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D.Caroline Mohamed
07/07/2013 1 D Caroline Mohamed
Outline of lecture Description of normal gingiva
Gingival index by silness and loe
OHI index simplified
CPITN index
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Remembering gingiva anathomy
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Characteristics of normal gingiva
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Characteristics of gingivitis
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How do we know there is a problem?? DIAGNOSIS
Individual complaine
Clinical examinations
Radiographic examination
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Individual complaine Bleeding gums Red gums
Blood on my pilow
Bad taste
Bad smell (halitosis)
Smokers ....less bleeding
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Clinical examinations
Plaque index
Gingival index
Pocket measurment
Furcation
Tooth mobility
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Gingival index of loe and silness The most frequently used index for evaluating
gingivitis.
It is possible to measure
bleeding tendencies
color, contour changes of the gingiva
alternations in the consistency of tissue
and the presence of ulcerations.
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Steps..
The gingival condition around each tooth is examined, and a score for the mesial, distal, buccal, and lingual areas is recorded.
If desired, the gingival index can also be used on only selected teeth in the mouth.
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Bleeding is the most important criterion of inflammation in this index; however, the distinction between normal {0} and mild inflammation {l} is based on visual appearance of the tissues
The intensity of probing with a blunt instrument must be carefully controlled.
The basic intention of this index is not to assess the depth or extent of a pocket or to determine bone loss but only to evaluate the status of gingival health.
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Mesio-facial
Disto-facial
Buccal
Lingual
Buccal
Mesial Distal
Palatine or lingual
Gingival Index: GI
0 1 2 3
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Appearance Bleeding Inflammation Points
normal no bleeding none 0
slight change in color
and mild edema with
slight change in
texture
no bleeding mild 1
redness,
hypertrophy, edema
and glazing
bleeding on
probing/pressu
re
moderate 2
marked redness,
hypertrophy, edema,
ulceration
spontaneous
bleeding
severe 3
Gingival Index Le & Silness 1963
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Training What is the gingival index of this
tooth?
0 normal
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0 normal
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2 bleeding on probing/pressure
moderate
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marked redness, hypertrophy, edema, ulceration
spontaneous bleeding
3
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2
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3
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Gingival Index Method
Six index teeth
16; 12; 24; 36; 32; 44
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6 2 4
4 2 6
Gingival Index Calculation GI for a tooth:
Scores for the four areas of the tooth are added and then divided by four
GI for the individual:
Indices for each of the teeth are added & then divided by the total of number of teeth examined
GI for a group:
Indices for each member of a group is added up & then divided by the total number of individuals in the group.
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GI FORMULA
GI ( tooth) = scores M+D+B+L
4
GI ( individual ) = GI each teeth added
N. of teeth
GI ( group) = GI each individual added
N. of individuals
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Training Youve just assessed Omars gingival situation and filled
his chart now give me his gingival index.
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Gingival Index Tooth
Sum of scores of each tooth divided for 4:
15 ( M=3; D=2;B=1; P=0) /4=
12 ( M=1; D=2; B=3; P=1) /4=
11 ( M=0; D=1; B=0;P=1) /4 =
21 ( M=0; D=1; B=3; P=0) /4=
24 ( M=1; D=2; B=3; P=1 ) /4=
33 ( M=1; D=2; B=3; L=2) /4=
GI individul= Scores each tooth added
N. Teeth
Training Youve just assessed Omars gingival situation and filled
his chart now give me his gingival index.
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Gingival Index Tooth
Sum of scores of each tooth diveded for 4:
15 ( M=3; D=2;B=1; P=0) 6/4=1.5
12 ( M=1; D=2; B=3; P=1) 7/4= 1.75
11 ( M=0; D=1; B=0;P=1) 2/4 = 0.5
21 ( M=0; D=1; B=3; P=0) 4/4=1
24 ( M=1; D=2; B=3; P=1 ) 7/4=1.75
33 ( M=1; D=2; B=3; L=2) 8/4=2
GI individual= Scores each teeth
N. Teeth
Omars GI= =1.5+1.75+0.5+1+1.75+2 6
Omars GI= 8.5 = 1.4 6
Omars gingival index is = 1.4.
What does it mean?
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Average
Gingival Index
Interpretation Patient
evaluation
< 0.1 no inflammation Healthy
0.1 - 1.0 mild inflammation Mild gingivitis
1.1 - 2.0 moderate
inflammation
Moderate gingivitis
2.1 - 3.0 severe
inflammation
Severe gingivitis
Gingival Index Le & Silness 1963
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It means that Omar has moderate inflammation/ gingivitis ( 1.1 to 2.0)
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Oral hygiene index (OHI) Greene, Vermillion, and Waggener,
The OHI of Greene and Vermillion has two components,
the debris index ( DI)
and the calculus index, ( CI)
It is an indication of
oral cleanliness.
The term oral debris include plaque, materia alba and food remnants.
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The scores may be used singly or in combination.
For scoring, the clinician divides the dentition into sextants and selects the facial (or buccal) and lingual tooth surface in each sextant that is covered with the greatest amount of debris and calculus.
Twelve surfaces, therefore, will be evaluated.
For this index, a surface includes half the circumference of the tooth.
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Debris Index
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How to proceed? Each tooth is dried and examined visually using a mirror,
an explorer, and adequate light.
The explorer is passed over the cervical third to test for the presence of plaque.
A disclosing agent may be used to assist evaluation.
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Criteria for classifying debris Silness and Loe
Score Criteria
0 No debris or stain present
1 A film of plaque covering the
tooth or soft debris covering
not more than 1/3 of the tooth
surface, or presence of
extrinsic stain without other
debris regardless of surface
area covered
2 Moderate accumulation of
soft deposits in the gingival
pocket or on the tooth. Soft
debris covering more than 1/3
but not more than 2/3 of the
exposed tooth surface
3 Soft debris covering more
than 2/3 of the exposed tooth
surface or abundance of soft
matter within the pocket 07/07/2013 47 D Caroline Mohamed
Training Give me the right debris score:
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3
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0
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1
2
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3
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1 3
2
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3
1
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0
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Criteria for classifying calculus
Scores Criteria
0 No calculus present
1 Supragingival calculus covering not more than 1/3
of the exposed tooth surface
2 Supragingival calculus covering more than 1/3 but
not more than 2/3 of the exposed tooth surface or
the presence of individual flecks of subgingival
calculus around the cervical portion of the tooth or
both
3 Supragingival calculus covering more than 2/3 of the exposed tooth surface or a continuous heavy
band of subgingival calculus around the cervical
portion of the tooth or both 07/07/2013 62 D Caroline Mohamed
Training
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Training
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3 1
3
0
0
2
3
1
To help to memorize....
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ORAL HYGIENE INDEX SIMPLIFIED Greene and Vermilion
One of the most popular indicators for determining oral hygiene status in epidemiologic study
Greene and Vermillion have also developed a simplified OHI in which the clinician measures only one tooth surface in each sextant, equaling only six surfaces. ( 6 rather than 12)
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Selection of tooth surfaces
Six Index surfaces are examined:
The buccal surface of the upper 1st molars ( 16, 26)
The lingual surfaces of the lower 1st molars ( 36, 46)
The labial surface of the upper right central incisor (11 )
The labial surface of the lower left central incisors ( 31)
16 11 26
46 31 36
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Calculating OHI-Simplified DI-S = Buccal total score + Lingual total score
N. of segments scored
CI- S = Buccal total score + Lingual total score
N. of segments scored
Oral Hygiene Index (OHI-S) = D I-S + C I-S
OHI-S Value ranges from 0 to 6
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Good 0.0 to 1.2
Fair 1.3 to 3.0
Poor 3.1 to6.0
Sign the worse score FOR debris
index and Calculus index (WHO, pathfinder methods, 1993).
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Oral hygiene index-s
Advantages:
It takes less time to score.
It is easy to score.
It is useful in survey work
Disadvantages:
Results are biased
The index is not sensitive.
It is not ideal for clinical trials {Research}.
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Community Periodontal Index of Treatment Needs (CPITN)
Developed by Russell, the PI determines the periodontal disease status of populations in epidemiologic studies. Each tooth is scored according to the condition of the surrounding tissues.
It can be based solely upon clinical examination, or it can make use of Xrays.
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CPITN index
Indicators. Three indicators of periodontal status are used for this assessment:
presence or absence of gingival bleeding
supra- or subgingival calculus
periodontal pockets-subdivided into shallow (4-5mm) and deep (6mm or more).
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CPITN probe
A specially designed light weight probe with a 0.5-mm ball tip is used, bearing a black band between a 3.5 and 5.5 mm from the ball tip.
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D Caroline Mohamed
Sextant The mouth is divided into
6 sextant defined by the teeth number
A sextant should be examined only if there are two or more teeth present and not indicated for extraction.
When only 1 tooth remain in a sextant it should be included in the adjacent sextant
Upper right
posterior
18-14
Upper
anterior
13-23
Upper left
posterior
24-28
lower right
posterior
44-48
Lower
anterior
33-43
lower left
posterior
38-34
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Teeth to be examined For adults aged 20 years and over, the teeth to be examined are: The
2 molars in each posterior sextant are paired for recording, and if one is
missing, there is no replacement.
If no index teeth or tooth is present in a sextant qualifying for examination, all the remaining teeth in that sextant are examined
For young people up to the age of 19 years, only six teeth 16,11,26,36,31 and 46 are examined
For children under 15 recording for pocket should not be attempted. ie., only bleeding and calculus should be considered
If no index tooth is present in a sextant qualifying for examination, single fully erupted incisor or premolar may be substituted
17 16 11 26 27
47 46 31 36 37 07/07/2013 75 D Caroline Mohamed
Sensing gingival pocket The sensing force used should be no more than 20 gms
A practical test for establishing this force is to place the probe point under he thumb nail and press until blanching occurs
For sensing sub gingival calculus, the lightest force that will allow movement of the probe ball point along the tooth surface should be used
The depth of insertion read against the colour coding.
At least 6 point on each tooth should be examined: mesio-buccal, mid-buccal, disto-buccal, and the corresponding lingual sites.
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When non-index teeth are examined, the highest score found in the sextant is recorded in the appropriate box.
If there are not at least two teeth remaining and not indicated for extraction in a sextant, the appropriate box should be cancelled by a cross ( x ).
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Examination and recording. The incisor and either the first molars (up to 19 years) or the pairs of first and
second molars (above 19 years) should be sensed and
the highest score recorded in the appropriate box.
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Scoring criteria for Russels ( CPTI) 0: normal
l: bleeding observed, directly or by using mouth mirror,
after sensing
2: calculus felt during probing but all the black area is
visible
3: pocket 4 or 5 mm (gingival margin situated on black
area of probe
4: pocket > 6 mm (black area of probe not visible)
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CPTIN Score Criteria for field studies
Additional X ray criteria
Treatment Needs
0 Healthy. Neither overt inflammation nor loss of
function caused by the
destruction of supporting
tissue is noted
Radiographic appearance
normal
No need for treatment
1 Mild Gingivitis. Overt inflammation in the free
gingiva is present, but
does not circumscribe the
tooth.
-------------------------------- TN 1 .Need to improve individual OH. Require
OHI nstructions
2 Gingivitis. Inflammation surrounds the tooth, but
there is no apparent break
in the epithelial
attachment
--------------------------------- TN2. Patient needs OHI and Professional cleaning.
Pockets of 4 to 5 mm
needs Scaling an root
planning
6 Gingivitis with pocket formation. The tooth is not
mobile in the socket and
not drifted.
Horizontal bone lost
involving the entire
alveolar crest, up to half of
the length of the tooh root(
distance from apex to
cementoenamel junction)
TN 3. Needs of complex
treatment ( deep scaling,
efficient personal OH
measures)
8 Advanced destruction with loss of function. The tooth
may be loose or drifting. It
may sound dull on
percussion and may be
depressible in the socket.
Advanced bone loss,
involving more than half of
the length of the tooth root
or a definite intrabony
pocket with definite
widening of the
periodontal membranes.
Therre may be root
resorption, or rarefaction
of the apex.
. // 07/07/2013 D Caroline Mohamed 80
Scores for each tooth are added, and the total divided by the number of teeth examined. Scores can be interpreted
as follows:
0-0.2: Clinically normal supportive tissues.
0.3-0.9: Simple gingivitis.
0.7-1.9: Beginning destructive periodontal disease.
1.6-5.0: Established destructive periodontal disease.
3.8-8.0: Terminal periodontal disease.
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Thank you
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