World Health Organization World Health Oral Health Assessment Form Organization for Adults (by tooth surface), 2013 ‘Leave blank Year___Month Day Identification No. Orig/Dupl Examiner e ‘Community (geographical location) (34) (35) Location Urban (1) Periurban(2) Rural (3) (36) DDentition status by tooth surface | wov 6 no 2 es 6 oe Permanent teeth oe 34 V ve LI sm | Status Or ety axe [ 7-98 cara f 2 led fees oe | 7-200 led nl 4 aang dete ra cosas cane * = Mae for a 6 6 4 oe one 3 es ote reason 6 fares ce feo 7 inert dense tow, fe se atest veneer, | | |_| s-se) sa hee | em 8 Vertes = 9 traded is asian) ra Jory ‘periodontal status (CI Modified) Gingival beeing | score aia a sale sale x ale ss ar oO Aone fend I I 11> Presence of condition tending (188) (208) | 9 = Tooth excluded X= Tooth ot present rat 05 za) meme ney ony |Poct frost cons tas | 9 Absence of odton 25 Pockst mm or more 9 Tooth excuses Ke Tooth not present | ooo 6 sw 8 2 nom omWorld Health Organization Oral Health Assessment Form for Adults, 2013 ioas of strachiment Index teeth Enamel fluorosis 073) Severity Severity A611 26/27 |o= Normal 1 = Questionable Cemento-enamel junction (CE!) within black band os) 075) /2-verymild CCE) between upper limit of black band and. mm ring ia 11 mm Cel between 85 mm and 1. mm ring (ars) (178) \q= Moderate =I2mmormore CEJ beyond 11.5 mm ring 47/86 3136/37 |= Severe xcluded sextant 8 = Excluded (crown, restoration, '9=Not recorded "bracket" 9 = Not recorded (unerupted tooth) * Not recorded under 15 years of age Dental erosion Poaitsuee severity |_| (120) status |_| (283) Number of teeth affected = No sign of erosion (84) (295) Enamel lesion (= No sign of injury = Treated injury 2 Enamel fracture only Enamel and dentine fracture 4= Pulpinvolvement ‘5 Missing tooth due to trauma /2= dentinal lesion 3= Pulp involvement Number of teeth affected = Other damage fis) (a82) ‘9 Excluded tooth ‘Oral mucosal lesions Denture(s) (088) (089) Upper Lower 3871 390) (92) 93 _}iaa8) st) [condition Location Seotus }0 = No abnormal condition (0= Vermilion border O= Nodenture 41 Malignant tumour (orl cancer) 15 Commissures Ls Faria denture Fe trees Pans 2=complete denture 3 = Uchen planus B= Sui 9 Not recorded = Ulceration (aphthous, herpetic, traumatic) 44 Buccal mucosa 5 Acite necrotizing ueerative gingivitis (ANUG) $= Floor ofthe mouth 6 = Candidiass 6 = Tongue 7 Abscess = Hard andor soft palate 8 Other conltion speci if possible) 8 = Alveolar rdges/gingva 9. Notrecorded (ot recorded Intervention urgency (94 ]O No treatment needed Preventive of routine treatment needed rompt treatment (including sealing) needed mmediate (urgent) treatment seeded due to pain ar infection of dental andar oral origin ferred for comprehensive evaluation or mesical/dental treatment [systemic concition]