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Gingival: Index, Systems
Gingival: Index, Systems
1. Ackerman, M. Anne: A clinical study of the Do- dence of periodontal disease. J. Periodont., 30:51-59,
minion electric toothbrush. Typed thesis. Univ. of Mich. 1959.
School of Dentistry, Ann Arbor, 1965. p. 86. 5. Ramfjord, S. P., Nissle, R. R., Shick, R. A. and
2. Greene, J. C: Periodontal disease in India: Re- Cooper, H.: Subgingival curettage versus surgical elimi-
port of an epidemiological study. J. dent. Res., 39:302- nation of periodontal pockets. J. Periodont. (In press).
312, 1960. 6. Russell, A. L.: A system of classification and
3. Jamison, Homer: Prevalence and severity of per- scoring for prevalence surveys of periodontal disease.
iodontal disease in a sample of a population. Typed J. dent. Res., 35:350-359, 1956.
thesis. Univ. of Mich. School of Public Health, Ann 7. Smith, W. A. and Ash, M. M., Jr.: A clinical
Arbor, 1960. 153 p. evaluation of an electric toothbrush. J. Periodont., 35:
4. Ramfjord, S. P.: Indices for prevalence and inci- 127-136, 1964.
THE GINGIVAL INDEX (Gl) CRITERIA FOR THE GINGIVAL INDEX SYSTEM
Mild inflammation
gival Index system was introduce a sys-
to
=
slight change in
tem for the assessment of the gingival con-
color, slight oedema. No bleeding on
—
probing
dition which clearly distinguished between 2 =
Moderate inflammation—redness, oede-
the quality of the gingiva (the severity of ma and glazing. Bleeding on probing
the lesion) and the location (quantity) as 3 =
Severe inflammation marked redness
and oedema. Ulceration. Tendency to
—
Fig. 1. Normal gingiva. Gingival Index score = 0. Fig. 2. Mild gingivitis. Gingival Index score = 1.
surface after drying is matt. The soft tissue wall of the entrance of
degree of stippling may vary. The the gingival crevice.
gingival margin may be located on GI = 3 is the score for severe inflamma-
the enamel (Fig. 1) or at various tion. The gingiva is markedly red
levels apical to the cemento-enamel or reddish-blue and enlarged (Fig.
lary teeth are assessed beginning with the ssurface. Finally, all lingual surfaces are
upper left second molar. scored beginning with the lower left second
s'
molar.
n
Fig. 5. Chart for the recording of Plaque Index, Gingival Index and Retention Index.
The Gingival, Plaque and Retention Indices Page 41/613
be examined, for instance by saying: "first the location of the soft debris aggregates.
molar," or the number of the tooth. In this The purpose of introducing this system
way, a good contact is continuously main- (Silness and Löe, 1964) was also to create
tained between examiner and recorder (Fig. a plaque index which would match the Gin-
5). gival Index completely.
Since the gingival area constitutes the CRITERIA FOR THE PLAQUE INDEX SYSTEM
unit the Gingival Index may be scored for
0 =
No plaque in the gingival area.
all surfaces of all or selected teeth or for 1 = A film of plaque adhering to the free
selected areas of all or selected teeth. It gingival margin and adjacent area of the
thus follows that the GI may be used for tooth. The plaque may only be recog-
the assessment of prevalence and severity nized by running a probe across the
of gingivitis in large population groups as tooth surface.
2 =
Moderate accumulation of soft deposits
well as in the individual dentition. Recent within the gingival pocket, on the gin-
analyses show no difference in the results gival margin and/or adjacent tooth sur-
when only one of the interproximal surfaces face, which can be seen by the naked
are examined instead of both, for which rea- eye.
3 =
Abundance of soft matter within the
son current examinations have been re-
gingival pocket and/or on the gingival
stricted to buccal, mesial and lingual aspects margin and adjacent tooth surface.
of the teeth. However, the score for the one
interproximal surface should be doubled
and the total score for the tooth divided by Each of the four gingival areas of the
four. tooth is given a score from 0-3; this is the
Pll for the area. The scores from the four
areas of the tooth may be added and divided
Subjects with mild inflammation usually
score from 0.1-1.0, those with moderate in- by four to give the Pll for the tooth. The
flammation from 1.1-2.0, and an average scores for individual teeth (incisors, pre-
score between 2.1-3.0 signifies severe in- molars and molars) may be grouped to
flammation. designate the Pll for the groups of teeth.
Finally, by adding the indices for the teeth
and dividing by the number of teeth exam-
THE PLAQUE INDEX (Pll) ined, the Pll for the individual is obtained.
Recent epidemiological research has es-
tablished that any clinical study with the P11 = 0 This score is given when the gin-
aim of evaluating the various etiologic fac- gival area of the tooth surface is
tors cannot be carried out without taking
literally free of plaque. The sur-
into account the gingival deposits and their face is tested by running a pointed
possibilities for retention. probe across the tooth surface at
the entrance of the gingival crevice
Accordingly, the ideal set of index sys- after the tooth has been properly
tems is which allows the assessment of
one dried, and if no soft matter ad-
the severity of the different factors in the heres to the point of the probe, the
same area as the gingival condition is re- area is considered clean.
corded. Index systems for the recording of Pll = 1 This score is given when no plaque
oral hygiene have been proposed by Ram- can be observed in situ by the
fjord (1959) and Green-Vermillion (1960). unarmed eye, but when the plaque
is made visible on the point of the
The Plaque Index (Pll) is fundamentally probe after this has been moved
based on the same principle as the Gingival across the tooth surface at the en-
Index, namely the desirability of distin- trance of the gingival crevice. Dis-
guishing clearly between the severity and closing solution has not been used
Page 42/614 LÖE
in our investigations, but may be conditions and chairside assistance are pro-
useful for the recognition of this vided and all teeth are to be examined scor-
film of plaque. ing according to this system requires ap-
PI I = 2 This score is given when the gin- proximately 5 minutes.
gival area is covered with a thin to
moderately thick layer of plaque. The sequence of the examination for
The deposit is visible to the naked plaque is carried out according to the sys-
eye. tem described for the Gingival Index. When
PI I = 3 Heavy accumulation of soft mat- both GI and P1I are to be used, assessment
ter, the thickness of which fills out of PI I should always precede that of GI.
the niche produced by the gingival
margin and the tooth surface. The THE RETENTION INDEX
interdental area is stuffed with soft
debris. Recent microscopic and electronmicro-
scopic research has shown that supra- and
Thus, the Plaque Index scores consider
subgingival calculus, other rough surfaces
differences thickness of the soft
including ill-fitted margins of dental resto-
only as to
rations are invariably covered with a non-
deposit in the gingival area of the tooth mineralized bacterial plaque. This indicates
surfaces, and no attention is paid to the that these irregular surfaces do not per se
coronal extension of the plaque. PI I = 0 is exert a direct mechanical influence on the
the score given when the gingival area of
gingival tissue, but that mineralized depos-
the tooth surface is literally free of plaque.
its, insufficient dental restorations, untreated
PI I = 1 represents the situation where the carious lesions etc. constitute a group of
gingival area is covered with a thin film of retentive elements the rough surfaces of
plaque which is not visible, but which is which provide the possibilities for the bac-
made visible. PI I = 2 is the score given teria to accumulate in the gingival area.
when the deposit is visible in situ and P1I =
3 is reserved for the heavy (1-2 mm. thick)
accumulation of soft matter. The assess- The purpose of creating a Retention In-
ment of plaque is made on top of calculus dex System (Björby and Löe, 1967) was to
introduce a system for the assessment of
deposits, on fillings and crowns. the main retentive factors and which ex-
pressed the quality of the tooth surface (de-
Since the gingival area constitutes the gree of roughness) adjacent to the gingival
unit, the Plaque Index may be scored for tissues. Technically, the Retention Index is
all surfaces of all or selected teeth or for built on principles similar to those under-
selected areas of all or selected teeth. Con- lying the Gingival Index and the Plaque
sequently, the PI I may be used in large Index.
scale epidemiological investigations as well
as in the examination of smaller groups or
within the dentition of the individual. Re- CRITERIA FOR THE RETENTION INDEX SYSTEM
and Retention Index systems constitute a sensitivityof and the correspondence be-
set of reversible indices which have proved tween the different indices have facilitated
to be useful instruments in screening the the evaluations of various therapeutic and
gingival conditions of children, young and preventive measures.
old adults. The flexibility of the systems
provides the possibility of selecting specified The reproducibility is good provided the
areas or teeth when a large material is ex- examiner's knowledge of periodontal biol-
amined and of utilizing all areas of all teeth ogy and pathology is optimal.
in the examination of small samples. The
REFERENCES
Björby, A. and Löe, H.: The relative significance of supervised oral hygiene on the gingiva of children. The
different local factors in the initiation and development effect of mouth rinsing. J. Periodont. Res., 1:268-275,
of periodontal inflammation. Scand. Symp. Periodon- 1966.
tology. 1966. Abstr. no. 20. J. Periodont. Res., 2:000, Löe, H. and Silness, J.: Periodontal disease in preg-
1967. nancy. I. Prevalence and severity. Acta odont. scand.,
Björn, Anna-Lisa, Koch, G. and Lindhe, J.: Evalua- 21:533-551, 1963.
tion of gingival fluid measurements. Odont. Revy, 16: Löe, H. and Holm-Pedersen, P.: Absence and pres-
300-307, 1965. ence of fluid from normal and inflamed gingivae. Perio-
Holm-Pedersen, P. and Löe, H.: Flow of gingival dontics, 3:171-177, 1965.
exudate as related to menstruation and pregnancy. J.
Löe, H., Theilade, Else and Jensen, S. B.: Experi-
Periodont. Res., 2:00-00, 1967. mental gingivitis in man. J. Periodont., 36:177-187,
Koch, G. and Lindhe, J.: The effect of supervised 1965.
oral hygiene on the gingiva of children. The effect of and Löe, H.: Periodontal disease in preg-
tooth brushing. Odont. Revy, 16:327-335, 1965. Silness, J.
nancy. II. Correlation between oral hygiene and perio-
Koch, G. and Lindhe, J.: The effect of supervised dontal condition. Acta odont. scand., 22:112-135, 1964.
oral hygiene on the gingiva of children. The effect of Silness, J. and Löe, H.: Periodontal disease in preg-
sodium fluoride. J. Periodont. Res., 2:000, 1967. nancy. III. Response to local treatment. Acta odont.
Lindhe, J. and Koch, G.: The effect of supervised scand., 24:747-759, 1966.
oral hygiene on the gingiva of children. Progression and
inhibition of gingivitis. J. Periodont. Res., 1:260-267,
Theilade, Else, Wright, W. H., Jensen, S. B. and
Löe, H.: Experimental gingivitis in man. II. A longi-
1966. tudinal clinical and bacteriological investigation. J.
Lindhe, J., Koch, G. and Mansson, Ulla, The effect of Periodont. Res., 1:1-13, 1966.