D.

Caroline Mohamed
07/07/2013

D Caroline Mohamed

Outline of lecture
Description of normal gingiva
Gingival index by silness and loe
OHI index simplified
CPITN index

07/07/2013

D Caroline Mohamed

Remembering gingiva

anathomy

07/07/2013

D Caroline Mohamed

07/07/2013

D Caroline Mohamed

07/07/2013

D Caroline Mohamed

07/07/2013

D Caroline Mohamed

Characteristics of
normal gingiva

07/07/2013

D Caroline Mohamed

07/07/2013

D Caroline Mohamed

07/07/2013

D Caroline Mohamed

07/07/2013

D Caroline Mohamed

10

07/07/2013

D Caroline Mohamed

11

Characteristics of gingivitis

07/07/2013

D Caroline Mohamed

12

How do we know there is a problem??

DIAGNOSIS
Individual complaine
Clinical examinations
Radiographic examination

07/07/2013

D Caroline Mohamed

13

Individual complaine
Bleeding gums

Red gums
Blood on my pilow
Bad taste
Bad smell (halitosis)
Smokers ....less bleeding

07/07/2013

D Caroline Mohamed

14

Clinical examinations
Plaque index
Gingival index
Pocket measurment
Furcation

Tooth mobility

07/07/2013

D Caroline Mohamed

15

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.

07/07/2013

D Caroline Mohamed

16

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.

07/07/2013

D Caroline Mohamed

17

 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.

07/07/2013

D Caroline Mohamed

18

B
u
c
c
a
l
Mesiofacial

B
u
c
c
a
l

Distofacial

Mesial
L
i
n
g
u
a
lD Caroline Mohamed

Distal

Palatine
or lingual
19

Gingival Index: GI
0

07/07/2013

D Caroline Mohamed

20

Gingival Index Le & Silness 1963

Appearance

Bleeding

Inflammation

Points

normal

no bleeding

none

slight change in color no bleeding

and mild edema with
slight change in
texture

mild

moderate

severe

redness,
hypertrophy, edema
and glazing

bleeding on
probing/pressu
re

marked redness,
hypertrophy, edema,
ulceration

spontaneous
bleeding

07/07/2013

D Caroline Mohamed

21

Training
What is the gingival index of this
tooth?

07/07/2013

D Caroline Mohamed

22

0 normal

07/07/2013

D Caroline Mohamed

23

07/07/2013

D Caroline Mohamed

24

0 normal

07/07/2013

D Caroline Mohamed

25

07/07/2013

D Caroline Mohamed

26

2 bleeding on
probing/pressure
moderate

07/07/2013

D Caroline Mohamed

27

07/07/2013

D Caroline Mohamed

28

 marked redness, hypertrophy, edema, ulceration

spontaneous bleeding

07/07/2013

D Caroline Mohamed

29

07/07/2013

D Caroline Mohamed

30

07/07/2013

D Caroline Mohamed

31

07/07/2013

D Caroline Mohamed

32

07/07/2013

D Caroline Mohamed

33

Gingival Index
Method
Six index teeth

16; 12; 24; 36; 32; 44

6

07/07/2013

D Caroline Mohamed

34

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.

07/07/2013

D Caroline Mohamed

35

GI FORMULA
GI ( tooth) =

GI ( individual ) =
GI ( group) =

07/07/2013

scores M+D+B+L
4
GI each teeth added
N. of teeth
GI each individual added
N. of individuals

D Caroline Mohamed

36

Training

Youve just assessed Omars gingival situation and filled

his chart now give me his gingival index.

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=

07/07/2013

D Caroline Mohamed

GI individul=
Scores each tooth added
N. Teeth

37

Training

Youve just assessed Omars gingival situation and filled

his chart now give me his gingival index.

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

07/07/2013

D Caroline Mohamed

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

38

 Omars gingival index is = 1.4.

What does it mean?

07/07/2013

D Caroline Mohamed

39

Gingival Index
Le & Silness 1963
Average
Gingival Index

Interpretation

Patient
evaluation

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

< 0.1

07/07/2013

D Caroline Mohamed

40

 It means that Omar has

moderate
inflammation/ gingivitis ( 1.1 to 2.0)

07/07/2013

D Caroline Mohamed

41

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.

07/07/2013

D Caroline Mohamed

42

 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.

07/07/2013

D Caroline Mohamed

43

Debris Index

07/07/2013

D Caroline Mohamed

44

 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.

07/07/2013

D Caroline Mohamed

45

07/07/2013

D Caroline Mohamed

46

Criteria for classifying debris Silness and Loe

Score

07/07/2013

Criteria

No debris or stain present

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

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

Soft debris covering more

than 2/3 of the exposed tooth
surface or abundance of soft
matter
within the pocket
D Caroline Mohamed

47

Training
Give me the right debris score:

07/07/2013

D Caroline Mohamed

48

07/07/2013

D Caroline Mohamed

49

07/07/2013

D Caroline Mohamed

50

07/07/2013

D Caroline Mohamed

51

07/07/2013

D Caroline Mohamed

52

07/07/2013

D Caroline Mohamed

53

07/07/2013

D Caroline Mohamed

54

07/07/2013

D Caroline Mohamed

55

07/07/2013

D Caroline Mohamed

56

07/07/2013

D Caroline Mohamed

57

07/07/2013

D Caroline Mohamed

58

07/07/2013

D Caroline Mohamed

59

07/07/2013

D Caroline Mohamed

60

07/07/2013

D Caroline Mohamed

61

Criteria for classifying calculus

Scores

Criteria

No calculus present

Supragingival calculus covering not more than 1/3

of the exposed tooth surface

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

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
D Caroline
Mohamed
62

07/07/2013

Training

07/07/2013

D Caroline Mohamed

63

Training
3

1
2

0
3

07/07/2013

D Caroline Mohamed

64

To help to memorize....

07/07/2013

D Caroline Mohamed

65

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)

07/07/2013

D Caroline Mohamed

66

Selection of tooth surfaces

Six

16

11

26

46

31

36

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)

07/07/2013

D Caroline Mohamed

67

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

07/07/2013

Good

0.0 to 1.2

Fair

1.3 to 3.0

Poor

3.1 to6.0
D Caroline Mohamed

68

Sign the worse score FOR debris

index and Calculus index
(WHO, pathfinder methods, 1993).

07/07/2013

D Caroline Mohamed

69

Oral hygiene index-s

Advantages:

It takes less time to

score.
It is easy to score.
It is useful in survey
work

07/07/2013

D Caroline Mohamed

Disadvantages:

Results are biased

The index is not sensitive.
It is not ideal for clinical

trials {Research}.

70

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.

07/07/2013

D Caroline Mohamed

71

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 (45mm) and deep (6mm or more).

07/07/2013

D Caroline Mohamed

72

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.

07/07/2013

73
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

07/07/2013

D Caroline Mohamed

Upper right
posterior
18-14

Upper
anterior

Upper left
posterior
24-28

13-23
lower right
posterior
44-48

Lower
anterior

lower left
posterior
38-34

33-43

74

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

D Caroline Mohamed

75

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.

07/07/2013

D Caroline Mohamed

76

 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 ).

07/07/2013

D Caroline Mohamed

77

 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.

07/07/2013

D Caroline Mohamed

78

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)

07/07/2013

D Caroline Mohamed

79

CPTIN Score

Criteria for field

studies

Additional X ray
criteria

Treatment Needs

Healthy. Neither overt

inflammation nor loss of
function caused by the
destruction of supporting
tissue is noted

Radiographic appearance
normal

No need for treatment

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

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

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)

Advanced destruction with

loss of function. The tooth
may be loose or drifting. It
may sound dull on
percussion
and
may be
D Caroline
Mohamed

Advanced bone loss,

involving more than half of
the length of the tooth root
or a definite intrabony
pocket with definite

07/07/2013

. //

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.

07/07/2013

D Caroline Mohamed

81

Thank you

07/07/2013

D Caroline Mohamed

82