Particular attention should be paid to hygienic condition of the oral cavity as a major risk factor for the development of dental diseases. An obligatory stage of the initial examination is to assess the hygienic condition of the oral cavity by determining hygiene indices depending on the age of the child and the pathology with which the patient came in.
Indexes proposed for assessment of the hygienic state of the oral cavity(hygiene index - IG) are conventionally divided into the following groups:
The 1st group of hygienic indices that evaluate the area of dental plaque includes the Fedorov-Volodkina and Green-Vermillion indices.
It is widely used to study the hygienic state of the oral cavity. Fedorov-Volodkina index. Hygienic index determined by the intensity of coloring of the labial surface of the six lower frontal teeth (43, 42, 41, 31, 32, 33 or 83, 82, 81, 71, 72, 73) with an iodine-potassium iodine solution consisting of 1.0 iodine, 2.0 potassium iodide, 4.0 distilled water. Evaluated using a five-point system and calculated using the formula:
where K avg is the general hygienic cleaning index;
K and - hygienic index of cleaning one tooth;
n - number of teeth.
Criteria for evaluation:
Coloring the entire surface of the crown - 5 points
Coloring 3/4 of the crown surface - 4 points.
Coloring 1/2 of the crown surface - 3 points.
Coloring 1/4 of the crown surface - 2 points.
Lack of staining - 1 point.
Normally, the hygiene index should not exceed 1.
Interpretation of results:
1.1-1.5 points - good GI;
1.6 - 2.0 - satisfactory;
2.1 - 2.5 - unsatisfactory;
2.6 - 3.4 - bad;
3.5 - 5.0 - very bad.
I.G.Green and I.R.Vermillion(1964) proposed a simplified oral hygiene index OHI-S (Oral Hygiene Indices-Simplified). To determine OHI-S, the following surfaces of teeth are examined: vestibular surfaces of 16,11, 26, 31 and lingual surfaces of 36, 46 teeth. On all surfaces, plaque is determined first, and then tartar.
Criteria for evaluation:
Dental plaque (DI)
0 - no plaque
1 - plaque covers 1/3 of the tooth surface
2 - dental plaque covers 2/3 of the tooth surface
3 - plaque covers >2/3 of the tooth surface
Calculus (CI)
0 - tartar is not detected
1 - supragingival tartar covers 1/3 of the tooth crown
2 - supragingival tartar covers 2/3 of the tooth crown; subgingival tartar in the form of separate conglomerates
3 - supragingival tartar covers 2/3 of the tooth crown and (or) subgingival tartar covers the cervical part of the tooth
Formula for calculation:
Calculation formula:
where S is the sum of values; zn - dental plaque; zk - tartar; n - number of teeth.
Interpretation of results:
Second group of indices.
0 - plaque near the neck of the tooth is not detected by the probe;
1 - plaque is not visually detected, but a lump of plaque is visible on the tip of the probe when passed near the neck of the tooth;
2 - plaque visible to the eye;
3 - intensive plaque deposition on tooth surfaces and in interdental spaces.
J. Silness (1964) and H. Loe (1967)) proposed an original index that takes into account the thickness of the plaque. In the counting system, a value of 2 is given to a thin layer of plaque, and 3 to a thick layer. When determining the index, the thickness of the dental plaque (without staining) is assessed using a dental probe on 4 tooth surfaces: vestibular, lingual and two contact. 6 teeth are examined: 14, 11, 26, 31, 34, 46.
Each of the four gingival regions of the tooth is assigned a value from 0 to 3; this is the plaque index (PII) for a specific area. The values from the four areas of the tooth can be added and divided by 4 to obtain the PII for the tooth. Values for individual teeth (incisors, molars and molars) can be grouped to obtain PII for various groups teeth. Finally, by adding the indexes for the teeth and dividing by the number of teeth examined, the PII for the individual is obtained.
Criteria for evaluation:
0 is this value when the gingival area of the tooth surface is truly free of plaque. Plaque accumulation is determined by passing the tip of the probe along the surface of the tooth at the gingival sulcus after the tooth has been thoroughly dried; if the soft substance does not stick to the tip of the probe, the area is considered clean;
1 - is prescribed when a plaque in situ cannot be detected with the naked eye, but the plaque becomes visible at the tip of the probe after passing the probe along the surface of the tooth at the gingival sulcus. No detection solution was used in this study;
2 - prescribed when the gingival area is covered with a thin to moderately thick layer of plaque. The plaque is visible to the naked eye;
3 - intensive deposition of a soft substance that fills the niche formed by the gingival border and the surface of the tooth. The interdental area is filled with soft debris.
Thus, the value of the plaque index only indicates the difference in the thickness of soft dental deposits in the gingival region and does not reflect the extent of the plaque on the tooth crown.
Formula for calculation:
a) for one tooth - sum up the values obtained from examining different surfaces of one tooth, divide by 4;
b) for a group of teeth - the index values for individual teeth (incisors, large and small molars) can be summed up to determine the hygienic index for different groups teeth;
c) for an individual - sum up the index values.
Interpretation of results:
PII-0 indicates that the gingival area of the tooth surface is completely free of plaque;
PII-1 reflects a situation where the gingival area is covered with a thin film of plaque that is not visible but is made visible;
PII-2 indicates that the deposit is visible in situ;
PII-3 - about significant (1-2 mm thick) deposits of soft matter.
Tests α=2
1. The doctor stained plaque on the vestibular surface of the lower front teeth. What hygienic index did he define?
A.Green-Vermillion
S. Fedorova-Volodkina
D. Tureski
E. Shika - Asha
2. Which tooth surfaces are stained when determining the Green-Vermillion index?
A. vestibular 16, 11, 26, 31, lingual 36,46
B. lingual 41, 31.46, vestibular 16.41
C. vestibular 14, 11, 26, lingual 31, 34,46
D. vestibular 11, 12, 21, 22, lingual 36, 46
E. vestibular 14, 12, 21, 24, lingual 36, 46
3. When determining the Fedorov-Volodkina index, stain:
A. vestibular surface of 13, 12,11, 21, 22, 23 teeth
B. vestibular surface of 43, 42, 41, 31, 32, 33 teeth
C. lingual surface of teeth 43,42,41, 31, 32, 33
D. oral surface of 13,12, 11, 21, 22, 23 teeth
E. no staining is performed
4. When determining the Silness-Loe index, the teeth are examined:
A. 16,13, 11, 31, 33, 36
B. 16,14, 11, 31, 34, 36
C. 17, 13,11, 31, 31, 33, 37
D. 17, 14, 11, 41,44,47
E. 13,12,11,31,32,33
5. Using the Silness-Loe hygiene index, the following are assessed:
A. plaque area
B. plaque thickness
C. microbial composition of plaque
D. amount of plaque
E. plaque density
6. To assess the hygienic state of the oral cavity in children under 5-6 years old, the following index is used:
B. Green-Vermillion
D. Fedorova-Volodkina
7. To assess dental plaque and tartar, the following index is used:
B. Green-Vermillion
D. Fedorova-Volodkina
8. A solution consisting of 1 g of iodine, 2 g of potassium iodide, 40 ml of distilled water is:
A. Lugol solution
B. fuchsin solution
C. Schiller-Pisarev solution
D. methylene blue solution
E. trioxazine solution
9. Good level Oral hygiene according to Fedorov-Volodkina corresponds to the following values:
10. Satisfactory level of oral hygiene according to Fedorov-Volodkina
correspond to the values:
11. An unsatisfactory level of oral hygiene according to Fedorov-Volodkina corresponds to the following values:
12. According to Fedorov-Volodkina, a poor level of oral hygiene corresponds to the following values:
13. According to Fedorov-Volodkina, a very poor level of oral hygiene corresponds to the following values:
14. To determine the Fedorov-Volodkina index, stain:
A. vestibular surface of the anterior group of teeth of the upper jaw
B. palatal surface of the anterior group of teeth of the upper jaw
C. vestibular surface of the anterior group of teeth of the lower jaw
D. lingual surface of the anterior group of teeth of the lower jaw
E. approximal surfaces of the anterior group of teeth of the upper jaw
15. During a preventive examination, a 7-year-old child was assessed with a Fedorov-Volodkina hygiene index of 1.8 points. What level of hygiene does this indicator correspond to?
A. good hygiene index
B. poor hygiene index
C. satisfactory hygiene index
D. poor hygiene index
E. very poor hygiene index
Control questions(α=2).
1. Basic hygienic indices.
2. Methodology for determining the Fedorov-Volodkina hygienic index, evaluation criteria, interpretation of results.
3. Methodology for determining the Green-Vermillion hygienic index, evaluation criteria, interpretation of results.
4. Methodology for determining the hygienic index J.Silness - H.Loe, evaluation criteria, interpretation of results.
, ORGAN AND TISSUE TRANSPLANTATION.docx , 6. States of matter. LR No. 5 “Observation of various states of things, PRELIMINARY ASSESSMENT OF THE CONDITION OF TRANSBOUNDARY RIVERS (pdf.io).doc.
Index assessment of the condition of periodontal tissues
There are reversible, irreversible and complex indices. At using invertible indexes evaluate the dynamics of periodontal disease, effectiveness therapeutic measures. These indices characterize the severity of symptoms such as inflammation and bleeding of the gums, tooth mobility, and the depth of gingival and periodontal pockets. The most common of them are the PMA index, the periodontal Russell index, etc. The same group includes hygienic indices (Fedorov-Volodkina, Green-Vermilion, Ramfjord, etc.).
Irreversible Indexes: radiographic index, gingival recession index, etc. – characterize the severity of symptoms of periodontal disease such as resorption bone tissue alveolar process, gum atrophy.
Using complex periodontal indices, they provide a comprehensive assessment of the condition of periodontal tissues. For example, when calculating the Komrke index, the PMA index, the depth of periodontal pockets, the degree of atrophy of the gingival margin, bleeding gums, the degree of tooth mobility, and Svrakov’s iodine number are taken into account.
Oral Hygiene Index
To assess the hygienic condition of the oral cavity, the hygiene index is determined according to the method of Yu.A. Fedorov and V.V. Volodkina. As a test for hygienic cleaning of teeth, coloring of the labial surface of the six lower front teeth with an iodine-iodide-potassium solution (potassium iodide - 2 g; crystalline iodine - 1 g; distilled water - 40 ml) is used.
Quantitative assessment is made using a five-point system:
staining the entire surface of the tooth crown – 5 points;
staining 3/4 of the surface of the tooth crown – 4 points;
staining 1/2 of the surface of the tooth crown – 3 points;
staining 1/4 of the surface of the tooth crown – 2 points;
absence of staining of the surface of the tooth crown – 1 point.
By dividing the sum of points by the number of teeth examined, an indicator of oral hygiene is obtained (hygiene index - IG).
The calculation is made using the formula:
IG = Ki (sum of ratings for each tooth) / n
where: IG – general index cleaning; Ki – hygienic index of cleaning one tooth;
n – number of teeth examined [usually 6].
The quality of oral hygiene is assessed as follows:
good IG – 1.1 – 1.5 points;
satisfactory IG – 1.6 – 2.0 points;
unsatisfactory IG – 2.1 – 2.5 points;
poor IG – 2.6 – 3.4 points;
very bad IG – 3.5 – 5.0 points.
With regular and proper care for the oral cavity, the hygiene index is in the range of 1.1–1.6 points; an IG value of 2.6 or more points indicates the absence regular care for teeth.
This index is quite simple and accessible for use in any conditions, including when conducting mass population surveys. It can also serve to illustrate the quality of tooth brushing when teaching hygiene skills. Its calculation is carried out quickly, with sufficient information to draw conclusions about the quality of dental care.
Simplified hygiene index OHI-s [Green, Vermilion, 1969]
6 nearby are being explored standing teeth or 1–2 from different groups (large and small molars, incisors) of the lower and upper jaw; their vestibular and oral surfaces.
1/3 of the surface of the tooth crown – 1
1/2 of the surface of the tooth crown – 2
2/3 of the surface of the tooth crown – 3
no plaque – 0
If the plaque on the surface of the teeth is uneven, then it is assessed by a larger volume or, for accuracy, the arithmetic average of 2 or 4 surfaces is taken.
OHI-s = Sum of indicators / 6
OHI-s = 1 reflects normal or ideal hygienic condition;
OHI-s > 1 – poor hygienic condition.
Papillary marginal alveolar index (PMA)
The papillary-marginal-alveolar index (PMA) allows one to judge the extent and severity of gingivitis. The index can be expressed in absolute numbers or as a percentage.
The inflammatory process is assessed as follows:
inflammation of the papilla – 1 point;
inflammation of the gum edge – 2 points;
inflammation of the alveolar gum – 3 points.
The condition of the gums of each tooth is assessed.
The index is calculated using the following formula:
RMA = Sum of indicators in points x 100 / 3 x number of teeth of the subject
where 3 is the averaging coefficient.
The number of teeth with the integrity of the dentition depends on the age of the subject: 6–11 years – 24 teeth; 12–14 years – 28 teeth; 15 years and older – 30 teeth. When teeth are lost, they are based on their actual presence.
Index value with limited prevalence pathological process reaches 25%; with pronounced prevalence and intensity of the pathological process, the indicators approach 50%, and with further spread of the pathological process and an increase in its severity - from 51% or more.
Definition numerical value Schiller–Pisarev tests
To determine the depth of the inflammatory process, L. Svrakov and Yu. Pisarev proposed lubricating the mucous membrane with an iodine-iodide-potassium solution. Staining occurs in areas of deep lesions connective tissue. This is due to the accumulation of large amounts of glycogen in areas of inflammation. The test is quite sensitive and objective. When the inflammatory process subsides or stops, the intensity of the color and its area decrease.
When examining the patient, lubricate the gums with the specified solution. The degree of coloring is determined and areas of intense darkening of the gums are recorded in the examination card; for objectification, they can be expressed in numbers (points): coloring of the gingival papillae - 2 points, coloring of the gingival margin - 4 points, coloring of the alveolar gum - 8 points. The total score is divided by the number of teeth in which the study was carried out (usually 6):
Iodine number = Sum of assessments for each tooth / Number of teeth examined
mild inflammation process – up to 2.3 points;
moderately expressed inflammation process – 2.3-5.0 points;
intensive inflammatory process– 5.1-8.0 points.
Schiller–Pisarev test
The Schiller-Pisarev test is based on the detection of glycogen in the gum, the content of which increases sharply during inflammation due to the lack of keratinization of the epithelium. In the epithelium of healthy gums, glycogen is either absent or there are traces of it. Depending on the intensity of inflammation, the color of the gums when lubricated with a modified Schiller-Pisarev solution changes from light brown to dark brown. In the presence of healthy periodontium, there is no difference in the color of the gums. The test can also serve as a criterion for the effectiveness of the treatment, since anti-inflammatory therapy reduces the amount of glycogen in the gums.To characterize inflammation, the following gradation has been adopted:
– staining of the gums in a straw-yellow color – negative test;
– staining of the mucous membrane in a light brown color – weak positive test;
– dark brown color – positive test.
In some cases, the test is used with the simultaneous use of a stomatoscope (20 times magnification). The Schiller-Pisarev test is performed for periodontal diseases before and after treatment; it is not specific, however, if it is impossible to use other tests, it can serve as a relative indicator of the dynamics of the inflammatory process during treatment.
Periodontal index
The periodontal index (PI) makes it possible to take into account the presence of gingivitis and other symptoms of periodontal pathology: tooth mobility, clinical pocket depth, etc.The following estimates are used:
no changes and inflammation – 0;
mild gingivitis (gum inflammation does not cover the tooth
from all sides) – 1;
gingivitis without damage to the attached epithelium (clinical
pocket is not detected) – 2;
gingivitis with the formation of a clinical pocket, dysfunction
no, the tooth is immovable – 6;
pronounced destruction of all periodontal tissues, the tooth is mobile,
can be shifted – 8.
The periodontal condition of each existing tooth is assessed - from 0 to 8, taking into account the degree of gum inflammation, tooth mobility and the depth of the clinical pocket. In doubtful cases, the highest possible rating is given. If an X-ray examination of the periodontium is possible, a score of “4” is entered, in which the leading sign is the condition of the bone tissue, manifested by the disappearance of the closing cortical plates at the apexes of the alveolar process. X-ray examination especially important for diagnosis initial degree development of periodontal pathology.
To calculate the index, the resulting scores are added and divided by the number of teeth available using the formula:
PI = Sum of ratings for each tooth / Number of teeth
The index values are as follows:
0.1–1.0 – initial and mild degree periodontal pathology;
1,5–4,0 – moderate degree periodontal pathology;
4.0–4.8 – severe degree of periodontal pathology.
Index of need for treatment of periodontal diseases
To determine the periodontal disease treatment need index (CPITN), it is necessary to examine the surrounding tissues in the area of 10 teeth (17, 16, 11, 26, 27 and 37, 36, 31, 46, 47).
| 17/16 | 11 | 26/27 |
| 47/46 | 31 | 36/37 |
This group of teeth creates the most complete picture of the condition of the periodontal tissues of both jaws.
The study is carried out using the probing method. Using a special (button) probe, bleeding gums, the presence of supra- and subgingival “tartar”, and a clinical pocket are detected.
The CPITN index is assessed using the following codes:
– no signs of disease;
– gingival bleeding after probing;
– the presence of supra- and subgingival “tartar”;
– clinical pocket 4–5 mm deep;
– clinical pocket with a depth of 6 mm or more.
The condition of only 6 teeth is recorded in the corresponding cells. When examining the periodontium of teeth 17 and 16, 26 and 27, 36 and 37, 46 and 47, codes corresponding to a more severe condition are taken into account. For example, if bleeding is detected in the area of tooth 17, and “tartar” is detected in area 16, then a code indicating “tartar” is entered in the cell, i.e. 2.
If any of these teeth is missing, then examine the tooth next to it in the dentition. In the absence and nearby standing tooth the cell is crossed out diagonally and is not included in the summary results.
From the official website of the department therapeutic dentistry SPbSMU
Prevalence periodontal diseases, the need for their objective diagnosis and comparability of results obtained by different researchers and doctors have led to the emergence of a large number of indices.
Periodontal indices allow you to monitor the dynamics of the disease over a long period of time, assess the depth and extent of the pathological process, and compare the effectiveness various methods treatment, produce mathematical processing the results obtained.
Periodontal indices are divided into reversible, irreversible and complex.
Using reversible indices, the dynamics of periodontal disease and the effectiveness of treatment measures are assessed. These indices characterize the severity of symptoms such as inflammation and bleeding of the gums, tooth mobility, and the depth of gingival and periodontal pockets. The most common of them are the PMA index, the Russell periodontal index, etc.
The same group includes hygienic indices (Fedorov-Volodkina, Green-Vermillion, Ramfjord, etc.).
Irreversible indices characterize the severity of such symptoms of periodontal disease as alveolar bone resorption and gum atrophy. Examples include radiographic index, gingival recession index, etc.
Using complex periodontal indices, they provide a comprehensive assessment of the condition of periodontal tissues. For example, when calculating the Kotschke index, the PMA index, the depth of periodontal pockets, the degree of atrophy of the gingival margin, bleeding gums, the degree of tooth mobility, and Svrakov’s iodine number are taken into account.
Currently, about a hundred periodontal indices have been described. However, in our opinion, even the most advanced and informative indexes do not provide individual approach to the patient and do not replace clinical experience and the doctor's intuition. Therefore in clinical practice We assign a secondary role to the index assessment, limiting ourselves to only the minimum number of reversible indices that allow us to objectively assess the dynamics of the pathological process and the effectiveness of the treatment.
We consider it advisable to use the Fedorov-Volodkina hygienic index, PMA index, and peripheral circulation index when examining a patient.
For developed forms of periodontitis, it is possible to recommend determining the Russell index. At epidemiological studies- CPITN index (Community Periodontal Index of Treatment Needs), reflecting the need for various types treatment.
Determination of the oral hygiene index
The hygienic condition of the oral cavity is determined according to the method of Yu.A. Fedorova, V.V. Volodkina (1971). As a test for hygienic cleaning of teeth, coloring of the labial surface of six lower frontal teeth with an iodine-iodido-potassium solution (potassium iodide - 2.0; crystalline iodine - 1.0; distilled water - 40.0) is used.
Quantitative assessment is made using a five-point system: staining the entire surface of the tooth crown - 5 points; staining 3/4 of the surface of the tooth crown - 4 points; staining 1/2 of the surface of the tooth crown - 3 points; staining 1/4 of the surface of the tooth crown - 2 points; absence of staining of the surface of the tooth crown - 1 point. The calculation is carried out according to the formula:
| IG = | Ki (sum of ratings for each tooth) |
| P |
Where:
IG - general purification index;
Ki - hygienic index of cleaning one tooth;
n is the number of teeth examined (usually 6).
By dividing the sum of points by the number of teeth examined, an indicator of oral hygiene (hygiene index) is obtained.
When determining the quality of oral hygiene, the studied indicator is interpreted as follows:
- 1.1-1.5 points - good hygiene index;
- 1.6-2.0 points - satisfactory;
- 2.1-2.5 points - unsatisfactory;
- 2.6-4.0 points - bad;
- 3.5-5.0 points - very poor hygiene index.
With regular and proper oral care, the hygiene index varies between 1.1-1.6 points. A hygiene index reaching 2.6 points or more indicates a lack of regular dental care.
Using the hygiene index, you can determine the quality of dental cleaning by the patient. This index is quite simple and accessible for use in any setting, including when conducting mass population surveys; it can also serve to illustrate the quality of teeth cleaning when teaching hygiene skills. Its calculation is carried out quickly with sufficient information content to draw conclusions about the quality of dental care.
Determination of the papillary-marginal-alveolar index (PMA)
The papillary-marginal-alveolar index (Massler M., Shur D., 1948) allows one to judge the extent and severity of gingivitis. The index can be expressed in absolute numbers or as a percentage (Parma S, 1960). The inflammatory process is assessed as follows:
- inflammation of the papilla - 1 point;
- inflammation of the gum edge - 2 points;
- inflammation of the alveolar gum - 3 points.
The condition of the gums of each tooth is assessed. The index is calculated using the following formula:
where 3 is the averaging coefficient.
The number of teeth with the integrity of the dentition depends on the age of the subject:
- 6-11 years - 24 teeth;
- 12-14 years - 28 teeth;
- 15 years or more - 30 teeth.
When teeth are lost, they are based on their actual presence.
Index values with limited prevalence of the pathological process reach 25%; with pronounced prevalence and intensity of the pathological process, the indicators approach 50%, and with further spread of the pathological process and an increase in its severity - from 51% or more.
In practical work, the PMA index can be used in a number of cases:
- at preventive examinations for the purpose of identifying the disease early stages process development;
- when examining periodontal disease in dental patients;
- when treating a patient with gingivitis or periodontitis - to assess the severity of the disease and the effectiveness of treatment.
Determination of the numerical value of the Schiller-Pisarev test (Svrakov iodine number)
The Schiller-Pisarev test for objectification can be expressed in numbers (points), assessing the color of the papillae as 2 points, the color of the gingival margin as 4 points and the color of the alveolar gum as 8 points. Received total amount The points should then be divided by the number of teeth examined (usually 6):
In this way, the digital value of the Schiller-Pisarev test (Svrakov iodine number) is determined in points. Estimation of Svrakov iodine number values:
- mild inflammation process - up to 2.3 points;
- moderately expressed process of inflammation - 2.67-5.0 points;
- intense inflammatory process - 5.33-8.0 points.
Determination of the peripheral circulation index (PCI)
The peripheral circulation index is assessed based on the ratio of indicators of resistance of gum capillaries and the time of resorption of vacuum hematomas (Dedova L.N., 1981).
The indicators of these tests are assessed in points, their ratio is expressed as a percentage. The index is calculated using the formula:
Based on the index indicators, the following assessment can be made functional state peripheral circulation:
- IPC = 0.8-1.0 (80-100%) - physiological norm;
- IPC = 0.6-0.7(60-70%) - good, compensated condition;
- IPC = 0.075-0.5 (7.5-50%) - satisfactory condition;
- IPC = 0.01-0.074 (1-7.4%) - state of decompensation.
The scoring system used to calculate the IPC
| Resistance of gum capillaries | Resorption time of vacuum hematomas | ||
| seconds | points | day | points |
| 1-10 | 1 | 2,5 | 10 |
| 11-20 | 2 | 3,0 | 20 |
| 21-30 | 4 | 3,5 | 40 |
| 31-40 | 6 | 4,0 | 60 |
| 41-50 | 8 | 4,5 | 80 |
| 50 or more | 10 | 5,0 | 100 |
Determination of periodontal index
The periodontal index (PI) (Russell A., 1956) makes it possible to take into account the presence of both gingivitis and other symptoms of periodontal pathology: tooth mobility, clinical pocket depth, etc.
The following estimates are used:
- 0 - no changes and inflammation;
- 1 - mild gingivitis (gum inflammation does not cover the entire tooth);
- 2 - gingivitis without damage to the attached epithelium (the clinical pocket is not determined);
- 4 - disappearance of the closing cortical plates at the apexes of the alveolar process according to the radiograph;
- 6 - gingivitis with the formation of a clinical pocket, no dysfunction, the tooth is not mobile;
- 8 - pronounced destruction of all periodontal tissues, the tooth is mobile and can be displaced.
The periodontal condition is assessed for each existing tooth. In doubtful cases, the highest possible rating is given.
To calculate the index, the resulting scores are added and divided by the number of teeth available using the formula:
The index value is evaluated as follows:
- 0.1-1.0 - initial and mild degree of periodontal pathology;
- 1.5-4.0 - moderate to severe degree of periodontal pathology;
- 4.0-8.0 - severe degree of periodontal pathology.
Index of Periodontal Treatment Need (CPITN)
To determine the CPITN index, it is necessary to examine the surrounding tissues in the area of the ten teeth presented below:
| 17 / 16 | 11 | 26 / 27 |
| 47 / 46 | 31 | 36 / 37 |
This group of teeth creates a complete picture of the condition of the periodontal tissues of both jaws.
The study is carried out by probing to detect bleeding, supra- and subgingival “tartar”, and a clinical pocket using a special (button) probe.
The CPITN index is assessed using the following codes:
- 0 - no signs of disease;
- 1 - gum bleeding after probing;
- 2 - the presence of supra- and subgingival “tartar”;
- 3 - clinical pocket 4-5 mm deep;
- 4 - clinical pocket with a depth of 6 mm or more.
In the corresponding cells, the condition of only six teeth is recorded. When examining teeth 17 and 16, 26 and 27, 36 and 37, 46 and 47, codes corresponding to a more severe condition are taken into account. For example, if bleeding is detected in area 17 of the tooth, and “tartar” is detected in area 16, then a code indicating “tartar” (i.e. 2) is entered in the cell.
If any of these teeth is missing, then examine the tooth next to it in the dentition. If there is no tooth nearby, the cell is crossed out with a diagonal line and does not participate in the summary results.
Diagnosis, treatment and prevention of periodontal diseases
L.M. Tsepov, A.I. Nikolaev, E.A. Mikheeva.
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.
Stained with Lugol's solution next teeth: 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 ZN covers 1/3 of the tooth surface or dense brown coating 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.
The index of Yu. A. Fedorov and V. V. Volodkina (1971) is determined by staining the labial
the surfaces of the lower six frontal teeth with solutions that contain iodine (Schiller-Pisarev, etc.).
Quantitative assessment is carried out using a five-point system:
5 points - staining the entire surface of the tooth crown;
4 points - painting 3/4 of the surface;
3 points - painting 1/2 of the surface;
2 points - painting 1/4 of the surface;
1 point - no staining of all teeth.
The index values are determined by the formula:
ГІ=У/6
where Y is the sum of index values.
The hygiene index is assessed as follows:
1.1-1.5 points - good;
1.6-2.0 points - satisfactory;
2.1-2.5 points - unsatisfactory;
2.6-3.4 points - bad;
3.5-5.0 points - very bad.
Qualitative assessment hygiene conditions can be carried out using the same formula as coloring, but using three-point system:
3 points - intense staining of the entire tooth surface;
2 points - weak staining;
1 point - no staining.
Modification of the Fedorov-Volodkina index.
The presence of plaque is assessed on 16 teeth of the upper and mandible. The sum of points obtained from the examination of each tooth is divided by the number of teeth (16).
Evaluation of results
good hygiene- 1.1-1.5 points;
satisfactory - 1.6-2.0 points;
unsatisfactory - 2.1-2.5 points;
bad - 2.6-3.4 points;
very bad - 3.5-5.0 points.
Green-Vermillion Index (1964)
Simplified Hygiene Index oral cavity
To determine the simplified oral hygiene index, the vestibular surfaces are painted
16, 11, 26, 31, and lingual surfaces 36 and 46 teeth with Schiller-Pisarev solution or another
Green-Vermillion Index Evaluation Criteria
Formula for calculation:
OHI-S = ∑ ZN / n + ∑ ZK / n
where H is the sum of values, ZN is dental plaque, ZK is dental calculus, n is the number of teeth examined
Silnes-Low Hygiene Index(Silness, Loe, 1964) is used to determine the thickness of dental plaque. 11, 16, 24, 31, 36, 44 are examined; all teeth can be examined or at the request of the researcher. 4 tooth surfaces are examined: vestibular, oral, distal, medial; at the same time, plaque is detected in the gingival area.
The presence of plaque is determined visually or using a probe without staining. After drying the enamel, the tip of the probe is passed along its surface at the gingival sulcus.
Criteria for evaluation:
· 0 points - there is no plaque in the gingival area (it does not stick to the tip of the probe);
· 1 point - the plaque film in the gingival area is determined only by the probe, a soft substance sticks to its tip, the plaque is not visually detected;
· 2 points - plaque is visible to the naked eye in the gingival groove and in the subgingival area of the tooth crown. The layer is from thin to moderate.
· 3 points - excess plaque on most of the tooth surface, intensive deposition of plaque in the area of the gingival sulcus and interdental spaces.
Index calculation for one tooth:
PLI of teeth = (∑ points of 4 surfaces) / 4.
Calculation of the index for a group of teeth:
PLI individual = (∑ teeth) / n teeth.
It is used in epidemiological surveys and to identify risk factors for the development of caries in a patient.
40 Principles for the development, implementation and evaluation of the effectiveness of prevention programs.
Principles of planning, implementation and evaluation of the effectiveness of dental disease prevention programs
Planning and implementation of dental programs- both preventive and therapeutic - must be comprehensive. They may differ in details and have their own characteristics, but the general scheme is similar.
Planning programs for the prevention of dental diseases among the population consists of the following stages:
Identifying the main problems;
Formulation of goals and objectives;
Selection of methods and means of prevention;
Training;
Implementation of the program;
Evaluation of program effectiveness.
