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1. Ackerman, M . Anne: A clinical study of the Do- dence of periodontal disease. J. Periodont., 30:51-59,
minion electric toothbrush. Typed thesis. Univ. of Mich. 1959.
School of Dentistry, Ann Arbor, 1965. p. 86. 5. Ramfjord, S. P., Nissle, R. R., Shick, R. A . and
2. Greene, J. C : Periodontal disease in India: Re- Cooper, H . : Subgingival curettage versus surgical elimi-
port of an epidemiological study. J. dent. Res., 39:302- nation of periodontal pockets. J. Periodont. (In press).
312, 1960. 6. Russell, A . L . : A system of classification and
3. Jamison, Homer: Prevalence and severity of per- scoring for prevalence surveys of periodontal disease.
iodontal disease in a sample of a population. Typed J. dent. Res., 35:350-359, 1956.
thesis. Univ. of Mich. School of Public Health, Ann 7. Smith, W. A . and Ash, M . M . , Jr.: A clinical
Arbor, 1960. 153 p. evaluation of an electric toothbrush. J. Periodont., 35:
4. Ramfjord, S. P.: Indices for prevalence and inci- 127-136, 1964.
Page 38/610
T H E GINGIVAL, P L A Q U E A N D R E T E N T I O N INDICES Page 39/611
Fig. 1. Normal gingiva. Gingival Index score = 0. Fig. 2. M i l d gingivitis. Gingival Index score — 1.
surface after drying is matt. The soft tissue wall of the entrance of
degree of stippling may vary. The the gingival crevice.
gingival margin may be located on G I = 3 is the score for severe inflamma-
the enamel ( F i g . 1) or at various tion. The gingiva is markedly red
levels apical to the cemento-enamel or reddish-blue and enlarged ( F i g .
junction. Although the margin 4). Tendency to spontaneous bleed-
should be thin, the buccal and lin- ing. Ulceration.
gual gingiva may present a rounded
termination against the tooth, there- A s seen, the decisive criterion i n the dif-
by forming the entrance or orifice ferentiation between the G I = scores 1, 2
of the gingival crevice. The form of and 3 is the various tendencies of the gin-
the interdental gingiva depends on giva to bleeding: G I = 1 is the score for
the shape and size of the interden- the slight change from normal, but the
tal areas. The tip of the papilla change is not of the order that bleeding
should be the most incisally or oc- may be provoked by gentle probing. G I = 2
clusally located part of the gingiva. represents the stage where bleeding may be
O n palpation with a blunt instru- initiated by probing and G I = 3 shows tend-
ment (pocket probe) the gingiva ency to spontaneous bleeding.
should be firm.
G I = 1 is the score given when the gingiva Scoring according to this system requires
is subject to m i l d inflammation. light, drying of the teeth and gingivae, mir-
The gingival margin is slightly ror and a pocket probe. If the gingival con-
more reddish or bluish-reddish than dition of mesial, buccal and lingual surfaces
normal and there is slight oedema of a full set of teeth (28) are to be exam-
of the margin ( F i g . 2 ) . A colorless ined, scoring according to the G i n g i v a l In-
gingival exudate may be observed
or collected at the entrance of the
crevice. Bleeding is not provoked
when a blunt instrument (pocket
probe) is run along the soft tissue
wall of the entrance of the gingival
crevice.
G I = 2 This is the score for a moderately
inflamed gingiva ( F i g . 3 ) . The gin-
giva is red or reddish-blue and
glazy. There is enlargement of the
margin due to oedema. Bleeding is
provoked when a blunt instrument
(pocket probe) is run along the Fig. 3. Moderate gingivitis. Gingival Index score = 2.
Page 40/612 LÖE
Fig. 5. Chart for the recording of Plaque Index, Gingival Index and Retention Index.
T H E G I N G I V A L , P L A Q U E A N D R E T E N T I O N INDICES Page 41/613
be examined, for instance by saying: "first the location of the soft debris aggregates.
molar," or the number of the tooth. In this The purpose of introducing this system
way, a good contact is continuously main- (Silness and L ö e , 1964) was also to create
tained between examiner and recorder ( F i g . a plaque index which would match the G i n -
5). gival Index completely.
i n our investigations, but may be conditions and chairside assistance are pro-
useful for the recognition of this vided and all teeth are to be examined scor-
film of plaque. ing according to this system requires ap-
P l l = 2 This score is given when the gin- proximately 5 minutes.
gival area is covered with a thin to
moderately thick layer of plaque. The sequence of the examination for
The deposit is visible to the naked plaque is carried out according to the sys-
eye. tem described for the Gingival Index. W h e n
P l l = 3 Heavy accumulation of soft mat- both G I and P l l are to be used, assessment
ter, the thickness of which fills out of P l l should always precede that of G I .
the niche produced by the gingival
margin and the tooth surface. The
THE RETENTION INDEX
interdental area is stuffed with soft
debris. Recent microscopic and electronmicro-
scopic research has shown that supra- and
subgingival calculus, other rough surfaces
Thus, the Plaque Index scores consider including ill-fitted margins of dental resto-
only differences as to thickness of the soft rations are invariably covered with a non-
deposit i n the gingival area of the tooth mineralized bacterial plaque. This indicates
surfaces, and no attention is paid to the that these irregular surfaces do not per se
coronal extension of the plaque. P l l = 0 is exert a direct mechanical influence on the
the score given when the gingival area of gingival tissue, but that mineralized depos-
the tooth surface is literally free of plaque. its, insufficient dental restorations, untreated
P l l = 1 represents the situation where the carious lesions etc. constitute a group of
gingival area is covered with a thin film of retentive elements the rough surfaces of
plaque which is not visible, but which is which provide the possibilities for the bac-
made visible. P l l = 2 is the score given teria to accumulate i n the gingival area.
when the deposit is visible in situ and P l l =
3 is reserved for the heavy (1-2 m m . thick)
The purpose of creating a Retention In-
accumulation of soft matter. The assess-
dex System (Björby and L ö e , 1967) was to
ment of plaque is made on top of calculus
introduce a system for the assessment of
deposits, on fillings and crowns.
the main retentive factors and which ex-
pressed the quality of the tooth surface (de-
Since the gingival area constitutes the gree of roughness) adjacent to the gingival
unit, the Plaque Index may be scored for tissues. Technically, the Retention Index is
all surfaces of all or selected teeth or for built on principles similar to those under-
selected areas of all or selected teeth. C o n - lying the Gingival Index and the Plaque
sequently, the P l l may be used i n large Index.
scale epidemiological investigations as well
as i n the examination of smaller groups or
CRITERIA FOR T H E R E T E N T I O N INDEX S Y S T E M
within the dentition of the individual. Re-
cent analyses show no difference i n the re- 0 = N o caries, no calculus, no imperfect
sults when only one of the interproximal margin of dental restoration in a gingi-
surfaces are examined instead of both pro- val location.
1 = Supragingival cavity, calculus or imper-
vided the score is given double load and the fect margin of dental restoration.
score for the tooth is divided by four. 2 = Subgingival cavity, calculus or imperfect
margin of dental restoration.
3 = Large cavity, abundance of calculus or
Scoring according to the Plaque Index grossly insufficient marginal fit of den-
System requires light, drying of the teeth tal restoration in a supra- and/or sub-
gingival location.
and gingivae, mirror and a probe. If optimal
T H E GINGIVAL, P L A Q U E A N D R E T E N T I O N INDICES Page 43/615
and Retention Index systems constitute a sensitivity of and the correspondence be-
set of reversible indices w h i c h have proved tween the different indices have facilitated
to be useful instruments i n screening the the evaluations of various therapeutic and
gingival conditions of children, young and preventive measures.
old adults. T h e flexibility of the systems
provides the possibility of selecting specified T h e reproducibility is good provided the
areas or teeth when a large material is ex- examiner's knowledge of periodontal biol-
amined and of utilizing all areas of all teeth ogy and pathology is optimal.
i n the examination of small samples. T h e
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Björn, Anna-Lisa, Koch, G . and Lindhe, J . : Evalua- 21:533-551, 1963.
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300-307, 1965. ence of fluid from normal and inflamed gingivae. Perio-
Holm-Pedersen, P. and Löe, H . : Flow of gingival dontics, 3:171-177, 1965.
exudate as related to menstruation and pregnancy. J. Löe, H . , Theilade, Else and Jensen, S. B . : Experi-
Periodont. Res., 2:00-00, 1967. mental gingivitis in man. J. Periodont., 36:177-187,
Koch, G . and Lindhe, J . : The effect of supervised 1965.
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oral hygiene on the gingiva of children. Progression and Theilade, Else, Wright, W. H . , Jensen, S. B . and
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Lindhe, J., Koch, G . and Mansson, Ulla, The effect of periodont. Res., 1:1-13, 1966.