DentAl Algorithms

Dentistry and Oral Medicine

Indices for Evaluating Dental Health Status

01.01 Calculus Surface Index

01.02 Community Periodontal Index of Treatment Needs (CPITN)

01.03 Eastman Interdental Bleeding Index

01.04 Gingival Bleeding Index of Carter and Barnes

01.05 Gingival Bone Count

01.06 Navy Plaque Index

01.07 Navy Periodontal Disease Index

01.08 Oral Hygiene Index

01.09 Periodontitis Severity Index

01.10 Periodontal Treatment Need System (PTNS)

01.11 Quigley and Hein's Plaque Index, as Modified by Turesky et al

01.12 Sulcus Bleeding Index

01.13 Gingival Index of Loe and Silness

01.14 Periodontal Index of Russell

Temporomandibular Joint (TMJ) Disorders

02.01 Jaw Symptom Questionnaire for Evaluating Patients with Temporomandibular Joint Disorders

02.02 Activity Limitation Scale for Patients with Temporomandibular Joint Disorders

Periodontal Surgical Therapy

03.01 Contraindications to Performing Periodontal Osseous Resective Surgery

03.02 Healing Index of Landry, Turnbull and Howley

Evaluation of Malocclusion and Need for Orthodontic Treatment

04.01 Handicapping Labio-Lingual Deviation (HLD) Index

04.02 The California Modification of the Handicapping Labiolingual Deviation [HLD(CalMod)] Index

04.03 The Index of Orthodontic Treatment Need (IOTN)

04.04 The Dental Aesthetic Index (DAI)

05 Systems for Dental Notation

06 Using a Simple Classification System in Planning the Surgical Management of Maxillomandibular Asymmetry

Cephalometric Analysis

07.01 Diagnosis of the Long Face Syndrome

08 Xerostomia (Dry Mouth)

09 Cariology

09.01 Risk Factors for Caries Development

09.02 Severity Grades of Root Surface Caries

09.03 Root Caries Index (RCI) of Katz

09.04 Risk Factors for Root Caries in the Elderly

10 Mandibular Fracture Score

Cleft Lip and Palate

11.01 Estimation of the Possibility to Restore a Positive Overjet in Patients with Unilateral Cleft Lip and Palate

Oral Leukoplakia

12.01 LCP Classification and Staging System for Oral Leukoplakia

12.02 Criteria for the Diagnosis of Oral Hairy Leukoplakia

Assessment of the Tonsils and Adenoids

13.01 Estimating Adenoidal Obstruction of the Nasopharyngeal Airway in Children

Dental Health Surveys

14.01 The Geriatric Oral Health Assessment Index (GOHAI)

14.02 The Child Dental Neglect Scale

14.03 Importance of Dental Behaviors Questionnaire

Halitosis and Oral Malodor

15.01 Clinical Evaluation of Halitosis

16 Differential Diagnosis of Tooth Discoloration

Tongue Size and Macroglossia

17.01 Identification of Pseudomacroglossia

17.02 Clinical and Cephalometric Features of Macroglossia

18 Measurements of Mouth Opening

Indices for Evaluating Dental Health Status

01.01 Calculus Surface Index

Overview:

The Calculus Surface Index is a measure of dental calculus formation. It can be used to quantitate the accumulation of dental calculus in short-term testing programs to evaluate the effectiveness of preventive care.

Method

• Each of the 4 mandibular incisors is assessed on 4 surfaces (one labial, one lingual and two proximal).

• Each surface with calculus is scored 1 point.

calculus surface index =

= SUM(calculus points on the 16 surfaces surveyed)

Interpretation

• minimum score: 0

• maximum score: 16

References:

Ennever J, Sturzenberger OP, Radike AW. The calculus surface index method for scoring clinical calculus studies. J Periodontol. 1961; 32: 54-57.

01.02 Community Periodontal Index of Treatment Needs (CPITN)

Overview:

The Community Periodontal Index of Treatment Needs (CPITN) is an epidemiologic tool developed by the World Health Organization (WHO) for the evaluation of periodontal disease in population surveys. It can be used to recommend the kind of treatment needed to prevent periodontal disease.

Teeth examined: 2 methods of selection

(1) sextants: 14 teeth on the maxilla and 14 teeth on the mandible, divided into 3 segments on each

• FDI notation maxilla: (1) 17, 16, 15, 14; (2) 13, 12, 11, 21, 22, 23; (3) 24, 25, 26, 27

• FDI notation mandible: (4) 47, 46, 45, 44; (5) 43, 42, 41, 31, 32, 33; (6) 34, 35, 36, 37

• third molars are not used unless they function in place of the second molars

(2) use of index teeth: 5 teeth on the maxilla and 5 teeth on the mandible

• FDI notation maxilla: (1) 17, 16; (2) 11; (3) 26, 27

• FDI notation mandible: (4) 47, 46; (5) 31; (6) 36, 37

Dental evaluation

(1) A special probe is used to to evaluate the depth of the dental sulcus.

(2) The teeth are examined for supragingival or subgingival calculus.

(3) Any bleeding after gentle probing is noted.

Evaluation

• The worst finding in each sextant is coded according to the table below..

• The maximum code for the entire mouth is used for the treatment recommendation.

Findings / Code
pathologic pockets >= 6 mm deep / 4
pathologic pockets 4-5 mm deep / 3
supragingival or subgingival calculus / 2
gingival bleeding after gentle probing / 1
no signs of periodontal disease / 0

Treatment recommendation

• maximum score 0: no need for additional treatment

• maximum score 1: need to improve personal oral hygiene

• maximum score 2: need for professional cleaning of teeth, plus improvement in personal oral hygiene

• maximum score 3: need for professional cleaning of teeth, plus improvement in personal oral hygiene

• maximum score 4: need for more complex treatment to remove infected tissue

References:

Ainamo J, Barmes D, et al. Development of the World Health Organization (WHO) Community Periodontal Index of Treatment Needs (CPITN). International Dental Jounral. 1982; 32: 281-291.

Ainamo J, Parviainen K, Murtomaa H. Reliability of the CPITN in the epidemiological assessment of periodontal treatment needs at 13-15 years of age. International Dental Journal. 1984; 34: 214-218.

Cutress TW, Hunter PBV, Hoskins DIH. Comparison of the Periodontal Index (PI) and Community Periodontal Index of Treatment Needs (CPITN). Community Dental Oral Epidemiol. 1986; 14: 39-42.

Gaengler P, Goebel G, et al. Assessment of periodontal disease and dental caries in a population survey using the CPITN, GPM/T and DMF/T indices. Community Dent Oral Epidemiol. 1988; 16: 236-239.

Lewis JM, Morgan MV, Wright FAC. The validity of the CPITN scoring and presentation method for measuring periodontal conditions. J Clin Periodontol. 1994; 21: 1-6.

01.03 Eastman Interdental Bleeding Index

Overview:

Gingival bleeding after a defined method of interproximal stimulation is a valid indicator for the presence of inflammation in the midinterproximal gingival tissues. The interdental bleeding index is a simple procedure for monitoring the gingival health of a patient. It can be used by patients to monitor their own gingival status between visits to the dentist.

Procedure (as devised at the Eastman Dental Center in Rochester, New York):

(1) A wooden interdental cleaner is inserted between the teeth from the facial aspect.

(2) The path of insertion is horizontal, with care taken not to direct the point of the cleaner apically.

(3) The cleaner is used to depress the interdental papilla 1-2 mm, then removed.

(4) The process is repeated until the interdental cleaner has been inserted and removed a total of 4 times.

(5) The presence or absence of bleeding within 15 seconds is then recorded.

interdental index =

= (number of interdental spaces that bled) / (number of interdental spaces studied)

Interpretation

• minimum score: 0

• maximum score: 1.00

• The higher the value, the greater the extent of gingivitis.

References:

Caton JG, Polson AM. The interdental bleeding index: A simplified procedure for monitoring gingival health. Compendium Contin Educ Dent. 1985; 6: 88-92.

Caton J, Polson A, et al. Associations between bleeding and visual signs of interdental gingival inflammation. J Periodontol. 1988; 59: 722-727.

01.04 Gingival Bleeding Index of Carter and Barnes

Overview:

The Gingival Bleeding Index is a measure of gingivitis as indicated by bleeding following dental flossing. It can be used either for initial patient evaluation or over time to assess response to interventions to improve periodontal health.

Procedure

• The mouth is divided into 6 segments (upper right, upper anterior, upper left, lower left, lower anterior, lower right).

• The American dentition notation is used, with maxillary dentition numbered 1 to 16 going from right to left, and mandibular dentition going 17 to 32 from left to right.

• Areas involving the third molars are not scored because of variations in arch position, access and vision.

• Unwaxed dental floss is alternately passed interproximally into the gingival sulcus on both sides of the interdental papillae. With the floss extended as far as possible towards the buccal and lingual, the floss is carried to the bottom of the sulcus. The floss is then moved in an inciso-gingival motion for one double stroke. Care is taken not to cause laceration of the papillae.

• A new length of clean floss is used for each interproximal unit.

• Bleeding is generally immediately evident in the area or on the floss, but 30 seconds are allowed for reinspection of each segment. If bleeding is copious, the patient should rinse between segments.

• An area is nonscoreable when tooth positions, diastemas or other factors compromise the desirable interproximal relationships.

Bleeding assessment

• no attempt is made to quantify the degree of bleeding

• bleeding is assessed only as present or absent

Coding

• not bleeding: none (blank)

• bleeding: B

• not scoreable: X

Interproximal Areas of Maxillary Teeth / Code / Code / Interproximal Areas of Mandibular Teeth
2 - 3 / 30 - 31
3 - 4 / 29 - 30
4 - 5 / 28 - 29
5 - 6 / 27 - 28
6 - 7 / 26 - 27
7 - 8 / 25 - 26
8 - 9 / 24 - 25
9 - 10 / 23 - 24
10 - 11 / 22 - 23
11 - 12 / 21 - 22
12 - 13 / 20 - 21
13 - 14 / 19 - 20
14 - 15 / 18 - 19

total scoreable areas =

= 26 - (number of nonscoreable areas)

Gingival Bleeding Score =

= total bleeding areas =

= SUM(number of bleeding areas)

total nonbleeding areas =

= SUM(number of nonbleeding areas)

= (total scoreable areas) - (total bleeding areas)

Interpretation

• The fewer the number of bleeding sites, the less the extent of gingivitis. Ideally the score should be 0.

• If the patient is to be followed over time, previous bleeding sites are monitored to see if they become nonbleeding. The goal of interventions is to reduce the score as much as possible.

References:

Carter HG, Barnes GP. The gingival bleeding index. J Periodontol. 1974; 45: 801.

Ciancio SG. Current status of indices of gingivitis. J Clin Periodontol. 1986; 13: 375-378.

01.05 Gingival Bone Count

Overview:

The gingival bone count is a composite score based on the gingival condition and degree of bone loss affecting a person's teeth. This can be used to evaluate periodontal health, especially in epidemiologic studies.

Scoring

• The gingival score is based on the clinical examination.

• The bone score is based on the clinical examination and evaluation of dental X-rays.

• A single gingival score and a single bone score is generated for each tooth studied.

• A mean for each score is then computed for the whole mouth.

Parameter / Finding / Score
gingival score / negative / 0
mild gingivitis involving the free gingiva (margin, papilla, or both) / 1
moderate gingivitis involving both free and attached gingiva / 2
severe gngivitis with hypertrophy and easy hemorrhage / 3
bone score / no bone loss / 0
incipient bone loss or notching of alveolar crest / 1
bone loss about one fourth of root length, or pocket formation one side not over one half of root length / 2
bone loss about one half of root length, or pocket formation one side not over three fourth root length; mobility slight / 3
bone loss about three quarters of root length, or pocket formation one side to apex; mobility moderate / 4
bone loss complete; mobility marked / 5

gingival bone score =

= SUM((gingival score) + (bone score)) / (number of teeth examined) =

= (mean gingival score) + (mean bone score)

Interpretation

• minimum score: 0

• maximum score: 8

• The higher the score, the more serious the periodontal disease.

References:

Dunning JM, Leach LB. Gingival-bone count: A method for epidemiological study of periodontal disease. J Dent Research. 1960; 39: 506-513.

01.06 Navy Plaque Index

Overview:

The Navy Plaque Index (NPI) was developed as part of the Navy Periodontal Screening Examination, along with the Navy Periodontal Disease Index. It reflects the plaque control status of the patient and emphasizes plaque in the cervical portion of the tooth which is in contact with the gingiva margins. Comparison of scores over time can help guide intervention to prevent periodontal disease.

Teeth examined

• 3

• 9

• 12

• 19

• 25

• 28

Substitutions

• If 3, 12, 19 or 28 is missing, then substitute the next most posterior tooth.

• If 9 or 25 is missing, then substitute the nearest incisor in the arch. If all of the incisors are missing from the arch. If all incisors are missing from the arch, then substitute a cuspid.

Surfaces examined on each tooth

• facial

• lingual

Plaque Status / Designated / Points
plaque in contact with gingival tissue on mesial proximal surface / M / 3
plaque in contact with gingival tissue on facial or lingual surface / G / 2
plaque in contact with gingival tissue on distal proximal surface / D / 3
plaque on facial or lingual surface of tooth surface but not in contact with gingival tissue / R / 1

For each tooth

facial points =

= (M points on facial aspect) + (G points on facial aspect) + (D points on facial aspect) + (R points on facial aspect)

lingual points =

= (M points on lingual aspect) + (G points on lingual aspect) + (D points on lingual aspect) + (R points on lingual aspect)

Generating the NPI

tooth score =

= (facial points) + (lingual points)

NPI score =

= MAX(all 6 tooth scores)

NPI total =

= SUM(all 6 tooth scores)

Interpretation

• minimum score for a surface: 0

• maximum score for a surface: 9

• minimum tooth score: 0

• maximum tooth score: 18

• maximum NPI score: 18

• minimum NPI total: 0

• maximum NPI total: 108

References:

Grossman FD, Fedi PF Jr. Navy Periodontal Screening Examination. J Am Soc Prevent Dentistry. 1973; 3: 41-45.

Hancock EB, Wirthlin MR Jr. An evaluation of the Navy periodontal screening examination. J Periodontol. 1977; 48: 63-66.