment systems developed
over the last decade. RSBO. 2012 jul-sep;9(3):316-21
Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries diagnostic
system differentiating between active and inactive caries lesions. Caries
Research. 1999;33:252-260.
Sikri V, Sikri P. Community dentistry. CBS Publishers and Distributors; 1999
Moustakis VS, Laine ML, Koumakis L et al. Modeling genetic susceptibility:
a case study in periodontitis. In: Combi C, Tucker A, editors. Proceedings
of IDAMAP-2007: Intelligent Data Analysis in Biomedicine and
Pharmacology. Amsterdam, The Netherlands: Artificial Intelligence
Fisher J, Glick M; A new model for caries classification and managementThe FDI World Dental Federation Caries Matrix. Journal of American
Dental Association. Jun 2012; 143(6):546-51
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88. References
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88
Notes de l'éditeur
Indices used in WHO Oral Health Survey
Counts, proportion, rate,
Russell??Expression of clinical observation expressed in a numerical value. This numerical value permits comparison and is more consistent and less subjective than a word description of that condition
Unambiguous- having no uncertainity, mutually exclusive criteriaShould correspond with the clinical stages of disease under study
Intra- and inter- examiner reproducibility
Most extensively used caries measurement tool.it will not be easy to replace DMF index as epidemiologists had collected or still collecting lot of data based upon this indexNo idea on state of disease progresion
Field surveys can miss early lesions whereas practitioners can overtreat
In developed countries where caries cannot be attributed only to frank cavitations and detection of early lesions is important
With dmf, the caries incidence is found to be higher in occlusal surface due to higher chance of presence of cavitation; whereas, incidence of precavitated lesions in higher in facial surface with Nyvad’s CDC
By 1995, in industrialized European countries, majority of population had little or no decay, say 0, 1 or 2 DMFT whereas a minority of them still had considerable DMF-experience. DMFT could not explain this discrepancy
In 15 communities, 11 with 0 DMFT and 4 with 5,10,15,20. mean dmft=3.3; SIC=10(in 5)
Reduces the chances of underestimation of caries by DMFT
Shashidhar
This scoring pattern was based on Black‘s well-known classification of cavity preparation for operative dentistry that was based on morphological consideration. If caries involved two or more surface, then highest score was given.
This will ensure optimal utilization of scarce dental manpower as well as materials.
developed on the basis of insights gained from a systematic review of the literature on clinical caries detection systems
the ICDAS committee developed the ‘wardrobe’ concept where the users can decide at what stage (noncavitated or cavitated) and severity they wish to measure dental caries
Ordinal scale: lists conditions in order of severity w/o attempting to define any mathematical relation between the categoriesOthers---nominal scale, interval/ration
Before describing the codes, it is important to define the term ‘tooth surface’
The characteristics of the base of the discolored area on the root surface can be used to determine whether or not the root caries lesion is active or not.Whenever both a coronal and root surface are affected by a single carious lesion that extends at least 1 mm past the CEJ in both the incisal and apical directions, both surfaces should be scored as caries. However, for a lesion affecting both crown and root surfaces that does not meet the 1 mm or greater extent of involvement, only the coronal or root surface that involves the greater portion (more than 50%) of the lesion should be scored as caries. When it is impossible to invoke the 50% rule (i.e., when both coronal and root surfaces appear equally affected), both surfaces should be scored as caries.the most severe lesion is scored. Non-vital teeth are scored the same as vital teeth.
Correlational and discrimatory validity
Root caries>only face validitycode 1 was the code most scoredAs the DMF index has been used extensively by many for decades, the results obtained from the ICDAS II index should be convertible to the DMF index, thus allowing the use of the latter index for comparison purposes the chance that every person in the world is affected by dental caries becomes very high
Its importance is highlighted in developing countries, where access to oral health services is limited and teeth are often left untreated or are extracted because of pain or discomfort; such an index can provide useful information for researches and authorities.
Results are reported in line with the presentation of results according to the DMF index. They are presented alongside results for carious lesions without pulpal infection, excluding those in enamel, using the DMF index.
not proposed as just another caries assessment index
The CAST index follows the scoring instructions accompanying the use of the ICDAS II, save code 1 and combines codes 2 and 3, and 5 and 6; that of PUFA, save code ‘u’ and combines codes ‘f’ and ‘a’; that of the DMF-index (for the M- and F- component); and includes sealant. Excluding ICDAS II code 1 from the CAST index eliminates the need to dry the tooth surface with an air spray before assessing the enamel: this dental aid is often not available in field situations in many countries. Combining ICDAS II codes 5 and 6 reflect obvious cavities without pulpal involvement. The latter situation is reported in PUFA code ‘p’ and taken up in the CAST index as code 6. As the difference between an abscessed tooth and a tooth with a fistula is minimal, these situations are combined as CAST index code 7.
usefulness for analysis of the dental caries situation in the public oral health setting.However shift from visuo-tactile means to exclusively visual diagnosis
Includes systems that includes:use in clinical practice;use in large-scale epidemiologic surveys in more than one geographical region;promotion for use in clinical practice by one or more NDAs;inclusion of elements likely to enable a shift towards prevention
The proposed matrix does not offer a definitive solution to caries lesion classification and disease management, but it provides a springboard for a dynamic and integrated process in which experts can assess consistency and parallels between different systems. this will provide a more sensitive guide to care management than does a system based solely on visual inspection of the lesion’s site and size
Widespread use of CPITN has produced substantial contributions to WHO’s Global Oral Health Data BankCPITN/PSR not a research toolDigital Plaque Image Analysis
Simplified index -full mouth
Full mouth
An international panel of 97 orthodontists gave subjective judgments on treatment need, complexity, treatment improvement and acceptability based on diverse sample
Quality of life:An individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their personal goals, expectations, standards and concerns
Although philosophically, it is desirable to measure health rather than disease; in practice the epidemiology concerns with measuring disease as health is difficult to define in operational terms and hence difficult to measure.As we cannot measure all diseases…
pærədaɪm
The OHIP-49 is concerned with impairment and three functional status dimensions (social, psychological and physical) which represent four of the seven quality of life dimensions.The OHIP-14 (Oral Health Impact Profile) comprises 14 items that explore seven dimensions of impact (functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap) and participants respond to each item according to the frequency of impact on a 5-point Likert scale ranging from never to very often (never = 0, hardly ever = 1, occasionally = 2, fairly often = 3, very often = 4), using a twelve-months recall periodThe OHQoL-UK consists of a battery of 16 questions, which takes into account both 'effect' and 'impact' of oral health on life quality, incorporating dimensions and an individualised weighting system.The OIDP (Oral Impacts on Daily Performances) questionnaire assesses the impacts of oral conditions on the abilities of individuals to perform eight daily activities eating, speaking, hygiene, occupational activities, social relations, sleeping-relaxing, smiling, and emotional state; using a severity-based approach
The OHIP-49 is concerned with impairment and three functional status dimensions (social, psychological and physical) which represent four of the seven quality of life dimensions.The OHIP-14 (Oral Health Impact Profile) comprises 14 items that explore seven dimensions of impact (functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap) and participants respond to each item according to the frequency of impact on a 5-point Likert scale ranging from never to very often (never = 0, hardly ever = 1, occasionally = 2, fairly often = 3, very often = 4), using a twelve-months recall periodThe OHQoL-UK consists of a battery of 16 questions, which takes into account both 'effect' and 'impact' of oral health on life quality, incorporating dimensions and an individualised weighting system.The OIDP (Oral Impacts on Daily Performances) questionnaire assesses the impacts of oral conditions on the abilities of individuals to perform eight daily activities eating, speaking, hygiene, occupational activities, social relations, sleeping-relaxing, smiling, and emotional state; using a severity-based approach