 Hello everyone, welcome back to dentistry and more. So today we have a continuation of dental cadies indices. So today's indices is on Peridontal help. So Peridontal indices will be checking results indices, then CPITN, CPI index. So these three are the Peridontal index. We will be covering there are lots and lots of indices in Peridontal health oral hygiene dental cadies, there is lots of help indices are there but we are checking only specifically needed for our exam purpose. So let's see results Peridontal index is one of the first index which has come to assess the Peridontal help which was put forward by Russell 96 is the same person who has defined dental index. So this index is all teeth are examined is a full mouth index and he has given scores such as 0, 1, 2, 4, 6, 8 in order to relate the stages of disease. So this represents the stages of disease, 0 is very healthy, 8 is very worse Peridontal status. So results rule is if you have a doubt always give less score. So if you have a doubt 1 and 2 you are getting confused whether it is 1 and 2 give 1 if it is 0 and 1 give 0 if it is 6 and 8 you are getting confused give 6 that is a results rule when in doubt same the less score. So let's see the criteria and radiographics findings. So we use a normal Peridontal probe if there is no inflammation and the investing tissue and no loss of function due to destruction we give 0 there is no change in radiograph. If it is mild gingivitis that is overt inflammation in the Phrygian Jiva that is 1 proper gingivitis with inflammation completely circumscribe the tooth we give score 2 but there is no break in epithelial attachment. So till 0, 1, 2 there is no radiographic finding but 4 only radiographic findings there is no clinical finding there is early notch like resorption of the alveolar crest. So we give score 4, 6 both clinical and radiographic findings are there. Here gingivitis with pocket formation so that is the addition in 6 epithelial attachment is broken and there is a pocket there is no interference with normal masticatory function so that is important even if it is slightly mobile and the normal mastication is happening we should give 6 to this firm in socket and not drifted. There is only horizontal bone loss involving the entire alveolar crest up to half of the length but 8 is advanced destruction with loss of masticatory function the tooth may be loose may have drifted may sound dull on percussion with metallic instrument or may be depressible that means there is apical infection or apical lesion that is where it is slightly depressible in its socket and sound dull percussion on metallic instruments. So there is advanced bone loss involving more than half of the tooth root definite intra bony pocket with widening of PDL and there may be root resorption. So why he has given 0, 1, 2 after that there is no 3 there is no 5 and there is no 7 it is why because he has to avoid confusion so that is why he has given the rule also when in doubt I say less score. So if it is kept 3 there will be lot of confusion again 5, 7 lot of confusion so to avoid confusion and to give very concrete criterias he has skipped 3, 5 and 7. So how we calculate it is nothing it is very easy we need to add up all the scores so scores will be individual so all the teeth will be getting 1, 1 score based on this criteria then add up all the teeth scores and divided by number of teeth. So this is an interpretation just like HIS 0 to 0.2 it is normal supportive tissue 0.3 to 0.9 simple gingeritis 1 to 1.9 beginning of the destructive periodontal lysis 2 to 4.9 established and 5 to 8 is terminal lysis and always this is very over represented or exaggerated result we can use only in field condition individual patients this score always will be exaggerated so it is not very commonly used in clinical condition. So the next index is CPITN index after that people started using this index in 1982 this is known as community pererontal index for treatment it is introduced by Chukka Aynamo in WSHO and FTA joint working committee in 1982. So it is primarily to survey and evaluate periodontal treatment needs rather than the past and present periodontal status so it is based to on the treatment needs so what is the condition or what could be done on the patient rather than the results which is giving past and present periodontal status like recession and loss of alcohol. So treatment needs implies that CPITN SSS only those conditions potentially responsive to treatment but not non-treatable irreversible condition. So here the procedure it's not like full mouth index it is like OHS dividing the tooth mouth into six extents I told you segment sextant if it is one of six it is known as sextant okay so one two three four five six just like our OHS connect to connect connect to connect premolar to molar on the right and left side and around lower so one seven two one four one three two two three two four two so three two seven on lower and upper third molars are not included except whether they are functioning in place of second molar okay so it is commonly used for more than 20 years less than 20 years it is not used so we take the index teeth like one seven one six and one one two six two seven four seven four six three one and three six three seven just like our OHS indexes teeth all the molars are there one six two six three six and four six and replacement is one seven or two seven and one one and three one the index teeth are same so here we are using CPITN probe so this probe as described by WCHO it has two purposes one is measurement of pockets and the detection of subgenital calculus okay its weight is five grams and working force should be 20 to 25 grams or 0.75 Newton so there's two types one is E probe and one is clinical and this is epidemiological probe so there's 0.5 mm tip ball and there is a black man between 3.5 to 5.5 but in clinical probe which needs more investigation because this is field condition we won't be checking very detail about patient we just check whether pocket is present or not if ginger margin is coming within the black band that is pocket because ginger cell case it will be more than 3.5 mm if it has to come between the black between this black band so if the margin is coming here we don't need to check it is a pocket but here we are checking exactly what is the depth of pocket so clinical we have more detailing that is 8.5 to 9.5 mm again rings are there this is not band there are two rings the lower ring and upper ring it is for more detailed study so clinical side we use this detailed one and epidemiological surveys we use this probe scoring criteria and treatment needs are there zero means healthy predomination one is bleeding two is calculus three is pocket that is ginger margin is between the black band so ginger margin will be here four three one is bleeding and two is calculus okay so four is pocket six mm or more black band will not be visible so ginger margin will be here so black band will not be visible it will be completely immersed in the ginger well X is when X when only one tooth or no teeth are present in this extent okay so X we we need to give for sextant where is no tooth supposed sextant is no tooth or only one tooth remaining we are removing or we will not check that particular sextant so treatment need based on the codes if it is zero there is no treatment one there is self-care two there is professional scaling three means scaling and root planning and four is complex wrapping so that is about CP IT and proc its codes its treatment needs types of CPI probes and its procedure and its uh um sextants and little bit about its history so we covered results index CPI T and index and next will be CPI so these are two types of CPI T and probes so this is epidemiological probe and this is clinical probe so just I shown you before I have a better picture so we have a 0.5 mm ball tip and a black band between 3.5 to 5.5 mm and a rinse between 8.5 to 11.5 mm so these are the two types of CPI T and probe so these are the codes and criteria so zero is healthy predominant probe is here or one there is bleeding and two is between just entering the sulcus it is just a calculus and three is the black band is visible and the ginger margin is just coinciding with the black band whereas score four the black band is not visible okay so ginger margin it is completely immersed in ginger margin so I just want to show you a better picture of this coding okay thank you okay next we have a communal periodontal index that is CPI index which is a modification of CPI T and index actually the modification is we included a loss of attachment segment and remove the treatment needs category and CPI scroding criteria is same as CPI T and done with CPI T and C probe so both the criteria and the instruments are same but the thing is the true sign of periodontitis is loss of attachment in results periodontal index and CPI T and index they failed to mention about the true periodontal sign that is loss of attachment so WHO in 1994 introduced a new index that is community periodontal index or CPI index which actually measures the loss of attachment which is a true sign of periodontitis so this is the same code for CPI T and zero there is no problem one is bleeding two is calculus three the pocket is 4 to 5 mm that is ginger margin is within the black band four is black band is not visible a pocket of more than 6 mm and X is excluded 6 10 and 9 is not recorded so this is a new segment where it is added that is loss of attachment so there is no criteria is here there should be loss of attachment there is should be recession or there should be visibility of CEJ then only we can assess this or we need to have a minimum score of four then only we can go for a CEJ assessment or loss of attachment assessment either the CEJ should be visible or the minimum score four should be there so remaining all are same procedure same indexed teeth same replacement everything is same only thing is instead of treatment need there is loss of attachment so let's see the codes code zero that is we are checking the loss of attachment so we will be measuring the depth between CEJ to the bottom of sulcus okay where in CPI codes we will be checking CEJ not CEJ from the ginger margin to bottom of sulcus here bottom of sulcus and CEJ so code zero is loss of attachment zero to 3 mm that is cemento enamel junction is covered by the ginger margin and cps score will be zero to three so CEJ visible or cps score is four loss of attachment for one to four are used so just what I mentioned the CEJ is visible or if cps score is four the codes are used that is one two three four code is nothing but zero to three there is no loss of attachment so let's see what is code one that is 3.5 to 5.5 mm loss of attachment CEJ is within the black band okay so the CEJ is within the black band so we are checking the measurement between CEJ and bottom of sulcus the CPI where it is measuring the ginger margin to bottom of sulcus so ginger margin to bottom of sulcus it is very less but actually there is big loss of attachment so that is the difference here we are measuring the loss of attachment which was not mentioned in the results of CPITN so here the black band is within the CEJ so that is code one so loss of attachment is 3.5 to 5.5 this length code 2 is 6 to 8 mm loss of attachment CEJ is between the top of the black band and 8.5 mm ring so this is the top of the black band and this is 8.5 mm ring so this loss of attachment is between 6 to 8 mm because this CEJ is coming between the black per end of this black band and this 8.5 mm ring okay so code 3 is 9 to 11 mm loss of attachment CEJ is between 8.5 to 11.5 mm ring so CEJ is coming between here this two rings though this is between 8.5 to 11.5 so definitely the measurement will be 9 to 11 so this measurement will be 9 to 11 and code 4 is 12 mm or greater that is CEJ is beyond the 11.5 mm ring so CEJ is beyond the 11.5 mm ring so code 3 and code 4 the mobility will be grade 2 or grade 3 so this is a actual sign of Peridontitis so only remember that we are checking code 1,2,3,4 only under these two criteria if the CEJ is visible our CPI score should be 4 then only we will be checking 1 to 4 because it will be 0 so that's all about Peridontal Indices we are covered Russell Indices CPI TN Indices and CPI Loss of Attachment Indices