Periodontal indices in dentistry

The condition of the oral cavity largely determines the health of the whole organism as a whole, because there is a close relationship between them. It is very convenient for dentists to use special dental indices to express oral diseases. The index in a different way is quantitative data on the assessment of the state of the oral cavity at the time of the examination.

Involves almost all components that have at least some relation to the health of teeth and gums. This includes the degree of plaque on the enamel, the presence of tartar, tissue damage and the degree of this lesion in the periodontium, inflammation reactions, the integrity and strength of tooth units, the presence and severity of gum pockets, the ratio of healthy and carious teeth, etc. These indices may not only to identify the presence of pathologies, the causes of destruction, but also to predict their further course, and also to take certain preventive measures.

Using indices, the dentist can also find out:

• stage of destruction of periodontal tissues;
• units of teeth that cannot be restored, but only replaced with implants;
• the number of deleted or dropped out;
• thoroughness of house hygiene;
• malocclusion;
• assessment of the effectiveness of the treatment.

Each type of violation is determined strictly by its index, they are all specialized.

What are indexes?

Periodontal indices (article 1999) in dentistry are designed to measure the dynamics of periodontal tissue damage. They help the doctor to track the entire process of the spread of the disease, its depth and prognosis, the need for specific treatment. At the appointment, the doctor uses both standard research methods and the index system, therefore, the assessment of the periodontal condition is accurate and comprehensive.

Periodontal index system in general

The following types of periodontal indices in dentistry are distinguished:

1. IG are hygiene indices; they give an assessment of enamel contamination and the presence of tartar.
2. IV - inflammation indices - the inflammatory pathology of the gums, periodontitis and periodontal disease are assessed.
3. IDK - bone destruction index; combined indexes.

All indexes are not difficult and do not require special equipment, easy to identify. There are a lot of them, then the main ones will be sorted out.

What index divisions exist

Periodontal indices are distinguished by reversibility, i.e., subject to regression and not subject, as well as complex.

Reversible - track the dynamics of the pathological process, the effectiveness of treatment. These indices are aimed at the current symptoms of pathologies in their acute period:

• bleeding and gum disease;
• loose teeth;
• pockets of inflammation - gingival and periodontal.

The most frequently used of these periodontal indices are papillary-alveolar, PI, IG - hygiene indices, which in general number more than 15 (Schiller-Pisarev, Pakhomov, Ramfjord index, etc.). The data of these indices can change, and the problems respond well to treatment and have a good prognosis, i.e. reversible.

Irreversible indices: gingival recession, radiological, etc. The processes of irreversible nature are already recorded here when it comes to the consequences and complications of pathologies, such as resorption (resorption) of the bone component of the alveolar processes, recession or amyotrophy of the gums. Treatment is ineffective.

Complex periodontal indices produce a comprehensive assessment of periodontal health. For example, the Komrke index includes a large number of studies: the PM index, the depth of the gingival pockets, the degree of tissue atrophy, bleeding gums, the degree of looseness of the teeth (indicating the degree of inflammation).

Periodontal Disease

Pathologies exist quite a lot, but more often than others 5 main categories of periodontal diseases appear:

1. Gingivitis is an inflammation of the gum tissue.
2. Periodontitis is an inflammation of the periodontium, when already soft tissues and bones undergo destruction and it constantly grows.
3. Periodontal disease - there is a uniform resorption (destruction) of the bone. There are no signs of inflammation, there are dystrophic changes.
4. Unreasonable periodontal pathology - a progressive lysis (periodontolysis) of tissues occurs. Lysis is simply the breakdown of tissues.
5. Various periodontal tumors are periodontal tumors.

Segments in Dentistry

Often at the dentist's office you can hear, for example, that you need a filling for 45, or 37, 73 teeth, etc. For an ordinary person, this is not clear, because a person has only 32 teeth. However, this is not about excess teeth, it's just a number plate accepted by dentists system of teeth and jaw segments.

There are a lot of such systematizations, and they have their own application in different dentistry. But today, the WHO European International Two-Digit Viola System is considered generally accepted. It was developed in 1971. One needs to have an idea about it in order to understand some indices.

Tooth numbers

Everyone knows that the teeth are symmetrical, that is, the right and left halves of both jaws are identical. In addition, they have their own numbering.

The front (front) teeth are incisors. They are flat, with a sharp edge and are used to bite off food. There are only 2 of them on each half of the jaw, that is, only 8. The beginning of the calculus is taken from the incisors: the central ones are under number 1, and the next ones are number 2. These numbers have all 4 incisors in each half of the jaw.

For tearing and holding food, a person has fangs - they are cone-shaped and there are only 4. Their ordinal number is 3.

Next are the chewing teeth - they are divided into small and large - premolars and molars. Premolars are numbers 4 and 5; and 6 and 7 are already molars.

Teeth number 8 - appear after 25 years, and not all. They are called the teeth of wisdom. But they are present in the numbering system.

Jaw segments

It turns out that 4 teeth have each number, and there is no clear location for a specific tooth. To fix this, there are jaw segments. The segment number is written in tens, and the tooth number in units. So it turns out that each tooth has a two-digit number.

So, the countdown of the segments starts from the top right (side of the patient, not the dentist). Next is the left upper half of the jaw (maxillary), the 3rd segment is the left, but the lower half of the mandible, the 4th segment is the right lower side of the mandible. Thus, the 45th tooth is just the fifth premolar on the fourth segment of the jaw, that is, the second premolar on the right side of the mandible from the bottom.

A huge advantage of the Viola system is that there are no bulky teeth names, the location of the necessary tooth is indicated exactly, the risk of error in this case is minimal. This numbering is very convenient in the work of the dentist, for example, when the patient is referred to an X-ray, for the radiologist himself when describing a panoramic picture of the teeth.

Papillary-marginal-alveolar index (pma)

Introduced since 1947, the index is considered one of the basic ones and gives an idea of ​​the patient’s existing gingivitis - the duration of its appearance and how deeply it penetrated. It is therefore attributed to the gingivitis index. It reflects the initial changes in periodontal, inflammatory response (quantitatively).

Points are set depending on the place of gum inflammation:

• there is an inflamed papilla - 1;
• inflammation of the outer wall of the gingival groove - 2;
• alveolar part of the gum - 3.

The total indicator depends on the total score: the sum of all units X100 / 3X the number of teeth in the patient. When calculating PMA, the total number of teeth will be different depending on age:

• at 6-11 years old - this is 24;
• 28 - at the age of 12-14 years,
• 30 - from 15 years old.

There are 3 stages of gingivitis:

• up to 30% - mild inflammation;
• up to 60% - inflammation of moderate neglect;
• over 60% - severe gum disease.

RI Index

RI, or the Russell periodontal index was proposed in 1956 and is intended to establish the stage of development of gingivitis, but also for periodontitis:

• pockets, tooth mobility;
• establishes the severity of bone destruction of the tooth, i.e., its loss.

When calculating the periodontal index PI summarize the indices and get the quotient taking into account the teeth examined.

Scoring criteria are obtained as follows:

• the absence of signs of pathology - 0 points - there are no pathological changes, i.e., its intact state;
• 1 - mild gingivitis (the tooth is preserved almost completely, because the inflammation did not cover the perimeter of the tooth);
• 2 - gingivitis has spread circularly, but the tooth-gum connection is not broken;
• 4 - resorption of the septum of the tooth began (this is detected only on x-ray);
• 6 - the gum is inflamed, there is a gingival pocket, but the tooth does not stagger and is fully functional;
• 7 - resorption of the interdental septum has reached the root length;
• 8 - periodontal tissues are degraded and the chewing function by the tooth is not performed (the tooth is loose, can be displaced), the resorption exceeds the root length, and the formation of the intraosseous pocket is also possible.

When determining the PI index, all teeth except 8 are examined.

The periodontal index PI determines the degree of plaque on the enamel and refers to the periodontitis indices. There are 4 degrees of plaque - from 0 to 3. Zero degree - no plaque, the last, third degree - plaque expressed.

Periodontal PI index is obtained from the result of dividing scores for all teeth by the number of examined. According to the results of such an examination, we can talk about the degree of gingival inflammation in the 8-point system, starting from 1.5 points. The last degree is the hardest.

CPITN Index

The periodontal CPITN index is always considered a marker of the need for treatment of periodontal diseases. It has been used since 1982 and is recommended by WHO. To identify indicators of this index, dividing the dentition into 3 sextants is used - frontal and 2 lateral. Not all teeth are examined, but only selective ones. It is necessary to examine the tissues around the numbers - 17, 16, 11, 26, 27, 37, 36, 31, 46 and 47. These units, that is, these 10 teeth, give a complete picture of the condition of both jaws. From each sextant, the tooth that is the most periodontal sick is taken. The bleeding of the gums, the prevalence of tartar and the severity of periodontal pockets are determined.

Research is carried out by a special probe, each tooth is examined for the presence of these disorders. They are registered and analyzed by codes:

• there are no signs of the disease - this is 1 point;
• if during the study the blood came out immediately or after 30 seconds. - this is 2 points;
• the presence of tartar (mineralized deposits) - above and below the gum;
• overhanging seal - they delay the onset of plaque - this is 3 points;
• detection of gingival pockets up to 5 mm deep - 4 points;
• if the depth of the gingival pocket is up to 6 mm or more - 5 points;

X points - there is not a single tooth in the sextant or only 1 (moreover, 8 molars are not included in this calculus).

Next, the amount for each tooth is divided by 6 and get the CPITN indicator by codes:

• 0 - no treatment required;
• 1 - correction and control of oral hygiene individually in this patient;
• 2 - conducting professional cleaning and eliminating the above factors delay plaque on tooth enamel; familiarization with proper oral hygiene;
• 3 - the need for curettage (removal of plaque);
• 4 - complex treatment of periodontal disease.

Integrated Index (Leus, 1988) - KPI

Comprehensive periodontal KPI index (it is also called combined) - the average value of all indicators of periodontal lesions.

Designed for a group study of periodontal health status in people of different ages:

• in children under 4 years old;
• schoolchildren under 14 years old;
• and boys.

For KPI, each tooth is first evaluated, and then the sum of the codes is divided by the number of teeth examined. It turns out this index.

For research, use tweezers and a probe. They determine the formation of clusters, the depth of periodontal pockets, check the mobility of the teeth. With lesions of several teeth, they are guided by the heaviest tooth.

Received codes and criteria:

• healthy teeth - no plaque and no inflammation - code 0;
• there is a certain amount of white dental plaque (soft and easily removable), which was determined by examination with a probe on the enamel surface - this is 1;
• 2 - light sounding gave a slight bleeding;
• 3 - there is tartar (even a small one);
• 4 - periodontal pocket revealed; tooth recession of 1-2 degrees - code 5.

Ramfiord Index (Tooth Plaque)

The SP Ramford Index (1957) has 2 criteria: the degree of inflamed gum and the depth of the periodontal pockets. This is an indicator of periodontal disease. Unlike PI, it not only determines the depth of the pocket from the top of the papillary triangle, but also takes into account the height of the root exposure due to gum retraction (expansion of the gingival groove with exposure of the neck and part of the tooth root).

The distance is measured from the enamel cement border to the top of the papilla triangle. With atrophied gums, these 2 indicators are plus, with hypertrophy - they take the difference between them. Periodontium is examined on 2 surfaces - lingual and vestibular - on the amount of plaque polluting the enamel, as well as on the dental subgingival stone.

For gingivitis, indicators will be:

• 0 - no disease;
• 1 - locally, the gum is slightly inflamed;
• 2 - noticeable inflammation of a large area of ​​the gums;
• 3 - severe gingivitis.

Data on periodontitis:

• permissible pocket sizes - 0–3;
• 4 - pocket depth 3 mm;
• 5 - depth 6 mm;
• 6 - depth greater than 6 mm.

The sum of the estimates obtained is divided by the number of dental units examined.

This index is important for those people who cannot or cannot do an x-ray. In the elderly, this index is impractical to detect, since there are age-related changes in periodontal disease: gum retraction, bone tissue involution.

Gingival Fissure Bleeding (SBI) by Muhlemann and Son

SBI - will show the early stages of periodontitis and gingivitis. Externally, the oral mucosa may look healthy, but there may be occult bleeding. With these pathologies, bleeding is possible even with a slight lesion.

The procedure for examining teeth is carried out as follows: without pressure, a button probe is carried out along a certain line of the gums and they look at the bleeding reaction.

There are 3 degrees of bleeding power:

• 0 - bleeding did not appear at all;
• 1 - blood appears only in the second half of the minute;
• 2 - blood appeared immediately or within 30 seconds;
• 3 - blood is visible with brushing and eating.

Simplified gingival sulcus hemorrhage index

Here the probe is not used, only the patient's responses are recorded in the form of a test. The answers to the questions asked the patient determine the severity of gingival inflammation.

It is used only during treatment. For its effectiveness, it is often combined with an API index.

The situation is therefore estimated approximately. So, the 1st and 3rd quadrant are evaluated on the surface of the buccal-oral, and on the lingual side - 2 and 4.

Papillary bleeding (PBI) by Saxer and Miihiemann

The periodontal bpe index (PBI) is needed to determine the extent of gum disease. The probe conducts the furrow along the interdental papillae and observe for 30 seconds.

The severity of gingivitis is 4 points:

• 0 - no blood;
• 1 - the appearance of only blood points;
• 2 - point blood protrusions along the furrow;
• 3 - blood fills the triangle between the teeth.
• 4 - intense bleeding.

The study of the papillae - PapillaBleeding - is carried out in the following quadrants: gums of the 1st and 3rd quadrants from the lingual surface and the 2nd and 4th quadrants from the vestibular side (the vestibular side is the vertical wall of the tooth from the lips and cheeks). First, each quadrant is calculated, then the arithmetic mean is derived.

Output

All dental indices are individual in their own way and help to evaluate the condition of the oral cavity from different sides. The examinations used are simple to carry out and do not cause the patient any inconvenience. They are painless and do not require special rigorous preparation. The solutions used for staining teeth when detecting bleeding and staining of plaque are completely harmless.

It is very important to understand why a periodontal index is needed. Its role is that thanks to it, in total, the doctor can evaluate not only the initial stages of pathologies, but also make a prediction for the development of the disease in the future, even after treatment.