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PERIO EXAM 2 > Periodontal Indices > Flashcards

Periodontal Indices Flashcards

1
Q

How can you identify disease?

A

Data Collection
- personal interview
- questions of a surrogate
- written questionnaire
- scrutinizing pre-existing records
- direct examination
Symptoms, Signs and Tests
- subjective observations by the patient
- perceptions and observations by the examiner
- quantifiable measures of physiologic, immunologic, and biochemical processes

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2
Q

what two factors can affect the accuracy of an examination?

A

Reproducibility (examiner; instrument; condition)
- the ability to produce the same result (e.g., gingivitis) every time the test was repeated in the same patient
Validity (predictive; content; criterion-related)
- the ability of a test to discriminate between people with and without disease

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3
Q

How can the true value of a diagnostic test be assessed?

A

the true value of a diagnostic test is a combo of both the reliability and the validity of the data. For example, if a test is designed to discriminate between health and disease, then a highly reliable and valid test will have values centered around the true value every time the test is used. A highly reliable, but poorly valid test will produce the same result every time the test is used. A highly variable, but poorly valid test will produce the same result every time, but the result is not correct. A poorly reliable, but highly valid test will not detect the result every single time, but will be correct some of the time.

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4
Q

What’s sensitivity?

A
  • the probability that a test result will be positive when the test is administered to people who actually have the disease in question
  • sensitivity = Pr(T+/D+)
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5
Q

What’s specificity?

A

the probability that a test will be negative when administered to people who are free of the disease in question.
specificity= Pr(T-/D-)

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6
Q

What’s Predictive Value Positive (PVP)?

A
  • the probability of disease in a subject with a positive test result
  • PVP = Pr (D+/T+)
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7
Q

what’s Predictive Value Negative (PVN)?

A
  • the probability of not having the disease when the test is negative
  • PVN = Pr (D-/T-)
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8
Q

What are some potential problems (examiner bias) when diagnosing?

A

Halo Effect
Leniency/Severity Error
Central Tendency Error

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9
Q

What’s the halo effect?

A

the examiner’s general impression of target distorts his/her perception of the target on specific dimensions

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10
Q

what’s leniency/severity error?

A

the examiner’s tendency to be lenient or severe

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11
Q

what’s central tendency error?

A

the examiner’s reluctance to rate at either the positive or negative extreme, so all scores cluster in the middle

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12
Q

what are some parameters commonly used in clinical periodontology?

A
  • plaque accumulation
  • calculus formation
  • gingival inflammation
  • periodontal destruction
  • periodontal treatment needs
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13
Q

what’s the plaque index?

A
  • the PI-I assesses the amount of plaque at the gingival margin, examine the same anatomical units as the GI
  • plaque scores range from 0 to 3
  • a probe is used to distinguish between scores 0 and 1. Visible plaque is scored a 2 or a 3
  • the PI-I is computed for a tooth, subject, or population
  • it parallels the GI of Loe & Silness
  • first published by Silness & Loe
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14
Q

What’s the Silness and Loe plaque index (PLI)?

A
  • introduced in 1967
  • association of plaque and pregnancy gingivitis
  • measures abundance of plaque
  • no disclosing
  • index teeth
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15
Q

What’s index teeth (Ramfjord teeth)?

A
  • used by Ramfjord in 1957 to study disease progression
  • tooth numbers - 3, 9, 12, 19, 25, 28
  • advantages:
    • representative of changes in entire mouth
    • less time
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16
Q

What’s the scoring criteria for the plaque index?

A

0 - no plaque
1 - plaque detected by running probe margins
2 - visible plaque
3 - abundant plaque

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17
Q

What’s the Turesky Modification of Quigley-Hein Plaque Index scores?

A

Score 0 - no plaque
Score 1 - spots of plaque at cervical margin
Score 2 - thin, continuous band of plaque, 1 mm but, <1/3 of crown height
Score 4 - Plaque covering >_ 1/3 but <2/3 of crown height
Score 5 - plaque covering >_ 2/3 of crown height

18
Q

What’s the Turesky Modification of Quigley-Hein Plaque Index?

A
  • the quigley-hein index is biased toward the gingival third of the tooth surface
  • facial and lingual surfaces are examined
  • plaque is made visible using a disclosing agent and scored using a 0 to 5 scoring system
  • scores are computed for subject, population
  • it is the most frequently used plaque index in clinical trials
  • quigley and hein (1962); turesky et al. (1970)
19
Q

What are the NIDR Calculus index score?

A

0: calculus is absent
1: supra gingival calculus , but no sub gingival calculus is present
2: supra gingival and sub gingival, or sub gingival calculus only is present

20
Q

What’s the Volpe-Manhold Index?

A
  • determines the quantity of supra gingival calculus
  • lingual surfaces os lower anteriors (#22-27)
  • quantity is determined in mm of calculus along the 2 diagonal and the central lines drawn over the lingual surface of each tooth
  • index, expressed in mm, is computed for tooth, subject, population
  • most frequently used calculus index in longitudinal studies
  • published by Volpe and Manhold (1962)
21
Q

What are some calculus Indices?

A 
Simplified Oral Hygiene Index (OHI-S)
Periodontal Disease Index (PDI)
Probe Method (Volpe-Manhold)
Calculus Surface (Severity) index (CSI)
Marginal Line Calculus Index (MLCI)
NIDR Calculus Index
22
Q

What’s the papillary-marginal- attachment (PMA) - Index

A
  • background: the number of units affected correlates with the severity of gingival inflammation
  • facial gingiva surface is divided in 3 scoring units P-M-A
  • gingival units affected with gingivitis are counted. Presence or absence of inflammation is counted as 1 and 0, respectively
  • severity component can be considered
  • score computed for tooth, subject. and population
  • first published by Schour & Massler (1947)
23
Q

What parameters of gingival condition does Loe and Silness gingival index look at?

A

color
consistency
contour
BOP

24
Q

What’s the gingival index?

A
  • the severity of inflammation is assessed in 4 distinct gingival areas: distofacial papilla, facial margin, mesiofacial papilla, lingual gingival margin
  • scores: 0 to 3; bleeding is considered. Presence of bleeding automatically leads to a score >_2
  • score for tooth, subject, population
  • useful for calculation of prevalence and severity in population and individual
  • frequently used index in clinical trials
  • first published by Loe and Loe & Silness
25
Q

What is the criteria for gingival index?

A 
0 - healthy gingiva
1 - mild inflammation
    * slight change in color
    * slight edema
    * no BOP
2 - moderate inflammation
    * redness
    * edema
     * glazing
     * BOP
3 - severe inflammation
     * marked redness
     * edema
     * ulceration
     * spontaneous bleeding (eating, chewing, blood on my pillow)
26
Q

How is bleeding-on-probing (BOP) assessed?

A
  • the bleeding tendency is assessed upon probing a periodontal pocket using standardized pressure
  • periodontal probe is inserted to the bottom of the periodontal pocket. bleeding is absorbed 15 seconds following retraction of probe
  • presence or absence of bleeding is scored as 1 and 0 respectively.
  • not be confused with bleeding as scored in GI
  • B-o-P is a valid indicator for periodontal stability. However, it is a poor indicator of periodontal breakdown
27
Q

How do you calculate attachment levels?

A

attachment level (mm) = probing depth (mm) + recession (mm)

28
Q

what are some factors affecting probe readings?

A
  • probing force
  • probe angulation
  • tissue condition
29
Q

What are some Periodontal Indices?

A
  • The Extensions and Severity Index
  • The Periodontal Index System
  • The Periodontal Disease Index System
  • The CPITN
  • Periodontal Screening and Recording
30
Q

What’s the purpose of Periodontal Screening and Recording?

A
  • this is a rapid and effective way to screen patients for periodontal diseases and summarizes necessary information with minimum documentation
    Endorsements: the ADA and AAP support the use of PSR by dentists as a part of oral examinations
31
Q

What’s an advantage of Periodontal Screening and Recording (PSR)?

A
  • early detection
  • easy to use
  • cost effective
  • identify individuals in need of more extensive evaluation
  • indicated for
    • all new patients
    • recall visit > 1 yr
  • educate and motivate patient
  • not a monitoring tool for periodontal disease
32
Q

What’s the procedure for the PSR?

A

Probe each tooth
- assign code (0 to 4) for every tooth
- record highest score of the sextant
- indicate sextant with <2 teeth with ‘X’
- include sextant with 1 functional tooth in preceding sextant
walk about the Sulcus
Record highest score

33
Q

What does code 0 mean in PSR and what’s the treatment for it?

A
  • colored band of periodontal probe completely visible
  • no BOP
  • no calculus or defective margin
  • treatment: prophylaxis and preventive care
34
Q

What does code 1 mean in PSR and what’s the treatment for it?

A
  • colored band of periodontal probe completely visible
  • BOP is present
  • no calculus or defective margin
  • treatment: OHI and sub gingival plaque removal
35
Q

What does code 2 mean in PSR and what’s the treatment for it?

A
  • colored band of periodontal probe completely visible
  • supra or subgingival calculus detected
  • defective margins seen
  • treatment: sub gingival instrumentation to remove plaque and calculus, correction of defective margins, and OHI
36
Q

What does code 3 mean in PSR?

A
  • colored band of periodontal probe partially visible

- BOP, calculus, defective margins, plaque may be present

37
Q

what’s the treatment for code 3?

A

Comprehensive periodontal examination and charting of the affected sextant
- identify probe depths
- mobility
- recession, mucogingival defects
- furcation involvements
When two or more sextants score code 3 - a comprehensive full mouth periodontal examination and charting is required
- include radiographs
patient is counseled regarding appropriate treatment plan

38
Q

What does code 4 mean in PSR and what’s the treatment for it?

A
  • colored band of periodontal probe is not visible
  • PD > 5.5 mm
  • BOP
  • Calculus
  • plaque
  • treatment: comprehensive periodontal assessment, patient is counseled regarding appropriate treatment plan
39
Q

What does code * mean in PSR?

A
  • furcation involvement
  • mobility
  • mucogingival problem
  • recession extending to colored band of periodontal probe
40
Q

What are some benefits of PSR?

A

Early detection:
- PSR includes evaluation of all sites
- it is a highly sensitive technique for detecting deviations from periodontal health
Speed:
- once learned, PSR takes only a few minutes to conduct for each patient
Simplicity
Cost Effectiveness:
- PSR utilizes a simple periodontal probe designed specifically for used with this screening system
Recording ease:
- six numerical scores, one for each sextant of the mouth
Risk Management:
- proper, consistent, and documented use of PSR shows that the dentist is evaluating a patient’s periodontal status

41
Q

What are the limitations of PCR?

A
  • designed to detect periodontal diseases
  • not intended to replace a comprehensive periodontal examination
  • not indicated for recalls
  • for use with adult patients only
  • limited utility in screening children and adolescents

PERIO EXAM 2 (4 decks)

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