DENTAL CARIES INDEXES

Student's Name: Tariq Shah

Class Roll No:38
Session:2021-2022

DEPARTMENT OF COMMUNITY AND PREVENTIVE DENTISTRY

DENTAL COLLEGE, QUETTA
Table of Contents

1. Introduction of index……………………………1
2. Dental Indices…………………………………...2
3. History of Index…………………………………3
4. Uses of Index……………………………………4
5. Oral Health Index………………………………..5
6. Oral Hygiene Index……………………………...6
7. Debris Index……………………………………..7
8. Calculus Index…………………………………...8
9. Dental Caries Indices……………………………9
10.Calculation of Index……………………………..10
11.Conclusion……………………………………….11
12.References ………………………………………12
Introduction of Index

An index can be defined as a numeric value describing the relative status of

population on a graduated scale with definite upper and lower limits, which
is designated to permit and facilitate comparison with other populations
classified by the same criteria and method.1

Ideal Requirements for Index

The ideal requisites of an indices are clarity, simplicity, objectivity, validity,
reliability, Quantifiability, sensitivity, acceptability.

Classification of Indices

Figure 1. It shows different types of indices.

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Dental Indices

Dental indices are tools used to quantify dental diseases thereby cross
comparisons can be made based on disease burden and treatment efficacy. In
dental literature, there exists an ambiguity on selecting the ideal scale or index to
measure dental diseases.Dental caries is reported to be one of the oldest and most
common diseases found in humans.
Dental caries is a prevalent chronic infectious disease resulting from tooth-
adherent cariogenic bacteria that metabolize sugars to produce acid, which over
time demineralizes tooth structure.

Figure 2. Dental Caries at Molars.

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HISTORY OF INDICES

Before the invention of printing in the fifteenth century book indexing had
limited use as no two copies were the same nor with the same pagination. Indexes
from that time are of several kinds:

o lists of terms or phrases

o concordances to the Bible (from the 7th century)
o subject indexes to canonical law (from the 11th century)
o ‘real concordances’ or classified lists of references to theological
concept
o subject indexes to works on ethics, natural philosophy and logic. In
some manuscripts headwords and marginal references served as
guides to the text.

Printed book indexes appeared in the 1460s, almost from the beginning of the era of
printing. Developments in medicine were aided by indexes to medical texts and
herbals. The first printed Biblical concordance was published in 1544. In the 19th
century there were moves to codify indexing. The Index Society was formed in London in
1877 with the aim of creating ‘a general index of universal literature’. Dr Henry Benjamin
Wheatley, after whom the Wheatley Medal is named, wrote What is an indexer? in 1878.
This society continued until 1890. Soon afterwards women began to enter the field.
Eventually the Society of Indexers was formed in Great Britain in 1957.

3
 Uses of the Indices
For Individual patient:
- Recognition of oral problem
- Effectiveness of present oral hygiene practices

In Research
- Determine baseline data before experimental factors are introduced.
- Measure the effectiveness of specific agents for prevention, control or
treatment.

In community
- Shows prevalence and incidence.
- Assess the needs of community.
- Compare the effects of community program and evaluate the result.

4
Oral Health Index
OHI index (Oral Hygiene Index) shows patient’s oral hygiene and express the
presence of plaque on the surface of the teeth. OHI allows determination of a presence
of the dental plaque, material-alba, and food residues. The most commonly used index
for determining the soft sediments is a Green – Vermillion - Hirschman index (Figure
4).2

Figure 4. Method of scoring the presence of soft sediments

There are three stages of soft plaque presence according to the method of Green -
Vermillion . This method simply allows us to investigate and determine the numerical
presence of soft plaque and classified into four classes from 0 to 3. The index was
determined twice in our patients: during the first visit to the clinic when we diagnosed
the disease, and immediately before physiological replacement of deciduous teeth.
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Indices for Oral hygiene and Plaque

DEBRIS: It is a soft foreign material loosely attached to a tooth surface.

PLAQUE: It is a structured, resilient yellow-greyish substance that adheres to the

intra-oral hard surfaces including removable and fixed restorations.

CALCULUS: It is a hard deposit i.e. formed by mineralization of dental plaque on

the surfaces of natural teeth generally covered by layer of un-mineralized plaque.

OHI consists of two components

1.Debris index
2.Calculus index

Each of these indices is based on 12 numerical determinations representing the

amount of Debris or calculus found on the buccal and lingual surfaces of each of 3
segments of each dental arch9

Figure 5. It shows different segments of arch.

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Rules of Oral Hygiene Index
• Only fully erupted teeth are scored.
• Third molars and incompletely erupted are excluded.
• From each segment, 1 tooth is used.
• The tooth in a particular segment used must have the greatest area covered by
either debris or calculus.3

Debris Score Criteria

0: No debris or stains.
1: soft debris covering not more than one-third of the tooth.
2: soft debris covering more than one-third but not more than two-thirds of the
tooth; 3: soft debris covering more than two-thirds of the tooth.
Scores are totaled and divided by the number of segments scored.3
Debris Index DI = Total Debris Score
No. of segments scored

Figure 6. It shows criteria for scoring debris.

Calculation
- Debris Index (DI) = Buccal score + Lingual Score
No. of segments

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Calculus Index
Dental calculus, both supra- and subgingival occurs in the majority of adults
worldwide. Dental calculus is calcified dental plaque, composed primarily of calcium
phosphate mineral salts deposited between and within remnants of formerly viable
microorganisms. A viable dental plaque covers mineralized calculus deposits.4

Figure 6. Calculus Index and score criteria for calculus

Calculation
- Calculus Index (CI) = Buccal score + Lingual Score
No. of segments
Oral Hygiene Index(OHI) = DI + CI

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Dental Caries Indices
Dental caries indices are quantitative measures designed to quantify the prevalence
and severity of dental caries in populations, enabling healthcare professionals and
policymakers to make informed decisions about oral health interventions. These
indices are typically based on standardized clinical examinations, radiographic
assessments, or a combination of both. They help in tracking changes in dental health
over time, identifying high-risk groups, and evaluating the effectiveness of preventive
programs.

Two commonly used dental caries indices are the Decayed, Missing, and Filled Teeth
(DMFT) index and the Decayed, Missing, and Filled Surfaces (DMFS) index.

1. DMFT Index: This index assesses the number of decayed, missing, and filled
teeth in an individual. It provides a comprehensive overview of the oral health
status, taking into account the impact of decay, tooth loss, and restorative
interventions.
2. DMFS Index: Unlike the DMFT index, the DMFS index evaluates the
decayed, missing, and filled surfaces rather than whole teeth. This finer level
of detail allows for a more precise analysis of the distribution and progression
of dental caries on specific tooth surfaces.

Figure 7. Shows DMFT Index

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Calculation of Index
Step 1: Understand the Tooth Surfaces:
Dental surfaces are classified as follows:
 D (Decayed): Surfaces with visible cavities or lesions.
 M (Missing): Surfaces where teeth are missing due to caries or other reasons.
 F (Filled): Surfaces with restorations or fillings.
Step 2: Examine the Dental Chart or Images:
For each tooth, carefully examine the surfaces to determine if they are decayed,
missing, or filled. Use dental charts or images to aid in this process.
Step 3: Counting Decayed Surfaces (D):
Count the number of surfaces with visible cavities or lesions (decayed surfaces).
Step 4: Counting Missing Surfaces (M):
Count the number of surfaces where teeth are missing. This includes extracted teeth
due to caries or other reasons.
Step 5: Counting Filled Surfaces (F):
Count the number of surfaces with restorations or fillings.
Step 6: Calculate the DMFS Index:
Once you have counted the number of decayed (D), missing (M), and filled (F)
surfaces, use the following formula to calculate the DMFS index:
DMFS Index = D + M + F

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Conclusion
Dental indices provide a quantitative method for measuring, scoring, and analyzing
dental conditions in individuals and groups. An index describes the status of
individuals or groups with respect to the condition being measured. Oral health
surveys depend on dental indices, as do researchers and clinicians, to help in
understanding trends and patient’s needs. In dentistry, indices are commonly used for
measuring a patient’s periodontal status, dental indices can measure the amount of
plaque and calculus present or not present in a patient’s mouth, the amount of
bleeding present in the gingiva, the amount of tooth mobility present at a given time,
the amount of fluorosis present, and the number of decayed, missing, or filled teeth
present.6,7,8

Therefore, it becomes important to have knowledge of different dental indices, their

uses, advantage and limitations of each. With this objective this chapter explains what
an index is and what are the properties and requisites of an ideal index. A detailed
description of the indices commonly used in dentistry can help the reader in
evaluation and monitoring the progress and maintenance of oral health of their
patients in clinical practice along with their applications in clinical trials and
epidemiological surveys.5
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References
1. Indices for dental caries https://www.slideshare.net/kourravneet/indices-for-
dental-caries-80723307
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839453/#:~:text=OHI
%20index%20(Oral%20Hygiene%20Index,%2Dalba%2C%20and%20food
%20residues.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378657/#:~:text=0%3A
%20No%20debris%20or%20stains,the%20number%20of%20segments
%20scored.&text=Calculus%20Index%20(CI).
4. https://pubmed.ncbi.nlm.nih.gov/9395117/#:~:text=Dental%20calculus%2C
%20both%20supra%2D%20and,plaque%20covers%20mineralized
%20calculus%20deposits.
5. Textbook of public health Dentistry by Cm Marya
6. https://onlinelibrary.wiley.com/doi/pdf/10.1002/9781118705018.app5
7. https://www.slideshare.net/SyedMajdi/oral-hygiene-index-ohi-and-oral-
hygiene-indexsimplified-ohis-249339522
8. https://journals.lww.com/amjm/fulltext/2020/16040/
measuring_dental_diseases__a_critical_review_of.3.aspx#:~:text=Dental
%20indices%20are%20tools%20used,index%20to%20measure%20dental
%20diseases.
9. https://www.uoanbar.edu.iq/eStoreImages/Bank/21944.pdf
10. Figure 1 = https://www.uoanbar.edu.iq/eStoreImages/Bank/21944.pdf
https://www.slideshare.net/kourravneet/indices-for-dental-caries-80723307
11. Figure 2 = https://www.marsfielddentalcare.com.au/
12. Figure 3 = https://www.semanticscholar.org/paper/Newer-Concept-of-
Measuring-Dental-Caries-A-Review-Shyam-Manjunath/
933c859bcd3fcc893eea13cfbe2a41690bfe341d
13. Figure 4= https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839453/#
14. Figure 5 = https://capp.mau.se/methods-and-indices/
15. Figure 6 = https://www.marsfielddentalcare.com.au/
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The Society of Indexers was followed by the founding of indexing societies in
the USA (American Society of Indexers, 1968), Australia and New Zealand
(Australian Society of Indexers, 1976), Canada (Indexing and Abstracting
Society of Canada, 1977), China (China Society of Indexers, 1991) and South
Africa (Association of South African Indexers and Bibliographers, 1994).
Meanwhile the British Standard on Indexing (BS3700:1976) was published;
with its subsequent revisions it is still used throughout the English- speaking
world.