The state of the oral cavity largely determines the he alth of the whole organism as a whole, because there is a close relationship between them. To express diseases of the oral cavity, it is very convenient for dentists to use special dental indices. The index in a different way is a quantitative assessment of the state of the oral cavity at the time of the examination.
Involves almost all the components that have anything to do with the he alth 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 he althy and carious teeth, etc. These indices can not only to identify the presence of pathologies, the causes of destruction, but also to predict their further course, as well as to take certain preventive measures.
With the help of indices, the dentist can also find out:
- stage of tissue destructionperiodontal;
- units of teeth that cannot be restored, but only replaced with implants;
- number of deleted or dropped out;
- careful home hygiene;
- curvature in the bite;
- assessment of the effectiveness of the treatment.
Each type of violation is determined strictly by its index, they are all specialized.
What are indices
Periodontal indices (article 1999) in dentistry are designed to measure the dynamics of periodontal tissue damage. They help the doctor track the entire process of the spread of the disease, its depth and prognosis, and the need for specific treatment. At the appointment, the doctor uses both standard research methods and an index system, therefore, the assessment of the periodontal condition is accurate and comprehensive.
The periodontal index system in general
There are the following types of periodontal indexes in dentistry:
- IG are hygiene indices, they evaluate enamel contamination and the presence of tartar.
- IV - Inflammation Indices - assesses inflammatory gum disease, periodontitis and periodontal disease.
- IDK – index of bone tissue destruction; combined indices.
All indexes are not difficult and do not require special equipment, easy to identify. There are a lot of them, the main ones will be analyzed further.
What are subdivisions of indexes
Distinguish between periodontal indices by reversibility, i.e.regressible, non-regressible, and complex.
Reversible - monitor the dynamics of the pathological process, the effectiveness of treatment. These indexes target the current symptoms of pathologies in their acute phase:
- bleeding and inflammation of the gums;
- loose teeth;
- pockets of inflammation - gingival and periodontal.
The most commonly used of these periodontal indices are papillary-alveolar, PI, IG - hygiene indices, of which there are more than 15 in general (Schiller-Pisarev, Pakhomov index, Ramfjord, etc.). The data of these indexes can change, and problems respond well to treatment and have a good prognosis, i.e. reversible.
Irreversible indices: gingival recession, X-ray, etc. Here, processes of an irreversible nature are already recorded 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 provide a comprehensive assessment of periodontal he alth. For example, the Komrke index includes a large number of studies: the PM index, the depth of the gum pockets, the degree of tissue atrophy, bleeding gums, the degree of looseness of the teeth (indicates the degree of inflammation).
Periodontal disease
There are a lot of pathologies, but 5 main categories of periodontal diseases appear more often than others:
- Gingivitis - inflammation of the gum tissue.
- Periodontitis is an inflammation of the periodontium, when already soft tissues and bones undergo destruction and it is constantly growing.
- Periodontosis - there is a uniform resorption (destruction) of the bone. There are no signs of inflammation, there are dystrophic changes.
- Uncaused periodontal pathology - there is a progressive lysis (periodontolysis) of tissues. Lysis is simply tissue breakdown.
- Various periodontal tumors - periodontoma.
Segments in dentistry
Often at the dentist's appointment you can hear, for example, that a filling is needed for 45, or 37, 73 teeth, etc. For an ordinary person, this is incomprehensible, because a person has only 32 teeth. However, we are not talking about an excess of teeth, this simply the numbering system of teeth and jaw segments adopted by dentists.
There are a lot of such systematizations and they have their own application in different dentistry. But today, the International European two-digit Viola system according to WHO is considered generally accepted. It was developed in 1971. It is necessary to have an understanding of 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 most anterior (frontal) teeth are the incisors. They are flat, with a sharp edge and serve to bite off food. There are only 2 of them on each half of the jaw, i.e. in total 8. The beginning of the calculation is taken from the incisors: the central ones at number 1, and the ones following them - number 2. These numbers have all 4 incisors in each half of the jaw.
For tearing andfood retention, a person has fangs - they are cone-shaped and there are only 4 of them. Their ordinal number is 3.
Next are chewing teeth - they are divided into small and large - premolars and molars. Premolars are numbered 4 and 5; and 6 and 7 are already molars.
Teeth number 8 - appear after 25 years, and not for everyone. They call them wisdom teeth. But they are present in the numbering system.
Jaw segments
It turns out that each number has 4 teeth, and there is no clear definition of the location for a particular 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 segment count starts from the top right (the side of the patient, not the dentist). Next comes the left upper half of the jaw (maxillary), segment 3 is the left but lower half of the mandible, segment 4 is the lower right 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 below.
The huge advantage of the Viola system is that there are no cumbersome tooth names, the location of the required tooth is indicated exactly, the risk of error in this case is minimal. This numbering is very convenient in the work of a dentist, for example, when referring a patient to an X-ray, for the radiologist himself when describing a panoramic image 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 existing gingivitis in a patient - the duration of its appearance and how deeply it has penetrated. Therefore, it is referred to as the gingivitis index. It reflects the initial changes in the periodontium, the inflammatory response (quantitatively).
Points are given depending on the place of inflammation of the gums:
- there is an inflamed papilla – 1;
- inflammation of the outer wall of the gingival sulcus – 2;
- alveolar gingiva – 3.
The total indicator depends on the sum of points: 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 is 24;
- 28 - aged 12-14,
- 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.
PI index
PI, or Russell's periodontal index, was proposed in 1956 and is intended to establish the stage of development of gingivitis, but also for periodontitis:
- pocketing, tooth mobility;
- sets the severity of bone destruction of the tooth, i.e. its loss.
When calculating the periodontal PI, the index values are summed up and the quotient is obtained, taking into account the examined teeth.
The scoring criteria are obtained as follows:
- absencesigns of pathology - 0 points - no pathological changes, i.e. its intact state;
- 1 - mild gingivitis (the tooth is almost completely preserved because the inflammation has not covered the perimeter of the tooth);
- 2 - gingivitis has spread circularly, but the tooth-gingival junction is intact;
- 4 - resorption of the septa of the tooth has begun (this is detected only on x-rays);
- 6 - the gum is inflamed, there is a gum pocket, but the tooth does not wobble and is fully functional;
- 7 - resorption of the interdental septum has reached the length of the root;
- 8 - periodontal tissues are destructured and the chewing function of the tooth is not performed (the tooth is loose, can be displaced), resorption exceeds the length of the root, the formation of an intraosseous pocket is also possible.
When determining the PI index, all teeth are examined except for 8.
Periodontal index PI determines the degree of plaque on the enamel and refers to periodontitis indices. There are 4 degrees of plaque - from 0 to 3. Zero degree - there is no plaque, the last, third degree - plaque is pronounced.
The periodontal index PI is obtained from the result of dividing the scores for all teeth by the number of examined. Based on the results of such an examination, we can talk about the degree of gingival inflammation according to an 8-point system, starting from 1.5 points. The last degree is the hardest.
CPITN Index
The CPITN periodontal index is always considered a marker of the need for the treatment of periodontal diseases. It has been used since 1982 and is recommended by WHO. To identify indicatorsThis index is used to divide the dentition into 3 sextants - 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 state of both jaws. From each sextant, the most diseased periodontal tooth is taken. Bleeding gums, the prevalence of tartar and the severity of periodontal pockets are determined.
Research is carried out with a special probe, each tooth is examined for the presence of these violations. They are registered and analyzed by codes:
- no signs of disease - this is 1 point;
- if during the study the blood came out immediately or after 30 seconds. is 2 points;
- presence of tartar (mineralized deposits) - above and below the gum;
- overhanging filling - they delay the emerging plaque - this is 3 points;
- detection of a gingival pocket up to 5 mm deep - 4 points;
- if the depth of the periodontal 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 calculation).
Next, the sum for each tooth is divided by 6 and the CPITN indicator is obtained by codes:
- 0 - no treatment required;
- 1 - correction and control of oral hygiene individually for this patient;
- 2 - professional cleaning and elimination of the above factors of plaque retention on tooth enamel; introduction to proper oral hygiene;
- 3 -the need for curettage (removal of plaque);
- 4 - comprehensive periodontal treatment.
Complex Index (Leus, 1988) – KPI
Complex periodontal index KPI (it is also called combined) is the average value of all indicators of periodontal damage.
Designed for group study of periodontal he alth status in people of different ages:
- in children under 4;
- schoolchildren under 14;
- and boys.
For CPI, each tooth is evaluated first, and then the sum of the codes is divided by the number of teeth examined. This index is obtained.
Tweezers and a probe are used for research. They determine the formation of clusters, the depth of periodontal pockets, check the mobility of the teeth. In case of damage to several teeth, they are guided by the heaviest tooth.
Received codes and criteria:
- he althy teeth - no plaque and no inflammation - code 0;
- there is a certain amount of dental white plaque (soft and easily removed), which was determined during examination with a probe on the surface of the enamel - this is 1;
- 2 - light probing resulted in slight bleeding;
- 3 - there is tartar (even if small);
- 4 – periodontal pocket detected; 1-2 degree tooth loosening - code 5.
Ramfiord Index (dental plaque)
Index S. P. Ramford (1957) has 2 criteria: the degree of inflamed gums and the depth of 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 papillarytriangle, but also takes into account the height of the root exposure due to gum retraction (expansion of the gingival sulcus with exposure of the neck and part of the root of the tooth).
The distance is measured from the border of the enamel-cement to the top of the papilla triangle. With an atrophied gum, these 2 indicators are plus, with hypertrophy, they take the difference between them. The periodontium is examined on 2 surfaces - lingual and vestibular - for the amount of plaque that pollutes the enamel, as well as for dental subgingival calculus.
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.
Periodontitis Data:
- pocket of acceptable sizes – 0–3;
- 4 - pocket depth 3 mm;
- 5 - depth 6 mm;
- 6 - depth greater than 6 mm.
The sum of the scores obtained is divided by the number of dental units examined.
This index is important for those people who cannot or cannot be x-rayed. In the elderly, this index is inappropriate to identify, since there are age-related changes in the periodontium: gum retraction, bone tissue involution.
Gingival sulcus bleeding (SBI) by Muhlemann and Son
SBI - will show the early stages of periodontitis and gingivitis. Outwardly, the oral mucosa may look he althy, but there may be hidden bleeding. With these pathologies, bleeding is possible even with a slight lesion.
The method of examination of the teeth is carried out as follows: without pressure, they are carried out with a buttonprobe along a certain gum line and look for a bleeding reaction.
There are 3 degrees of bleeding strength:
- 0 - no bleeding at all;
- 1 - blood appears only in the second half of the minute;
- 2 - blood appeared immediately or within 30 seconds;
- 3 - Blood is seen with brushing teeth and eating.
Simplified sulcus bleeding index
The probe is not used here, only the patient's responses are recorded in the form of a test. According to the answers to the questions asked, the patient determines the severity of gingival inflammation.
It is used only during ongoing treatment. For its effectiveness and often combined with the API index.
The situation is estimated therefore approximately. So, the 1st and 3rd quadrants 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 degree of gum inflammation. With a probe, a furrow is made along the interdental papillae and observed for 30 seconds.
Gingivitis grades of 4 points:
- 0 – no blood;
- 1 - the appearance of only blood points;
- 2 - spot bloody appearances along the line of the furrow;
- 3 - blood fills the triangle between the teeth.
- 4 - heavy bleeding.
Examination of the papillae - PapillaBleeding - is carried out in the following quadrants: gums of the 1st and 3rd quadrants from the lingual surface and 2nd and 4th quadrants - from the vestibular side (vestibular side - vertical wallteeth from lips and cheeks). Each quadrant is calculated first, then the arithmetic mean is calculated.
Conclusion
All dental indexes are individual in their own way and help to assess the condition of the oral cavity from different angles. The surveys used are easy to perform and do not cause inconvenience to the patient. Painless and do not require special strict preparation. The solutions used for staining teeth in detecting bleeding and plaque staining are completely harmless.
It is very important to understand why a periodontal index is needed. Its role is that thanks to it, in the aggregate, the doctor can evaluate not only the initial stages of pathologies, but also make a forecast for the development of the disease in the future, even after treatment.
