Dental Indices
Dental Indices
By:
Muthukumaran. L. R
Final year BDS(Aug batch)
Dental Indices
Contents
● Introduction
● Definition
● Requirements
● Objectives and Uses
● Indices
○ DMFT/DMFS index
○ Russell's periodontal index
○ Dean’s fluorosis index
○ IOTN index
○ CPITN index
○ CPI index
● Conclusion
Introduction
- Russel A L (1969)
- Irving Glickman
Requirements
1. Simplicity
2. Objectivity
3. Validity
4. Reliability
5. Quantifiability
Requirements (Cont.)
1. Simplicity:
● Should be easy to apply, without losing more time than necessary
● No expensive equipments should be needed.
2. Objectivity:
Criteria for the index should be clear and unambiguous, with mutually exclusive
categories.
Requirements (Cont.)
3. Validity:
It should correspond with the clinical stages of the disease under study at each stage.
Two components:
Sensitivity: To detect the disease when it is present.
Specificity: To not detect the disease when it is not present.
Requirements (Cont.)
4. Reliability:
It should measure consistently at different times and under various conditions.
Two components:
Intraexaminer reliability: Same examiner should get the same results at different
times.
5. Quantifiability:
2. In Research:
● To form a base line of data for the research before adding any variable to the examination.
● To assess the effectiveness of a oral hygiene practice or a treatment method towards a certain disease.
3. In Community health:
● In assessing and evaluating the prevalance and incidence of a condition in a community.
● To compare the effects of community programs and evaluate the results.
Indices
1. DMFT index
2. DMFS index
5. IOTN index
6. CPITN index
7. CPI index
DMFT Index
(Decay-Missing-Filled teeth index)
This index was given by Henry T. Klein , Carole E. Palmer and Knutson. J. W in 1938.
This index was formed based on the fact that the dental hard tissues are not self healing and have
scars of past established caries.
It is a irreversible index which records lifetime caries experience.
Instruments used:
1. Mouth mirror
2. Explorer
Procedure:
This index is only for permanent dentition.
It has 3 components:
3. D - used to describe the decayed tooth
4. M - used to describe the teeth missing due to caries
5. F - used to describe teeth that has been filled due to caries.
DMFT index (cont.)
Examination method:
● D-Decayed : Indicating the permanent teeth that are decayed. It includes teeth with
dental caries and restored teeth with recurrent caries. The explorer should catch
into the deep grooves for occlusal caries.
● M-Missing : Indicates the teeth that are missing due to decay. The teeth that are
badly decayed abd indicated for extraction are also counted as missing. Proper
history should be taken to ensure the teeth are marked correctly.
● F-Filled : Indicates the number of permanent teeth that are affected and restored to
its previous healthy condition. Tooth with multiple restorations is evaluated as one
tooth. Any teeth with restoration and recurrent caries is not counted as filled tooth,
but as decayed tooth.
DMFT index (cont.)
Scoring format:
17 16 15 14 13 12 11 21 22 23 24
25 26 27
47 46 45 44 43 42 41 31 32 33 34
35 36 37
Calculation:
Individual DMFT:
Maximum score: 28
DMFT score = D + M + F
Group average:
Total DMF
Average DMFT =
Total number of the subjects examined
DMFT index (cont.)
Modifications:
Limitations:
● DMFT values are not related to number of teeth at risk.
● It can be invalid in older patients since teeth czn be lost due to many reasons
other than caries.
● DMFT indexncan overestimate the caries experience of tooth with preventive
restorations.
● It cannot be used in cases of root caries.
DMFS index
(Decay-Missing-Filled surface index)
This index was developed by Henry T. Klein, Carole E. Palmer and Knutson. J. W in 1938, along
with the DMFT index.
This index was formed to evaluate the prevalance of the coronal caries.
Procedure:
It is applied only to the permanent dention.
It has 3 components:
D - used to describe the decayed teeth surface.
M - used to describe the teeth surfaces missing due to caries.
F - used to describe the surfaces that has been previously filled due to caries.
Instruments used:
Mouth mirror
Explorer
DMFS index (cont.)
Surfaces examined:
For posterior teeth: Facial, Lingual, Mesial, Distal, Occlusal.
For anterior teeth: Facial, Lingual, Mesial, Distal.
The principle, rules, criteria, and calculations are all same as the DMFT index.
DMFS index (cont.)
Scoring format:
17 16 15 14 13 12 11 21 22 23 24 25 26 27
47 46 45 44 43 42 41 31 32 33 34 35 36 37
Advantages:
The DMFS index is more sensitive and it is the preferred index in clinical trial of a
caries-preventive agents.
Limitations:
● DMFS examinations take longer.
● It is more likely to produce inconsistencies in diagnosis.
● Radiographs may be required for accurate diagnosis.
Russell’s periodontal index
Purpose:
Instruments used:
Mouth mirror
Blunt probe
Scoring format:
28 27 26 25 24 23 22 21 11 12 13 14 15 16
17 18
38 37 36 35 34 33 32 31 41 42 43 44 45
46 47 48
Russell’s periodontal index (cont.)
SCORE CRITERIA
Interpretation:
0 - 0.2 Normal
Procedure:
The recording of this index is based on the two most affected teeth.
If the two teeth are not equally affected, the score of the less
affected tooth is recorded. When scoring, the examiner starts at
highest or severe score and eliminates each score till the right score
arrives.
When in doubt, lower scores should be recorded.
Trendley H. Dean
(1893 - 1962)
Dean’s Fluorosis Index (cont.)
Scoring format:
18 17 16 15 14 13 12 11 21 22 23 24 25
26 27 28
48 47 46 45 44 43 42 41 31 32 33 34 35
36 37 38
Fluorosis score:
Dean’s Fluorosis Index- Original criteria was given in Dean’s Fluorosis Index- Modified criteria was given in
1934, it was based on a 7 point ordinal scale:
● 1942, it is based on a 6 point ordinal scale:
Normal
● Questionable ● Normal
● Very mild ● Questinable
● Mild
● Very mild
● Moderate
● Moderately severe ● Mild
● Severe ● Moderate
● Severe
Dean’s Fluorosis Index (cont.)
Modified criteria (1942):
Questionable 0.5 Slight aberrations with few white flecks or occational spots.
Very mild 1 Small opaque white spots involving approx 25% of tooth surface.
The Index of Orthodontic Treatment Needs was given by P.H. Brook and W.C. Shaw in
1989.
This index was given to assess the need for orthodontic treatment from an anatomical and
aesthetic perspective.
Introduced by Jukka Ainamo, David Barmes, George Beagrie, Terry Cutress, Jean Martin
and Jennifer Sardo-Infirri for joint committee of WHO and FDI in 1982.
Developed to evaluate the periodontal treatment needs rather than the past and present
periodontal health status.
It assesses only conditions that are responsive to treatments, but not the non-treatable or
irreversible conditions.
This index provides guidance on planning and monitoring the effectiveness of periodontal care
programme and dental personal required.
CPITN index (cont.)
Procedure:
For Clinical practice the highest score in each sextant is identified after examining all teeth.
17 - 14 13 - 23 24 - 27
SEXTANTS
47 - 44 43 - 33 34 - 37
For Epidemiological purposes the score is identified by examination of specific index teeth.
17/16 11 26/27
INDEX
47/46 31 36/37 TEETH
CPITN index (cont.)
Instruments used:
1. Mouth mirror
2. CPITN probe
a. CPITN-E probe
b. CPITN-C probe
Purpose:
Examination procedure:
● Aim : To record the highest score in each quadrant with least number of
measurements.
● The sextant can be scored only if more than one functional tooth is present.
● If ‘no’, the score is marked ‘X’ and move on to next sextant.
● If ‘yes’, the teeth are examined for pocket of 6mm or deeper, 4 or 5mm
● pockets, calculus and bleeding in the same order.
● Once the highest score has been recorded, there is no need to check for the
lower scores in the same sextant.
● In epidemiological studies, only the index teeth are checked. While for
clinical examination, all teeth are examined.
CPITN index (cont.)
Rules to be examination:
● Two or more functional teeth must be present in a sextant for it to be scored.
● In posterior sextant, if one of two index teeth is absent or excluded, then the scoring is
done based on the remaining index teeth.
● If both the index teeth are absent or excluded, all remaining teeth in the sextant are
examined and the highest score is recorded.
● In anterior sextant, if 11 is excluded, its is substituted with 21. If 21 is also excluded l,
remaining teeth are examined and the worst score is recorded. This applies for both maxilla
and mandible.
● In subjects of age 20 or below, if the first molar is absent or excluded, the nearest adjacent
premolar is examined.
● Single tooth in a sextant is considered to be part of adjacent sextant, if it is an index tooth,
then the worst index tooth score is recorded.
● Third molar are excluded unless they are functioning in place of second molar.
CPITN index (cont.)
Scoring format:
CPITN score:
17/16 11
26/27
47/46 31
36/37
Treatment needs:
17/16 11
26/27
47/46 31
36/37
CPITN index (cont.)
CODE CRITERIA
Code 4 Pathological pocket formation of 6mm or more. (Band in probe not visible)
TN 0 A recording of code 0 or code X for all sextants indicate there is no need for periodontal treatment.
TN 1 A recording of code 1
Indicating the need for improving personal oral hygiene habits of the individual.
TN 2a A recording of code 2
Indicates need for scaling and root planing.
Indicating the need for improving personal oral hygiene habits of the individual.
TN 2b A recording of code 3
Indicates need for scaling and root planing.
Indicating the need for improving personal oral hygiene habits of the individual.
TN 3 A recording of code 4
Complex treatment which could involve deep scaling, root planning, and more complex surgical
procedures.
CPI Index
( Community Periodontal Index)
The CPI index is based on the modification of CPITN index by WHO in 1997.
This modification is done by inclusion of measurement of “Attachment loss” and
elimination of the “Treatment needs” category.
Instruments used:
Mouth mirror
The CPITN-C probe.
Procedure:
The teeth to be examined, the procedure of probing and examination are same
as CPITN index.
Attachment loss
Scoring format:
17/16 11
26/27
47/46 31
36/37
CPI Index (cont.)
Score Criteria
0 Healthy.
X Excluded sextant.
9 Not recorded.
CPI Index (cont.)
Score Criteria
0 Loss of attachment 0-3mm (CEJ not visible and CPI score is 0-3)
If the CEJ is not visible and the CPI score is 4 or CEJ is visible