Dental indices of the state of the oral cavity: hygienic and periodontal

The health of the oral cavity directly affects the state of the entire human body as a whole. Hygiene is the simplest and most affordable, as well as the main way to prevent diseases of the teeth and gums. Compliance with the rules of hygiene for the care of the mucous membrane will allow you to maintain health and avoid many serious diseases.

The dentist performs a thorough examination of all teeth and tissues. Doctors use hygiene indices to assess cavity health. With their help, they quantitatively reflect the degree of the disease and track its development. In dentistry, there are a large number of indicators of hygiene, each of which in different ways allows you to assess the health of the oral cavity.

What is the dental hygiene index

In dentistry, health status is measured in the form of special indices. The hygiene index is data that can be used to assess the hygiene of the oral cavity. The degree of contamination of the enamel surface is assessed, as well as the presence of bacteria and stone, their quantitative expression, the ratio of healthy and carious.

Thanks to these hygiene data, during periodic examinations, the doctor can identify the causes of tooth decay and gums, as well as take preventive measures to prevent many serious diseases of the mucous membrane mouth.

With the help of hygiene data, the dentist finds out:

• oral health;
• the stage of destruction;
• deleted units and those that cannot be restored;
• how thoroughly the cleaning is carried out;
• the stage of tissue destruction;
• curvature in the bite;
• evaluation of the effectiveness of treatment.

The dentist observes these and many other useful information about the health of the mucous membrane thanks to the indicators of hygiene. There are specialized data for the analysis of each type of destruction and damage to teeth and tissues.

KPU index types

KPU is considered the main indicator in dentistry. It reveals how intensively the process of caries damage is going on. It is used to analyze both temporary and permanent teeth.

Basic data:

• K - number of foci caries;
• P - the number of delivered fillings;
• Y is the number of units that have been removed.

The summarized expression of these data provides information about the intensity with which caries develops in the patient.

KPU classification:

• KPU teeth - the number of caries affected and sealed units in a patient;
• KPU surfaces - the number of enamel surfaces infected with caries;
• KPU cavities - the number of cavities from caries and fillings.

For milk teeth the indicators of kp are applied, where k is carious lesions, p is sealed. In this case, units that were removed or dropped out are not taken into account. In the presence of two types of teeth, both indicators of CP and KPU are used, and the infection of all teeth is taken into account.

Evaluation of the KPU index

Three main indicators are used to identify the degree of infection.

The incidence of caries is estimated as a percentage. To do this, the number of patients with caries problems must be divided by the total number of people studied and multiplied by 100. To compare regions in terms of the level of dental health, an assessment of the state of their health in 12-year-old adolescents is used.

Prevalence of caries:

• up to 30% low;
• up to 80% average;
• up to 100% high.

The intensity of infection is determined based on the number of dental units damaged by caries.

Allocate 5 degrees based on the KPU indicator:

In children 12 years old

• less than 1.1 - very low;
• up to 2.6 - low;
• up to 4.4 - moderate;
• up to 6.4 - high;
• over 6.5 is very high.

Adults 35 years old

• less than 1.5 - very low;
• up to 6.2 - low;
• up to 12.7 - moderate;
• up to 16.2 - high
• over 16.3 - very high.

The increase in caries infection is determined in the same patient after a certain period of time. Changes in values ​​during examinations are an increase. These studies provide an opportunity to study the level of health and prescribe an individual treatment plan for each patient.

Disadvantages of KPU indicators

KPU indicators have some disadvantages:

• the total includes both cured and deleted units;
• the overall picture is influenced by the past dynamics of caries infection, which only increases with the age of the patient;
• only the incipient manifestations of caries are not taken into account.

Due to these shortcomings, KPUs do not provide completely reliable information about the state of the oral cavity. Over time, a person may form new foci of caries, may fillings fall out etc. All these data are re-summed up, and the general picture of the state of the mucous membrane becomes incorrect.

Periodontal indices

Periodontal data are intended in dentistry to measure the dynamics of tissue infection. They allow you to track the distribution process periodontal disease, its depth and distribution, and track the success of treatment.

There is a large body of evidence for periodontal research. All of them are divided into types and categories depending on the goals of the study and the patient's health. During one visit, the dentist uses several methods at once to more accurately assess tissue health.

Papillary-marginal-alveolar index (pma)

The papillary-marginal-alveolar index (PMA) is one of the basic ones. He gives information about gingivitishow long it lasts and how deep it penetrated. For this, the condition of the gums is analyzed.

When gum inflammation is detected, the number of points is given based on the place of its occurrence:

• 1 - the papilla is inflamed;
• 2 - marginal gum;
• 3 - alveolar gum.

After analysis, the total indicator is calculated: the sum of all units X 100/3 X the number of teeth in the patient.

There are three stages of gingivitis:

• less than 30% - mild inflammation;
• from 30 to 60% - average;
• over 60% - severe inflammation of the gums.

Periodontal index (PI)

PI is intended to determine to what stage gingivitis has developed. During the study, the doctor finds out if there is periodontal pockets, mobility and destruction of bone tissue.

After the examination, points are awarded:

• 0 - no symptoms of the disease;
• 1 - there is a slight inflammation on one side;
• 2 - surrounded by inflammation, but well attached;
• 4 - there were resorptions of the tops of the septa (only after X-ray);
• 6 - a pocket appeared, but the tooth is stable and does not hurt;
• 8 - obvious destruction of gum tissue, staggers and displaces.

PI is obtained from the result of dividing the points for all dental units by the number of those examined. Based on this result, you can identify the severity of gum disease:

• less than 1.5 - the first stage;
• up to 4.0 - second stage;
• up to 8.0 - the third stage.

CPITN Index

CPITN is also called the indicator of the need for treatment of periodontal disease. This method requires examining the tissues around the following numbers - 17, 16, 11, 26, 27, 37, 36, 31, 46 and 47. These units characterize the condition of both jaws.

Using a special probe, each unit is examined to detect bleeding, periodontal pockets and stone. The data is analyzed according to the following parameters:

• 0 - there are no symptoms of the disease;
• 1 - blood appeared after the furrow was drawn;
• 2 - there is a stone;
• 3 - there is a periodontal pocket up to 5 mm;
• 4 - the presence of a pocket over 6 mm.

Further, the sum for each unit is divided by 6 and the CPITN indicator is obtained:

• 0 points - no treatment is needed;
• 1 point - need cleaning and periodic visits to the doctor;
• 2-3 points - cleaning is required on professional equipment;
• 4 points - needs complex treatment.

Measuring the depth of the periodontal pocket

The appearance of periodontal pockets is one of the signs periodontitis. Such pockets are inconvenient when eating, cause bad breath and food rotting in them.

The depth of the pockets is a criterion for determining the severity of gum disease. It is measured using a dental probe with a scale. The probe is lowered into a pocket and looked at the marks.

A distance of 1-2 mm is considered the norm. At the initial stage of gingivitis, the pocket can reach a depth of 3.5 mm. At a depth of more than 4 mm, there is a middle stage inflammation of the gums, and with a pocket depth of more than 5 mm, there is a severe stage of inflammation with obvious bone deformities.

Comprehensive periodontal index (CPI)

CRPD is an average indicator of the symptoms of periodontal disease from possible occurrences to the complex stage of the disease. It is designed to study health in different age groups of people - 3-4 years old, 7-14 years old and over 18 years old.

A dental probe and tweezers are used to examine signs of disease. The formation and the area of ​​accumulations are revealed, how deep are the periodontal pockets and whether the dental units move. When several symptoms occur on one unit, the most severe manifestation is taken.

The average CRPD is calculated based on the sum of the values ​​of all surveyed people. Based on the data, the level of intensity of the spread of the disease is checked:

• up to 1.0 - a weak possibility of developing the disease;
• up to 2.0 - slight tissue infection;
• up to 3.5 - there is a disease of moderate severity;
• up to 6.0 - high severity of the disease.

Gingivitis Index (IG)

IG is used to identify the location and extent of the spread of gingivitis. For analysis, the following numbers are examined - 16, 12, 24, 44, 32 and 36.

Each unit is examined from four sides:

• distal;
• medial;
• vestibular nucleus;
• lingual department.

Inspection is carried out visually, sometimes a special probe is used. The assessment is put down according to the following criteria:

• 0 - no inflammation;
• 1 - the color and structure of the gums slightly changed without bleeding;
• 2 - changed color, swelling and light bleeding;
• 3 - severe edema and obvious inflammation, bleeding at the slightest damage to the gums.

After the survey, the average value is derived by dividing the total scores for each unit by the number of those examined.

Meaning:

• less than 1.0 - the course of the disease in a mild form;
• up to 2.0 - middle stage disease;
• about 3.0 - severe gingivitis.

Ramfiord Index

It is also known as an indicator periodontal disease. It includes an assessment of gum and periodontal health. For the study, the vestibular and lingual facets of the numbers are taken - 16, 21, 24, 36, 41, 44. An accumulation of plaque and stone is recorded.

Gingivitis meanings:

• 0 - no disease;
• 1 - part of the gum is slightly inflamed;
• 2 - gum disease is severe enough;
• 3 - severe manifestations of the disease.

Periodontal disease values:

• 0-3 - the pocket has acceptable dimensions;
• 4 - the pocket reaches a depth of 3 mm;
• 5 - the pocket reaches up to 6 mm;
• 6 - pocket size over 6 mm.

Sulcus bleeding (SBI) by Muhlemann and Son

SBI is designed to detect gingivitis and periodontitis in the early stages. With a healthy appearance of the oral mucosa, these diseases at the very beginning can cause bleeding even with a minor lesion.

The research methodology is as follows - a special probe, without much pressure, is carried out along a certain line along the gum around the tooth and the reaction is monitored.

Criteria for assessing the strength of bleeding:

• 0 - no symptoms;
• 1 - blood appears only after 30 seconds;
• 2 - blood appears instantly or in the first 30 seconds;
• 3 - blood appears even at the time of eating or when cleaning.

Simplified sulcus bleeding index

This method involves determining the presence of bleeding only in the form of patient responses. It is not tested empirically. The patient is asked questions about possible bleeding in different cases, and according to his answers, the degree of inflammation of the gums.

It is used during treatment to check the results. Based on such a survey, only a rough estimate of the situation is possible.

Papillary bleeding (PBI) by Saxer and Miihiemann

PBI also detects the degree of gum inflammation and is carried out by passing a sulcus with a special probe along the interdental papillae.

The severity of gum disease:

• 0 - no blood;
• 1 - there are punctate hemorrhages;
• 2 - there are many punctate hemorrhages or blood along the line of the sulcus;
• 3 - blood flows or fills the entire furrow.

All periodontal indicators allow us to assess the degree of development of gum disease. Gingivitis and periodontitis are very serious diseases that lead to the loss of teeth. The sooner treatment is started, the more likely it is to maintain chewing ability.

Hygienic Index

Hygiene indicators are used in dentistry to determine the degree of contamination. Various data characterize clusters in terms of their quality and quantity. They differ in the way the teeth are evaluated, which are taken for examination.

Each of the hygiene methods approaches the problem of cleanliness from its side.

Fedorova-Volodkina

The index of hygiene according to Fedorov-Volodkina is the most popular and simple. This method of assessing cleanliness consists of staining the lower frontal incisors with iodine solution. After staining, observe the reaction.

Reaction analysis:

• 1 - color did not appear;
• 2 - color appeared on ¼ of the surface;
• 3 - the color appeared on ½ part;
• 4 - the color appeared on the ¾ part;
• 5 - the entire surface is completely painted.

Calculated by dividing all scores by 6.

Meaning:

• up to 1.5 - cleaning is excellent;
• from 1.5-2.0 - a good level of hygiene;
• up to 2.5 - insufficient purity;
• from 2.5-3.4 - poor level of hygiene;
• up to 5.0 - cleaning is practically not carried out.

Green Vermillion

This method allows you to identify the presence of soft plaque and a stone without the use of dyes. For this, 6 rooms are examined - 16, 26, 11, 31, 36 and 46. The incisors and upper molars are examined from the vestibular part, the lower molars from the lingual part. Inspection is carried out visually or using a special probe.

According to the results of the inspection of each unit, points are put down:

• 0 - clean surface;
• 1 - 1/3 of the surface is covered with deposits;
• 2 - 2/3 are occupied by clusters;
• 3 - observed on more than 2/3 of the surface.

Assessment is made separately for calculus and bacterial accumulations. Points are summed up and divided by 6.

Values:

• up to 0.6 - very good condition;
• from 0.6-1.6 - cleanliness is at a good level;
• up to 2.5 - insufficient hygiene;
• from 2.5-3 - poor level of cleanliness.

Silnes Low

This method makes it possible to analyze all of the patient's dental units or only some at his request. The examination is carried out by a doctor using a probe; coloring is not applied.

Based on the presence of plaque, the following points are awarded:

• 0 - clean;
• 1 - deposition in a thin strip, which can only be detected with a probe;
• 2 - plaques are clearly visible visually;
• 3 - cover the entire surface.

The indicator is calculated based on the sum of points for all four facets divided by 4. The total value for the entire cavity is calculated as the average between the individual data.

Tartar Index (CSI)

This method reveals the accumulation of plaque on the lower incisors and canines at the junction with the gum. All sides of each tooth are examined separately - vestibular, medial and lingual.

Points are assigned for each face:

• 0 - clean;
• 1 - the presence of deposits no more than 0.5 mm;
• 2 - width up to 1 mm;
• 3 - more than 1 mm.

The stone index is calculated by dividing the sum of points on all faces by the number of units examined.

Plaque Index by Quigley and Hein

This method examines the congestion in 12 frontal numbers of the lower and upper jaws. For inspection, such numbers are taken - 13, 12, 11, 21, 22, 23, 33, 32, 31, 41, 42 and 43.

For research, surface staining with a fuchsin solution is required. After that, the vestibular facet of each tooth is examined and scores are given:

• 0 - color did not appear;
• 1 - some parts appeared in the neck area;
• 2 - color up to 1 mm;
• 3 - deposit more than 1 mm, but does not cover 1/3;
• 4 - cover up to 2/3;
• 5 - cover more than 2/3.

The indicator is calculated by dividing the points by 12.

Simplified Lange Approximate Plaque Index (API)

Aprokismal surfaces require careful maintenance. From whether there are accumulations on them, the doctor determines how well the patient is cleaning.

For this method, the mucous membrane must be stained with a special solution. The formation of plaque on the proximal surfaces is then determined using the answers "yes" or "no". Examination is carried out in the first and third quadrants from the oral side and in the second and fourth quadrants from the vestibular side.

It is calculated as a percentage between positive answers to all answers.

Grade:

• less than 25% - cleaning is good;
• up to 40% - adequate hygiene;
• up to 70% - hygiene at a satisfactory level;
• more than 70% - cleaning is insufficient.

Ramfiord Index

Identifies plaque deposits, examines the vestibular, lingual and palatal sides. Several numbers are taken for analysis - 11, 14, 26, 31, 34 and 46.

Before examining the teeth, stain them with a brown bismarck solution. After the inspection, an assessment is made based on the nature of the clusters:

• 0 - clean;
• 1 - the presence of deposits on separate parts;
• 2 - appeared on all faces, but occupy less than half;
• 3 - visible on all edges and cover more than half.

Navi

In this method, only the anterior incisors from the labial side are examined. Before starting, you need to rinse your mouth with a solution of fuchsin. According to the results of staining, scores are given:

• 0 - clean;
• 1 - deposits are slightly stained only along the border with the gum;
• 2 - a strip of accumulations on the border with the gum is clearly visible;
• 3 - up to 1/3 of the tooth near the gums is covered with deposits;
• 4 - cover up to 2/3;
• 5 - cover more than 2/3 of the surface.

The value is the average of one tooth.

Tureski

Its creators used the Quigley and Hein method as a basis, only for the study they took the edges from the lingual and labial sides of the entire dentition.

The mouth is similarly stained with a fuchsin solution and the manifestation of clusters is analyzed by points:

• 0 - clean;
• 1 - separate parts appeared in the neck area;
• 2 - the size of deposits up to 1 mm;
• 3 - over 1 mm, but do not cover 1/3;
• 4 - the area of ​​deposits covers up to 2/3 of the surface;
• 5 - cover more than 2/3.

Turesky's data are calculated by dividing all points by the total number of teeth.

Arnim

This method provides an opportunity to study plaque most accurately, to measure its area. But it is quite laborious and more suitable for research purposes. Its complexity does not allow it to be carried out during routine examinations of patients.

The upper and lower anterior incisors are taken for examination. They are stained with erythrosine and a photograph of the surface is taken from the vestibular side. The image is enlarged 4 times and printed. Next, you need to translate the contour of the teeth and painted surfaces onto paper and determine these areas using a planimer. Thereafter, the size of the surface area on which the plaque has formed is obtained.

Plaque Formation Rates (PFRI) by Axelsson

Using this method, they investigate the rate at which plaque is formed. To do this, they carry out cleaning on professional equipment and do not clean the mouth for the next day. After that, the mucous membrane is stained with a solution and the surfaces with the formed plaque are examined.

The result is assessed as a percentage of the contaminated units to all examined:

• less than 10% - very low rate of plaque deposition;
• from 10-20% - low
• up to 30% - average;
• from 30-40% - high;
• more than 40% is very high.

Such a study provides an opportunity to analyze the degree of risk of the appearance and spread of caries and to find out the nature of plaque deposition.

Plaque scores in young children

It is used to analyze plaque in children that appears after the appearance of milk teeth. During the examination, all the erupted teeth in the child are examined visually or using a special probe.

The condition is assessed as follows:

• 0 - clean;
• 1 - there are deposits.

It is calculated by dividing the number of cloves with deposits by the total number of cloves in the oral cavity.

Values:

• 0 - hygiene is good;
• up to 0.4 - cleaning at a satisfactory level;
• from 0.4-1.0 - hygiene is very poor.

Oral Hygiene Effectiveness (OOH)

This indicator is used to establish the level of thoroughness of cleaning. For the study, the following numbers are taken - vestibular parts 16, 26, 11, 31 and lingual parts 36 and 46. The surface is divided into 5 parts - medial, distal, occlusal, central and cervical.

The mouth is rinsed with a special solution and the degree of coloration of each sector is analyzed by points:

• 0 - clean;
• 1 - color has appeared.

The indicator of one tooth is obtained by summing all the points based on the results of its examination. The total value is obtained by dividing the sum of individual indicators by their total number.

Hygiene level:

• 0 - hygiene is very good;
• up to 0.6 - cleaning at a good level;
• up to 1.6 - hygiene is satisfactory;
• more than 1.7 - cleaning is poor.

Hygiene metrics are important for analyzing contamination levels. It is important to follow hygienic care and thoroughly clean your mouth daily. Tartar and plaque inflame the tissue around the teeth and can lead to tooth loss.

Stages of an epidemiological survey according to the WHO methodology

Epidemiology is a way of studying the nature of the spread of diseases in different segments of the population. It is also used for dental purposes.

An epidemiological survey consists of three main stages:

1. Preparatory stage. A plan is drawn up indicating the terms, methods and tasks of the study. The site for the study and the necessary equipment are being prepared. A group of two doctors and a nurse is being formed and trained. Special groups of the population are selected, characterizing their populations and living conditions (climatic conditions, social conditions, environment, etc.). The number of males and females should be the same. The size of the groups depends on the required level of research accuracy.
2. Second stage - examination. A registration card is used to record data. For children under 15 years old, it has a simplified form. Additions and corrections to the map are prohibited. All entries are made in the form of codes indicating the specific manifestation of symptoms or their absence. For a complete picture of the state of health, information is collected about the oral mucosa and about the extraoral area.
3. Stage three - evaluating the results. The data are calculated according to the required parameters - the level of prevalence of caries, the level of periodontal disease, etc. The results are displayed as a percentage.

Such examinations make it possible to assess the dental situation in a particular region, to reveal the dependence of the health of the oral mucosa on the surrounding and social conditions of life. And also to trace the changes in the condition of the teeth and gums with increasing age of the patient.

It is important to identify the most common diseases and their intensity in different regions and age groups. Based on the research results, preventive measures for the treatment of serious diseases and hygiene education are planned.

Output

All dental indicators are individual in their own way. They allow you to assess the health of the oral cavity from different angles. When examining a patient, the dentist uses one or another method based on the individual characteristics of the body and the state of the oral mucosa.

All research methods are quite simple to use. They do not cause pain to the patient and do not require special training. Special solutions for staining plaque are absolutely harmless to the patient.

Thanks to them, the doctor can not only assess the initial state of the oral cavity, but also predict future deterioration or track changes in the teeth and gums after treatment.