EXAMINATION OF THE

PERIODONTIUM
GINGIVAL INDEX (LÖE AND SILNESS

Use
• Describes the clinical severity of gingival
inflammation as well as its location.
 GINGIVAL INDEX

Appearance Bleeding Inflammation Grades

Normal No bleeding None 0
Slight change in color and mild edema
No bleeding Mild 1
with slight change in texture

Bleeding on
Moderate 2
Redness, hypertrophy, edema and glazing probing

Marked redness, hypertrophy, edema, Spontaneous

Severe 3
ulceration bleeding
Appearance Bleeding Inflammation Grade

Normal No bleeding None 0

 Appearance Bleeding Inflammation Grade

1
Slight change in color and mild edema
No bleeding Mild
with slight change in texture
 Appearance Bleeding Inflammation Grade

2
Bleeding on
Redness, hypertrophy, edema and Moderate
probing
glazing
 Appearance Bleeding Inflammation Grade

3
Marked redness, hypertrophy, Spontaneous
Severe
edema, ulceration bleeding
How to calculate the index?
• Teeth examined - Ramfjord Teeth

• Number of surface to be examined – 4 (Buccal,

Lingual/Palatal, Mesial, Distal)

• Instrument to be used – Periodontal probe

Ramfjord Teeth

Maxilla
16
21
24

Mandible
36
41
44
Substitute Teeth
Maxilla
17
11
25

Mandible
37
42
45
EXAMPLE:
• Tooth index

16

2
D 2 M
1
1

L/P

GI for 16=> (2+2+1+1)/4 = 1.5

 Tooth Code

Right maxillary first molar 1.5

(16)
Left maxillary central incisor 2
(21)
Left maxillary first premolar 1.5
(24)
Left mandibular first molar 2.2
(36)
Right mandibular central incisor 2
(41)
Right mandibular first premolar 1.5
(44)

Index for the patient will be = (1.5 + 2 +1.5 + 2.2 + 2 + 1.5) / 6 = 1.7

GI per person = Sum of individual scores/ Number of teeth examined

INTERPRETATION OF THE
RESULTS
Average Gingival Index Interpretation
2.1 - 3.0 severe inflammation
1.1 - 2.0 moderate inflammation
0.1 - 1.0 mild inflammation
< 0.1 no inflammation
PLAQUE INDEX (SILNESS & LOE)

• Use – To measure the state of oral hygiene

PLAQUE INDEX

Grade Criteria
0 No plaque
1 A film of plaque adhering to the free gingival margin and
adjacent area of the tooth. The plaque may be seen in situ only
after application of disclosing solution or by using the probe on
the tooth surface
2 Moderate accumulation of soft deposits within the gingival
pocket, or the tooth and gingival margin which can be seen with
the naked eye
3 Abundance of plaque within the gingival pocket and/or on the
tooth and gingival margin.
Grade Criteria

0 No plaque
Grade Criteria
A film of plaque adhering to the free gingival
margin and adjacent area of the tooth.
1
The plaque may be seen in situ only after
application of disclosing solution or by using the
probe on the tooth surface
Score Criteria
3 Abundance of plaque within the gingival pocket
and/or on the tooth and gingival margin.
Grade Criteria
2 Moderate accumulation of soft deposits within the
gingival pocket, or the tooth and gingival margin
which can be seen with the naked eye
HOW TO CALCULATE PLAQUE
INDEX?
• Teeth to be examined – Ramjford teeth

• Number of surfaces to be examined – 4

(Facial,Lingual/Palatal, Mesial, Disatal)

• Instrument to be used – Explorer or periodontal

probe
• Plaque Index is calculated in similar manner to the gingival
index

PI for a specific tooth = average points for the 4 surfaces.

PI for patient = Sum of individual scores/ Number of teeth examined.

INTERPRETATION OF THE RESULTS

Average Plaque index Interpretation

2.1 - 3.0 Heavy plaque accumulation
1.1 - 2.0 Moderate plaque accumulation
0.1 - 1.0 Mild plaque accumulation
< 0.1 No plaque accumulation
 
PERIODONTAL SCREENING AND RECORDING
• Use - should be used in every adult patient (≥18yrs) to assess
the need for comprehensive periodontal treatment

• PSR is an adaptation of the Community Periodontal Index of

Treatment Needs (CPITN), which is endorsed by the World
Health Organization (WHO) and the Federation Dentaire
Internationale (FDI) for periodontal screening.
Objectives of Screening

• The PSR system does not replace the need for a

comprehensive periodontal examination.

• It acts as a time saving screening of periodontal health to

indicate when a partial or full-mouth examination is required.

• Similar to a traditional comprehensive periodontal

examination, the PSR system measures each tooth individually
with implants examined the same way as natural teeth.
• Instrument to be used – WHO(World Health Organization) probe
• Surfaces of the tooth to be examined – 6 (1.Mesiobuccal,
2.Buccal, 3. Distobuccal, 4. MesioP/L, 5. Palatal/Lingual, 6.
Disto P/L)
• Number of teeth to be examined – Full mouth dentition
• The dentition is divided into 6 sextants
• The probe tip is gently inserted into the gingival crevice until
resistance is met.

• The depth of insertion is read against the color-coding.

• The total extent of the crevice should be explored by "walking"
the probe around the crevice.

• At least six areas in each tooth should be examined: mesiofacial,

midfacial, distofacial, and the corresponding lingual/palatal

areas.
• For each sextant with one or more teeth or implants, only the
highest score is recorded.

• An X is recorded if the sextant is edentulous.

• A simple box chart is used to record the scores for each sextant.
• The examiner may pass to the next sextant whenever Code 4 is
recorded or the sextant is completely examined.

• In addition to these scores, the symbol * should be added to the

sextant score whenever individual findings indicate clinical
abnormalities.
Periodontal Screening and Recording codes.

• Assignment of a PSR value is based on bleeding, calculus,

subgingival restorations and degree of pocket depth, using the
following criteria:

Subgingival
Code Pocket depth Bleeding Calculus
restorations

0 < 3.5mm No No No

1 < 3.5mm Yes No No

2 < 3.5mm Yes Yes Yes

3 > 3.5 but < 5.5mm. Yes Yes Yes

≥ 5.5mm.
4 Yes Yes Yes
Code management
0 review of daily plaque control habits
1 OHI, subgingival plaque removal
2 OHI, SC, correction of plaque-
retentive margins and restorations
3 Comprehensive charting
4 Comprehensive charting

IF TWO OR MORE SEXTANTS SCORE A CODE 3, A COMPREHENSIVE FULL MOUTH

EXAMINATION AND CHARTING ARE INDICATED.
IF ONE SEXTANT SCORES 4, FULL CHARTING NEEDED
The Symbol *:

• The symbol * should be added to a sextant score whenever the

following is found: furcation involvement, mobility,
mucogingival problems, or recession extending to the colored
area of the probe (indicating 3.5mm or greater).

The Symbol X:

• if the sextant is edentulous or only one tooth is present.

PSR

x 1 4

3 2* 3*
Advantages
• Early detection: Since all sites are evaluated, the risk of
periodontal disease can be made early and appropriate treatment
can be performed.
• Speed: Once the technique of the PSR system is learned, it
should take only a few minutes to perform the screening. This
saves time versus a comprehensive examination.
• Simplicity: It is easy to do and understand for patients.
• Cost-effectiveness: It is not necessary to purchase expensive
equipment since all that is needed is a ball-tipped probe.
• Ease of recording: Only one number is recorded for an entire
sextant.
• Risk management: The dental team is monitoring and recording a
patient's periodontal status for legal requirements.
Limitations
• It is not intended to replace a full-mouth periodontal
examination.
• Those patients who have received treatment for periodontal
diseases and/or are in a maintenance phase of care should
receive comprehensive periodontal examinations.
• There is also limited use of the PSR system in children. It is
necessary to differentiate pseudo-pockets from true periodontal
pockets with these younger patients.
• Since the PSR does not measure epithelial attachment, the
severity of periodontal disease may be underestimated with its
use.
COMPREHENSIVE PERIODONTAL EXAMINATION.
(PERIODONTAL CHARTING):
• When you get a grade of 3 or 4 in any sextant with PSR,
periodontal charting should be done for that particular sextant.

• Things you check in comprehensive periodontal examination

1. Probing depth
2. Gingival margin to Cemento enamel junction
3. Clinical attachment level/loss
4. Furcation involvement
5. Bleeding point
• Instrument to be used- UNC (University of North Carolina) 15
or 12 probe.
• Surfaces of the tooth to be examined – 6 (1.Mesiobuccal,
2.Buccal, 3. Distobuccal, 4. MesioP/L, 5. Palatal/Lingual, 6.
Disto P/L)
Probing Depth - Gingival margin to base of the sulcus

PD = Gingival margin (M)  Base of the sulcus

Probing Technique:
• parallel to the vertical axis of the tooth
• “walked” circumferentially
• One Reading Per Site.
• deepest reading obtained
• Full Millimeter Measurements.
• Probing depths are recorded to the nearest full millimeter.
Clinical Attachment Level (CAL):
• Measured from

CAL = Cementoenamel junction  base of the sulcus

CAL= PD- M-CEJ

• In healthy periodontium or during gingivitis base of the sulcus is
located next to CEJ.
• In periodontitis, CAL is termed as Clinical Attachment Loss

Characterized by
1. Relocation of the junctional epithelium to the tooth root,
2. Destruction of the fibers of the gingiva,
3. Destruction of the periodontal ligament fibers, and
4. Loss of alveolar bone support from around the tooth.
Determining the Clinical Attachment Loss

• 3 possible relationships of the gingival margin to the CEJ are

present for determining the CAL

Eg: M-CEJ = 0mm Eg: M-CEJ = -3mm Eg: M-CEJ = 3mm

PD = 6mm PD= 3mm PD = 9mm
CAL = 6mm CAL= 6mm
CAL = 6mm
WIDTH OF ATTACHED GINGIVA
• The attached gingiva from the base of the sulcus to the mucogingival
junction.
• The width of the attached gingiva is determined by subtracting the
sulcus or pocket depth from the total width of the gingiva (gingival
margin to mucogingival line).

Attached gingiva = gingival margin base of the sulcus - PD

TOOTH MOBILITY

• Grade 1 Slight mobility, up to 1 mm of horizontal displacement

in a facial-lingual direction
• Grade 2 Moderate mobility, greater than 1 mm of horizontal
displacement in a facial-lingual direction
• Grade 3 Severe mobility, greater than 1 mm of displacement in a
facial-lingual direction combined with vertical displacement
(tooth depressible in the socket)
 FURCATION INVOLVEMENT

• Naber’s probe is used for detection of

furcation involvement.
GLICKMAN'S CLASSIFICATION OF FURCATION
INVOLVEMENT

Grade I:
• Early bone loss may have
occurred with an increase in
probing depth, but
radiographic changes are not
usually found.
Grade II:
• Can affect one or more of the
furcations of the same tooth.
• The furcation lesion is
essentially a cul-de-sac with a
definite horizontal component.
• Radiographs may or may not
depict the furcation
involvement.
 Grade III.

• In early grade III involvement the opening may be filled

with soft tissue and may not be visible.

• May not be able to pass a periodontal probe completely

through the furcation because of interference with the
bifurcational ridges or facial/lingual bony margins.

• However, if one adds the buccal and lingual probing

dimensions and obtains a cumulative probing measurement
that is equal to or greater than the buccal/lingual dimension
of the tooth at the furcation orifice, it must be concluded
that a grade III furcation exists.

• Properly exposed and angled radiographs of early class III

furcations display the defect as a radiolucent area in the
crotch of the tooth .
Grade IV:
• The interdental bone is destroyed
and the soft tissues have receded
apically so that the furcation
opening is clinically visible.

• A tunnel therefore exists between

the roots of such an affected tooth.

• The periodontal probe therefore

passes readily from one aspect of
the tooth to another
• After collecting all the data the following has to be
written depending on the same

1. Diagnosis
2. Prognosis
3. Treatment Plan
 Before arriving at a periodontal diagnosis, the clinician
must answer 3 basic questions that are:
• What periodontal disease or condition does the patient
has?

• Is the periodontal disease or condition localized or

generalized ?

• How severe is the problem ?

How to write the diagnosis statement:

Extent + Severity + Disease Entity

EXTEND

• Generalized • Localized
• > or = 30% • < 30%