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  1. 1. DEFINITIONS OF INDICES
  2. 2. 1. An Index can be defined as a 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. (Russal A. L) 2. An Index is an expression of clinical observation in numerical values which is used to describe the status of the individual or group with respect to a condition being measured. (Wilkins Esther M.)
  3. 3. 3. Dental Index is an abbreviated measurement of the amount or condition of disease in a population; a numerical scale with a defined upper and lower limits designed to permit and facilitate comparison with other population classified by the same criterion and methods. (Zarkowski Pamela) 4. Epidemiologic Indices are attempts to quantitate clinical conditions on a graduated scale, thereby facilitating comparison among populations examined by the same criterion and methods. (Glickman Irving)
  4. 4. 1. To increase understanding of the disease process. 2. To discover populations at high and low risk. 3. To define specific problem under investigation.
  5. 5. 1. Clarity, Simplicity and Objectivity 2. Validity 3. Reliability 4. Quantifiability 5. Sensitivity 6. Acceptability
  6. 6. Measures the conditions that can be changed Indices for periodontal conditions Reversible Measures the conditions that will not change. Dental caries index Irreversible A. Depending upon the directions in which the scores can fluctuate
  7. 7. Measures patients entire periodontium or dentition Russels Periodontal index Full Mouth Measures only a representative sample of dental apparatus Greene and Vermillions oral hygiene index-Simplified Simplified B. Depending upon the extent to which areas of oral cavity are measured
  8. 8. Disease Index Symptom Index Treatment Index C. Depending upon the entity they measure
  9. 9. D. Special Category Indices Measures the presence or absence of a condition. Index measuring presence of dental plaque without an evaluation of its effect on gingiva. Simple Index Measures all the evidence of a condition, past and present. DMF index for dental caries Cumulative Index
  10. 10. INDICES FOR DENTAL
  11. 11. It is a dyanamic process of demineralisation due to microbial metabolism resulting in net mineral loss which subsequently may not always lead to cavitation Frejeskov 1997 DENTAL CARIES
  12. 12. Dental caries is an irreversible microbial disease of calcified tissues of the teeth, characterised by demineraliasation of the inorganic portion and destruction of the organic substance of the tooth, which often leads to cavitation SHAFERS
  13. 13. HISTORICAL BACKGROUND OF CARIES INDICES. BODECKER CF and BODECKER HWC described a Caries Index in 1931 Modified it later by addition to counting of decayed surfaces. DEAN HT Counting carious teeth visibly in the mouth MELLANBY M In 1934 described the carious lesions depending upon the degree of severity 1 = Slight caries 2 = Moderate caries 3 = Advanced caries
  14. 14. First systematic description - DMF index Attributed to Knutson JW, Henry Klein and Carole Palmer in their studies of dental caries in Hagerstown and Maryland (1930) FINALLY.
  15. 15. MOST COMMONLY USED OTHER MIXED DENTITION INDICES DMFT 1. Primary Teeth (dmft & dmfs) 2. Permanent Teeth (DMFT & DMFS) 1. Stones Index 2. Caries Severity Index 3. Czechoslovakian Index 4. Caries Susceptibility Index 5. Modified DMFT Index 6. Functional Measure Index 7. Tissue Health Index 8. Dental Health Index 9. DMFS Percentage Index 10.Mollers Index 11.Restorative Index INDICES FOR DENTAL CARIES
  16. 16. DIAGNOSING PIT AND FISSURE CARIES : -CRITERIA ANGLO-SAXON SYSTEM {LIBERAL} By Horowitz H.S. In 1972 The pits and fissure on the occlusal, vestibular and lingual surfaces are carious when- 1 The explorer catches after insertion with moderate to firm pressure . 2. When the catch is accompanied by one or more of the following signs of decay a) Softness at the base of the area. b) Opacity adjacent to the area provides evidence of undermining or demineralization. c) Softened enamel that can be scraped by explorer. NOTE : - Areas should be diagnosed as soundwhen there is apparent evidence of demineralisation but no evidence of softness.
  17. 17. DIAGNOSING PIT AND FISSURE CARIES : -CRITERIA EUROPEAN SYSTEM {CONSERVATIVE} By Backer-Dirks O., Houwink B., Kwant G.W. in 1961 Teeth are first dried and sharp new explorers are used Upper molars : Mesio-occlusal and disto-occlusal-palative fissures are assessed separately. Lower molars : Occlusal fissures and buccal pits are assessed separately. C I - Minute black line at the base of fissure C II - In addition, a white zone along margins of fissure. C III - Smallest precipitable break in the continuity of enamel. C IV - Large cavity, more than 3mm wide.
  18. 18. SOME OTHER IMPORTANT INDICES 1. Root Caries Index (RCI) 2. Dental Caries Severity Index For Primary Teeth
  19. 19. Developed to determine the prevalence of coronal caries. Is a simple, rapid, versatile, universally accepted and widely used index for several decades. It is used to determine total dental caries experience past and previous. The DMFT Index is an irreversible index (meaning that it measures total lifetime caries experience). The tooth either remains decayed or if treated it is extracted or filled.
  20. 20. Procedure The DMFT Index is applied only to permanent teeth is composed of three components.
  21. 21. Examination of DMFT Index has to be done with : - 1. Favorable lighting conditions 2. A No. 3 plain mirror 3. A Fine-pointed pig-tail explorer
  22. 22. Third molars and Unerupted teeth Congenitally, missing and supernumerary teeth Teeth removed for reasons other than dental caries Teeth restored for reasons other than dental caries Primary tooth retained with permanent successor erupted. All 28 teeth are examined. Teeth not to be included
  23. 23. Principles and Rules in recording DMFT:1. No tooth must be counted more than once. It is either decayed, missing, filled or sound. 2. Decayed, missing, and filled teeth should be recorded separately since the components of DMF are of great interest. 3. When counting the number of decayed teeth, also include those teeth which have restorations with recurrent decay. 4. Care must be taken to list as missing only those teeth which have been lost due to decay. 5. Also included should be those teeth which are so badly, decayed that they are indicated for extraction.
  24. 24. The following should not be counted as missing: a) Unerupted teeth b) Missing teeth due to accident c) Congenitally missing teeth d) Teeth that have been extracted for orthodontic reasons. 6. A tooth may have several restorations but it is counted as one tooth. 7. Deciduous teeth are not included in DMF count. 8. A tooth is considered to be erupted when the occlusal surface or incisal edge is totally, exposed or can be exposed by gently, reflecting the overlying gingival tissue with the mirror or explorer. 9. A tooth is considered to be present even though the crown has been destroyed and only the roots are left.
  25. 25. WHO modification of DMF Index (1986)1. All third molars are included. 2. Temporary restorations are considered as decayed 3. Only, carious cavities are considered as D', the initial lesions (Chalky spots. stained fissures, etc) are not considered as D'. The DMF Index can be applied to denote the number of affected teeth (DMFT) or to measure the surfaces affected by dental caries (DMFS).
  26. 26. For tooth absent , O Missing Tooth - unerupted , impacted , congenitally missing. X Extracted permanent tooth. E Excluded tooth or tooth space 1 Sound permanent tooth 2 Filled permanent tooth 3 Decayed permanent tooth
  27. 27. Calculation of the Index Individual DMFT: total D+M+F= DMF. Group Average: Total DMF Total number of the subjects examined Percent Needing Care Total number of decayed tooth Total number examined Percentage of teeth lost: Total number of missing teeth Total number examined Percent of filled teeth : Total number of filled teeth Total DMFT
  28. 28. Missing permanent teeth/100 Total number of missing teeth X 100 Total number examined The maximum possible DMFT score is 32 ( if third molars are included ) DMFT score is 28 ( if third molars are excluded)
  29. 29. Advantages of DMFT index 1. Because of its wide spread use world wide over the past 60 years , it provides a reasonably accurate historical account of changes in prevalence of dental caries.
  30. 30. Limitations of DMFT Index: 1.DMFT values are not related to the number of teeth at risk. 2. DMFT index can be invalid in older adults because teeth can become lost for reasons other than caries. 3. DMFT index can be misleading in children whose teeth have been lost due to the orthodontic reasons. 4. DMFT index can over estimate caries experience in teeth in which "preventive fillings" have been placed. 5. DMFT Index is of little use in studies of root caries.
  31. 31. OTHER METHODS OF DMF EXMINATION Shorthand' Methods 1. Intended for use in surveys where basic prevalence is assessed. 2. Based on examination of selected teeth only 3. Objective is to decrease the time taken for each examination and still provide valid data.
  32. 32. I. WORLD HEALTH ORGANISATION (WHO) has described a shorthand method 1. Recommends the use of "half-mouth" DMF in its basic survey techniques. 2 Objective is to obtain assessments of caries prevalence in a population which has not been previously surveyed. 3. Half the upper arch only is scored. then the contra lateral lower half arch and the results doubled. It is Quicker and easier t

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