INDICES

INDICES
Index is defined as 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
its comparison with other
population classified by the same
criteria and methods.
Given by RUSSEL.A.L. in 1969.
IDEAL REQUISITES OF AN INDEX

1.Clarity,simplicity and objectivity.

2.Validity
3.Reliability
4.Quantifiability
5.Sensitivity.
6.Acceptability
 CLARITY, SIMPLICITY AND
OBJECTIVITY
The examiner should be able
to remember the rules of the
index clearly in his mind. The
index should be simple and
easy to apply so that there is
no undue time lost during
field examinations.
 Validity
• The index must measure
what it is intended to
measure and it should
correspond with the clinical
stages of the disease under
study at each point.
 Reliability
• The index should measure consistenly at
different times and under a variety of
conditions. The term “reliability” is virtually
synonyms with reproducibility, which means the
ability of the same ( intra examiner
reproducibility) or different examiners ( inter
examiner reproducibility) to interpret and use
the index in the same way.
 Quantifiability
• The index should be
amenable to statistical
analysis, so that the
status of a group can be
expressed by a number
that corresponds to a
relative position on a scale
from zero to the upper
limit.
 Sensitivity
• The index should be able
to detect reasonably
small shifts, in either
direction in the group
condition.
 Acceptability
• The use of the index should not be painful or
demeaning to the subject.
• In practice no index or measure is wholly accurate
and probably no index used in oral epidemiology
completely meets all of these conditions, but the
choice of an index in any given situation should be
made on the basis of how closely the index
approximates them and by the requirements of the
study in which the index is being used.
 CLASSIFICATION OF INDICES
1. Based upon the direction in which their scores can
fluctuate, indices are classified as either reversible
or irreversible.
a) REVERSIBLE
Index that measures conditions that can be
changed. Eg: Indices that measure periodontal
conditions
b) IRREVERSIBLE
Index that measures conditions that will not change..
Eg. An index that measures dental caries
2. Depending upon the extent to which areas of oral cavity
are measured. Indices are classified into ‘Full mouth’ or
‘simplified’
a)FULL MOUTH
These indices measure the patient’s entire periodontium
or dentition.
Eg: Russel’s Periodontal index
b) Simplified
These indices measure only a representative sample of the
dental apparatus.
Eg: Oral Hygiene Index- Simplified(OHI-S)
3. Indices may be classified in certain general
categories according to the entity which
they measure like:
a) Disease index
b) Symptom index
c) Treatment index
.
The D(decay) portion of the DMF index best
exemplifies a disease index.
The indices measuring gingival/sulcular bleeding
are essentially symptom indices
The F(filled) portion of the DMF index best
exemplifies a treatment index
4. Dental indices can also be classified under
special categories as:
a) SIMPLE INDEX
Index that measures the presence or absence of a condition.
Eg: An index that measures the presence of dental plaque
without an evaluation of its effect on gingiva.
b) CUMULATIVE INDEX
Index that measures all the evidence of a condition, past
and present.
Eg: DMF index for dental caries
DECAY- MISSING-
FILLED TEETH
 DECAY- MISSING- FILLED TEETH (DMFT INDEX)

Introduced by Henry Klein , Carrole E Palmer

and Knutson J W in 1938.

DMFT is IRREVERSIBLE INDEX

 PROCEDURE
• DMFT Index is applied to permanent teeth only.
• D- used to describe decayed teeth
• M- used to describe missing teeth due to caries
• F- used to describe teeth that have been
previously filled.
• INSTRUMENTS USED
• Number 3 plain mouth mirrors
• Fine pointed pig tail explorers.
 METHOD
All 28 teeth are examined.
Teeth not included are
1) Third molars.
2) Un-erupted teeth.
3) Congenitally missing and supernumerary teeth.
4) Teeth removed for reasons other than dental
caries such as for orthodontic treatment or
impaction.
5) Teeth restored for reasons other than dental caries
such as trauma, abutment etc
6) Primary teeth retained with permanent successor.
Criteria to identify caries is
1) Discoloration or loss of translucency
typical of demineralized or undermined
enamel.
2) Catch to the explorer tip.
3) Explorer tip can penetrate deep into the
soft yielding tooth material.
4) Radiograph (when needed)
RULES OF DMFT:
1)No tooth should be recorded more than once,
either decayed ,missing or filled teeth.
2)Decayed, missing and filled teeth should be
recorded separately.
3)Secondary caries below the filling should be
counted as decayed.
4)Teeth missing only due to caries should be
counted as missing.
5) A tooth which is restored separately on different
surfaces should be counted only once as filled
tooth.
6) Deciduous teeth should not be counted.
7) A tooth is considered to be erupted when the
occlusal surface or incisal edge is totally exposed.
8) A tooth is considered to be present even though
the crown has been destroyed and only the roots
are left.
 RECORDING FORM

17 16 15 14 13 12 11 21 22 23 24 25 26 27

• 47 46 45 44 43 42 41 31 32 33 34 35 36 37

• D________, M________, F________ T

 Calculation of Index
• The maximum score of DMFT in an individual is
28 or 32.
• Individual DMFT: Total each component D, M
and F separately and then total.
D + M + F = DMF
 ADVANTAGES-
• The index has gained worldwide acceptance for its
versatility in assessing dental caries.
• DMF index has been the primary outcome measure
by which relative efficacy of various caries preventive
agents have been demonstrated in clinical trials.
• The index is sensitive enough to detect differences in
relative efficacy of a wide variety of fluoride delivery
systems including water fluoridation, fluoride
mouthrinses, fluoride prophylaxes and fluoride
dentifrices
 LIMITATIONS OF DMFT INDEX:
1)DMFT values are not related to the number of
teeth at risk.
2)DMF can be invalid in older adults because teeth
can become lost for reasons other than caries.
3)DMF index can be misleading in children whose
teeth have been lost due to orthodontic
treatment.
4) DMF index can overestimate caries experience in
teeth in which preventive filling have been placed.
5) DMF index is of little use in studies of root caries.
DECAYED MISSING
FILLED SURFACES
 DECAYED MISSING FILLED SURFACES (DMFS)

• DMFS was given by Henry Klein, Carrole E.

Palmer and John W. Knutson in 1938.

Principles, rules and regulations are the same as that

of DMFT except in this the surfaces are examined.
 CALCULATION
Surfaces examined
Anterior teeth (canine to canine) – 4 surfaces -
Labial, lingual, mesial, distal
12 X 4 = 48 surfaces
Posterior teeth( Ist premolar to 2nd molar) – 5 surfaces
Buccal, lingual, mesial, distal and occlussal
16 X 5 = 80 surfaces
If third molars included
4 X 5 = 20 surfaces
Maximum DMFS index is 148.
For permanent dentition the maximum score for DMFS is 128
(for 28 teeth ) and 148 for (32 teeth)
• Individual DMFS
• Total number of decayed surfaces = D
• Total number of missing surfaces = M
• Total number of filled surfaces = F
• DMFS score= D(s) + M(s) + F(s)
 RECORDING FORM
17 16 15 14 13 12 11 21 22 23 24 25 26 27

47 46 45 44 43 42 41 31 32 33 34 35 36 37

• D_______, M________, F________S

• ADVANTAGES-
• The DMFS index is more sensitive as compared to
the DMFT
• The index gives a true status of the caries attack.
• LIMITATIONS
• The index takes a longer time than DMFT index.
• May require radiographs.
Oral Hygiene Index
 Oral Hygiene Index
• This index was developed by John. C. Green and
Jack. R. Vermillion in 1960
• Index was depicted as a sensitive, simple
method for assessing group or individual oral
hygiene quantitatively.
 Oral Hygiene Index
• METHOD:-
• The Oral Hygiene Index is composed of Debris
Index and Calculus Index.
• Each of these indices is based on 12 numerical
determinations representing the amount of
debris or calculus found on the buccal and
lingual surfaces of each of the three segments
of each dental arch
• Upper right posterior:- distal to the right
cuspid on the maxillary arch.
• Upper anterior:- mesial to right and left
bicuspid on maxillary arch.
• Upper left posterior:- distal to the left
cuspid on the maxillary arch.
• Lower right posterior:- distal to the right
cuspid on the mandibular arch.
• Lower anterior:- mesial to right and left
bicuspid on mandibular arch
• Lower left posterior:- distal to the left
cuspid on the mandibular arch.
Each segment is examined for debris or calculus. from each
segment one tooth(i.e., the tooth having the greatest area
covered either by debris or calculus) is used for calculating the
individual index
 Rules Of Oral Hygiene Index
• Only fully erupted (occlusal and incisal surface has
reached the occlusal plane) permanent teeth are
scored.
• Third molars and incompletly erupted teeth are not
scored because of the wide variation in height of
clinical crown.
• The buccal and lingual debris scores are both taken on
tooth in a segment having the greatest surface area
covered by debris.
• The buccal and lingual calculus scores are both taken
on tooth in a segment having the greatest surface area
covered by supragingival and subgingival calculus.
• The examination should in the following way:
• First the buccal and then the palatal surfaces of the
teeth in the upper right posterior segment are
inspected and scored for oral debris.
• Then the labial and palatal surfaces of upper anterior
teeth are examined.
• Finally, the buccal and palatal surfaces of the teeth in
upper left posterior segment are examined and scored.
• The lower arch inspection proceeds in the same
manner, but from left to right. This routine is repeated
for inspection of calculus after the debris recordings
have been completed.
 Criteria for Classifying Oral Debris-
• Oral debris is defined as “the soft foreign matter
on the surface of the teeth, consisting of mucin,
bacteria and food, and varying in color from
grayish white to green or orange.”
• The surface area covered by debris is estimated
by running the side of explorer (Shephard’s hook)
along the buccal/ labial and lingual surfaces.
• The scores and criteria for oral debris are:
• 0- No debris or stain present
• 1- Soft debris covering not more than one third of the
tooth surface, or the presence of extrinsic stains
without other debris regardless of surface area
covered.
• 2- Soft debris covering more than one third, but not
more than two thirds, of the exposed tooth surface.
• 3- Soft debris covering more than two third of
exposed tooth surface.
 Criteria for Classifying Calculus-
• Calculus is defined as “a deposit of inorganic salts
composed primarily of calcium carbonate and
phosphate mixed with food debris, bacteria and
desquamated epithelial cells.”
• Only definite deposits of hard calculus should be
recorded. The amount of calculus present is determined
by visual examination and probing with no. 5 explorer.
• The scores and criteria for oral calculus are:
• 0- No calculus present
• 1- Supragingival calculus covering not more than one
third of the exposed tooth surface.
• 2- Supragingival calculus covering more than one third
but not more than two thirds of the exposed tooth
surface or the presence of individual flecks of
subgingival calculus around the cervical portions of the
tooth or both.
• 3- Supragingival calculus covering more than two thirds
of the exposed tooth surface or a continuous heavy
band of subgingival calculus around the cervical
portion of the tooth or both
 CALCULATION OF INDICES
• The scores for debris and calculus should be
tabulated separately and indexes for each
calculated independently, but in the same manner.
• 12 scores are recorded for debris and 12 for
calculus when there are permanent teeth present
in each of the six segments of the mouth.
• For either debris or calculus, since the number of
scores may vary from none to 12 and each score
may range from 0 to 3, the total score for each of
the debris and calculus examination may range
from 0 to 36.
• The two indexes are then combined and
expressed as the Oral Hygiene Index which has
a possible range of 0 to 12, since the debris
index and Calculus Index each has a possible
range of 0 to 6.
 Debris Index

Right Anterior Left Total

Buccal Lingual Buccal Lingual Buccal Lingual Buccal Lingual

Upper 3 1 2 2 3 1 8 4

Lower 2 2 1 1 1 2 4 5

Total 5 3 3 3 4 3 12 9

Debris index = Buccal Score + Lingual Total

Score/ Number of segments scored
Debris Index=12+9/6
=3.5
 Calculus Index

Right Anterior Left Total

Buccal Lingual Buccal Lingual Buccal Lingual Buccal Lingual

Upper 1 0 0 0 1 0 2 0

Lower 0 1 0 2 0 2 0 5

Total 1 1 0 2 1 2 2 5

• Calculus index = Buccal Score + Lingual Total score/ No of

segments scored
= (2+5)/6
= 1.16
• Oral Hygiene Index = Debris index+ Calculus Index
= 3.5 +1.16 = 4.66
 INTERPRETATION
• The minimum number of points for all segments in
either the debris or calculus is 0.
• The maximum number of points for all segments in
either the debris or calculus is 36.
• The oral hygiene index is the sum of two indices,
its value ranges from 0-12.
• The higher the score the poorer the oral hygiene.
 ADVANTAGES
• It is a simple, rapid method for classifying oral
hygiene status quantitatively.
• Sensitive enough to reflect the cleansing efficiency
of tooth brushing and the expected relationship
between oral cleanliness and periodontal disease.
• Can assess individual’s attitude and effectiveness of
tooth brushing in oral hygiene practices.
• Used to carry out clinical studies of detailed
investigation of plaque, debris and calculus.
 LIMITATIONS
• Examination of all surfaces of all teeth present in
the mouth (though only 12 surfaces scored).
Hence requires more time.
• Intra examiner and inter examiner errors are
more.
• Cannot be used in mixed dentition.
 ORAL HYGIENE
INDEX- SIMPLIFIED
 ORAL HYGIENE INDEX- SIMPLIFIED
• The oral hygiene index was sensitive, simple and
useful, it was time consuming and required
more decision making. An effort was made to
develop more simplified version with equal
sensitivity. Another index was developed named
Oral Hygiene Index Simplified
• This index was developed by John. C. Green and
Jack. R. Vermillion in 1964
The Oral Hygiene Index Simplified differs from the
original Oral Hygiene Index in
• The number of tooth surfaces scored (6 rather than
12)
• The method of selecting the surfaces to be scored
• The scores which can be obtained.
The criteria used for assigning scores to the tooth
surfaces are the same as those used for the Oral
Hygiene Index.
 SELECTION OF THE TOOTH SURFACES
• Six surfaces are selected from four posterior and two
anterior teeth. In 'the posterior portion the first fully
erupted tooth distal to the second bicuspid, usually
the first molar but sometimes the second or third
molars are examined on each side of each arch.
• The buccal surfaces of the selected upper molars and
the lingual surfaces of the selected lower molars are
inspected.
• In the anterior portion, the labial surfaces of upper
right and lower left central incisors are scored. In the
absence of either anterior teeth, the central incisor
of opposite side of the midline is substituted.
 Index teeth
16 – upper right first molar – buccal
11 – upper right central incisor– labial
26 – upper left first molar – buccal
36 – lower left first molar – lingual
31 – lower left central incisor – labial
46 – lower right first molar – lingual
EXAMINATION METHODS AND SCORING
SYSTEMS
• The six preselected tooth surfaces are examined
first for the debris and then for calculus.

• Debris Index Simplified- same as that of OHI

• Calculus Index Simplified- same as that of OHI
 CALCULATING THE INDEX
• For each individual, the debris scores are totalled and
divided by the number of surfaces scored.
• A score for a group of individuals is obtained by
computing the average of the individual scores.
• The average individual or group score is known as
Simplified Debris Index.
• The same methods are used to obtain the calculus
score or the Simplified Calculus Index.
• The average individual or group debris and calculus
scores are combined to obtain : Simplified Oral
Hygiene Index.
• DEBRIS INDEX- SIMPLIFIED
16 11 26
3 2 3

2 1 2

46 31 36
• Debris index(s)= 8+5/6
=2.2
• CALCULUS INDEX SIMPLIIFED
• 16 11 26
1 0 1

1 2 2

46 31 36
Calculus Index (s) = 7/6=1.2
• OHI –S Index = DI-S + CI-S
= 2.2 +1.2
=3.4
 INTERPRETATION
• The values for DI-S and CI-S may range from 0-3
• DI-S and CI-S score
• Good – 0.0-0.6
• Fair – 0.7-1.8
• Poor – 1.9-3.0
• The OHI-S values range from 0-6
• For OHI-S score,
• Good – 0.0-1.2
• Fair - 1.3-3.0
• Poor – 3.1-6.0
 ADVANTAGES-
• Appears to be a reasonably sensitive method
for assessing oral hygiene in population groups.
• Easy to use because the criteria are objective,
the examination can be performed quickly.
 USES
• Widely used in the study of periodontal disease.
• Useful in evaluation of dental health education
programs in public school systems.
• Used in evaluating the cleansing efficiency of
toothbrushes.
• OHI-S is used to evaluate an individual’s level of
oral cleanliness and, to a limited extent in
clinical trials.
RECAP
 PERIODONTAL INDEX
• The Periodontal Index was given by A.L. Russell in
1956.
• The periodontal index is intended to estimate
deeper periodontal disease by measuring the
presence or absence of gingival inflammation and
its severity, pocket formation and masticatory
function.
• It is known as a COMPOSITE INDEX
 INSTRUMENTS USED
• Initially a Jacquette scaler and a chip blower
were used to determine the presence or
absence of periodontal pockets. Now a
periodontal probe and mouth mirror is used.
 METHOD
• All the teeth present are examined using a mouth
mirror and a periodontal probe.
• The probe is placed inside the crevice and if pocket
is present the probe is walked along the tooth.
 SCORING CRITERIA
SCORE CRITERIA X-RAY CRITERIA
0 Negative. There is neither overt inflammation in the investing Radiographic appearance is
tissues nor loss of function due to destruction of supporting essentially normal
tissue.
1 Mild Gingivitis. There is an overt area of inflammation in the
free gingiva which does not circumscribe the tooth.
2 Gingivitis. Inflammation completely circumscribes the tooth,
but there is no apparent break in the epithelial attachment.
4 Used only when radiograph are available. There is early, notch like
resorption of the alveolar crest
6 Gingivitis with Pocket Formation- Epithelial attachment has There is horizontal bone loss
been broken and there is a pocket formation. The tooth is firm in involving the entire alveolar crest,
the socket, and has not been drifted. up to half of the length of the tooth
root.

8 Advanced Destruction with Loss of Masticatory Function- Advanced bone loss, involving
the tooth has been loose; may have drifted. more than one-half of the length of
the tooth with definite widening of
the periodontal membrane.
 Recording Form for Russell’s Periodontal
Index

18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28

48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38

PI Score-
 CALCULATION
• Each tooth is assigned a score from 0 (no
disease) to 8 (severe disease with loss of
function)
• The periodontal index per person is obtained by
adding all the individual scores and dividing by
the number of teeth present or examined.
• Individual score = Sum of individual score
Number of teeth present
• Average score= Total number of individual score
Number of individuals examined
RULE: When in doubt, assign the lesser score
Interpretation of Russell’s Periodontal Index Scores

CLINICAL CONDITION PI SCORE STAGE OF

DISEASE
Clinically normal supportive tissues 0- 0.2
Simple gingivitis 0.3- 0.9
Beginning of periodontal destructive 0.7- 1.9 Reversible
disease
Established destructive periodontal 1.6- 5.0 Irreversible
disease
Terminal disease 3.8- 8.0 Irreversible
 ADVANTAGES
• All teeth are examined
•Periodontal index measures both reversible
and irreversible aspects of periodontal
disease.
 DISADVANTAGES
• The index is time consuming
• The index has an overlapping of scores.
• The scoring is not continuous.
• Radiographs are needed for assessment
CPITN
INDEX
 CPITN INDEX
“CPITN” was developed for the ‘Joint Working
Committee’ of the W.H.O & F.D.I by Jukka , Barmes
et al in 1982.
The value of this index in epidemiological studies
was described by Ainamo et al.
 METHOD TO EXAMINE
The mouth is divided into sextant defined by
tooth number : 18-14 ; 13-23 ; 24- 28 ; 38- 34;
33-43 ;44-48.
The highest score in each segment is recorded.
A sextant is examined only if there are 2 or
more functional teeth present and not indicated
for extraction.
• INDEX TEETH below 20 YEARS :
• Six teeth are selected.
16 11 26
46 31 36
• INDEX TEETH ABOVE 20 YEARS
• 10 teeth are selected
• Only one score is recorded in each sextant

17 16 11 26 27

47 46 31 36 37
 THE WHO PERIODONTAL
EXAMINTION-CPITN PROBE
First described by WHO in 1978
Designed for –pocket depth measurement &
subgingival calculus detection.
• It is a light weight probe
• The probe has 0.5mm ball tip & extending from 3.5mm
to 5.5 mm and was designated for epidemiological use.
• The further marking on probe
• were used for clinical use i.e.,
• 8.5 & 11.5
• Thin handle with 5 gms weight.
• The round ball tip was designed to sense subgingival
calculus and does not injure gingiva.
• Working force applied is 20 gms
An index tooth is used to detect calculus and
periodontal pocket
The sensing force should not be more than 20 gms
A test check force is to place the probe under the
thumb nail and place until blanching occurs.
The probe tip should be placed gently into the
gingival sulcus and pocket then explored
completely.
• A tooth should be probed in at least 6 points,
the mesio-buccal, mid-buccal, disto-buccal, and
the corresponding sites on the lingual surface
(AINAMO,CUTRESS and SARDO INFIRRI, 1987,
WHO 1987)
• After probing, gingiva is inspected for bleeding
17 16 15 14 13 12 11 21 22 23 24 25 26 27

47 46 45 44 43 42 41 31 32 33 34 35 36 37
 Scoring Criteria
CODE 0 Healthy tissue, no signs of disease
No pathological pocket. Coloured area of the probe remains visible.
CODE 1

Bleeding on probing.
No pathological pocket. Supragingival, subgingival calculus or
CODE 2
defective margin of filling or crown present.
Pathological pocket where coloured area of the probe is partly
CODE 3
visible(3.5-5.5)
Pathological pocket of 6mm or more present ie the black area
CODE 4
of the cpitn probe is not visible
When only 1 tooth or no teeth are present in a sextant
CODE X
 TREATMENT NEEDS SCORING
CRITERIA
CODE 0 None(TN -0)

CODE 1 Oral hygiene instruction(TN 1)

CODE 2 Oral hygiene instruction + scaling and correction of defective

margins.(TN-2)

CODE 3 Oral hygiene instruction + scaling & correction of defective

margins taking longer treatment time. More specified assessment
required.(TN -2)

CODE 4 Extensive periodontal treatment required.(TN -3)

RECAP
 GINGIVAL INDEX (GI)
• This index was developed by Loe. H and Silness J
in 1963.
• The index was developed solely for the purpose
of assessing the severity of gingivitis and its
location in four possible areas by examining only
the quantitative changes (i.e., severity of the
lesion) of the gingival soft tissue.
 TEETH EXAMINED
• The severity of gingivitis is scored on all
surfaces of all teeth or on selected surfaces of
all teeth or selected teeth.
• The teeth selected are-
• 16 – Maxillary right first molar
• 12 – Maxillary right lateral incisor
• 24 – Maxillary left first premolar
• 36 – Mandibular left first molar
• 32 – Mandibular left lateral incisor
• 44 – Mandibular right first molar.
 METHOD
• To obtain a GI score the examiner needs sufficient lightning, a mouth
mirror and a probe.
• The teeth and gingiva are dried slightly with a blast of air and/or
cotton rolls.
• The tissue surrounding each tooth is divided into four gingival
scoring units-
• The distofacial papilla
• The facial margin
• The mesiofacial papilla
• Entire lingual gingival margin
• The lingual surface is not divided to minimize examiner variability in
scoring as it is most likely to be viewed indirectly with a mouth
mirror.
• A blunt instrument like a periodontal probe is used to assess the
bleeding potential of the tissues.
 SCORING CRITERIA
• Each of the four gingival areas is assessed according to
the following criteria-
SCORES CRITERIA
0 Normal gingiva
1 Mild inflammation, slight change in color,
slight edema, no bleeding on probing.
2 Moderate inflammation, redness, edema,
glazing, bleeding on probing
3 Severe inflammation, marked redness and
edema, ulcerations, tendency to
spontaneous bleeding
 CALCULATION
• Calculating the scores around each tooth yields
the GI score for the area.
• If the score around each tooth are totalled and
divided by four, the GI score for the tooth is
obtained.
• Totalling all the scores per tooth and dividing by
the number of teeth examined provides the GI
score per person.
Recording Form for Gingival Index
(Selected Teeth)
16 12 24

44 32 36

SCORE
 INTERPRETATION
• Gingival Scores Degree of Gingivitis
• 0.1 – 1.0 Mild
• 1.1 – 2.0 Moderate
• 2.1 - 3.0 Severe
 ADVANTAGES

• Records the severity of gingivitis within marginal

and interproximal tissues.
• The GI is one of the most widely accepted and
used gingival indices due to its documented
validity, reliability and ease of use.
 DISADVANTAGES
• A wide range of variability exists in the use of this
index. For example, the bleeding component may
not always be included and when used variations
can exist in the probing force, probe placement and
the motion to elicit bleeding.
•In cases of multiple examinations as in longitudinal
studies, an invasive index may introduce additional
variability by injuring the sulcular tissue and/ or
inadvertently disturbing the bacterial plaque.
 USES
• The GI has been used in most current studies of
both adults and children.
• The index can be used to determine the prevalence
and severity of gingivitis in epidemiologic surveys.
 PLAQUE INDEX
• The Plaque Index was described by Silness P. and
Loe H. in 1964 more fully described by Loe in 1967.
• In this index plaque thickness in given an important
consideration. It is one among the most widely used
indices to measure plaque.
 TEETH EXAMINED
• The evaluation or scoring is done on the entire dentition or on selected
teeth. Only plaque of the cervical third of the tooth is evaluated. The
surfaces examined are four gingival areas of tooth i.e. disto- facial, facial,
mesio- facial and lingual surfaces. The lingual surface is considered as one
unit.
• Teeth examined are-
• Maxillary left first molar 16
• Maxillary right lateral incisor 12
• Maxillary left first bicuspid 24
• Mandibular left first molar 36
• Mandibular left lateral incisor 32
• Mandibular right first bicuspid 44
If any tooth is missing there is no substitution
and the index has to be done on a full mouth
basis.
 PROCEDURE
• The tooth is dried and examined visually with the help
of mouth mirror and explorer.
• When no plaque is visible an explorer is used to test
the surface. The explorer is passed across the tooth
surface in the cervical third and near the entrance to
the sulcus.
• When no plaque adheres to the point of the explorer,
the area is considered to have a 0 score. When plaque
adheres a score of 1 is assigned. Plaque that is on the
surface of calculus deposits and on dental restorations
of all types in the cervical third is evaluated.
 SCORING CRITERIA in 1964
• Each gingival area is scored as follows-
• 0- No plaque.
• 1- A film of plaque adhering to the free gingival margin
and adjacent area of tooth. Disclosing solution is use
to see the plaque.
• 2- Moderate accumulation of soft deposits within the
gingival pocket or the tooth and gingival margin which
can be seen with naked eye.
• 3- Abundance of soft matter within the gingival pocket
and/or on the tooth and gingival margin.
 Recording form for Plaque Index
17 16 15 14 13 12 11 21 22 23 24 25 26 27

47 46 45 44 43 42 41 31 32 33 34 35 36 37

SCORE
• For A Group-
• The score for each member of a group or
population is added and then divided by the total
number of individuals in the group or population.
• SUGGESTED SCALE FOR PATIENT EVALUATION
Rating Scores
• Excellent 0
• Good 0.1- 0.9
• Fair 1.0- 1.9
• Poor 2.0- 3.0
 ADVANTAGES
• This index is the most widely used and recognized
among plaque indices that have demonstrated good
validity and reliability.
• Can be scored on all surfaces of all or selected teeth or
for selected surfaces of all or selected teeth.
• The plaque index may be used in large scale
epidemiological studies.
• In optimal conditions with chair side assistance scoring
of all teeth requires approximately 5 minutes.
• Can be applied to studies in children as well as adults
 DISADVANTAGES
• Ignores the coronal extent of plaque on the tooth
surface area and assesses only the thickness of plaque
at gingival area of a tooth
• One criticism is the subjectivity in estimating plaque.
Therefore it is recommended that a single examiner be
trained and used with each group of patients
throughout a clinical trial.
• The difficulty is encountered in scoring of interdental
areas.
 USES
• Can be used to evaluate oral cleanliness.
• Can be applied to studies involving children and
adults.
• Is considered a reliable technique for evaluating
both mechanical antiplaque procedures and
chemical agents.
.
SUMMARY