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Introduction Health examination is not complete without the oral health assessment. Regular assessment of dental diseases have been seen to be important as they keep on varying in occurrence and severity. This has to be measured both qualitatively and quantitatively and the measure of these parameters are recorded by an µIndex¶ (plural ± Indices). It is a very important tool in the branch of dental public health and in the study of epidemiology.
Definitions An µIndex¶ has been defined by µRussell¶ as ³A numerical value describing the relative status of a population on a graduated scale with definite upper and lower limits, which is designed to permit and facilitate comparison with other populations classified by the same criteria and methods.´
³Periodontal disease´ means disease involving either or all of the attachment apparatus of a tooth. Many researchers place gingival diseases also under the heading of Periodontal diseases while others differentiate the two.
Periodontitis is a bacterially induced inflammation of the gingival tissues together with loss of both the attachment of the periodontal ligament and bony support.
Periodontal Index (PI) This Index was developed by Russell A.L. (1956).
It took him ten years to develop this index because of a lack of sophisticated methodologies to assess the prevalence and severity of gingivitis and destructive periodontal disease. In earlier times, clinical appearance of the tissues of the anterior teeth was taken as the only basis for segregating individuals for epidemiologic studies of gingival and periodontal disease in large populations. These observations permitted evaluation of only relative proportions of affected and unaffected individuals in the populations under consideration. So, according to WHO the PI has made great strides to the epidemiology of periodontal disease due to its definition that very quickly achieved wide international acceptance. (WHO, 1999)
However nowadays this index in not used much in epidemiologic surveys because of the introduction of new periodontal indices and refinement of criteria amid increasing periodontal research.
The PI was intended to estimate deeper periodontal disease by measuring the presence or absence of gingival inflammation and its severity, pocket formation, and masticatory function. The scale of value for the PI ranges from 0 ± 8 with increasing prevalence and severity of disease. The PI is a composite index because it records both the reversible changes due to gingivitis and the more destructive and presumably irreversible changes brought by deeper periodontal disease. Because of this, it is an epidemiological index with a true biological gradient.
Method All the teeth present are examined. Gingival tissue is assessed for gingival inflammation and periodontal involvement.
Instruments used Mouth mirror and explorer are supplemented occasionally by straight jaquette scaler or the chip blower for demonstration of a periodontal pocket. Periodontal probing was not recommended because, according to Russell, it added little and proved to be a troublesome focus of examiner disagreement.
Scoring Criteria Russell chose the scoring values (0,1,2,4,6,8) in order to relate the stages of the disease in an epidemiological survey to the clinical conditions observed.
Russell¶s rule According to Russell¶s rule ³When in doubt assign the lower score´.
Calculation of the index The PI score per individual is obtained by adding all of the individual scores and i.e. PI score per person = Sum of individual scores/number of teeth. dividing by the number of teeth present or examined.
PI score per group = Sum of scores of all individuals/number of individuals
Scoring Relation to clinical severity (1959) .
a plane mouth mirror and an explorer.8 to 8.7 to 1.6 to 5.Use of the PI requires a minimum of equipment: a light source.0 Full mouth extractions Uses of PI 1. It is also important because a number of epidemiological surveys have been conducted world over using this index.2 0.The PI is fast and easy to use.Clinical conditions Clinically normal supportive tissues Simple gingivitis PI scores Treatment 0 to 0.Used in epidemiological surveys. 2.9 Oral prophyllaxis Beginning of destructive periodontal disease 0.PI serves well for making an overall assessment of the periodontal status of a population. . 5. 3.9 Minimal periodontal treatment Established destructive periodontal disease 1. 4.3 to 0.Used in the national Health Survey (NHS).More data can be assembled using PI than most other indices of periodontal disease. 6. the largest ongoing health survey in the United States.0 Ellaborate treatment periodontal Terminal disease 3.
Modern understanding has shown the PI to be invalid because it does not include evaluation of Clinical Attachment Loss (CAL). The PDI is a clinician¶s modification of Russell¶s Periodontal Index. Ramfjord developed his own system for measuring periodontal disease. This system became known as the Periodontal Disease Index (PDI). The Periodontal Disease Index (PDI) was developed by Siguard P. grades all pockets of 3 mm or more equally and scores gingivitis and Periodontitis on the same weighted scale.Drawbacks of PI 1. Periodontal Disease Index As a consultant to the World Health Organization for a 1957 study of periodontal disease in India. . 4.The number of periodontal pockets without obvious supragingival calculus is also underestimated in the periodontal index. 2. Taking the most valuable features of existing indices and adding new features to compensate for their shortcomings. Ramfjord in 1959. Ramfjord was faced with the inadequacies of the available indices for measuring periodontal disease. 3. the results tend to underestimate the true level of periodontal disease.It doesn¶t indicate the degree of periodontal tissue destruction. especially early bone loss in a population.Since no caliberated probe or essentially radiographs are used when performing the PI examination.
To provide measurable reference data for assessment of correlations with factors of potential significance in the etiology of periodontal disease. Calculus component 3. 4. The PDI has been framed to be accurate for use in longitudinal studies. 3. The most important feature of PDI is measurement of the level of the periodontal attachment related to the CEJ of the teeth. 2. namely: 1. To assess prevalence and severity of gingivitis and Periodontitis within the individual dentitions and in population groups. the PDI was developed due to a lack of methodologies to determine prevalence and severity and with the intent to be a more sensitive version of the PI for use in clinical trials. Components of Periodontal Disease Index The PDI comprises of three components. 5.Gingival and Periodontal component Scoring methods .As in the case of the PI. To provide accurate recordings for clinical trials of preventive and therapeutic procedures in periodontics. Plaque component 2. The PDI is primarily concerned with an accurate assessment of the periodontal status of the individual person. Objectives 1. To provide an accurate basis for longitudinal studies of periodontal disease. To provide a meaningful basis for estimate of need for periodontal therapy in selected population groups.
36. Evidence of ulceration of the gingiva with bleeding is considered. The gingival status is scored first. 44). lingual and interproximal surfaces with each other. 24. Presence or absence of stippling is not considered as related to gingival inflammation. Changes in colour are evaluated by observing the colour of the gingivae around the tooth to be scored and comparing the colour corresponding to the buccal. Any minor change either in contour.Only six selected teeth are scored for assessment of the periodontal status of the mouth. The gingivae around the teeth to be scored are first dried superficially by gently touching with absorbing cotton. one may concern all of the teeth in the mouth. 21. for short term clinical trials and where a limited number of patients are available. However slight contour change alone is never scored as gingivitis. Change in consistency is checked by applying gentle pressure with the side of periodontal probe against the gingiva to determine if there is a soft or spongy consistency. as well as comparing it with the colour of the gingiva around the adjacent teeth. Change in form is initially a blunting or rounding of the margin of the gingivae and thickening of papillae. if the . stippling or consistency alone is not considered to be a definite manifestation of gingivitis. The six selected index teeth are (according to FDI notation 16. however. These are known as Ramfjord¶s teeth. 41.
a ³University of Michigan´ number O probe is used. After the distance from the free gingival margin to the CEJ has been measured. The following criteria is used for crevicular measurements:- . The next step is recording of crevice depth related to the CEJ. The University of Michigan number O probe is graduated at 3.gingiva is touched gently with the side of a periodontal probe. of if there is severe redness and marked change in contour. This can be achieved only if there has been loss of periodontal attachment. The end of the probe should be placed against the enamel surface coronally to the margin of the gingiva so that the angle formed by the working end of the probe and long axis of the crown of the tooth is approximately 45°. an attempt should be made to move the probe along the cemental surface. Later on it was simplified by taking the score at the mesial surface of the tooth as representative of all surfaces. The probe should always be pointed towards the apex of the tooth or the central axis of multirooted teeth. The mesial measurement should be made at the buccal aspect of the interproximal contact area with the probe touching both teeth if there is a neighbour tooth present and the probe pointing in the direction of the long axis of the tooth to be scored. making it necessary to estimate intervening measurements. The buccal measurements should be made at the middle of the buccal surfaces. 6 and 8 mm. For this purpose. Minimal force should be used to pass the probe in apical direction maintaining contact with the tooth.
If the gingival margin is on cementum.1. The distance from the CEJ to the bottom of the pocket can then be found by subtracting the first from the second measurement. record the distance from the CEJ to the gingival margin as a minus value (a) then record the distance from the CEJ to the bottom of the gingival crevice as a positive value (b). Ramfjord¶s method for measuring this distance is often referred to as the ³Indirect method for measuring periodontal attachment loss´ Scoring Score Criteria 0 1 2 3 Absence of inflammation Mild to moderate gingival changes not extending all around the tooth Mild to moderate gingival changes extending all around the tooth Severe gingivitis Calculation of the PDI score The PDI score can be calculated for an individual and a group For Individual = Total of individual tooth scores/ Number of teeth examined For group = Total individual PDI score/ Number of people examined . Both loss of attachment and actual crevice depth can easily be assessed from these scores. If the gingival margin is on enamel. measure from gum margin to CEJ and record the measurement. Then record the distance from the gingival margin to the bottom of the pocket. 2.
Epidemiologic surveys 2. Shannon I L. If any of the six index teeth is missing. This index is also known as ³Periodontal Screening Examination´ The GPI is a modification of the PDI of the Ramfjord for the purpose of screening individuals to determine who needs periodontal treatment. calculus and . The GPI assesses three components of periodontal disease: gingival status. and collectively material alba. hence leading to inter examiner bias. NHANES) Gingival Periodontal Index Developed by O¶Leary T J. Hence in between scores need to be estimated. Gibson W A. Uses: 1. It is more time consuming as compared to Russell¶s Index. Schuessler C F and Nabers C L. two aspects of the index are often used: Selection of the six Ramfjord teeth and the method for measuring pocket depth and loss of periodontal attachment. Although the PDI is rarely used nowadays. 2.g.Either of the PDI score ranges from 0 ± 6. another tooth is not substituted in its place. periodontal status (crevice depth). 6. Values marked on probe are 3. Ramfjord¶s technique for measuring pocket depth and periodontal attachment loss has been used in national surveys (e.Longitudinal studies in periodontal diseases Drawbacks: 1. in 1963. 8 mm.
Method: Scoring is done on all teeth present. The assessment is done segment wise. 38 to 34. 13 to 23.overhanging restoration. Segmentation of the mouth The Dentition is divided into six segments: (According to FDI notation) 18 to 14. Gingival status The specific criteria for the gingival status component of the GPI are as follows: . 33 to 43. 24 to 28. Eachsegment is assessed for each of the three components of periodontal disease. 44 to 48. The latter triad is independently called as the ³Irritation index´. The primary objective in using the index is to determine the tooth or its surrounding tissues. with the severest condition within each segment.
Compiling the Gingival Periodontal Index The highest score (either gingival or periodontal) found for each dentulous segment is recorded and the sum is divided by the number of segments to give the GPI score for the individual. Uses 1.To monitor patient progress 2.For epidemiologic surveys .The highest score found on any tooth in a segment is recorded as the periodontal score for the segment.
Gingival Bone (GB) Count Index The GB count index was given by Dunning J M and Leach L B (1960) This index records the gingival condition and the level of the crest of the alveolar bone. Scoring . and proportionate measurement of bone loss is made on a 0 to 5 scale. Subjective measurement of gingivitis is made on an arbitrary scale of 0 to 3 for each tooth. This index permits differential recording of both gingival and bone conditions. The bone level is assessed by clinical examination but radiographs are recommended for greater accuracy.
The criteria used for scoring bone loss is as follows: Score Criteria 0 Normal Lack of continuity of cortical plate at the crest of interdental bone. Time consuming .One score is assigned to each tooth studied. Up to 1/3rd of supporting bone lost 4 5 6 More than 1/3rd and up to 2/3rd of supporting bone lost 7 More than 2/3rd of supporting bone lost Disadvantages The index in its present form does not distinguish between slight involvement of many teeth and extensive involvement of a few teeth. with possible widening of Periodontal Ligament. Shetham A and Striffler D F developed an index similar to the Bone count component index in 1970. and a mean is computed for the whole mouth.
stage of advancement) of loss of Periodontal attachment (LPA) by determining the percentage of sites within the mouth with LPA greater than 1 millimeter (i. The ESI utilizes the Ramfjord¶s method to measure loss of periodontal attachment.e. . number of sites affected within the mouth) and severity (i.Extent and Severity Index (ESI) This index was developed by J P Carlos. the ESI has demonstrated relatively the same level of reliability in partial mouth examinations versus full mouth examinations.e. extent) and the mean LPA for affected sites (i. The ESI was developed because of a lack of satisfaction with the previous indices of periodontal disease and because of the emergence of a newer conceptual model of periodontal disease by ³Socransky and associates´ The PI was based on a model in which periodontal disease was a slowly progressing. severity). Furthermore. The ESI is considered to be a simple and reproducible procedure requiring minimal examiner training.e. It dealt with gingivitis as part of the biologic gradient that extended from health to advanced periodontal disease. In the newer model. It can be used in a variety of survey types such as cross sectional surveys and longitudinal studies.e. continuous disease process. periodontal disease is a chronic process. M D Wolfe and A Kingman (1986) to assess the extent (i. with intermittent periods of activity and remission that affects individual teeth and sites around teeth at different rates within the same mouth. Some consider the ESI not to be a true index since it summarizes data and is descriptive rather than analytical.
with an average severity of 1. for interpretation. Afterwards. a tooth site is considered diseased only when loss of attachment exceeds 1 mm.Procedure To obtain the ESI.g. an ESI of (60.0) suggests a generalized but mild form of periodontal disease whereas an ESI of (20. 27% of sites examined showed evidence of disease. mid-buccal and the mesio-buccal aspects of each tooth using the Ramfjord procedure. Disease severity. a coin toss) to select which upper quadrant to examine. E. In addition. 2. on average. S. ESI = (E.. is expressed as the mean loss of attachment. For the ESI. 6. in excess of 1 mm.e. So as stated earlier. disease extent.0) suggests a severe localized form of periodontal involvement.34 mm loss of attachment per diseased site. This results in a maximum of 28 measurements (i. So. . is expressed as the percentage of sites among examined sites with an LPA greater than 1 mm. for affected or diseased sites. a maximum of 14 measurements in each quadrant) for each subject. The contralateral quadrant in the lower arch is then automatically decided. use a random procedure (e. the ESI is written as follows where E is rounded off to the nearest whole number.34) means. Third molars are not examined. S) An ESI expressed as (27. 1.
e. . the recession of the gingival margin and alveolar bone. pathological pockets and numbers of erupted teeth were considered basic to data requirements. The assessment of gingivitis. the Oral health unit of the World Health Organization (WHO) took the initiative to organize a group of experts from 14 member countries to examine and advise on the epidemiology. George Beagrie.Community Periodontal Index of Treatment Needs (CPITN) This index was developed for the ³Joint Working Committee´ of the World Health Organization´ and ³Federation Dentaire Internationale´ (WHO/ FDI) by Jukka Ainamo. having the objective of developing a method for the evaluation of treatment needs. Jean Martin and Jennifer Sardo-infirri in 1978. For population studies and field trials. i. As far as calculus is concerned.. Having accepted that periodontal disease is one of the most wide spread diseases of mankind. Gingival recession and tooth mobility were also excluded from the recordings. gingival bleeding and pocket formation. This index was developed primarily to survey and evaluate periodontal treatment needs rather than determining past and present periodontal status. named for the WHO Technical Report Series (TRS) publication number in which this method was first featured. The CPITN is an evolution of the ³621´ method. Terry Cutress. recording of plaque was considered less important than the assessment of its consequences. etiology and prevention of periodontal diseases. David Barmes. it was included as being necessary to any study of treatment need.
. International uniformity Its limitations include partial recording. it provides guidance on the planning and monitoring of the effectiveness of periodontal care programmes and the dental personnel required. The CPITN is a procedure which uses clinical parameters and criteria relevant to planning for the prevention and control of periodontal diseases. Speed. CPITN is therefore not a diagnostic tool and should not be used for planning of specific clinical treatment of individual patients. namely periodontal pockets.Scope and Purpose The CPITN procedure is recommended for epidemiological surveys of periodontal health. and 3. The major advantages of CPITN are: 1. gingival inflammation (identified by bleeding of gentle probing) and dental calculus and other plaque retentive factors. Primarily the CPITN is a screening procedure for identifying actual and potential problems posed by periodontal diseases both in the community and by the individual. The CPITN records the common treatable conditions. Also. Simplicity 2. It does not record irreversible changes such as recession or other deviations from periodontal health such as tooth mobility or loss of periodontal attachment. exclusion of some important signs of past periodontal breakdown ± notably attachment loss and absence of any marker of disease activity or susceptibility. The CPITN is not intended as a comprehensive assessment of total past and present periodontal disease experience.
In order to determine periodontal disease status. in the maxilla. but not non-treatable or irreversible conditions (i. reduced halitosis. for the presence or absence of: 1.Pocket depths of 4 or 5 mm . these were the facial and mesial aspects of the right first molar (16 ± FDI notation). improved quality of life. reduced potential threat to longevity of teeth. enhanced general well-being and appearance. elimination of bleeding from the gums. the lingual and mesial aspects of the left first molar (36). right central incisor (41) and right first premolar (44). left central incisor (21) and left first premolar (24) and in the mandible. The recordings were made in the following order. attachment level). Originally. This selection of teeth was as proposed by Ramfjord (1959) for partial mouth recording of periodontal disease. recession. Reasons for attempting to control periodontal disease and promote good periodontal care include. and improved mastication. Treatment needs It implies that CPITN assesses only those conditions potentially responsive to treatment. Subgingival calculus 3.e. Supragingival calculus 2. the group supported the use of a partial mouth recording system with scores being taken with the aid of a probe from two surfaces of six teeth.With this information appropriate oral care services can be planned for populations and for individuals.
Each sextant is given a score. it is included in the adjacent sextant.Pocket depths of 6 mm or more 5. When only one tooth remains in a sextant.Gingival bleeding after probing 6. the recordings per sextant are based on findings from specified index teeth. For epidemiological purposes.Recession (eventually recession scores were discarded).4. Sextants Six sextants (depicted based on FDI notation) 17 ± 14 13 ± 23 24 ± 27 47 ± 44 43 -33 34 ± 37 The third molars are not included. the highest score in each sextant is identified after examining all teeth. . For clinical practice. Index teeth In epidemiological surveys assessing the periodontal treatment needs of a population. The treatment need in a sextant is recorded only if there are two or more teeth present and not indicated for extraction. except where they are functioning in place of second molars. the score is identified by examination of specific index teeth.(2 ) Procedure for CPITN The dentition is divided into six parts (sextants) for assessment of periodontal treatment needs.
This probe is particularly designed for gentle manipulation of the often very sensitive soft tissues around the teeth.5 mm markings. The probe has a ball tip of 0. The Joint Working Committee of WHO/ FDI have advised the manufacturers of CPITN probes to identify the instruments as either µCPITN±E¶ for the epidemiological probe with 3. The additional lines may be of use when performing a detailed assessment and recording of deep pockets for the purpose of preparing a treatment plan for complex periodontal therapy.The WHO Periodontal Examination Probe ± CPITN Probe Figure .5 mm markings. The CPITN probe is both thin in the handle and is of very light weight (5 gms).5 mm and 5. . thus decreasing the tendency for false reading by over measurement.5 mm and 11. namely measurement of pocket depth and detection of subgingival calculus.5 mm and ending at 5. A variant of this basic probe has two additional lines at 8. The probing force can be divided into a µworking component¶ ±to determine pocket depth and a µsensing component¶ ± to detect subgingival calculus.5 mm and 11. This probe was designed for two purposes.5 mm from the working tip.5 mm diameter that allows easy detection of subgingival calculus.5 mm.CPITN Probe The recommended periodontal probe for use with CPITN was first described by WHO (TRS -621 ± 1978). Probing procedure A tooth is probed to determine pocket depth and to detect subgingival calculus and bleeding response. This feature combined with the light probe weight facilitates the identification of the base of the pocket. or µCPITN±C¶ for the clinical probe with additional 8. The pocket depth is measured through colour coding with a black band starting at3.
Pain to the patient during probing is in most cases indicative of the use of a too heavy probing force. Recommended sites for probing are mesial. whenever possible be in the same plane as the long axis of the tooth. the lightest possible force which will allow movement of the probe ball point along the tooth surface is used. with the probe tip remaining in the sulcus. the probe may be µwalked¶ around the tooth. 1987). For µsensing¶ subgingival calculus.The working force should not be more than 20 grams ± a practical testfor establishing this force is to gently insert the probe point under the finger nailwithout causing pain or discomfort. The direction of the probe during insertion should. the ball tip should follow the anatomic configuration of the tooth root surface. When gently inserting the probe into the gingival pocket. mid line and distal. Sites in addition to the recommended ones should be probed if there is suspicion that a higher scoring condition is present.e. The probe is inserted between the tooth and the gingiva. and the sulcus depth or pocket depth is noted against the colour code or measuring lines. . both on facial and lingual/ palatal surfaces. The probing may be done by withdrawing the probe between each probing or by the probe tip remaining in the sulcus or pocket in order to walk the probe around each surface (i. buccal and lingual) of the tooth (Cutress. The ball end of the probe should be kept in contact with the root surface. ³Walking´ the probe should be done with short upward and downward movements. Ainamo and sardo-infirri. The probing may be done by withdrawing the probe between each probing or alternatively.
Recording of code 4 makes further examination of that sextant unnecessary. Note:. The codes are listed in descending order of treatment complexity as follows: Code ³X´ When only one tooth or no teeth are present in a sextant (third molars are excluded unless they function in place of second molars) Code ³4´ Pathological pocket of 6 mm or more present i.If the deepest pocket found at the designated tooth or teeth in a sextant is 4or 5 mm. Code ³3´ Pathological pocket of 4 mm or 5mm present. there is no need to examine for gingival bleeding. the black area of CPITN probe is not visible. Note:. when the gingival margin is on the black area of the probe.e.If code 2 is attained. a code of 3 is recorded ± there is no need to examine for calculus or gingival bleeding. Code ³2´ Calculus or other retentive factors such as ill fitting crowns or poorly adapted edges of restorations are either seen or felt during probing. i. Bleeding may be delayed for up to 10 ± 30 seconds after probing. Codes and Criteria The appropriate code for each sextant is determined with respect to the following criteria. . the gingiva or gum of the examined tooth should be inspected for the presence or absence of bleeding before the subject is allowed to swallow or close their mouth.e.After probing.
Code ³1´ Bleeding observed during or after probing. The requirement is that more than one functional tooth is present. If µyes¶. As soon as the highest scored criterion has been determined there is no need to examine for the presence of lower score criteria. Code ³0´ Healthy tissue. but bleeding occurs after gentle probing. a code of 1 is recorded for the sextant.4 or 5 mm deep pockets. Control of bleeding by means of self care is a pre. No signs of disease is observed. then score µx¶ and move to next sextant. calculus or other plaque retentive factor.requisite for all periodontal therapy. or examine all teeth (for clinical screening procedure). Note:.0) Bleeding is a sign of early disease which can be overcome by self care following suitable oral health education and instruction. This treatment is recognized as ³Treatment need 1´ (TN -1) . Classification of treatment needs (TN) A recording of Code 0 (healthy) or code X (missing) for all six sextants indicates that there is no need for treatment (TN . If µno¶. Determine appropriate highest score for each sextant. bleeding only. Examination procedure The aim is to determine the highest score applicable to each sextant with the least number of measurements. for presence of 6mm or deeper pockets. in that order.If neither pathological pocket nor calculus is observed. First decide whether the sextant can be validly scored. examine index teeth (in epidemiological procedure).
The treatment of these conditions may require ³complex therapy´ for which skilled clinically trained and experienced dental personnel are needed. for patients with deep pockets even after scaling. On the other hand. Oral hygiene and scaling will usually reduce inflammation and bring a 4 or 5 mm sulcus depth or below 3 mm. (TN -2) * Therefore. scaling and root plaining. Sextants with such pockets are placed in the same treatment category as calculus and other plaque retentive factors i. This need for complex treatment is recognized as ³Treatment need 3´ (TN -3) A sextant scoring code 4 also will fall in ³Treatment need 3´ (TN -3) Substitution for excluded and missing Index teeth The index (and substitute) teeth are excluded from the CPITN scoring when the decision has been made to go for extraction due to any cause. root plaining and control of bleeding by oral hygiene. there will generally be residual pockets. The CPITN differentiates between pockets of 4 or 5 mm and 6 mm or deeper because of the currently accepted different approach to their treatment. a CPITN code of 2 or 3 means TN ± 2.. the removal of calculus and other plaque ± retentive factors demands the professional care defined as µTreatment need 2¶ (TN -2) The depth of a pocket is not necessarily related to the amount of attachment loss.The control or elimination of gingival bleeding should be a prime goal even if further treatment is not available. Unlike plaque that can be eliminated through self care. . Although not pathological in themselves.e. calculus and other plaque retentive factors favour plaque retention and inflammation.
If all teeth in a sextant are missing or only one functional tooth remains. 25 ± . the nearest adjacent premolar is examined. substitute 21 for it. The ten CPITN index teeth are the first and second molars in the posterior sextants and a central incisor in each of the two anterior sextants. Choice of age groups While applying the CPITN. If the single tooth is an index tooth. the WHO standard are grouping should be used. if the first molar is not present or has to be excluded. then the worst index tooth score is recorded. substitute teeth are selected.The indication for extraction because of periodontal involvement is that the tooth has vertical mobility and causes discomfort to the patient. i. using the following rules. In subjects under 20 years of age. all the remaining teeth in that sextant are examined and the highest score is recorded. Remember that 2 or more functioning teeth must be present in a sextant for it to qualify for scoring. 3. 4.e. then the recording is based on the examination of the remaining index tooth. 6. 2. If both index teeth in a posterior sextant are absent or excluded from the examination. 1. substitute for mandibular teeth. A single tooth in a sextant is considered as a tooth in the adjacent sextant and subject to the rules for that sextant. 5. 7. If 21 is also excluded then identify the worst score for the remaining teeth. In the anterior maxillary sextant if tooth 11 is excluded. single years to 19 but including a group 15 ± 19 years then 20 ± 24 years. When one or more of the index teeth are missing or excluded at the time of examination. one of the two index teeth is not present or has to be excluded. Similarly. the sextant is coded as missing. If in a posterior sextant.
3. 1. 45 ± 54 years. Utilization of CPITN recordings The CPITN is designed for rapid and practical assessment of various periodontal treatment needs in population surveys and for initial screening of . or if a high prevalence of disease appears present at an early age. 55 ± 64 years and 75 ± 84 years and over. 2. It is recommended that age groups 15 ± 19 (or 15 years).29years. To obtain the µmean number of sextants¶ (MNS) for each condition per person. 4) Step 2: To obtain the prevalence (percentage) of subjects with codes 0. there have been very few changes to the index for epidemiological and public health purposes. examination of age groups 7± 11 years and 12 -14 years may be justified. 4 as their score. codes 0.e. 3. divide the total number of sextants with highest score for the person by the number of dentate subjects examined. 30 ± 34 years. Where resources allow. Modifications of CPITN Besides the slight changes to the CPITN since it was first described. 2. by the total number of dentate subjects examined and multiply by 100. 1. 35 ± 44 years. divide the counts of codes respectively. 35 ± 44 years and 65 ± 74 years be the age groups for data collection for international comparison and for planning and monitoring. Calculation of CPITN The CPITN for a population group can be calculated as follows: Step 1: Count the number of charts with different codes and add up the codes individually (i.
calculus and periodontal pockets. For this ³CPITN ± C´ probe is used. 16. Indicators:. Procedure: The mouth is divided into sextants as in the case of CPITN. 27 .Three indicators of periodontal status are used for this assessment. the teeth to be examined are: 17. (Note: this replaces the former instruction to include single remaining tooth in the adjacent sextant). A sextant should be examined only if there are two or more teeth present which are not indicated for extraction. gingival bleeding. However. 11. The time needed for the CPITN in recording the codes for the six segments should not exceed 1 ± 2 minutes.patients attending for regular dental care. The modification is done by the inclusion of measurement of ³Loss of attachment´ and elimination of the ³Treatment Needs´ category. a finding of the need for complex treatment necessitates a more precise identification of the teeth and tooth surfaces affected before starting the actual therapy required by the individual patient. 26. the CPITN recordings are sufficient for treatment planning. Community Periodontal index This index is based on a modification of the earlier used CPITN. Index teeth: For adults aged 20 years and over. For patients requiring oral hygiene instruction and scaling only.
only six index teeth 16. In this case. 37 The two molars in each posterior sextant are paired for recording and. 26. The probing for sensing gingival pockets and calculus is same as for CPITN. there is no replacement. 31 and 46 are examined. For subjects under the age of 20 years.e. If no index teeth or tooth is present in a sextant qualifying for examination. if one is missing. pockets should not be recorded i. 11. distal surfaces of third molars should not be scored. This modification is made in order to avoid scoring the deepened sulci associated with eruption as periodontal pockets. 41. 46. only bleeding and calculus should be considered. when children under the age of 15 are examined. 36. all the remaining teeth in that sextant are examined and the highest score is recorded as the score for the sextant. For the same reason. Examination and recording .. 36.47.
as a part of their ³Navy Periodontal Screening Examination´ (NSPE) The NPDI has two parts: 1.(according to FDI notation) 16. The six selected teeth are:. and 2.Navy Periodontal Disease Index (NPDI) The NPDI was introduced by Grossman F D and Fedi P F in 1974. dentisty.A pocket score which measures tissue destruction as determined by pocket depth. 21.A gingival score which assesses inflammation as determined by colour. Method The gingival and pocket score is done on six selected teeth. 24. consistency. enlargement and bleeding. .
41. middle and distal areas ofboth facial and lingual surfaces. µ1¶ ± Inflammatory changes are present. consistency. loss of normal dentisty and consistency. The greatest single measurement determines the pocket score for the tooth. any colour change. has firm consistency. The mesial and distal areas are measured at the facial and lingual line angles. The pocket examination includes six probing measurements of the depth of the gingival sulcus or pocket on each of the six designated teeth using a calibrated probe. substitute the next most posteriortooth and if the central incisor is missing substitute the nearest incisor in the samearch. Scoring Criteria µ0¶ ± Gingival tissue is of normal colour. The gingival examination is for colour. slight enlargement and/or blunting of papilla or gingiva and tendency to bleed on palpation.36. and no exudate is present. These measurements are taken on the mesial. If any of the selected posterior tooth is missing. Changes may include. but do not completely encircle the tooth. . µ2¶ . contour and bleeding.Inflammatory changes completely encircling the tooth. 44 The gingival scores are determined by examining the gingival tissues and the pocket scores by probing sulcular or pocket depth.
.Pocket Score µ0¶ ± pocket depth not over 3 mm µ5¶-pocket depth greater than 3mm but less than 5mm µ8¶ ± pocket depth greater than 5mm Calculation of NPDI score Gingival & pocket scores ± added & divided by no of index teeth.
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