 Hello everyone, welcome back to another session in dentistry ammo. So this topic is oral health assessment form So the name gives an idea It assess the oral health completely So usually a part of oral health can be assessed using various oral Entices such as oral hygiene index plague index in Java index bleeding index dental caries index or Paradontal index such as resell index CPI CPI TN Tains fluorosis index so many entices we have So each index assess a part of oral health But this is a form or pro forma which assess the entire oral health So it is a very common tool used by the research people to assess oral health and it is very universally Accepted it is very valid and very reliable Because it has put forward by none other than W. H. O. That is World Health Organization in 1997 So this is not the Latest version we have 2013 version also, but it was started in 1971 that is the first edition Came then the 1977 second edition then 1986 then the fourth edition this is fourth edition and we have recently The fifth edition one too So it is getting updated by decade or Every decade so sometimes it is updated twice in a decade then it came the third edition 1997 fourth edition then it was a longer period and it was recently updated in 2013 the uptation because there was a gradual change in the pattern of disease and They used to modify the index which they included in the assessment form because in 97 the periodontal indices was measured by a Russell index, but later it was CPI index with loss of attachment So that is how they Modified it similarly the lots of difference between the fourth edition and fifth edition that I will be Explaining you in another session. Okay, so in a one patient or two patient or a very few patient We can use case histories that is the return format the qualitative data But if we are going for a research purpose or a conducting a survey on 1,000 people or 2,000 people or we are doing the same in many places or many states or districts or countries The case is free Reliability and its reproducibility is a big question. So we need to have a fixed criteria to assess the oral health That is how this came into existence. It has got only quantitative data because we are entering everything in numbers So in normal case history, we take general information Then the chief complaint history of presenting illness Medical history and other dental history, then we go to the extra oral examination We have DMJ lymph nodes any other lesions then we go to Intraoral soft tissue then heart tissue and finally the dental caree status the periodontal status the malocclusion status or the prosthetic status or prosthetic need and The enamel hyperplasia or the dental fluorosis. So all things we are Assessing in a case history the same thing we are doing here, but everything in a number format So we are quantifying it. We have fixed criteria So we can easily reproduce it. We can use it anywhere at any time There is always a reliability because we have fixed criteria So if it is in a normal cases free scenario, there are chances of high Variability between the examiners or between the researchers or dentists So in order to avoid all those problems we use oral health assessment Since it's from WHO. There is no question of reliability or validity. It is all So the validity and reliability is already proven. So it is very widely used to assess oral health Mainly in research purpose. So we'll start with the Oral health assessment form fourth edition. That is 1997 So this is the WHO oral health assessment form 1997 you can see it has got many blank spaces Totally we have 180 blank spaces where we need to enter Alphabets or numbers. Okay, so everything what we enter in a quantified manner So we have the country here then the Year month day where the examination is being conducted identification number of the person the Examiner whether it is the first or second Whether it is original or duplicate then the name of the person then his date of birth We need to enter year and month Then age and years then the gender male or female then ethnic group occupation So I'll come up one by one. So I just have a glance on it occupation then geographic location Then we have the extra oral examination. We have the lesions or TMG problems Then comes the oral mucosa problem, then the enamel hyperplasia or fluorosis then the pedodontal status CPI and loss of attachment Then comes the dentition status that is mainly the KDs and its associated problem Then the prosthetic status and prosthetic need Then we have the malocclusion that is dental facial anomalies and finally the need for immediate care and referral So ultimately it is exactly like a case history, but in a different format So everything we enter here is number mostly number and sometimes alphabets So comparison is very easy because we are not writing any sentence So subject to variation is very very minimal. So high reliability is the Striking feature of world oral health assessment form so we'll start with the first column that is The column number One to four or the boxes one to four boxes one to four is the country quote So actually Investigator should write the name of the country in which the survey was conducted in capital letters. Okay, and Boxes one to four are reserved for the WHO court for the country. That is for WHO court the court one to four then the year and month when the examination or the research is being carried out so if it is 2013 or 2021 Then month Jan then we have day 15 So mostly we can go for 2101 that is The box five to eight then we can put one and five on Boxes nine and ten Then identification number Depends on the number of patients if we have Thousand patients and the first person should be zero zero one if we have hundred patients It will be zero zero one if we have just ten patients. It will be zero one and The examiner sometimes We may have many examiners because the study might be very huge So that time the number of examiner should be entered in that box number 15 and Sometimes for checking reliability same Performer will be duplicated. So that time we need to write original or duplicate only one. Okay Then we can write The name of the person in ball lettuce then similarly date of birth year if it is 86 May month we can write eight six and zero five and 21 and 22 boxes are age in years that is can write 34 34 Then the gender one or two that is in the box number 23 then the ethnic group Each country has different different ethnic groups if we have a standard criteria Ethnic groups we can enter that ethnic group number into that box Otherwise, we can leave it blank or we can just enter nine means not recorded Occupation also if we have a standard criteria in your country You can enter that in India. It is based on Kuppaswamy scale most commonly used So Kuppaswamy scale Occupation criteria we can use so I'll be doing another video on Kuppaswamy scale So that Standardized code we can use then the geographic location. So location also we can have 0 to 98 Locations we need to list out prior to the investigation and Wherever the study is being conducted. We need to enter that location can be a school a village or any place If it is not entering we need to enter nine and nine that is not recorded Since we have two boxes we are entering nine and nine and the location type is urban peri urban or rural So in WHO assessment form there are criteria how a place be urban peri urban and rural So according to that we need to enter in box number 28 and other data if we have any special data on smoking or Like or fluorosis or any others data if we have we can enter that data so if we have any data on the tobacco Usage or the level of fluoride in water or the sugar intake So any such thing we have We can enter in box number 29 and 30 Then contra-indication is there we can Mention it as one or zero In clinical examination We are just assessing the patient's condition extra orally that is any lesions any ulcers present on head neck, limb, nose, cheeks or any position if anything is there Just go through this and find out the location and enter the number in box number 32 Suppose your patient's upper and lower lip abnormality is there we can enter 6 in box number 32 if it is not there we can just enter 9 that is not recorded If patient has no problem we can enter zero regarding the temporal mandibular joint So it is just like a case history first we entered the demographic data then we collected the extra oral So now we are in temporal mandibular joint Assessment, so we have symptoms and signs any symptoms we enter one in box number 33 no symptom zero If the patient is in a condition where the examination is not possible can enter nine in Signs we have three options clicking Tenderness or reduced jaw mobility that is 34 35 and 36 boxes So if any signs other we can enter one in that respective box If the patient is okay, we enter zero if we are not able to record it we can enter nine Now we have the oral mucosa and its location so we have two Sets of boxes that is 37 38 39 on left side 40 41 and 42 on right side So left side we need to enter the conditions of oral mucosa now. We are into intraoral cavity, okay? On the right side, we have locations so on a horizontal manner so on a horizontal manner We need to enter number with respect to the condition here and on the right side where it is located so On a raw wise means the condition and its location so we can enter three conditions and locations So that is box number 37 to 42, okay? So we have one example here so you can easily assess it 2 2 4 1 so in 37 we have 2 That means look up like ya and 4 means buckle mucosa so presence of Look up like ya on buckle mucosa again. We have 2 and 1 That means look up like ya on Commissures Then the next tank example you have 116 here 1 2 6 here So one is malignant tumor that is oral cancer, which is present on the location vermalion Sorry commissure and lips then we have candidate asses on Tunk so we can add additional boxes if the patient has more lesions, okay? So on left side boxes, we have the conditions on right side boxes. We have the location So horizontally the lesion and its location so you can enter because here we have the malignant tumor Sorry look up like ya that is 2 is look up like ya that is a different position That is I mean different location buckle mucosa and commissure So you can repeat it 2 4 2 1 that means presence of look up like ya on Commissure and Buckle mucosa that is how you enter Box number 30 7 to 42 37 38 39 are Conditions and 40 41 and 42 are location now we have enamel Opacities or hypoglycea so for that Measurement we need to learn The developmental defects of enamel index that is DDE index is being used So this index is being used to measure the enamel Hypoglycea or opacities so we need to learn that index according to that We have eight categories that is normal demarcated opacity diffuse opacity Hypoglycea other defects demarcated and diffuse demarcated Opacity with hypoglycea and diffuse opacity hypoglycea all three conditions So whatever is there you need to enter in the tooth number Premolar to premolar that is upper premolar to Right to left and lower first molars. So this is the teeth where the enamel Opacities or hypoglycea is mostly affected. So that is how this is selected now. We have the dental fluorosis So for dental fluorosis the deans fluorosis index is being used deans fluorosis index So we need to know how the deans fluorosis index calculation is done. That is the highest Two numbers will be selected. So it is a full mouth index. So all teeth will be measured Based on the criteria Then we will enter the scores. Okay, suppose this is point five. This is one two one one one two This is three three four one two one Similarly, all teeth will be entered and we need to select the highest two values So highest two value here is three and four Three and four is the highest two values Suppose if we have four here again, so it will be four and four highest value So highest two values. Okay, so here it will be four here. It will be three and four So in this case the deans fluorosis index is four in this case deans fluorosis index is three If the dissimilar value is there the lowest will be taken. Suppose if it is two and four The score will be two The least value will be taken. So this is a criteria. The highest two scores will be taken if the same Scores are there will take the one definitely. It will be the mean or the average So eight by four eight by two it will be four here. We are not taking the average, but we are taking The least score that is how the deans fluorosis index is entered Now we have CPI index that is for periodontal measurement with loss of attachment. Okay, this is Done by CPI prop the entire questionnaire is the oral health assessment is done by CPI prop So this category is for basically the pocket measurement and this one is for loss of attachment It is a quadrant wise We need to learn the CPI probe and its type its basic measurement We have zero one two three four X and nine healthy bleeding calculus Then the pocket four to five mm then pocket more than six mm in four to five mm Uh, can see the picture here The score three that is CPI score three means the black band is partially visible because the pocket depth is between four to five mm The black band is between three point five to five point five mm. So it is not Completely immersed in the pocket because some part of black band will be visible because it has up to five point five mm marking But the pocket pocket is up to five mm But whereas the score four CPI score four means pocket is six mm So black band will be completely invisible because it has only up to five point five mm marking That is three point five to five point five mm. So it will be completely invisible So that is how we differentiate score three and four if it is partly visible score three Completely invisible score four now the loss of attachment loss of attachment. This CPI is measured from gin chival margin gin chival margin to Sulkus base of the sulcus, but loss of attachment is measured from cj cj to base of sulcus So sometimes you may get a condition where the CPI score is two And you get the loss of attachment score three in case of recession because it is measured from cj So again, you insert the probe to the base of sulcus then correspond The score with respect to the cj will be measured So if it is coming within cj, uh, it will be score one That is a black band within cj one Then if it is between the lower ring and upper band of upper limit of black band is two then between the Rings it is three and beyond the ring it is four x is excluded sextant if there is no tooth Uh, which is in a measurable condition We need to exclude that sextant So that is loss of attachment now we have The dentition status and treatment needs So here you can see this is for maxillary teeth. This is for mandibular teeth. We have three Rows here one is for crown one is for root one is for treatment And we are going to measure the caries presence using cpi probe. That is a probe with ball tip Not the sharp probe or explorer So as I said we have three rows First one is for crown then for root and one for treatment both for upper and lower So you have the teeth present here that is one eight to two eight three eight to four eight Then we have The deciduous teeth five five two six five seven five two eight five And we have chords on the right side. That is a b c d e then f g and t For that is for primary teeth crown. There's no code for primary teeth root Now we have a permanent tooth crown That is zero two Nine and one t also is there then root zero one two three four five six is not there then seven eight There is no trauma then nine Again, we have treatment status again zero p f one two three four five six seven eight and nine now For let's take an example what we need to do is just i'm not drawing all the Tooth just take an example. Okay, so this is the crown status root status and treatment Basically we take permanent teeth sometimes if we have patients with deciduous teeth we can replace one one position by five one or one one by five two Similarly, so now we are taking permanent rendition. So I just Put it as one one one two one three one four and one five. Okay Let's take an example one one. There is no carries on crown. Okay, so there is no carries on crown. I put zero and root what I enter here That is Root without any exposure. That is completely covered. There is no recession. There is no problem completely. Okay So I put eight here because to this not exposed with respect to the root portion Crown is anywhere exposed. So We just need to check whether carries is present or not. No carries mean zero eight now It doesn't require any treatment. So I put zero So it means zero eight zero means no carries on crown The root is not exposed and it doesn't need any treatment. Suppose one two is having carries So I put one that means carries is present on crown But the root is not exposed. There is no recession. I put eight But it needs treatment. So I Consider a one surface filling. So I put one if it needs two surface or more filling I should put two Suppose one three is again decade. I put one and there is presence of Recession that is root is exposed But there is no carries with respect to the root. So I should put zero because the root is exposed When crown is exposed. I put zero Root is exposed. I put zero if root is not exposed or in a normal condition. I should put eight So again, it needs treatment one or two surface filling. So I put one And one four is extracted due to carries So god is four. So in root status, we don't need to put anything Okay, sometimes it needs Implant therapy. So I'm going to put eight because in treatment status There is no implant. So we have Seven eight are empty spaces. So I can use seven or eight. So I just put seven and seven I need to enter implant and that code is fixed In one five one five the case is different. The root is extracted for authentic reason. So that is five Any other reason other than carries root again? We just put a hyphen And for authentic, we don't need any treatment Let's take an example here two one two two two three two four Just take two eight So two eight is impacted. Okay both crown is not exposed Root is not exposed So in that case I should put eight and eight Because crown it's not exposed root is not exposed Something is not exposed We put eight And if it needs extraction We are going to put six because in codes The six is for extraction And two three two three there is a carries in crown There is carries in root and it needs Two surface filling So here one thing is evident that is the root is exposed So without an exposed root we cannot explore the carries status using a Probe so we need to have a visibility in root side So one means Or zero means there is recession or root is exposed. Just make sure that presence of carries carries is there one So one is code for carries. Okay Suppose two is having A filling on crown surface That means three that is Filled without any decay and root is not exposed eight No treatment needed two two. There is a secondary carries in crown That case we need to enter two that is filling with decay crown is root is not exposed. So put eight and zero Sorry Carries is there. So we need to go for better. We go for uh pulp care and restoration. So we put five in two four There is severe carries which needs rct and crown. So carries anyway, it will be only one And root portion is also having carries. So one we are going to put uh pulp care and restoration therapy for that So we are going to enter five So you can see there is no Criteria is repeated. So you can have many options like this. So this is how you enter Crown status is different root status is different and treatment status is different. This is one tooth. This is entire crown of on arch Entire root of upper arch entire treatment status of upper arch So one means carries two means filling with carries three means filling without carries four means Missing due to carries five means missing Uh without carries or any other reasons suppose two six is having a fisher sealant So we need to enter six that means there is presence of fisher sealant We don't need to enter anything. See hyphen or we can also put eight Because uh the root is not exposed anyway And if we have uh, suppose if this is two seven and there is presence of bridge So if bridge is there or crown is there already we can put seven seven and zero because crown seven and seven And if one one is trauma We can just put T And it definitely needs treatment one or two three four up to The condition up to based on that condition. Okay, and if you are in a state where we are not able to Record anything. So we just put nine That is the temptation status. Okay, so I told you in treatment. We have eight and Seven if we have any additional treatment required for that particular patient, we can enter that to Suppose uh patient needs uh rpd or fpd or anything that sort of we can use that seven and eight codes Caught in treatment status That is dentition status and treatment need now we have prosthetic status and prosthetic need it is very simple Prosthetic status is a present condition. So what is present in that patient? So we have box number 162 and 163 So just check in upper arch is there any processes suppose we have uh one bridge and one partial denture uh in Upper arch we need to enter four if just a partial denture three if we have one bridge Then score one then if you have more than one bridge two and if we have a cd five similarly on the lower arch Next we have the prosthetic need Now we learned prosthetic status Prosthetic need is nothing but what the patient requires now So if patient similarly we have two boxes 164 and 165 if patient needs one unit processes We enter one Wherever upper or lower if patient needs a full processes that is four Patient needs a combination of one or multi-unit processes that is three So depending upon the requirement we enter the number in 164 165 that is separately for upper and lower arch Now we have the malocclusion status that is dental facial anomalies. So we have many Boxes here 166 to 176 Where as you see the picture here, we need to assess the Crowding the spacing dastema everything in millimeter But the crowding and spacing we have category 012 The rest everything like dastema the Irregularity in maxilla and mandible the overjet in maxilla and mandible then vertical open bite So all these will be measured in millimeter as you see the picture Using the cpi probe then we have the anterior posterior molar relationship Again that is having 012 So finally the da i index should be calculated With the formula as mentioned here that formula is a little complicated We need a lot of multiplication Addition so finally we get values. So depending upon that value We will classify that patient into Uh da i score less than 25 26 to 30 31 to 35 equal to or greater than 36 That is depending upon minor malocclusion definite severe and very severe malocclusion. So that is the da i scores So this is uh about the fourth edition what what happened to the fifth edition of oral health assessment this da i index is not there So i'll be putting into Putting those differences in my next video So this is uh completely on the fourth edition. Okay And lastly we have the need for immediate care and referral we need to understand the patient's condition diagnose it and we need to Put into life threatening condition pain or infection Or whatever it is we need to enter that and referral is required or not. That is a 180th box So that is all about oral health assessment format is a very commonly used assessment tool to collect the oral health data It is a complete data with respect to the soft tissue hard tissue general information and kiri status Pyridontal status prosthetic status the malocclusion status so everything will be in a single format that is uh a quantitative format so it is very easy to tabulate for statistical analysis Unlike the qualitative data how we get using a case history the normal case history So i'll come up with the oral health assessment form 2013 in my next video and i'll put The difference of 97 that is a fourth and fifth edition there So hope you understood this you need to learn the dde index that is a developmental index for enamel hyperplasia deans fluorosis index for Fluorosis status then the cpi and loss of attachment index for pyridontal status So then only it will be easy for you to Record it properly and you need to Be well thorough with this dentition status because you need to have many combinations In dentition status and treatment needs. Okay, so i'll come up with that video in my next session. Thank you