Dental Indices

Dental Indices

• Epidemiological methods of study require the

conditions be measured and quantified
accurately based on sound scientific
principles.
• One of the major problem in studying dental
diseases and its factors is the development of
a suitable, practicable method for recording
the occurrence and severity of disease.
• Quantitative measurement of disease most
commonly relies on index.
• The dental index is the main tool of
epidemiological studies in dental diseases to
measure incidence, prevalence and severity.

• Index: A numerical value describing the relative

status of a population on a graduated scale with
definite upper and lower limits, which is designed
to permit and facilitate comparison with other
populations classified by the same criteria and
methods.
 Objectives

• 1- To increase understanding of the disease

process, leading to methods of control and
• prevention.
• 2- To discover populations at high and low
risk.
• 3- To define the specific problem under
investigation.
 Ideal properties of an Index

• 1- Clarity, simplicity and objectivity: The examiner should be able to

carry the rules of the index in his mind. Index should be easy to
apply. The criteria should be clear and simple.

• 2- Validity: It should measure what it is intended to measure. It

should be reflect the clinical stage of the disease, ex; number of
missing teeth in adults in adults is not a valid measure of caries
activity.

• 3- Reliability: It should be able to measure consistently at different

times and under a variety of conditions.
• Reproducibility: is the ability of the same or different person to use
the index in the same way.
• 4- Quantifiability: The index should be amenable to statistical
analysis. So that the
status of a group can be expressed by a statistical measure, ex;
mean and median.
• 5- Sensitivity: The index should be able to detect reasonably
small shifts, in either direction in the condition.
• 6- Acceptability: The use of the index should not be painful or
demeaning to the subject.
 Uses of dental indices
• 1- To study oral health status of individuals and population.
• 2- To study prevalence and incidence of disease.
• 3- To provide data for epidemiological studies.
• 4- To provide data for research to find out etiological and
predisposing factors for the
• diseases.
• 5- For planning of oral health policy.
• 6- To evaluate the effectiveness of oral health programs.
• 7- To evaluate the success of various preventive programs.
 Indices used for dental caries
assessment
• Dental Caries: A progressive irreversible microbial
disease affecting the hard parts of the tooth. It is
the most prevalent chronic disease affecting the
human race.
• Once it occurs, its manifestations persist
throughout life even the lesion is treated. It
usually begins soon after the teeth erupted into
the oral cavity. So, it is a post eruptive disease.
• It affects persons both genders, all races, all ages,
all socioeconomic groups.
• 1- Indices used for coronal caries:
A- Permanent teeth.
B- Primary teeth.
• 2- Indices used for root caries
 Permanent teeth index

• Decayed-Missing-Filled Index ( DMF ) which

was introduced by Klein, Palmer and Knutson
in 1938 and modified by WHO:
• 1. DMF teeth index (DMFT) which measures
the prevalence of dental caries/Teeth.
• 2. DMF surfaces index (DMFS) which measures
the severity of dental caries.
 D component
Used to describe (Decayed teeth) which include:
• 1. Carious tooth.
• 2. Filled tooth with recurrent decay.
• 3. Only the root are left.
• 4. Defect filling with caries.
• 5. Temporary filling.
• 6. Filled tooth surface with other surface decayed
 M component

• Used to describe (Missing teeth due to caries) other cases

should be excluded these are:

• 1. Tooth that extracted for reasons other than caries

should be excluded, which include:
a- Orthodontic treatment.
b- Impaction.
c- Periodontal disease.
• 2. Unerupted teeth.
• 3. Congenitally missing.
• 4. Avulsion teeth due to trauma or accident.
 F component

• Used to describe (Filled teeth due to caries).

Teeth were considered filled without decay
when one or more permanent restorations
were present and there was no secondary
(recurrent) caries or other area of the tooth
with primary caries.
• A tooth with a crown placed because of
previous decay was recorded in this category.
Teeth restored for reason other than dental
caries should be excluded, which include:

• 1. Trauma (fracture).
• 2. Hypoplasia (cosmatic purposes).
• 3. Bridge abutment (retention).
• 4. Seal a root canal due to trauma.
• 5. Fissure sealant.
• 6. Preventive filling.
• Note:
• 1. A tooth is considered to be erupted when just the
cusp tip of the occlusal surface or incisor edge is
exposed.
The excluded teeth in the DMF index are:
a. Supernumerary teeth.
b. The third molar according to Klein, Palmer and
Knutson only.
• 2. Limitations - DMF index can be invalid in older adults
or in children because index can overestimate caries
record by cases other than dental caries.
 Principle and rules in recoding

• 1. DMFT:
• a. A tooth may have several restorations but it
counted as one tooth, F.
• b. A tooth may have restoration on one
surface and caries on the other, it should be
counted as D .
• c. No tooth must be counted more than once,
D M F or sound.
2. DMFS: Each tooth was recorded scored as 4
surfaces for anterior teeth and 5 surfaces for
posterior teeth.
• a. Retained root was recorded as 4 D for
anterior teeth, 5 D for posterior teeth.
• b. Missing tooth was recorded as 4 M for
anterior teeth, 5 M for posterior teeth.
• c. Tooth with crown was recorded as 4 F for
anterior teeth, 5 F for posterior teeth.
 Primary teeth index

• 1. dmft / dmfs Maximum scores: dmft = 20 ,

dmfs = 88
• 2. deft / defs, which was introduced by Gruebbel
in 1944:
d- decayed tooth. e- decayed tooth indicated for
extraction . f- filled tooth.

• 3. dft / dfs: In which the missing teeth are

ignored, because in children it is difficult to make
sure whether the missing tooth was exfoliated or
extracted due to caries or due to serial extraction.
 Mixed dentition

• Each child is given a separate index, one for

permanent teeth and another for primary teeth.

• Information from the dental caries indices can be

derived to show the:
• 1. Number of persons affected by dental caries (%).
• 2. Number of surfaces and teeth with past and present
dental caries (DMFT / dmft -DMFS / dmfs).
• 3. Number of teeth that need treatment, missing due to
caries, and have been treated ( DT/dt, MT/mt, FT/f t).
 Q- How could you differentiate between tooth
missing due to caries and due to
exfoliation?
• 1. By age of the patient if it is near to exfoliation time or not.
• 2. The shape of ridge is concave in carious missing tooth and
straight in exfoliated one and permanent successor may be
seen.
• 3. DMF/dmf index is higher in association with carious missing
tooth especially adjacent and the contra lateral teeth.
• 4. Bad oral hygiene mainly associated with carious teeth.
 How could you differentiate between
tooth missing due to caries and due to
ortho. Treatment?
• 1. By type of teeth, in ortho, treatment most teeth
should be extracted are 4,5/c, d while in carious
missing teeth any teeth may be involved.
• 2. Bilateral and /or opposing missing generally
associated with ortho, treatment, while in carious
missing teeth it is not necessary.
• 3. DMF/dmf index is higher in association with carious
missing tooth especially adjacent and the contra lateral
teeth with bad oral hygiene mainly associated with carious
teeth.
• 4. Crowding or appliance may be seen in ortho, treatment