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Pi 2
INDICES
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ISBN: 9798679717367
(Periodontal Indices: epidemiological, staging & grading, extent & severity, clinical, and
treatment planning indices about periodontitis)
No part of this book may be reproduced in any form or by any electronic or mechanical
means, including information storage and retrieval systems, without written permission from
the author, except for the brief quotations in a book review.
Commercial use and distribution of the contents of the book are not allowed without express
and prior written consent of the author. It is illegal and a punishable offense to make media
files of the whole book (like .pdf files) and distribute them across different media.
Disclaimer:
“Periodontal Indices: epidemiological, staging & grading, extent & severity, clinical, and
treatment planning indices about periodontitis” is presented for awareness, education, and
explanation of periodontal indices so that they can be referred and used by Dentists,
Periodontists and alike. It is presented for research, academic or professional use. The
author and the publisher (or future publishers) are not offering it as professional service.
While best and dedicated efforts have been put in for preparing this book, the author and
the publisher (or future publisher) make no representations or warranties and assume no
liabilities of any kind with respect to the accuracy or completeness of the contents and
specially disclaim any implied warranties of using it for a particular purpose.
Neither the author nor the publisher (or future publisher) shall be held liable or responsible
to any person or entity concerning any loss, or incidental or consequential damages caused,
or alleged to have been caused, directly or indirectly, by the information and procedures
contained herein.
The information contained in this book may be used for research purposes, but professional
advice and thorough reference to the original journal article is advised.
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Contributors:
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Index
Chapter
No. Topic Page No.
1 Introduction to periodontal indices in brief
2 Radiographic alveolar bone loss index by Sheppard (1936)
3
4 Periodontal Index (PI) by Russell (1956)
5
6 Periodontal Disease Index (PDI) by Ramfjord (1959)
7
8
9
10
11
12 Periodontal assessment scoring in WHO Oral Health Surveys Basic Methods (1971)
13
14
15
16
17
18
19
20 Periodontal Status Index by WHO (1977)
21 Community Periodontal Index of Treatment Needs (CPITN) by WHO (1982)
22 The GPM/T Index by Gaengler (1984)
• The TRS 621 Methodology by WHO
23
24
25 Basic Periodontal Examination (BPE) by BSP (1986)
26
27
28 The Periodontal Control System (PCS) by Grace and Smales (1989)
29 Periodontal Screening and Recording Index (PSR) by AAP (1991)
30 Community periodontal index by WHO (1997)
Dutch Periodontal Screening Index (DPSI) by Dutch Society of Periodontology
31 (1998)
32
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33
34
35
36
37
38 Digital image analyzer and alveolar bone loss index by Teeuw et al. (2009)
39
40 Additional Periodontal Treatment Need Indices
Periodontal treatment need by Cross (1952)
Periodontal treatment need by Davies et al. (1961)
Periodontal treatment need by Heloe et al. (1973)
Periodontal treatment need by Markkanen et al. (1979)
Periodontal treatment need by Schonfeld (1981)
Periodontal treatment need by Gordon et al. (1986)
Periodontal treatment need by Oliver et al. (1989)
41 Oxidative stress index by Esen et al. (2012)
42 Modified Community Periodontal Index by WHO (2013)
43
44
45 Dysbiosis ratio of periodontitis by Meuric et al. (2017)
46 Grading based on alveolar bone loss & bleeding on probing by Liljestrand et al.
(2017)
47 Staging and grading of periodontitis by AAP & EFP (2017)
48
49
50 Immunological burden index by Liljestrand et al. (2018)
51 Periodontal indices: When, Why and How?
52 Citation analysis of periodontal indices based on Google Scholar matrix as on 25 th
August, 2020
53 References (Alphabetical)
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Chapter No. 1
Introduction to Periodontal indices in brief
Indices are very important to measure, quantify and grade, presence of disease, extent and
severity of disease, define appropriate treatment approaches, and project quality of life. Not
only for epidemiological purposes, various periodontal indexes have been found to be useful
in recording and preserving clinical patient data at multiple time-points for assessing
treatment results and medico-legal issues.
The understanding of periodontal diseases is improving over decades and because of this the
earlier proposed indices may or may not be useful in current scenario. A researcher or a
clinician should wisely choose between the available indices.
The attempts to measure periodontal disease in certain terms and units form the basis of
evolution of a periodontal index. Periodontitis is a multifactorial immuno-inflammatory
polymicrobial destructive disease of the supporting tissues of the teeth. The signs of the
disease include increased pocket depth, attachment loss, bleeding on probing, suppuration,
bone destruction, soft tissue destruction, tooth mobility, loss of teeth, etc. There are telltale
signs of the disease identified in saliva, gingival crevicular fluid and blood also. Because of
such nature, measurement strategies are varied. The attempts to characterize and measure the
disease can be classified as; morphological, radiological, molecular, genetic, immunological,
microbiological, clinical, biochemical, etc. The indices can also be classified according to
their purpose like, pertaining to definitions, extent and severity, staging and grading,
continuous variable type, etc. The indices can be invasive or non-invasive depending on the
encroachment on personal liberty for clinical examinations. They can be simple (stand-alone)
or composite, depending on number of characteristics chosen.
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Sources of information:
The primary source of information is the PubMed database. Once we finally selected the
article, the full text publication is retrieved from journal websites, online library resources or
physical libraries. The information about indices is directly referred from the original full text
articles as far as possible. We were able to retrieve all full-texts but three. The indices
published independently were also retrieved and discussed. The cross references from the
published articles is also one of the main sources of gathering information.
Expression style:
Information pertaining to only the index is tabulated, whenever possible, for easy referral.
The method of examination and other relevant details are added for each index. Each index is
expressed as a chapter for reducing confusion, and specific and easy reading.
Indices discussed:
Following are the various periodontal indices, 56 in number, presented in this book:
1. Radiographic alveolar bone loss index by Sheppard (1936)
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Chapter No. 2
Radiographic alveolar bone loss index by Sheppard (1936)
Irving Sheppard from New York, USA, while studying the relationship between diabetes
mellitus and alveolar bone destruction, used intraoral radiographs and graded the bone loss on
a scale so as to classify the patients on the basis of severity. He also classified diabetic
patients based on daily insulin requirements.
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Chapter No. 31
Dutch Periodontal Screening Index (DPSI) by DSP (1998)
In the Netherlands, a periodontal diagnosis and treatment protocol was introduced in 1998 by
the Dutch Society of Periodontology (DSP). A component of this protocol is the Dutch
periodontal screening index (DPSI), a procedure that functions as an initial evaluation to
determine the level of additional periodontal examination and subsequently, the treatment
needs of patients with differing disease levels (Van der Velden U, 2009).
Table No. 32: Description of clinical criteria per score of the Dutch periodontal
screening index (DPSI, 1998), to apply per sextant based on the site with the highest
score
Score Clinical criteria for the score per sextant
This index is also a modification of the CPITN and aims to screen for subjects with minor,
moderate and severe periodontal disease. To achieve this, the original CPITN codes 0, 1, 2
remained unchanged, i.e. now written as DPSI 0,1, 2, respectively. CPITN code 3 was
differentiated into 3 minus, that is pathological pockets of 4–5mm without gingival recession
(DPSI 3) and 3 plus that is pathological pockets of 4–5mmwith gingival recession now DPSI
4, CPITN code 4 was recorded into DPSI5. It is also referred to as the “Dutch perio-
protocol”. It recognizes three categories of patients mentioned in the Table No. 33.
Table No. 33: The DPSI treatment need scoring criteria
Treatment need Criteria
Scores
DPSI 1 & 2 Patients that require only oral hygiene instruction and calculus
removal
DPSI 3 Patients that require a limited periodontal examination in order to
be able to make a proper treatment plan
DPSI 4 & 5 Patients that require an extensive periodontal examination in order
to be able to make a proper treatment plan
It is then adopted by the Dutch Govt. and made it compulsory for all the dentists to record
and report.
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Chapter No. 51
Periodontal indices- When, Why and How?
Now after going through several indices on measuring periodontitis incidence and
prevalence, extent and severity, staging and grading, and treatment planning, it becomes more
and more complex and confusing to select an appropriate index for a particular study or
clinical recording. Apart from the problem of selection from many, several indices have been
used or modified as per convenience by the researchers. The modifications included, but not
restricted to, using the same index partly in the mouth, or on index teeth, or even full mouth.
Again, there are variations in taking measurements only on few selected sites on teeth under
observation.
‘’’’’’’’’’’’’’’’’’’’
‘’’’’’’’’’’’’’’’’’’
When?
It is mandatory for a post-graduate student to do research for the partial fulfillment to get the
degree of Master of Dental Surgery, MS, MPH, MClinDent or any other as per the country of
residence. Many interns and UG students also conduct various short term or long-term studies
for making their curriculum vitae stronger for opening multiple channels of education abroad
and in other fields. Studies on various aspects of periodontal diseases are the mainstay for
PGs pursuing studies in Periodontology and Public Health Dentistry.
PGs in Pediatric & Preventive Dentistry also can conduct research on, e.g.
• Prevalence of periodontitis in children visiting a dental hospital
• Prevalence of periodontitis in special and disabled children
• Extent and severity of periodontitis in mixed dentition phase
• Periodontitis prevalence in a locality, school, factory, special group etc., like
school for deaf and dumb
• Comparison between different periodontal indices amongst children and
adolescents
The PGs in Orthodontics also can think of doing a periodontal related study, e.g.
• Prevalence of periodontitis in orthodontic patients undergoing buccal orthodontics
versus lingual orthodontics
• Periodontally accelerated orthodontic therapy and crestal bone loss after
orthodontic therapy
• Various force application matrices and alveolar bone loss and periodontitis
• Types of malocclusions as related to extent and severity of periodontitis in adult
population
The PGs in Conservative Dentistry & Endodontics can also design an interdisciplinary
research topic, e.g.
• Prevalence of periodontitis and presence of class II lesions or fillings
• Cervical perforations/ cervical accessory canals and alveolar bone loss
• Extent and severity of periodontitis and pulpal problems
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• Level of attachment loss and need for root canal therapy
The PGs in other branches and also the interns can think of these lines to extract various
different research projects. All such studies definitely require an index, a periodontal index to
be specific.
Irrespective of which type of study you are doing, whether clinical, epidemiological,
radiographical, surgical, or linkage and association; you will require a corresponding
periodontal index for designing and executing your project. You can use a radiographical
index for finding out associations between periodontitis and diabetes mellitus, but it would be
much appropriate if you are using an extent and severity index for the same if your objective
is to correlate micromolecular aspects.
So, when periodontal index, almost every time when you are considering a project on
periodontal disease.
Why?
Let’s consider you are doing a research for establishing the association between periodontitis
and secondary infection in knee replacement surgeries. You are checking for DNA strands of
periodontal bacteria in washings of infected joints. Now there are two patients, the sample
size will be obviously more this is just an example, one with only one periodontal pocket of 6
mm and the other person has 10 pockets of 6 mm and 8 pockets of 8 mm. Do you feel these
two patients can be compared? Obviously, no. Even if they can be classified as periodontitis
patients, they can’t be compared for influence on infected joints. The influence on induced
bacteremia quotient of the first patient will be much lower than that of the second patient.
Therefore, you require a system where individuals of similar characteristics can be grouped
together for better comparisons. Every level will have a definite upper and lower limit. It will
have specific definitions. It will be realistic, easy to use, complementing rigorous scientific
methodology, repeatable, universal in application, amenable to statistical analysis, etc. This
system is referred to as an ‘Index’, and when it is application to periodontal disease, a
‘periodontal index’.
How?
Once you have selected a particular periodontal index suitable for your research, you should
know how to use it properly. Make tables, charts or recording systems appropriate for the
selected index for each patient/ individual. Write down the methods of calculations for each
patient on the same page.
Often times it becomes confusing where the disease extent and severity looks the same for
two different levels. This happens when the patient values or clinical findings are near the
upper value of lower level and lower values of upper level. Be clear about such doubts in the
beginning and assign clearly in which level you are going to place that patient.
Implementation of a selected index is also one of the most important steps.
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Chapter No. 52
Citation analysis of periodontal indices based on Google Scholar matrix as on
25th August, 2020
Author: Baghele Om N.
How to cite this manuscript: Baghele O. N. Citation analysis of periodontal indices based on
Google Scholar matrix as on 25th August, 2020. In Baghele Om, ed., Periodontal Indices:
epidemiological, staging & grading, extent & severity, clinical, and treatment planning
indices about periodontitis. 2020 Amazon Kindle (ASIN: B08FYH3HPN): Amazon.
www.amazon.com.
Abstract:
Background: The use of a periodontal index is a prerequisite for a vast majority of studies,
especially epidemiological research. The citations to a published periodontal index article
may represent its popularity and use in the literature. As of now there are no citation
analysis studies on articles of periodontal indices.
Materials & Methods: Individual searches were executed on PubMed database using
various terms, like ‘periodontal index’, ‘periodontitis index’, ‘periodontal AND index’, etc.
The cross references of the published articles were ultimately becoming the chosen mode
for further search on PubMed or otherwise. All the 54 indices discussed in the
corresponding book are considered for citation analysis.
The citable and non-citable articles from the selected manuscripts were identified and
Google Scholar citation companion used for noting down number of citations to individual
articles. Citation analyses then conducted using simple mathematical formulae.
Conclusion: Contrary to belief, the citations received by the most important manuscripts on
ways of conducting research is abysmal apart from the indices proposed by the apex
healthcare body, the World Health Organization. There is lack of citable articles for clinical
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periodontal indices like Basic Periodontal Examination and Periodontal Screening &
Recording.
Key words:
Introduction
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Chapter No. 53
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proposal of a new classification and case definition. J Clin Periodontol 2018; 45 Suppl 20:
S149–S161.
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85. Van der Velden U. The Dutch periodontal screening index validation and its application in
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Further reading:
1. Baltacioglu, E., Yuva, P., Aydin, G., Alver, A., Kahraman, C., Karabulut, E., et al. Lipid
peroxidation levels and total oxidant/antioxidant status in serum and saliva from patients
with chronic and aggressive periodontitis. Oxidative stress index: a new biomarker for
periodontal disease?J Periodontol. 2014; 85:1432–1441. doi: 10.1902/jop.2014.130654
2. Beck James D, Moss Kevin L, Morelli Thiago, Offenbacher Steven. In search of appropriate
measures of periodontal status: The Periodontal Profile Phenotype (P 3) system. J
Periodontol 2018; Feb;89(2):166-175. doi: 10.1002/JPER.17-0424. Epub 2018 Feb 22.
3. Buhlin K, et al., Periodontitis is associated with angiographically verified coronary artery
disease, J Clin Periodontol 2011; 38:1007e1014.
4. Dhingra K, Vandana KL. Indices for measuring periodontitis; a literature review. International
Dental Journal 2011; 61:76-84. Doi: 10.1111/j.1875-595X.2011.00018.x
5. Hodges KO. Concepts in nonsurgical periodontal therapy. Albany, NY. Delmar Publishers.
1998.
6. Khoury W, Glogauer J, Tenenbaum HC, Glogauer M. Oral inflammatory load: Neutrophils as
oral health biomarkers. J Periodont Res 2020;00:1–8. https://doi.org/10.1111/jre.12758
7. Kose, O., Arabaci, T., Kara, A., Yemenoglu, H., Kermen, E., Kizildag, A., et al. Effects of
melatonin on oxidative stress index and alveolar bone loss in diabetic rats with periodontitis.
J Periodontol 2016; 87, e82–e90. doi: 10.1902/jop.2016.150541
8. Sharma Vinoda, Hanafi Ahmed, Overgaard Christopher, et al. Oral inflammatory load in
patients with coronary artery disease. Journal of Oral Science 2019; Vol. 61, No. 3, 412-417.
9. Weinberg MA, Fine JB. Comprehensive periodontics for the dental hygienist. Upper Saddle
River, NJ. Pearson Education. 2010.
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About the Author:
www.ombaghele.com
For any issue in the book, please write to [email protected], we are eager to
correct and revise any wrong or inappropriate information in the book.
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