Periodontal Indicies Flashcards
What are the 5 parameters used to asses inflammation?
- Color
- Texture/edema
- Bleeding
- Exudate
- Plaques
How should you identify what type of disease you are looking at?
- Assessment of inflammation PLUS
- Loss of periodontal support including:
a. Probing depths
b. Clinical attachment levels
c. Radiographic evaluation
What are the 3 possible appointments you should make with your patient, following initial treatment, to assess treatment needs?
Initial treatment PLUS
- recall OR
- Periodontal maintenance OR
- Referral to periodontist
What is the purpose of using periodontal indicies?
- Degree of inflammation of the gingival tissues
- Degree of periodontal destruction
- Amount of plaque accumulation
- Amount of calculus accumulation
- Treatment needs
What are the 8 indicies created to assess dental plaque?
“PIMP SPOT”
- Simplified Oral Hygiene Index (OHI-S)
- Plaque Index (PII)
- Turesky Modification of Quiqley-Hein Plaque Index
- Modified Navy Plaque Index
- Irritants Index
- Patient Hygeine Performance Index
- Plaque Control Record
- O’Leary Plaque Index
What is the purpose of the Simplified Oral Hygiene Index?
To assess oral cleanliness by estimating the tooth surfaces covered with debris and/or calculus
What are the 2 components of the Simplified Oral Hygiene Index?
- Simplified Debris Index
2. Simplified Calculus Index
Which teeth are selected for the oral hygiene index and why?
Facials of #3, 8, 14, 24
Linguals of #19, 30
Because these are difficult areas for the patient to clean
Describe the scoring technique for the OHI-S
Each tooth is scored from 0-6 for both Debris and Calculus and then added together to get the Total Debris score (DI-Score) and the Total Calculus Score (CI-Score)
The total Debris score is then divided by 6, and the total Calculus score is divided by 6
These 2 figures are then added together to determine the OHI Score
Describe the assignment of values from 0-6 for the OHI-S
0-6 correlates to excellent, good, fair, and poor. 0 = Excellent 0.1- 1.2 = good 1.3- 3.0 = fair 3.1-6.0 = poor
What does the Plaque Index (PII) assess?
The amount of plaque at the gingival margin AND gingival soft tissues, too.
Describe the scoring method used for the Plaque Index (PII)
- Plaque scores range from 0-3
- A probe is used to distinguish between scores 0 and 1
- Visible plaque is scored a 2 or 3
How is the Plaque Index computed?
PII is computed for:
- a tooth (4 surfaces)
- a subject
- a population
What other study does the PII parallel and when was the PII first published? (sorry, had to do every line!)
- PII parallels the Gingival Index (GI) of Loe & Silness
- First published by Silness & Loe (1964)
What 2 parameters are used in the Turesky Modification of Quigley-Hein Index?
- Thickness of plaque
2. How much of the crown is covered in plaque
Describe the levels of scoring for theTuresky Modification of Quigley-Hein Index
- Score 0: No plaque
- Score 1: Spots of plaque at cervical margin
- Score 2: Thin, continuous band of plaque, < or equal to 1mm wide, at cervical margin
- Score 3: A plaque band > 1mm but < 1/3 of crown height
- Score 4: Plaque covering > or equal to 1/3 but < 2/3 of crown height
- Score 5: Plaque covering > or equal to 2/3 of crown height
What bias is seen in the TM of Quigley-Hein Plaque Index
Biased toward the gingival third of the tooth surface
Which tooth surfaces are examined with the TM of Quigley-Hein Index?
Facial and lingual surfaces
Are scores in the TM of Quigley-Hein Index computed for subject, population, or both?
Both
What is the most frequently used plaque index in clinical trials?
Turesky-Modification of Quigley-Hein Index
How is the O’Leary Plaque Index scored?
Based on the percentage of tooth surfaces for positive plaque
What are the 6 Calculus Indicies?
- 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
When is the NIDR Calculus Index used?
For large scale, epidemiological studies
Describe the scoring method for the NIDR Calculus Index
0 = Calculus is absent 1 = Supragingival calculus, but no subgingival calculus is present 2 = Supragingival and Subgingival, or subgingival calculus only is present
What is the Volpe-Manhold Index determining?
The quantity of supragingival calculus (aka the efficacy of tooth brushing)
Which teeth and which surfaces are evaluated in the Volpe-Manhold Index?
Lingual surface of lower anteriors (#22-27)
How is the quantity of supragingival plaque determined in the Volpe-Manhold Index?
Quantity is determined in mm of calculus along the 2 diagonal and the central lines drawn over the lingual surfaces of each tooth
In what units is the Volpe-Manhold Index expressed?
MM
Is the Volpe-Manhold Index computed for tooth, subject, or population?
All 3
In what kind of studies is the Volpe-Manhold the most frequently used index?
Longitudinal studies
What 4 Indicies are used in Assessing the Gingival and/or Periodontal inflammation (soft tissue evaluation)
- Papillary-Marginal Attachment (PMA) Index
- Gingival Index (GI)
- Modified Gingival Index
- Bleeding-on-probing
In the PMA Index, the number of affected areas correlates with what?
Number of affected areas correlates with the severity of gingival inflammation
Describe the gingival “scoring units” of the PMA index
The facial gingival surface is divided into 3 scoring units, P (papillary), M (marginal), A (attachment)
How is gingivitis counted in the PMA index?
Gingival units (P-M-A) affected with gingivitis are counted. Presence or absence of inflammation is counted as 1 and 0, respectively. Note that severity component can be considered
Is score computed for tooth, subject, or population?
All 3
Describe what is being assessed and where when using the Gingival Index (GI)
- The severity of inflammation is assess in 4 distinct gingival areas:
- Distofacial papilla
- Facial margin
- Mesiofacial papilla
- Lingual gingival margin
Describe the scoring system of the gingival index
Score: 0-3
Bleeding is automatically given a score of 2 or 3
Is the gingival index used to assess tooth, subject or population?
Can be all 3
Gingival index is useful for the calculation of ______ and ______ in population and individual
Prevalence and Severity
In what type of studies is the gingival index frequently used?
Clinical trails
How does the modified gingival index differ from the ginival index?
Modified gingival index has a more defined and detailed scaling system
Describe the clinical ratings and corresponding descriptions of the Modified Gingival Index
- 0 = No inflammation –> Normal tissue appearance
- 1 = Mild inflammation on portion of the unit –> Slight change in color, little changes in texture
- 2 = Mild inflammation on entire unit –> Slight change in color, little changes in texture
- 3 = Moderate inflammation –> Glazing, redness, edema, a/o hypertrophy
- 4 = Severe Inflammation –> Marked redness, edema, a/o hypertrophy, bleeding, congestion, or ulceration
Describe what is assessed during a Bleeding-On-Probing Index (BOP)
Bleeding tendency is assessed upon probing a periodontal pocket using standardized pressure
Describe the probing technique used in the BOP index
Periodontal probe is inserted to the bottom of the periodontal pocket….bleeding is observed for 15 seconds following the retraction of the probe
Describe the scoring method for BOP
Presence or absence of bleeding is scored as 0 or 1, respectively.
Note: not to be confused with the bleeding as scored in the GI Index
BOP is a valid indicator or periodontal ______, however it is a poor indicator of periodontal ______
Valid indicator of periodontal STABILITY, poor indicator of periodontal BREAKDOWN
How is periodontal destruction assessed?
Using periodontal probing to determine attachment loss
What is attachment loss?
NOT just the probing depth of the pocket
Attachment loss = probing depth + recession
Measured in mm
On how many surfaces is periodontal probing performed?
All 6 tooth surfaces
What 2 factors vary the most during periodontal probing?
Force of Probing
AND
Angulation of Probe
What do periodontal indicies measure?
Indicies for Tissue loss
What are the 5 periodontal indicies?
- The extent and severity index
- The periodontal index system
- The periodontal disease index
- The CPITN
- Periodontal Screening and Recording (PSR)
How is “disease” defined in The Extent and Severity Index (ESI)?
Disease is defined as attachment loss > 1mm
How is “extent” defined in the ESI?
Extent is the proportion of the tooth sites in a patient showing signs of destructive periodontitis
How is “severity” defined in the ESI?
Severity is the amount of attachment loss at the diseased sites, expressed as a mean value
How are teeth examined and evaluated using the Periodontal Index System (PI)?
All teeth are examined. The circumference of each tooth is inspected VISUALLY, and given a score.
Describe the scoring system of the PI system
Score 0: Negative
Score 1, 2: Gingivitis
Score 6: Gingivitis with pocket formation
Score 8: Advanced destruction with loss of masticatory function (aka Tooth Loss)
Is the PI system computed for tooth, subject or population?
Subject and population
What are the 5 components of the Periodontal Disease Index (PDI) System?
- Gingival status
- Crevicular measurements
- Periodontal disease index
- Plaque criteria
- Calculus criteria
Describe the scoring levels for the Periodontal Disease Index System
Score 1, 2, 3: Severity of gingivitis (no attachment loss)
Score 4: Initial attachment loss (> or equal to 3mm)
Score 5: Moderate attachment loss ( > 3mm and < or equal to 6mm)
Score 6: Advanced attachment loss (>6mm)
How are teeth examined and tabulated when using the Periodontal disease Index system?
- 4 areas of each tooth are examined USING A PROBE
- The most SEVERE score is tabulated and used for the calculation of the subject’s PDI
What teeth are measured when using Periodontal Disease Index system and why?
Romport: #3, 9, 12, 19, 25, 28
Represents each sextant
Why is the Periodontal Disease Index System especially good for teaching and studies?
Because each number has a very detailed description to do go along with it (like paragraph long description) for each of the 5 components of the system
Which 2 periodontal indicies are used to assess periodontal TREATMENT NEEDS?
- Community Periodontal Index of Treatment Needs (CPITN)
2. Periodontal Screening and Recording (PSR)
For which individuals is the CPITN designed to assess?
Primarily designed to assess periodontal treatment needs in under-served parts of the world
When reporting scores EPIDEMIOLOGICALLY for CPITN, how are teeth scores reported?
- 10 INDEX teeth per individual are examined
- The worst finding is recorded per sextant
When reporting scores FOR INDIVIDUAL SUBJECTS for CPITN, how are teeth scores reported?
- Worst finding of ALL teeth in a sextant is recorded, resulting in 6 scores per subject.
- The worse score determined the treatment needs
Can any probe be used to do a CPITN assessment?
No. Must use special probe.
What 2 parameters are determined using the CPITN system?
- Periodontal status
2. Treatment needs
Describe the “scoring” of periodontal status using the CPITN system
- Score 1: Bleeding on gental probing
- Score 2: Calculus felt during probing, crevicular depth < or equal to 3mm
- Score 3: Probing depth 4mm or 5mm
- Score 4: Probing depth > or equal to 6mm
Describe the “coding” of treatment needs when using the CPITN system
- Code 0: No treatment
- Code I: Improved oral hygiene
- Code II: Improved oral hygiene, plus professional scaling
- Code III: Improved oral hygiene, professional scaling, plus complex treatment
What is the purpose of the Periodontal Screening & Recording (PSR) system?
A rapid and effective way to screen patients for periodontal diseases and summarize necessary information with minimum documentation
Who endorses the PSR system and for what?
The ADA and the APP support the use of PSR by dentists as part of oral examinations
Describe the probe used for examination using PSR system
Specific type of probe with a band starting at 3 mm and that is a 3 mm thick band
Also, there is a ball at the tip of the probe for that the examiner does not push too hard
What 3 parameters are measured during a PSR exam?
- Pocket depth probing (0-4) PLUS
- Calculus/defective margins (+/-)
- B-o-P (+/-)
Describe the corresponding descriptions of PSR codes 0-4
- 0: Colored area visible, (-) calculus/defective margin, (-)BoP
- 1: Colored area visible, (-) calculus/defective margin, (+)BoP
- 2: Colored area visible, (+)calculus/defective margin,(+/-)BoP
- 3: Colored area partially visible, (+/-) calculus/defective margin, (+/-) BoP
- 4: Colored area not visible, (+/-) calculus/defective margin, (+/-) BoP
- *Basically once you cannot see all of the colored band, its really just about the probing depth and no longer determined by calculus, margin or BoP
Describe if/when teeth are scored when using PSR
- 1st score one tooth in each sextant.
- 0-2=okay
- 3 or more in ONE sextant, then must do full probing for entire SEXTANT
- 3 or higher in 2 OR MORE sextants, then must do FULL-MOUTH probing
Remember that periodontal disease is _____ specific
Site specific
What are the 6 major benefits of PSR?
- Early detection
- Speed
- Simplicity
- Cost-effective
- Recording ease
- Risk management
How does PSR achieve the benefit of Early Detection?
- PSR includes evaluation of all sites
- Highly sensitive technique for detecting deviations for periodontal health
- Uniquely appropriate screening tool for perio diseases which are, by nature, site specific and episodic
How does PSR achieve the benefit of Speed?
Only takes a few mins for a trained person, and can incorporated into a routine oral exam
How does PSR achieve the benefit of Simplicity?
- Easy to administer and comprehend
- Simple scoring system aids in monitoring a patient’s periodontal health
How does PSR achieve the benefit of Cost-Effectiveness?
Does not require special equipment besides the unique PSR perio porbe
How does PSR achieve the benefit of Recording Ease ***?
- Documentation for PSR requires the recording of 6 numerical scores, one for each sextant
- PSR does not require extensive charting or lengthy narrative explaination
How does PSR achieve the benefit of Risk Management ***?
- Can give patient feed back right away
- Proper, consistent and documented use of PSR shows that you are evaluating patient’s perio status
What are the 3 limitations of PSR
- Only designed as a screening system to detect perio disease. Does not replace comprehensive exams if indicated.
- Not comprehensive enough for patients that have been treated for perio disease and are now in maintenance phase
- Only valid in adults (don’t use in mixed dentition)
What are the 2 peri-implant tissue indicies?
- Modified PI
2. Modified GI
Describe “reliability” in gingival indicies in general
Reliability of an index: to measure a condition in the same subject repeatedly and obtain the same score results each time
Describe “validity” of a diagnostic test
Sensitivity and specificity of various diagnostic tools used to create an index
What are 3 potential problems related to Examiner Bias
- Halo effect
- Leniency/Severity Error
- Central Tendency Error
What is the Halo Effect?
Type of examiner bias where the examiner’s general impression of the target distorts his/her perception of the target on specific dimensions
What is Leniency/Severity Error?
Type of examiner bias when the examiner’s tendency is to be lenient or severe
What is the Central Tendency Error?
Type of examiner bias when the examiner is reluctant to rate at either end of the positive or negative extreme, so all scores cluster in the middle
What is the difference between calibration and training?
Training: learning/teaching thru hand-on experience
Calibrating: goal is to determine the inter/intra-examiner variations
What are the 3 parameters that effect calibrating?
- Several examiners at different experience levels
- Subjects with various disease extent and severity
- Follow-up appointments
What are the 4 ways to determine the “validity” of a diagnostic test?
- Sensitivity
- Specificity
- Predictive value positive (PVP)
- Predictive value negative (PVN)
What is “sensitivity”?
The probability that a test will be positive when the test is administered to people who actually have the disease in question
Sensitivity = Pr(T+/D+)
What is “specificity”?
The probability that a test will be negative when administered to people who are free of the disease in question
Specificity = Pr (T-/D-)
What is “predictive value positive”?
The probability of a disease in a subject with a POSITIVE test result
PVP= Pr(D+/T+)
What is “predictive value negative”?
The probability of not having the disease when the test is NEGATIVE
PVN= Pr (D-/T-)
