Professional Documents
Culture Documents
for caries over a 50-year period, the philosophical basis for measuring periodontal diseases has changed several times over a shorter time span
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periodontal disease was considered a single entity that began with gingivitis and progressed to periodontitis and tooth loss
They thought that theres a disease called periodontal disease which starts as gingivitis stage I then progresses to periodontitis stage II and then progresses to teeth loss
Gingivitis and periodontitis were seen as different stages of the same disease and it was proposed that all patients with gingivitis will progress to periodontitis a view that no longer finds
favor among periodontal researchers because we now know that gingivitis and periodontitis are two
disease entities and not all gingivitis cases progress into periodontitis
But they have not yet been replaced by new indexes, so methods of measuring periodontal diseases remain in something of a state of flux
Gingivitis
P-M-A
the severity of gingivitis based on examination and rating of the degree of involvement of the interdental papilla and the marginal and attached portions of the gingiva in each individual
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evaluate the severity of gingivitis based on visual inspection of the gingivae that takes into consideration the color, firmness and swelling of gingival tissue along with the presence of blood during probing
Normal gingiva
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right 1 or 2, upper left 4, lower left 6, lower left 1 or 2 and lower right 4
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it may NOT discriminate as well between the middle range It can distinguish very well between 1 and 3 scores but not between 1 and 2 scores
evaluate the existence of gingival bleeding in individual teeth and/or regions of the oral cavity upon gentle probing by assigning a score of 0-5 ordinal scale according to certain criteria
probing
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edema
3
edema
4
obvious edema
5
diagnostic reliability
as a measure of gingivitis by the SBI index has become accepted with further experience
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probing around the gingival margin by the sulcus bleeding index is more sensitive and more objective especially in sites that are difficult to view directly
So many bleeding indices appear after the sulcus bleeding index, and among them:
1.
tool used to verify the presence of gingival inflammation based on any bleeding that occurs at the gingival margin during or immediately
after flossing
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0 no bleeding 1 one point of blood 2 line or multiple points of blood 3 triangle of blood 4 profuse bleeding
2.
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papillary bleeding
measure in the clinical management of gingival conditions BUT it is a poor predictor of future periodontitis
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infectious diseases " " - Indexes using bleeding on probing are highly sensitive and high sensitivity is not required
-
non-invasive because it eliminates the use of bleeding on probing but still provide high visual sensitivity with incipient gingivitis early stages of gingivitis
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Normal, No inflammation Localized mild inflammation Generalized mild inflammation Moderate inflammation Severe inflammation
Periodontitis
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periodontitis BUT it is not used in surveys because of its impracticability, and because it adds little to the
measures an individual's periodontal condition by adding scores based on the condition of the gingiva and dividing the sum by the number of teeth
present
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Individuals with clinically normal gingiva have an index of 0 to 0.2 and the index reaches a maximum of 8.0 in persons with severe terminal destructive periodontitis so it is 0-8 ordinal scale
gingivitis and the more destructive changes due to periodontitis in the same scale
and assessed
0 - 0.2 clinically normal supportive tissues 0.3 - 0.9 simple gingivitis reversible 1.0 - 1.9 beginning of destructive periodontal disease reversible 2.0 4.9 established destructive periodontal disease irreversible 5.0 8.0 terminal disease irreversible
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Periodontal index be used without probing and this rule reflects how firmly the gingivitis - periodontitis continuum was then accepted gingivitis (stage I) & periodontitis (stage II)
the severity of gingivitis while in the reality pocketing is always a sign of periodontitis The diagnosis was unconsciously influenced
by the patient's age and oral hygiene status The opportunity for serious bias is apparent
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regardless of their individual pocket depth value, and mobile teeth were scored having the
same periodontal index score a value of 5.0 8.0 regardless of their actual pocket depth
value
2.
same weighted scale Perceptions of the extent and age-distribution of periodontitis were distorted by excessive statistical weight given to gingivitis most PI
scores describe gingivitis
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3.
distribution of the disease in the mouth and this doesnt show the real distribution of the disease
Russell stated that if an individual has already lost teeth because of periodontal involvement, there is a strong likelihood that his remaining teeth will show extensive disease So Russell considered diagnosis of teeth remaining after the extraction of others very easy and straightforward BUT this is not the real case because
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chronic process with intermittent periods of activity and remission that affects individual teeth and sites around teeth at different rates within the same mouth
which was invented by Ramfjord and was intended as a more sensitive modification of the Periodontal
too
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3 severe gingivitis with bleeding on probing 4 pocket extending apical to CEJ not more than 3 mm 5 pocket extending apical to CEJ by 3-6 mm 6 pocket extending apical to CEJ by more than 6 mm
Index is the fact it measures the clinical attachment loss relative to the CEJ which was NOT recorded by Periodontal Index
probe was used to measure the clinical attachment loss unlike periodontal index
left 1 or 2, upper left 4, lower left 6, lower right 1 or 2 and lower right 4
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and the method of measuring loss of periodontal attachment that Ramfjord described then is still used today
technique of measuring periodontal attachment loss is often referred to indirect method of measuring loss
of periodontal attachment (LPA) Indirect method of measuring loss of periodontal attachment consists of: Recording the distance from the gingival crest
Locating the cementoenamel junction (CEJ) Recording the distance from the CEJ to the
gingival crest
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between two and six sites per tooth, depending on the purposes of the study, and usually for either the
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Index (ESI)
number of sites affected in the mouth and severity stage of advancement of loss of
periodontal attachment by determining the
percentage of sites within the mouth with Loss of Periodontal Attachment greater than 1 mm extent and the mean Loss of Periodontal Attachment for the affected sites severity
measure and thats why it may receive limited use What does extent = 20% and severity = 5% mean?!
20% 20% of the examined sites have attachment loss
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Attachment is generally considered the best available measure of periodontitis in epidemiology BUT it is still considered far from ideal because it records past rather than present disease
Treatment need = determined by the practitioner Treatment demand = determined by the patient
dentist-patient factors that are not part of a clinical examination, and standard treatment for a given condition can change as the field develops
status pocket depth by dividing the whole dentition into 6 segments, and then the worst
condition found in any one segment was taken as the score for that segment
patients into levels of treatment need and assigned times for the type of treatment required
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Needs differs from earlier indexes in several ways: - The special disposable plastic periodontal probe it uses
Which is characterized by being lighter than most probes and has a clear black area in the center for accuracy marked at 3.5 mm and 5.5 mm Having a 0.5 mm diameter ball at its tip and the ball height extends to the 3.5 mark
o
ball disappeared and the whole black area is visible then pocket depth is less than 3.5
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of the black area disappeared then pocket depth is between 3.5 and 5.5 o If the probe gets inside the pocket so that the whole black area disappeared then pocket depth is more than 5.5 The purpose of the ball is to assist in feeling subgingival calculus and to prevent the probe from being pushed through inflammatory tissue at the base of a pocket. Probing pressure is recommended to be no more than 20 grams
Treatment Needs the mouth is divided into sextants The sex sextants are:
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CPITN in 10 teeth 8 posterior and 2 anterior The first and second molars are examined in the four posterior sextants the upper right central incisor in the upper anterior sextant, and the lower left central incisor in the lower anterior sextant These 10 teeth are called index teeth
CPITN in 6 teeth 4 posterior and 2 anterior The second molars are not examined
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one of four treatment groups on the basis of the most severe condition found
Code 0 = healthy tissue Code 1 = bleeding on probing + No pocketing Code 2 = bleeding on probing + calculus + No pocketing the whole black area of the probe is still visible Code 3 = pocketing of 4-5 mm half of the black area is still visible Code 4 = pocketing of 6 mm or more the black area is not visible anymore Code 0 treatment need 0 no treatment but prevention Code 1 treatment need 1 oral hygiene instructions Code 2 treatment need 2 oral hygiene instructions + removal of calculus
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Code 3 treatment need 2 oral hygiene instructions + removal of calculus Code 4 treatment need 3 oral hygiene instructions + removal of calculus + complex treatment
measures the current oral hygiene status based upon the amount of debris and calculus occurring on six representative tooth surfaces in the mouth
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practical, though its lack of sensitivity makes it less useful in the individual patient than in a group
OHI-S has not been used much in recent years, especially with the current focus on subgingival rather than supragingival, plaque and calculus as etiological agents
Index (PHP), intended for monitoring of oral hygiene performance by patients in the dental practice
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developed by Silness and Loe to be used along with their gingival index (GI)
OHI-S approach is that: - The plaque index scores the plaque present
according to its thickness at the gingival
margin
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- The simplified oral hygiene index scores the coronal extent of plaque
margin and adjacent area of the tooth. The plaque may only be recognized by running a probe across the tooth surface 2 Moderate accumulation of soft deposits within the gingival pocket, on the gingival margin, and/or adjacent tooth surface, which can be seen by the naked eye 3 surface
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measure most closely associated with periodontitis, a simple measure of its presence or
absence would be sufficient for most purposes
test agents for plaque control and calculus inhibition mouth washes for example
three planes of each of the lower six anterior teeth: gingival, distal and mesial
A probe is used to measure the linear extent of
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The tooth score = the sum of the scores in the three planes The patient total score = is the sum of the tooth scores
depending on the loss of periodontal attachment, plaque and calculus can be time consuming, investigators have tried using various indexes on a subset of teeth to save time
a "representative sample" of all teeth in the mouth, yielding information that can be applied to the
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