Oral hygiene indices
To assess oral hygiene during epidemiological studies, test the effectiveness of hygiene and preventive measures, as well as to identify the role of hygiene in the etiology and pathogenesis of major dental diseases, a large number of objective indices have currently been proposed. All these indices are based on an assessment of the area of dental plaque, its thickness, mass, and physicochemical parameters.
Hygiene index according to Pakhomov G.N.
The following teeth are stained with Lugol's solution: 6 lower frontal teeth, all 1st molars (16, 26, 36, 46), as well as 11 and 21 (12 teeth in total).
Color rating:
absence of staining – 1 point;
¼ of the tooth surface – 2 points;
½ tooth surface – 3 points;
¾ of the tooth surface – 4 points;
The entire surface of the tooth – 5 points.
The assessment is carried out by finding the arithmetic mean by adding the sum of the color (in points) of all twelve teeth and dividing the resulting sum by twelve.
In our country, its modification is most often used Fedorov-Volodkina. The basis is a semi-quantitative assessment of Lugol's solution staining of six anterior teeth of the lower jaw (incisors and canines). At the same time, staining of the entire surface of the tooth crown is estimated at 5 points, ¾ of the surface - 4 points, ½ of the surface - 3 points, ¼ - 2 points, absence of staining - 1 point (Fig. No. 6).
Rice. No. 6 Codes for assessing the Fedorov-Volodkina index
The assessment is carried out by finding the arithmetic mean by adding the sum of the color (in points) of all six teeth and dividing the resulting sum by six.
where is Ksr. – hygiene index, K – sum of hygiene assessment of all examined teeth, n – number of examined teeth.
Interpretation of indices by Pakhomov G.N. And Fedorov-Volodkina:
1.0 – 1.5 – good level of hygiene;
1.6 – 2.0 – satisfactory level of hygiene;
2.1 – 2.5 – unsatisfactory level of hygiene;
2.6 – 3.4 – poor level of hygiene;
3.5 – 5.0 – very poor level of hygiene.
In some cases, it is more convenient and faster to determine a qualitative assessment of plaque intensity using a 3-point system. In this case, intense staining of plaque with Lugol's solution is taken as 3 points, weak staining - 2.0, absence - 1.0. The calculation is carried out according to the formula:
where Sav. – qualitative hygienic indicator, Sn – sum of index values for all examined teeth, n – number of examined teeth. Normally, the quality index of oral hygiene should be equal to 1.0.
Modified Fedorova index (L.V. Fedorova, 1982)
It differs from the Fedor-Volodkina hygiene index in that the study is carried out in the area of 16 teeth (16, 13, 12, 11, 21, 22, 23, 25, 36, 33, 32, 31, 41, 42, 43, 45). This allows you to more objectively assess the level of hygiene of all groups of teeth. The area of dental plaque is assessed similarly to IG Fedorov-Volodkina.
Simplified index of oral hygiene (modified by Leus P.A.) - “IGR-U”(OHJ – S, Green, Wermillion, 1964).
Formula: IGR – U = +
Key: ∑ - sum of values;
ZN – dental plaque;
ZK – dental calculus;
n – number of teeth examined (usually 6).
Methodology: visually, using a dental probe, dental plaque and tartar are determined on the labial surfaces of 11 and 31, buccal surfaces of 16 and 26 and lingual surfaces of 36 and 46 teeth.
Assessment of dental plaque (P) values is carried out using a three-point system: 0 – no plaque detected; 1 – soft plaque covers 1/3 of the tooth surface or dense brown plaque in any quantity; 2 – soft ZN covers 2/3 of the tooth surface; 3 – soft teeth cover more than 2/3 of the tooth surface.
Assessment of tartar values (TC) is also carried out using a three-point system: 0 – TC not detected; 1 – supragingival zone covers 1/3 of the tooth surface; 2 – supragingival GC covers 2/3 of the tooth surface or subgingival GR is present in the form of separate conglomerates; 3 – the supragingival zone covers more than 2/3 of the tooth surface or the subgingival zone surrounds the cervical part of the tooth.
IZK = Sum of indicators 6 teeth / 6
UIG (OHJ-S) = IZN + IZK
The interpretation of the Green-Vermilion index is carried out according to the following scheme:
Ramfier Index (1956) By identifying dental plaque, it is determined on 6 teeth: 14, 11, 26, 46, 31, 34.
The lateral, buccal and lingual surfaces are examined using brown Bismarck solution. The assessment is carried out according to the following criteria:
0 – absence of dental plaque (DB);
1 – ST is present on some, but not all lateral, buccal and lingual surfaces of the tooth;
2 – ZB is present on all lateral, buccal and lingual surfaces, but covers no more than half of the tooth;
3 – ZB is present on all lateral, buccal and lingual surfaces, and covers more than half of the tooth. The index is calculated by dividing the total score by the number of teeth examined.
Schick-Asch Index (1961) according to the definition of ZN at 14, 11, 26, 46, 31, 34.
0 – no ZN;
1 – GN on the lateral or gingival border covers less than 1/3 of the gingival half of the labial or lingual surface;
2 – GL covers more than 1/3, but less than 2/3 of the gingival half of the labial or lingual surface;
3 – ZN covers 2/3 or more than half of the gingival labial or lingual surface of the tooth.
Target setting. Learn to determine the state of oral hygiene by the amount of plaque and tartar; methods, technical and organizational techniques, rules and manipulations necessary for the practical implementation of preventive measures.
One of the most important criteria for the condition of the oral organs when determining the level of health is the assessment of the state of oral hygiene. The main indicator of hygiene is the determination of the amount of soft plaque, tartar and pellicle that appears on the surface of the tooth after its eruption. The process of their accumulation depends on self-cleaning - the most important physiological function of the oral cavity. Quantitative accounting of dental plaque, a component of the oral cavity that depends on many factors, is most often used as an indicator of hygiene.
Soft plaque in the oral cavity is located on the surface of the tooth, most often in the gingival area, at the border of the neck of the tooth and the edge of the gum. It has a gray or yellow-gray color and is invisible in small quantities on the teeth. However, it can be easily detected by scraping the enamel surface in the cervical area with a trowel or excavator. When accumulated, it takes on the appearance of a soft amorphous grayish-white or grayish-yellow mass; The thickest layer of plaque is noted in the area of the gingival margin. At the point where the gums come into contact with plaque, signs of inflammation are often observed. When brushing your teeth or eating food, especially hard and dense food, part of the plaque from the surface of the tooth is constantly removed, but quickly forms again. Despite its softness and friability, dental plaque is firmly bound to the surface of the tooth.
Detection of soft dental plaque and its quantitative assessment are based on a chemical reaction or sorption of dyes by extracellular plaque polysaccharides. Usually Lugol's solution is used for this purpose (Kalii jodati 2.0; Jodi crist. 1.0; Aq. destill. 40.0), the iodine of which colors the polysaccharides in yellowish-pink tones (Fig. 16). Basic fuchsin (Fucsini bas. 1.5; Spiritus aet. 70% 25.0) is also used for staining dental plaque, 15 drops per 1/4 cup of water for rinsing, Bismarck brown, erythrosine in tablets. To detect plaque, Lugol's solution is used in the form of applications with small cotton swabs soaked in Lugol's solution and applied to the surface of the teeth. Fuchsin basic stains soft dental plaque a dirty red color by vigorously rinsing the mouth with the solution for 30 seconds, after which excess dye is removed by rinsing with plain water.
The amount of dental plaque in the oral cavity is assessed intravitally using various semi-quantitative methods that determine the area of colored plaque on the surface of the teeth. This allows you to individually objectively assess the state of oral hygiene. In our country, the Fedorov-Volodkina index is most widely used for this purpose. It is based on a semi-quantitative (score) assessment of the area of the vestibular surfaces stained with Lugol's solution of the six anterior teeth of the lower jaw - incisors and canines. In this case, staining of the entire surface of the tooth crown is assessed as 5 points, 3/4 of the surface - 4 points, V2 - 3 points, 1/4 - 2 points, absence of staining - 1 point. Then the arithmetic mean is found by dividing the sum of the color of all teeth by their number using the formula: [Ksr = EKn/n], where Ksr is the hygiene index; EKn - the sum of the assessment of the examined teeth; n is the number of teeth examined. A good level of hygiene is characterized by an index of 1.0-1.3 points. The higher the index value, the lower the level of oral hygiene. Other methods for assessing oral health are similar in principle to the one described and differ in some details.
Tartar is also an acquired structure of the oral cavity. It accumulates in small quantities on the lingual surfaces of the anterior teeth of the lower jaw, which is explained by the close location of the excretory ducts of the sublingual and submandibular salivary glands. It is a mineralized structure of varying degrees of looseness and strength, firmly welded to the surface of the teeth. Its color varies from yellowish-white to gray-black depending on the state of oral hygiene, smoking, diet and other factors.
There are supra- and subgingival tartar. Supragingival calculus is clearly visible upon visual inspection. It accumulates on the teeth located near the mouths of the excretory ducts of the salivary glands in all people; Tartar formation increases with age. Subgingival tartar is usually invisible, as it is located under the gum, in the depths of the formed pathological gum pocket. It is hard, dense, firmly connected to the root of the tooth, and therefore is removed with great difficulty.
Quantitative assessment of supragingival calculus is based on the same principles as the oral hygiene index, but is used less frequently. It can be painted, for example, with basic fuchsin.
Diagnostic dyes are also convenient to use as a test to assess the effectiveness of dental plaque removal. To do this, use 6% basic fuchsin for applications or 0.75% for rinsing for 20 seconds, as well as Lugol’s solution and other dyes.
Soft plaque and tartar form the main part of dental acquired structures, collectively called “dental deposits”. They are infected and can support and promote the development of foci of infection.
To maintain a healthy mouth, removing plaque is important. The method of removing plaque is described in detail in the section on oral hygiene. Tartar removal is usually done mechanically using excavators or tools specially designed for this purpose - hooks, enamel knives, curettage spoons, etc. When removing tartar, the following rules must be observed:
1) all instruments must be sterile;
2) before removing tartar, it is necessary to antiseptically treat the surgical field with a 3% solution of hydrogen peroxide and iodine. To isolate from saliva, use cotton swabs or gauze pads;
3) the hand holding an excavator or other tool for removing dental plaque should be fixed on the patient’s chin or adjacent teeth, which prevents damage to soft tissues;
4) mobile teeth are fixed with the fingers of the left hand;
5) after removing deposits, treat the oral cavity with antiseptic solutions (iodine, 2-3% hydrogen peroxide solution). When working as a doctor removing dental plaque, you need to protect your eyes with special glasses.
For thorough removal of tartar from all teeth, the correct position of the patient is important: the level of the chair and the position of the head vary depending on the group of teeth being treated.
It is recommended to complete the removal of tartar by polishing the root surface. This procedure is performed using special rubber cups, polishers, and wooden sticks. For polishing, use paste (10 g of pumice, 10 g of glycerin and 5 drops of iodine) or chalk mixed with hydrogen peroxide.
When removing a stone, a certain sequence is usually followed. For example, stone is first removed from the cheeks, then from the lingual surfaces, then from the interdental spaces. It is recommended to remove subgingival stone and granulation from no more than 5-6 teeth at a time, based on the rule that the quality of removal plays a paramount role. The removal of subgingival calculus is controlled by a probe. If roughness is felt when sliding along the surface of the root, this indicates incomplete removal and the manipulation should be repeated.
Oral hygiene is one of the most accessible and at the same time one of the leading methods of preventing oral diseases. Regular and competent oral care is an integral part of all preventive measures. Mass population surveys conducted in all countries of the world have convincingly shown that systematic oral care has an undoubted preventive value. It is possible to objectively assess the level of oral hygiene only using hygiene indices.
To identify dental plaque in assessing oral hygiene in modern dentistry, objective indicators (indices) are used that characterize the quality and quantity of dental plaque. However, the number of assessment methods, which are based on different numbers of teeth from different functional groups, up to staining all teeth on both sides or collecting and weighing plaque around individual teeth, indicates the relevance of the problem under consideration and the imperfection of existing methods.
Oral hygiene indices.
Method for determining the Fedorov-Volodkina hygienic index//E.M.Melnichenko “Prevention of dental diseases”, Minsk, “Higher School”., 1990, pp. 3-17.
It is determined by the intensity of the color of the vestibular surface of the six lower frontal teeth by applying an iodine-iodide-potassium solution (Schiller-Pisarev liquid).
The calculation is carried out according to the formula:
Ksr (hygiene index) = Kn (total hygiene index for each of the six teeth) / n (number of teeth).
Coloring the entire surface of the crown is scored 5 points, 3/4 of the surface - 4, 1/2 of the surface - 3, 1/4 of the surface - 2 points. If there is no staining, 1 point is given. The indicator is assessed as follows: good index, satisfactory, unsatisfactory, bad, very bad.
However, the proposed method has a number of disadvantages:
Determination of the quality and quantity of dental plaque and assessment of the hygiene index were carried out only on one’s own teeth;
- the use of known dyes is impossible when determining the amount of dental plaque on bridges, since these solutions are difficult to wash off from the surface of the dentures.
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Name |
Facilities diagnostics |
Self-control criteria |
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Lugol's solution 1.1-1.5 is good 1.6-2.0 - satisfactory 2.1-2.5 - unsatisfactory 2.6-3.4 - bad 3.5-5.0 - very bad |
The vestibular surface of the six front teeth of the lower jaw - incisors and canines - is stained with Lugol's solution. Rating on a 5-point system: 5 points - the entire surface of the teeth is stained, 4 points - 3/4 of the tooth surface, 3 points - 1/2 of the tooth surface, 2 points - 1/4 of the tooth surface, 1 point - no staining Then find the arithmetic mean by dividing the sum of the color of all teeth by their number: K av = Kp: p. Good level of hygiene: Ksr=1.0-1.3 b IG = sum of six teeth points |
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Schiller-Pisarev solution or Lugol's solution 0-0.6 good 0.7-1.6 satisfactory 1.7-2.5 unsatisfactory 2.6-3 - bad |
Determine the presence of plaque and tartar on the buccal surface of the first upper molars, the lingual surface of the lower molars, and the vestibular surface 1| and lower |1 6 1| 6
0 - no plaque (stone) 1 - plaque covers up to 1/3 of the tooth surface 2 - plaque covers from 1/3 to 2/3 of the tooth surface 3 - plaque covers more than 2/3 of the tooth surface Tartar assessment: 0 - absence of tartar 1 - supragingival tartar covers no more than 1/3 of the tooth crown 2 - supragingival tartar covers from 1/3 to 2/3 of the tooth crown, or single formations of subgingival tartar are detected 3 - supragingival tartar covers more than 2/3 of the tooth crown, or significant deposits of subgingival tartar are detected along the entire circumference of the tooth. IZN = sum of indicators of 6 teeth The assessment of the tartar index is carried out similarly to UIG = IZN + IZK |
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Schiller-Pisarev solution 0-no staining 1- staining up to 1/3 of the crown, 2- staining up to 2/3 of the crown 3- more than 2/3 of the tooth crown |
Staining of the vestibular and lingual surfaces 6 1 | 6
The plaque index and stone index are summed up and the average is obtained. |
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RHP Index - Oral Hygiene Performance Index (Podshadley, Haley - 1968) |
Color 6 teeth: 16, 26, 11, 31 - vestibular surfaces. 36, 46 - lingual surfaces |
The examined surface is divided into 5 sections: 1-medial, 2-distal, 3-mid-occlusal, 4-central, 5-mid-cervical. Plaque is assessed at each site: 0 - no staining 1 - staining detected For each tooth, the site codes are summed up. Then the values of all examined teeth are summed up and the resulting sum is divided by the number of teeth. Index values: 0 - excellent 0.1-0.6 - good 0.7-1.6 - satisfactory 1.7 or more - unsatisfactory |
Index of need for treatment of periodontal diseases - CPITN
To assess the prevalence and intensity of periodontal diseases, almost all countries use the index of need for the treatment of periodontal diseases - CPITN. This index was proposed by specialists of the WHO working group to assess the condition of periodontal tissues during epidemiological surveys of the population.
Currently, the scope of the index has expanded, and it is used to plan and evaluate the effectiveness of prevention programs, as well as calculate the required number of dental personnel. In addition, the CPITN index is currently used in clinical practice to examine and monitor the periodontal condition of individual patients.
This index registers only those clinical signs that may undergo reverse development: inflammatory changes in the gums, which are judged by bleeding, tartar. The index does not record irreversible changes (gingival recession, tooth mobility, loss of epithelial attachment), does not indicate the activity of the process and cannot be used to plan specific clinical treatment in patients with developed periodontitis.
The main advantages of the CPITN index are the simplicity and speed of its determination, information content and the ability to compare results.
To determine the CPITN index, the dentition is conventionally divided into 6 parts (sextants), including the following teeth: 17/16, 11, 26/27, 36/37, 31, 46/47.
The periodontium is examined in each sextant, and for epidemiological purposes only in the area of the so-called “index” teeth. When using the index for clinical practice, the periodontium is examined in the area of all teeth and the most severe lesion is identified.
It should be remembered that a sextant is examined if it contains two or more teeth that cannot be removed. If only one tooth remains in the sextant, it is included in the adjacent sextant, and this sextant is excluded from the examination.
In the adult population, starting from 20 years of age and older, 10 index teeth are examined, which are identified as the most informative:
When examining each pair of molars, only one code characterizing the worst condition is taken into account and recorded.
For persons under 20 years of age, 6 index teeth are examined during the epidemiological survey: 16, 11, 26, 36, 31, 46.
CODE 1: bleeding observed during or after probing.
Note: bleeding may appear immediately or after 10-30 seconds. after probing.
CODE 2: tartar or other plaque-retaining factors (overhanging edges of fillings, etc.) are visible or felt during probing.
CODE 3: pathological pocket 4 or 5 mm (the edge of the gum is in the black area of the probe or the 3.5 mm mark is hidden).
CODE 4: pathological pocket 6 mm deep or more (with the 5.5 mm mark or black area of the probe hidden in the pocket).
CODE X: When only one or no teeth are present in the sextant (third molars are excluded unless they are in place of second molars).
To determine the need for periodontal disease treatment, population groups or individual patients can be categorized based on the following criteria.
0: CODE 0 (healthy) or X (excluded) for all 6 sextants means that there is no need for treatment for this patient.
1: A CODE of 1 or higher indicates that this patient needs to improve his oral hygiene status.
2: a) CODE 2 or higher indicates the need for professional hygiene and the elimination of factors that contribute to plaque retention. In addition, the patient needs training in oral hygiene.
b) CODE 3 indicates the need for oral hygiene and curettage, which usually reduces inflammation and reduces pocket depth to values equal to or less than 3 mm.
3: Sextant with CODE 4 can sometimes be successfully treated with deep curettage and adequate oral hygiene. In other cases, this treatment does not help, and then complex treatment is required, which includes deep curettage.
The prevalence and intensity of periodontal disease in the population is assessed based on the results of a survey of 15-year-old adolescents.
Prevalence of signs of periodontal damage (adolescents 15 years old)
Prevalence Bleeding gums Tartar
low 0 - 50% 0 - 20%
average 51 - 80% 21 - 50%
high 81 - 100% 51 - 100%
Level of intensity of signs of periodontal damage (adolescents 15 years old)
INTENSITY LEVEL BLEEDING GUMS CALCULUS
LOW 0.0 - 0.5 sextants 0.0 - 1.5 sextants
AVERAGE 0.6 - 1.5 sextants 1.6 - 2.5 sextants
HIGH< 1,6 секстантов < 2,6 секстантов
Gingivitis index PMA (Schour, Massler) modified by Parma
Gingivitis index PMA (Schour, Massler) as modified by Parma (determination of risk factors) - papillary-marginal-alveolar index is calculated by adding the assessments of the gum condition of each tooth in % using the formula:
RMA = sum of indicators x 100%
3 x number of teeth
0 - no inflammation,
1 - inflammation of the interdental papilla (P)
2 - inflammation of the marginal gum (M)
3 - inflammation of the alveolar gum (A)
At the age of 6-7 years, the number of teeth is normally 24, at 12-14 years - 28, and at 15 years and older - 28 or 30.
The PMA index is very sensitive to the slightest changes in the clinical picture, and its value can be influenced by random influences.
COMPLEX PERIODONTAL INDEX, KPI(P.A.Leus, 1988)
Methodology. The condition of periodontal tissue is determined using a conventional dental probe and a dental mirror; dental tweezers can be used to determine mobility. In adults, 17/16, 11, 26/27, 37/36, 31, 46/47 are examined. If several signs are present, a more severe condition is recorded (higher score).
Criteria
0 - healthy - dental plaque and signs of periodontal damage are not detected;
1- dental plaque - any amount of dental plaque;
2- bleeding - bleeding visible to the naked eye upon slight probing of the periodontal groove;
3 - tartar - any amount of tartar in the subgingival area of the tooth;
4 - pathological pocket - pathological periodontal pocket determined by the probe;
5 - tooth mobility - mobility 2-3 degrees
The KPI of an individual is calculated using the formula:
KPI = Sum of codes / number of sextants (usually 6)
Interpretation:
Values Intensity level
0.1-1.0 Risk of disease
1.1-2.0 Light
2.1-3.5 Average
3.6-5.0 Heavy
Index CP.I.- communal periodontal index.
Designed to determine the condition of periodontal tissues during epidemiological studies. The condition of periodontal tissues is assessed by:
Presence of subgingival calculus
Bleeding gums after gentle probing
By the presence and depth of pockets
A special button probe is used for the study:
Weight 25 grams
Button diameter 0.5 mm
Marking 3-5-8-11 mm
Distance between 3 and 5mm black
In persons from 15 to 20 years old, teeth 11, 16, 26, 31, 36, 46 are examined. In persons over 20 years old, teeth are examined: 11, 16, 17, 26, 27, 31, 36, 37, 46, 47.
Research is carried out from the vestibular and oral surfaces, in the distal and medial areas
Research methodology:
1. The working part of the probe is placed parallel to the long axis of the tooth
2. The button of the probe is inserted with minimal pressure into the space between the tooth and soft tissues until an obstacle is felt
3. Mark the immersion depth of the probe
4. When extracting, the probe is pressed against the tooth to determine whether there is subgingival calculus on it
5. At the end of the study, the gums are observed after 30-40 seconds to determine bleeding
Data logging:
0 - healthy gums
1 - bleeding after 30-40 seconds, with a pocket depth of less than 3 mm
2 - subgingival calculus
3 - pathological pocket 4-5 mm
4 - pathological pocket 6 mm or more
If several symptoms are present, the most severe one is recorded.
In each sextant, the periodontal condition of only one tooth is recorded, recording the tooth with the most severe clinical periodontal condition
To evaluate the index, the proportion of people who have a particular number of sextants with a particular code is calculated.
Iodine index of enamel remineralization.
The active permeability of iodine in tooth tissue is known. Remineralization index (RI), which characterizes the effectiveness of the remineralization therapy used. It is assessed using a four-point system:
1 point – no staining of the tooth area;
2 points - light yellow coloration of the tooth area;
3 points - light brown or yellow staining of the tooth area;
4 points - dark brown staining of the tooth area.
The calculation is carried out according to the formula:
IR = IRNP x number of teeth with hypersensitivity / n,
where IR is the remineralization index;
RRI—remineralization index of one non-carious lesion;
P - number of teeth examined.
Dark brown and light brown staining indicates demineralization of the tooth area with non-carious lesions; light yellow - indicates a certain level of remineralization processes in this area of the tooth, and the absence of staining or its slightly yellow color demonstrates a good level of the remineralization process of a particular non-carious tooth lesion.
Prevalence and severity of hyperesthesia of hard dental tissues
(Fedorov Yu.A., Shtorina G.B., 1988; Fedorov Yu.A. et al., 1989).
The index is calculated using the formula and expressed as a percentage:
Number of teeth with increased = sensitivity / Number of teeth in a given patient x 100%.
Depending on the number of teeth with sensitivity to various irritants, the index varies from 3.1% to 100.0%.
3.1—25% are diagnosed with a limited form of hyperesthesia
26-100% - generalized form of dental hyperesthesia.
Dental hyperesthesia intensity index (DHI)
calculated by the formula:
IIGZ = Sum of index values of each tooth / Number of teeth with increased sensitivity
The index is calculated in points, which are determined based on the following indicators:
0 - no reaction to temperature, chemical and tactile stimuli;
1 point—sensitivity to temperature stimuli;
2 points - sensitivity to temperature and chemical stimuli;
3 points - sensitivity to temperature, chemical and tactile stimuli.
Values of the intensity index of hyperesthesia of hard dental tissues
1.0 - 1.5 points, degree I hyperesthesia;
1.6 - 2.2 points - II degree;
2.3 - 3.0 points - III degree.
The listed indices correlate with each other in 85.2-93.8% of cases and allow adequate and objective monitoring of the intensity and severity of the pathological process, and monitoring the dynamics of changes during treatment.
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O'Leary's Oral Hygiene Protocol (1972)
The protocol is very useful for systematic training in oral hygiene for a particular patient, as it allows us to identify not only the patient’s attitude towards oral hygiene, but also to detect shortcomings in cleaning certain surfaces of all groups of teeth.To complete the protocol, all surfaces (except the chewing surface) of each tooth are painted with a permanent dye.
Determine the presence of dental plaque on 4 tooth surfaces (on the vestibular, oral, distal and medial) or on 6 surfaces (on the distal-vestibular, vestibular, medial-vestibular, distal-oral, oral and medial-oral). Using a dental mirror, the presence or absence of staining in the area of the crowns of all teeth is recorded. The data is entered into a modified schematic “formula” of the dentition (see diagram for registering the CPUP), shading the sector of the square corresponding to the contaminated tooth surface. The number of painted surfaces is counted and what proportion (%) of all tooth surfaces is contaminated and which, accordingly, is free from dental plaque.
The result is recorded in the patient's chart and used for comparison with the results of subsequent oral hygiene studies.
Turesky Oral Health Index (1970)
The index is used for individual clinical work and is often used for comparative research of the quality of products intended for oral hygiene.After staining, the oral and vestibular surfaces of all teeth are examined. Rating scale for each surface:
0—no staining;
1 - staining in the form of a thin line at the border with the gum;
2 - the line at the gum is wider;
3 - the gingival third of the surface is painted;
4 — 2/3 of the surface is painted;
5 - more than 2/3 of the surface is painted.
The result is taken into account as the sum of all points, evaluated over time and when comparing different objects.
Silnes-Lowe Plaque Index PLI (1964)
The index allows you to examine all teeth or only some teeth selected at the request of the researcher. Without staining, the presence of soft dental deposits on the four surfaces of the tooth is examined visually or with a probe. The probe is directed to the gingival groove.The amount of plaque on one tooth surface is assessed on a scale:
0 points - no plaque in the gingival area;
1 point - a thin film of plaque in the gingival area is determined only by a probe;
2 points - plaque is visible to the eye in the gingival groove and cervical area;
3 points - there is excess plaque on most of the tooth surface and in the interdental space.
PLI of a tooth is calculated using the formula:
PLI = (Sum of points of four surfaces)/4
Oral PLI is calculated as the average of the PLI of all teeth examined.
Simplified Green and Vermilion Oral Health Index OHI-S (1964)
OHI-S was created by the authors on the basis of the Oral Hygiene Index (OHI), which they proposed in 1960, which involved a quantitative assessment of supra and subgingival dental plaque on the buccal and lingual surfaces of all permanent teeth, with the exception of third molars, assessing the result by segments (quadrants).OHI-S is proposed to assess oral hygiene only by the surface condition of six indicator teeth: all first molars of the upper and lower jaws (16, 26, 36 and 46, if they are absent - the adjacent second molars) and two central incisors (11 and 31, in the absence - the central incisors of the other side). Only one surface of the teeth is examined: for the molars of the upper jaw and all incisors - the vestibular surface, for the molars of the lower jaw - the lingual. In this case, these surfaces should not be affected by caries and hypoplasia.
Each surface is examined using a probe for the presence of soft plaque and tartar. On the surface under study (lingual, buccal), the probe is placed parallel to the axis of the tooth and, starting zigzag movements from the occlusal surface of the tooth to the neck, the level of the crown from which dental plaque accumulates on the probe is noted.
OHI-S is calculated as the sum of two indices - plaque index and calculus index.
Debris Index (DI-S):
0 points - no plaque or pigment;
1 point - soft plaque occupies no more than 1/3 of the crown height, or there is extradental pigmentation without visible soft plaque (Priestley plaque) on any surface area;
2 points - soft plaque covers more than 1/3, but less than 2/3 of the crown height;
3 points - soft plaque covers more than 2/3 of the tooth surface.
Calculus Index (CI-S):
0 points - no stone;
1 point - supragingival calculus, occupying no more than 1/3 of the examined surface;
2 points - supragingival calculus, occupying more than 1/3, but less than 2/3 of the examined surface or the presence of individual fragments of subgingival calculus;
3 points - supragingival calculus, covering more than 2/3 of the surface or subgingival calculus, encircling the neck of the tooth.
The DI-S and CI-S data for each tooth are entered into a special table with six cells, each of which is divided in two diagonally. To calculate OHI-S, the DI-S and CI-S of all teeth are summed up:
OHI-S = (DI-S + CI-S)/6
The state of oral hygiene according to the OHI-S is assessed as follows:
with OHI-S no more than 0.6 - good hygiene; 0.7—1.6—satisfactory; 1.7—2.5—unsatisfactory; > 2.6 - bad.
PHP Patient Oral Hygiene Performance Index (1968)
The index is used to control the quality of teeth brushing during training. The presence of plaque is recorded on the same surfaces of the same teeth as in OHI-S (vestibular surfaces 16 and 26, 11 and 31, lingual surfaces 36 and 46), but at the same time the contamination of several areas (sectors) of the examined surface of the tooth crown is taken into account ( Fig. 5.24).
Rice. 5.24. Scheme of dividing the vestibular surface of the tooth into sectors.
The presence of soft plaque is determined after rinsing with dye. If there is no staining in the sector, 0 points are given; if there is any coloring in the sector - 1 point. The scores of five sectors of one surface are summed up and the tooth’s RNR is obtained. RNR for the oral cavity is calculated as the average of all six indicators:
RNR = (sum of RNR of teeth)/(n teeth)
Oral hygiene assessment using PHP:
O - excellent oral hygiene;
0.1-0.6 - good;
0.7—1.6—satisfactory;
>1.7 – unsatisfactory.
Axelsson Plaque Formation Rate Index PFRI (1987)
The free (without hygienic interventions) formation of dental plaque is assessed within 24 hours after professional oral hygiene on all surfaces (except occlusal) of all teeth. After staining, the number of all contaminated surfaces is noted, then the proportion of those examined (%) is calculated. The result is assessed on a scale (Table 5.8).Table 5.8. PFRI Rating Scale 
Studies of the microflora of oral fluid and dental plaque make it possible to give a more complete and accurate description of their cariogenicity and clarify the degree of risk of caries development.
T.V. Popruzhenko, T.N. Terekhova
INDICES OF ORAL CAVITY CONDITION
Methods for assessing dental plaque
Fedorov-Volodkina Index (1968) was widely used in our country until recently.
The hygienic index is determined by the intensity of coloring of the labial surface of the six lower frontal teeth with an iodine-iodide-potassium solution, assessed using a five-point system and calculated using the formula:
,Where By Wed. – general hygienic cleaning index; To u– hygienic index of cleaning one tooth; n– number of teeth.
Staining the entire surface of the crown means 5 points; 3/4 – 4 points; 1/2 – 3 points; 1/4 – 2 points; absence of staining – 1 point.
Normally, the hygiene index should not exceed 1.
Green-Vermillion index (Green, Vermillion, 1964) . The Oral Health Index Simplified (OHI-S) evaluates the area of tooth surface covered by plaque and/or tartar and does not require the use of special stains. To determine OHI-S, examine the buccal surface 16 and 26, the labial surface 11 and 31, and the lingual surface 36 and 46, moving the tip of the probe from the cutting edge towards the gum.
The absence of dental plaque is indicated as 0 , dental plaque up to 1/3 of the tooth surface – 1 , dental plaque from 1/3 to 2/3 – 2 , dental plaque covers more than 2/3 of the enamel surface – 3 . Then tartar is determined according to the same principle.
Formula for calculating the index.
Where n– number of teeth, ZN- plaque, ZK– tartar.
Silnes-Lowe Index (Silness, Loe, 1967) takes into account the thickness of plaque in the gingival region in 4 areas of the tooth surface: vestibular, lingual, distal and mesial. After drying the enamel, the tip of the probe is passed along its surface at the gingival sulcus. If no soft substance adheres to the tip of the probe, the plaque index on the tooth area is indicated as - 0 . If the plaque is not visually detected, but becomes visible after moving the probe, the index is equal to 1 . A plaque with a thin to moderate thickness, visible to the naked eye, is assessed by 2 . Intensive deposition of dental plaque in the area of the gingival sulcus and interdental space is designated as 3 . For each tooth, the index is calculated by dividing the sum of the points of 4 surfaces by 4.
The general index is equal to the sum of the indicators of all examined teeth, divided by their number.
Tartar index (CSI) (ENNEVER" et al., 1961). Supra- and subgingival tartar is determined on the incisors and canines of the lower jaw. The vestibular, distal-lingual, central-lingual and medial-lingual surfaces are differentially examined.
To determine the intensity of tartar, a scale from 0 to 3 is used for each surface examined:
0 - no tartar
1 - tartar is determined to be less than 0.5mm in width and/or thickness
2 - width and/or thickness of tartar from 0.5 to 1 mm
3 - width and/or thickness of tartar more than 1 mm.
Formula for calculating the index:
Ramfjord index (S. Ramfjord, 1956) as part of the periodontal index involves the determination of dental plaque on the vestibular, lingual and palatal surfaces, as well as the proximal surfaces of the 11, 14, 26, 31, 34, 46 teeth. The method requires preliminary staining with a Bismarck brown solution. Scoring is done as follows:
0 - absence of dental plaque
1 - dental plaque is present on some tooth surfaces
2 - dental plaque is present on all surfaces, but covers more than half of the tooth
3 - dental plaque is present on all surfaces, but covers more than half.
The index is calculated by dividing the total score by the number of teeth examined.
Navy index (I.M.Navy, E.Quiglty, I.Hein, 1962). The color indices of tissues in the oral cavity limited by the labial surfaces of the front teeth are calculated. Before the examination, the mouth is rinsed with a 0.75% solution of basic fuchsin. The calculation is carried out as follows:
0 - no plaque
1 - the plaque was stained only at the gingival border
2 - pronounced plaque line at the gingival border
3 - the gingival third of the surface is covered with plaque
4 - 2/3 of the surface is covered with plaque
5 - more than 2/3 of the surface is covered with plaque.
The index was calculated in terms of the average number per tooth per subject.
Turesky index (S.Turesky, 1970). The authors used the Quigley-Hein scoring system on the labial and lingual surfaces of the entire row of teeth.
0 - no plaque
1 - individual spots of plaque in the cervical area of the tooth
2 - a thin continuous strip of plaque (up to 1 mm) in the cervical part of the tooth
3 - plaque strip is wider than 1 mm, but covers less than 1/3 of the tooth crown
4 - plaque covers more than 1/3, but less than 2/3 of the tooth crown
5 - plaque covers 2/3 of the tooth crown or more.
Index Arnim (S. Arnim, 1963) in assessing the effectiveness of various oral hygiene procedures, determined the amount of plaque present on the labial surfaces of four upper and lower incisors stained with erythrosine. This area is photographed and developed at 4x magnification. The outlines of the corresponding teeth and colored masses are transferred to paper and these areas are determined with a planimer. The percentage of surface area covered by plaque is then calculated.
Hygiene Performance Index (Podshadley, Haby, 1968) requires the use of dye. Then a visual assessment of the buccal surfaces of 16 and 26 teeth, labial surfaces of 11 and 31 teeth, and lingual surfaces of 36 and 46 teeth is carried out. The surveyed surface is conventionally divided into 5 sections: 1 – medial, 2 - distal 3 - mid-occlusal, 4 – central, 5 - mid-cervical.
0 - no staining
1 - staining of any intensity is available
The index is calculated using the formula:
where n is the number of teeth examined.
CLINICAL METHODS FOR ASSESSING GINGUM CONDITION
PMA Index (Schour, Massler ). Inflammation of the gingival papilla (P) is assessed as 1, inflammation of the gingival margin (M) - 2, inflammation of the mucous membrane of the alveolar process of the jaw (A) - 3.
By summing up the gum condition assessments for each tooth, the PMA index is obtained. At the same time, the number of examined teeth of patients aged 6 to 11 years is 24, from 12 to 14 years old – 28, and from 15 years old – 30.
The PMA index is calculated as a percentage as follows:
RMA = (sum of indicators x 100): (3 x number of teeth)
In absolute numbers, PMA = sum of indicators: (number of teeth x 3).
Gingival index GI (Loe, Silence ). For each tooth, four areas are differentially examined: vestibular-distal gingival papilla, vestibular marginal gingiva, vestibular-medial gingival papilla, lingual (or palatal) marginal gingiva.
0 – normal gum;
1 – mild inflammation, slight discoloration of the gum mucosa, slight swelling, no bleeding on palpation;
2 – moderate inflammation, redness, swelling, bleeding on palpation;
3 – severe inflammation with noticeable redness and swelling, ulceration, and a tendency to spontaneous bleeding.
Key teeth whose gums are examined: 16, 21, 24, 36, 41, 44.
To evaluate the examination results, the sum of points is divided by 4 and the number of teeth.
0.1 – 1.0 – mild gingivitis
1.1 – 2.0 – moderate gingivitis
2.1 – 3.0 – severe gingivitis.
IN periodontal index P.I. (Russell) the condition of the gums and alveolar bone is calculated individually for each tooth. For calculation, a scale is used in which a relatively low indicator is assigned to gum inflammation, and a relatively higher indicator to alveolar bone resorption. The indices of each tooth are summed up, and the result is divided by the number of teeth in the oral cavity. The result shows the patient's periodontal index, which reflects the relative status of periodontal disease in a given oral cavity without taking into account the type and causes of the disease. The arithmetic mean of the individual indices of the examined patients characterizes the group or population indicator.
Periodontal Disease Index - PDI (Ramfjord, 1959) includes an assessment of the condition of the gums and periodontium. The vestibular and oral surfaces of the 16th, 21st, 24th, 36th, 41st, and 44th teeth are examined. Plaque and tartar are taken into account. The depth of the periodontal pocket is measured with a graduated probe from the enamel-cement junction to the bottom of the pocket.
GINGIVITIS INDEX
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