 Hello everyone welcome back to a new session on dentistry and more. So let's start our index series. So in this video I'll be explaining about the basic definition classification idle requisites and the oral debris index that is OHI and OHIS that is oral hygiene indices. So in the next videos I'll be covering more a periodontal indices, caries indices and fluorosis index. So let's see what is an index. Okay an index is nothing but numbers which are used to find out the incidence prevalence and severity of disease based on which preventive programs can be adopted. Or we can say that it is not a definition we can say that we can express the clinical observation in numerical value. So the most common definition is given by SLAL. It is a numerical value describing the relative status of a population on a graduated scale with definite upper and lower limit which is designed to permit and facilitate comparison with other population classified by the same criterion methods. So it is nothing but a number we should describing the status of a population. So what is the status? What is the oral health? What is the caries status? What is the plaque status? What is the ginger status? With a graduated scale just like a scale with graduation proper markings in between with a definite upper and lower limit. There will be a definite upper limit and lower limit if it is OHIS upper limit is 6 lower limit is 0. And why we are using this facilitate comparison with other population. So other population which is classified by the same index we can compare it. So comparison between the groups is what index is made for. So that is the definition we need to by heart. So let's see what other idler requisites of an index. It will be very clear the criteria should be very simple and it should be objective. Objective means we have subject and object. The patient is a subject and object is the examiner. So the rules and criteria can only be decided by the or should be decided by the object. So if suppose a patient says or the patient has a different opinion about what you finding in his mouth. You can't trust on the patient's words or patient's judgment. The investigator or the researcher person has to be the final word. And it should be acceptable. The index should be acceptable by the patient and there should be sensitivity. Sensitivity means it should be able to detect the very small change in both the direction if it is very bigger or if it is very low. It has to be detect the minute changes. Then quantifiability. The index should be expressed in numbers and only we can do statistical analysis. So it should be a number. Anyway it is a number because the definition itself says it is a number. So index should be always in a quantity. So no quality can be measured or compared between each groups or between the different groups. So it is always should be quantifiable and reliability. We have different types of reliability that is inter-examinal reliability or inter-examinal reliability. So it can be calculated using capacity statistics. So it should be more than 0.8 or 80% all the researchers. So there should be training and calibration should be done before the actual examination. Validity means it should measure what it intends to measure. So validity we have phase validity, content validity and construct validity. So if it is a questionnaire based index we should always check the phase validity, content validity and construct validity before we are playing it. So these are the ideal requisites of an index that is clarity, simplicity, objectivity, validity, reliability, quantifiability, sensitivity and acceptability. So it has many uses if it can be used for individual patients in research in community. Community can detect the prevalence and in research we need to do a proper examination to find out baseline data. And for an individual patient we can check the patients before after oral hygiene status or something like that. So to motivate the patient after the proper instructions we can compare with indices and produce a result and make him convince that the patient has improved. So what are the classifications? So classification is based on the scores fluctuation that is irreversible and reversible. Irreversible indices are oral hygiene indices, plaque indices, ginger indices. The scores can be fluctuated. If patient has very poor oral hygiene the patient score will be very bad but if he is properly cleaning, if properly maintaining the scores will reduce. Again it will go back to the older scenario that is reversible index. Irreversible index means Dental carries such conditions for periodontal pocket which cannot be reversed. Depending upon the extent full mouth indices are teens, fluorosis index, Russell's periodontal indices, OHI indices, simplified are the shorter versions OHIS that is a simplified indices whereas OHI is a full mouth indices. The next classification is disease index based on the entity, disease, symptom and treatment. Disease is DMFT. The depotion is disease index. Symptom index is nothing but a ginger index. The presence or absence ginger index or plaque or the bleeding index. Treatment index means the T portion of the DMFT. Simple and cumulative index. Simple index means a ginger index. Cumulative index means which records the past condition also that is DMFT index. The past experience carries experiences recorded. So criterias are it should be simple. It should permit examination for many people and require minimum armamentarium and expenditure. It should be highly reproducible. It should not cause any discomfort. It should be amenable to statistical analysis and there should be a strongly numerically to clinical stages relation should be there. Okay so let's see what is the oral hygiene index. So first we are seeing oral hygiene index given by John C Green and Traca Vermelion in 1960. It is to measure the oral hygiene status of a patient. So we divide the total mouth into six categories. Six segments that is we call it as segment or sextant because it is one out of six because we have six segments so we can call it as segment also. So this is the first segment which starts from the third molar on the right side up to premolar. The second segment is canine to canine where it is premolar to third molar similarly on the lower arch. So we have total six arch. So what are the rules of oral hygiene index. The first one is only fully erupted permanent teeth will be recorded. Third molars are not commonly recorded. The buccal and lingual scores both are taken on a single tooth. So one segment so we will be taking all the buccal scores of here from 14218 and whichever tooth is having highest buccal score we will mention that similarly all the lingual score. So only one score per segment will be there. So here also all the buccal score will be checked and which tooth is having highest so that score will be mentioned again lingual score. So one segment having one buccal score and one lingual score. So what are the debris criteria. So debris is very simple. If it is zero means no debris one is one-third of the exposed tooth surface. Two means it is more than one-third but not more than two-third. Three means it is more than two-third that is debris score. Calculus score also same. Supra and subgenival calculus is there. Zero means no calculus. One is supra genival calculus one-third. Two is supra genival calculus more than one-third less than two-third but there is addition. If there is it is not and it is or either one has to be there for giving score to individual flex. The score two is for individual flex of subgenival calculus or supra genival calculus covering more than one-third and less than two-third. Either this or either this. Score three is more than two-third supra and there should be a continuous band. This is a band. This is individual flex. So for giving three either one should be there. Either subgenival continuous band or more than two-third of calculus. So this is how we calculate. It has two components what is one is debris index one is calculate index. So we have buckle score plus lingual score divided by number of segments that is always denominator will be six. So we need to calculate the six segments buckle score and lingual score divided by six. Again six segments buckle and lingual score of calculus divided by six. So finally orgy is equal to da plus ci. So usually debris index and calculate index range from zero to six because the maximum score in one segment can be three. So let me explain you one segment maximum we get three because out of all these scores the maximum score can be three. So all six segments the maximum score will be eighteen. Okay so three three three three three. Similar lingual score so eighteen plus eighteen thirty six and denominator is six. So maximum score can be six and if there is no calculus no debris it will be zero. Both buckle and lingual if it is zero means zero by six zero. Six means maximum score three all the segments buckle score six into three eighty lingual score six into three eighteen. So eighteen plus eighteen thirty six thirty six by six six. So OHI is addition of da and ci. So this can be zero plus six plus zero plus six. So this is a formula. So we get zero to six plus zero to six that is zero to twelve. So this is OHI not OHIS. So maximum score for all segment can be thirty six four. Depressor calculate as I mentioned eighteen plus eighteen. So higher the OHI power is the oral hygiene patient. So in OHI we don't have any special category for based on the score. So let's see what is OHIS or simplified oral hygiene index. The scores are same zero one two three same for OHI and OHIS but few modifications or changes are here. It is developed in nineteen sixty four by the same authors John C. Green and Chaka Vermillion and only fully erupted permanent teeth as code. But here instead of checking all the teeth only one teeth per segment is selected. It is known as index truth and natural teeth with full crown restoration and surfaces reduced to height will not be considered. So we have index teeth for all the six segments. So the first segment is one six one two six three six three one and four six. So all the molas first molas and central incisors and lower central incisors. So suppose one six is missing we can take one seven or one eight because it has a similar surface area. One six and one five is a different surface area. So we don't take it. So one one and two one same surface area not one two. Similarly two six two seven three eight replacement of second and third molar. This is right or left central incisor. So here we are checking only six teeth. Okay there we are checking all the teeth both the buckle and both lingual and we will be taking only one score of one segment. That is we check all the teeth. We take only one score out of it. And here also the difference is for lower three six and four six that is we take lingual surface and both all the rest of the teeth we take buckle or label surface. So only six surface we are checking. Only three six and four six are lingual surfaces and other teeth are buckle surfaces. Why because there is saliva pooling in all these areas here. Submandibular sublingual gland here, parotid glands. So it naturally it is all clean areas but if it is not clean we need to know we can assume that patients oral hygiene is not proper. So assessing that patients oral hygiene we check the these teeth because if it is natural cleaning cleansed area is not not even clean it reflects the patient's attitude. So this is how we calculate same way HIS one simplified version is added up here. Same formula HII is equal to DIS plus CAS. TIS or CAS total score by number of surfaces here it will be maximum score of six six into three that is 18 by six. So we get only zero to three minimum score is zero maximum score is three because total score is either buckle or lingual total we have six surfaces so maximum six into three so that is 18 18 by number of surfaces eight six so 18 by six is equal to three. So zero to three is a maximum score and OHS both debris and calculus will come. So zero to three plus zero to three that is six. So zero to six will be OHS and zero to three will be debris index or calculus index because it has only buckle score or lingual score not buckle and lingual okay. So six teeth has only one measurement there we have both buckle and lingual here only one measurement for four teeth it is buckle and two teeth is lingual that is three six and four six are lingual rest all buckle. So OHS and OHS DI and CAS has three category good, fair and poor it is good means zero to zero point six point seven to one point eight is fair four is one point nine to three OHS good means zero to one point two this is one point three to three three to six this is not exactly the double of this that is a change here. So this type of category is not there in OHS this is only for OHS this is a simplified version this is very easy to apply in patients or a large group of people. So OHS can be used to conduct oral hygiene service because it is very easy compared to OHS because it has taken only six surfaces not entire teeth. So there actually in OHS we are taking if it is 32 we are taking entire 32 buckle surface and entire 32 lingual surface so total 64 surface we need to check but only six scores will be there because only one tooth per segment but both lingual and buckles four but here we are not checking entire teeth only six teeth are checking instead of 64 surfaces and also here there is no buckle lingual on the same tooth on either buckle or lingual. So only six surfaces we are checking in OHI we are checking actually 64 surfaces so 64 surfaces and six surfaces have huge difference and they have a clear indication of why we are checking these surfaces I told you regarding the saliva pooling and patients hygiene patients attitude. So that's all about OHI and OHS it is very important in our practical sessions and for the university practical exam this is the compulsory index all students must follow. So I'll come up with DMFT and DMFS in my next session and then CPI indexes CPI TN and Russell index and finally fluoroosa syntax. Hello everyone welcome back to another session in dentistry and work so let's continue our indexes session. So today's session is about patient hygiene performance index or PHB index which is introduced by Portchartley agent Halle JV1968 so this is similarly as oral hygiene index simplified version so this is also having the same index as teeth 1611263631 and 46 and the same surface all buckle or labial only 36 and 46 are having lingual it is same as OHI yes simplified so there's also having six index teeth so this is nothing but a plaque and debris index so we'll be checking plaque and debris whereas in OHI as we were checking debris and calculus but here instead of calculus we will be checking plaque so debris and plaque is always different debris is loosely arranged collection of food particles, musins or bacteria but plaque is a very tenacious adherent on surfaces so it is not visible only debris is visible for plaque to be visible we need to apply disclosing solution so these are the six index teeth and these are the surfaces so after that we need to see the other properties that is a procedure first we need to apply a disclosing solution to make the plaque visible so patient will be asked to switch for 30 seconds of any of the plaque disclosing agent and then expect rate but not rinse so examination is made by using a mock mirror the change is we are dividing the tooth surface into five that is maceal one-third distal one-third and the middle one-third will be again divided into three gingival middle and occlusion or incisive so total five surfaces will be there that is five subdivisions so the options are either zero or one zero there is no debris or questionable one is debris present so debris score for individual tooth will be calculated by at all the scores and divided by five because five divisions are there so here it is one one one one so four scores are there the debris score for that tooth is four by five because five subdivisions becomes 0.8 so php index for an individual so we need to add up all the scores then divided by the number of teeth so how many teeth were examined that we have to keep it in denominator finally we get a score excellent zero good point one to one point seven where one point eight to three point four four three point five to five so this is like oh j's in this oh j's in this is also we have good fair score the score is a little different but in our chairs we were checking debris syntax and calculus index but here we're checking black index and black score and debris score so next we'll move on to black index so black index it was given by sillness and law in 1964 which actually checked the thickness of black at the cervical margin of tooth cervical margin plate will be checking whose black will be mostly concentrated on the cervical region so the distal mesial lingual and buckle so these four surfaces cervical region will be checked for the black score the scoring criteria is as follows 0 1 2 3 there is no black one is a film of black which is adhering to free ginger margin and not just an area of tooth black may be seen in in situ only after application of disclosing solution the two is moderate accumulation within the ginger pocket tooth and ginger margin which can be seen with the naked eye the one is only after application of disclosing solution and three is abundance of soft matter within the ginger pocket and or on the tooth and ginger margin two and three we can see with naked eyes one we need to apply this closing solution to the calculation we have 0 to 3 score for each surface so individual tooth goes added then divided by 4 because we have four surface mesial distal facial and lingual so for black index for group of teeth or for intuition we need to add up all the scores then divided by the number of teeth examined then black index for a group all indices are taken and divided by the number of individuals okay so interpretation is excellent score zero good one zero two one one two point nine where is one two one point nine four is two to three uses which is very reliable technique for evaluating both mechanical anti-black procedures and chemical agents also can be used in longitudinal studies and clinical trials now we have another black index which is known as q glean hidden black index later it was modified by durisky gilmore click map so the original index q glean in 1962 they reported a black measurement that focused on the ginger so mostly majority of the black indices will be causing on the ginger third of the tooth only the facial surface of anterior teeth were examined using basic with sin mouthwash as a disclosing agent but in 1970 it was modified by durisky gilmore and click man so in this modification the change was instead of anterior teeth they were checking all the teeth and not just a facial surface they were checking other surfaces like labial and the surfaces such as lingual labial and buckle surface because a posterior teeth also were involved but in the q glean it was only anterior surface facial surface of anterior teeth were examined but later modified into both the teeth with lingual and labial surfaces so that was modification done by 1970 so these were the scoring criteria zero one two three four five zero is no plaque money separate flecks of plaque at the cervical margin two is thin continuous band up to one mm three is band of plaque wider than one mm but covering less than one third of ground four is plaque covering at least one third but less than two third five is plaque covering more than two third of the car and the index is based on the numerical score is zero to five so we can calculate the individual tooth cure how we did in last and if we can calculate the patient total performance or total score by dividing their keeping denominator total teeth examined so we get a score okay so now we have few gingival indices the periodontal index and cp itn we already covered in our earlier sessions now let's see what is gingival index it was developed by low and silnes in 1963 the same authors of gingival index but gingal sorry plaque index plaque index was by silnes and low gingival index low and silnes same authors but one is having more contribution so he kept us a first author that is one of the most widely accepted used gingival indices it has a severity of gender it is at four possible areas mesilingual distal and facial only qualitative changes are assessed method is all surfaces of all teeth or selected teeth can be checked to select the teeth can be 1612243632 and 34 here the change in index to this lateral incisor and second premium like or js or php index so the teeth and ginger were first dried with a blast of air or cotton rules the tissues are divided into four gingival scoring units distofacial papillae facial margin mesofacial papillae and entire lingual margin a bland period probe will be used to assess the bleeding potential of the tissue so this is a score 01230 is no inflammation amaldine java one is mild inflammation slight change in color light edema no bleeding on probing two is moderate inflammation moderately raising redness edema and bleeding on probing three severe inflammation and moderate redness hypertrophy and spontaneous bleeding two is splitting on probing this is spontaneous bleeding so calculation and interpretation if the scores around each tooth are totaled and divided by number of surfaces per tooth examine that is for the gingival index score of the tooth is obtained but just like how we did in our previous decks and totaling all score per tooth and dividing by number of teeth examined gives us score for individual so this scenario is same for all index total score divided by number of segments or number of surfaces or number of sections per tooth and we add up all the course divided by number of teeth will give them individual score interpretation 0.1 to 1 mild gingivitis 1.12 moderate to 1.123 severe gingivitis and modified gingival index to us developed by lopin weatherford rose lamb and manaker in 1986 which assess the prevalence and severity of gingivitis which is strictly based on one invasive approach that is visual examination only without any probing do notice the difference there is no probing to obtain modified gingival index label and lingual surface of gingival margin and the inter dental papilla of all eruptor teeth except third molars examined and scored so this is scores here 1 2 3 4 one is mild inflammation who is mild inflammation entire gingival unit this is little change in the texture and only any portion of the gingival unit is affected there's three moderate inflammation and there will be redness edema and hypertrophy for a severe inflammation and spontaneous splitting this is all clinical examination nor is no invasive technique the next index is papillary marginal attachment index or PMA just given by mori mesler and shore in 1944 it is based on the number of gingival units affected were counted rather than the severity of inflammation so what we are doing is gingival unit is divided into three compartments that is papillary gingiva marginal gingiva attached gingiva the presence or absence of inflammation on each gingival unit is recorded usually only on maxillary and mandibular incisors canines and premolars so after that we need to score based on this criteria that is papillary and marginal component as scores 0 to 5 papillary 0 normal mild papillary enlargement increasing recent size excessive recent size necrotic papilla and atrophy and loss of papilla for five whereas marginal component 0 normal one is engorgement no bleeding two is bleeding on pressure three swollen collar beginning infiltration for his necrotic gingiva and five is recession of free marginal gingiva below C H M due to the inflammatory changes whereas a component that is PMA component attached component we have only four score that is 0 1 2 3 here we have six scores actually only five scores 1 2 3 4 5 0 will not be counted anyway the total six scores here we have four scores 0 1 2 3 0 is normal one is slight engorgement loss of stippling two is obvious engorgement with marked increase in retinus and pocate formation and trees advanced periodontitis the calculation will add up all the three p plus m plus a we'll get the kind of scores it is used in clinical trials individual patients and surveys now we have bleeding index given by i nam 1 way in 1975 gingiva bleeding index which is based on recording from all four tooth surface of teeth recorded as bleeding present plus and bleeding negative so these four surfaces are buckle lingual mesiland distilled so a negative or minus sign is equivalent to 0 and 1 plus sign is equivalent to 2 and 3 gingiva bleeding index is calculated as a percentage of affected sites for experimental studies and the reason individual patients also it can be used we have focus bleeding index which is developed by mulliman adjovance on us in 1971 it is a modification of papillary marginal index mulliman and major z so scoring criteria is 0 1 2 3 4 and 5 0 is healthy looking papillary and marginal gingiva no bleeding on probing and is healthy looking gingiva bleeding on probing 2 is bleeding on probing change in color but no edema 3 is slight edema 4 is same symptoms with obvious edema 5 is marked edema so 4 gingiva units are scored systematically for each tooth the labial lingual mesiland distilled gingiva scores of these units are added by divided by 4 gives valkus bleeding index but modified circular bleeding index developed by mobley van hosten and church et al in 1987 here we have 0 1 2 3 scores 0 no bleeding when probis passed along the gingiva engine one is isolated bleeding sports visible those blood forms a confluent red line of margins 3 is heavy or profuse bleeding so that was about bleeding index and gingiva index so i'll come up with a new session in dentistry and more thank you hello everyone welcome back to the dental indices session on dentistry and more so today we have dental caries indices so we will be seeing only dmft and dmfs so that is what important for us in our practical session or even for our exam so it was given by henry t clean carol abomber and nutson dw on 1938 this decade missing filled teeth index or dmft index so it is very simple rapid and versatile and very universally accepted when it is very easy to calculate this normal confusion in it and it is an irreversible index we have seen in classification of index so the tooth the idea is it is measuring the caries experience so caries experience is the term they used caries experience so the filling due to caries and the missing due to caries is what this index measuring okay so we have three category that is decade missing and filled so missing due to caries filling due to caries so what are the instruments and conditions there should be a proper lighting and i'm a three plane mirror that is our common mirror and a explorer that is a common explorer so these are the instruments or instrument and lighting setup and third molas are not included all 28 teeth are examined so teeth which are excluded so this is one of the pioneer setup in dental caries assessment this system so this is nowadays is modified by WHO but this is a true index and true and in its raw version or original version we have studied so later we have modifications in 1986 and 1997 by WHO so let's see the original version where the third molas and unerupted teeth are not included continually missing and so upon younger teeth teeth removed reason other than dental caries so all these in modification of 86 third molas are included and teeth lost due to periodontalysis for age 30 are included in 97 modification so in original version teeth removed other than caries so they use the term caries experience so other than caries reasons are not considered and teeth restored the reasons other than dental caries are also not included in filling criteria such as we do filling for abrasion trauma and ginger oil recession so all these things are not included primary tooth retained with permanent successor erected also not included so what are the basic principles and rules so only one tooth counted once no tooth must be counted more than once either decayed missing or filled so if a filling and a decay is present on the same tooth it will be always decay filling will not be counted in dmft and decayed missing and filled teeth should be recorded separately since the component of dmft are of great interest so dm and fr separate entity when counting the number of decay teeth also include those teeth which have rasterations with recurrent decay so i told you like if a tooth with rasteration and decay filling is not considered only decay so k must be taken to list as missing only those teeth which have been lost due to decay so missing due to paranormal reason missing for orthodontic extraction missing due to trauma accident are not considered here and also we can include which are indicated for extraction under missing category so that is another criteria so we can include such tooth also for missing teeth following should not be counted as missing uninterrupted missing due to accident continually missing teeth have been extracted for orthodontic reason tooth may have several rasteration but is counteract one these industries are not included under capital dm of count it has small dm of a tooth is considered only when the occlusion surface or incisal it is totally exposed or can be exposed by gentle probing so what are the modifications modification 986 modification like i told you all third models are included temporary rasterations are considered as decayed whereas original version it was a filling and only caries cavities are considered the initial lesions that is like chalky spots spain fishes are not considered as d whereas in original version a catch a slight discoloration and slight the deminialization area we considered as caries but those are excluded from caries category in this modification of 1986 so we put so calculation how do we calculate so calculate we have many like individual dm of t just add up dm of we get dm of group average total dm of by total number of subjects person needing care total decayed by total number examined percent of tooth lost like number of missing by total number filled tooth total filled by total dm of t and missing teeth percentage that is total missing by total number so we can have many categories of expression of data so the maximum possible is 28 if the raw version and 32 if the WHO modified version so in 1997 the WHO modified a little more elaborate that is the explorer is used in the raw version but in 1997 WHO recommended CPI probe and also one more addition is that tooth loss due to periodontal reason that is other than caries for the people more than 30 would also be considered as missing so if a tooth lost due to periodontal reason for a 35 age old it will be considered as missing the modification 1997 but it is not considered as a raw or the original version so this is a 1986 the WHO oral health performer third edition modification and the 1997 modification is also there that is the fourth edition so what are the advantages because of its widespread used it's been used for almost 60 years and it gives reasonable accurate historical count account of changes in prevalence of dental caries but the limitation we already discussed does not values are not related to the number of teeth at risk DMFT index can be invalid in oral adults because teeth can become lost due to other reasons than caries DMFT index can be misleading in children whose teeth have been lost due to other ontic reason and DMFT index can overestimate because of the preventive feelings such as spit and fissure sealants DMFT index is of little use in studies of root caries so so next is DMFS so here it is surface is also included instead of tooth that is same authors given by and particularly in Karoli, Burma and Atsunja blue same same authors in same year 1938 which is the most sensitive it is it has a option to enter multiple category in the single tooth you can have both caries and filling on the same tooth that is the advantage so usually the index of choice in a clinical trial of caries preventive agent used to determine total caries experience past and present so it has five surfaces buccal lingual mesial distal and occlusion and anterior it has no occlusion only mesial buccal distal and lingual so this is like decayed surface missing surface and filled surface so anterior it has four surface that is buccal lingual mesial distal and on the posterior it has occlusion for the premolars and molars so DMFS is more detailed index than DMFT by summing the total number of decayed missing and filled two surfaces so as in case of DMFT index DMFS index is simple and versatile and more sensitive it is giving more detailed output so how we are checking DMFS index like I told you for posterior teeth five surfaces like facial mesial distal lingual and occlusion anterior there is no occlusion so calculation is individual just like DMFT we can calculate DSMSFS so how many surfaces will be there so in DMFT there will be maximum 28 or 32 but in DMFS if it is 28 there will be 128 surfaces like how 16 into 5 it becomes 80 that is 16 molars and premolars two molars and two premolars on one quadrant so total 14 teeth each has five surfaces so 80 and three teeth that is central lateral and canine on one quadrant 4 into 3 12 into 4 48 so 80 plus 48 128 so if 32 means again 20 will be added up for the four molars that will become 14 teeth surfaces so 0 to 28 or 0 to 32 there's a DMFT scores and 0 to 128 and 0 to 14 teeth so score of DMFS so modifications like we have modifications of crown teeth bridge montex and any other particular required for study we can modify it so DMFS can be used in half mouth and such way for time management there are many disadvantage because sometimes we use like I mentioned half mouth and opposite quadrant that is producing inconsistent diagnosis to the score exactly the same under extreme of clinical condition and provides a little or no additional information in prevalent studies so the advantage is more sensitive because the same tooth can be mentioned if it has both carries and filling missing anyway there won't any chance of multiple entry so the color we commonly used black for carries blue for filling and red for missing so carry synthesis for primary condition this is what I was mentioning DEF index given by grubbel in 1944 this is just another version of DMFT so DEF in DFT index or DEFS index equal to DMFT or DMFS D4 decayed E4 extract F4 filled so the basic principles and rules of DEFS index are the same as capital letter or the uppercase DMFS or DMFT index D means indicate the number of deciduous teeth that are decayed in counting the number of decayed deciduous teeth only counted once just like our capital DMFT cannot be counter as filled and decayed if it is restored and carries can be detected it is decayed because carries has more weightage the explorer should fall into the carry speed substance are not just to the deep groove before counting a crucial carries and this is a tricky part E for extraction indicate those deciduous teeth which have been extracted due to carries or which are so badly decayed that are indicated for extraction because of the wide variation in the time of exfoliation teeth we cannot put M category we are putting E category it is difficult to determine whether tooth is missing from the deciduous rendition was normal exfoliated or was extracted because of carries so if it can be accurately established that a missing deciduous teeth has been lost due to carries include it without indicated for extraction with those indicated for extraction sorry so F is nothing but indicated for filling or filling has been done so modification of DEF is DEF index is DMF per use in children before the age of exfoliation that is children over seven years and up to 11 or 12 years so in this group we can use DMF because by the time all the teeth must have rupted and it will be in the mixed rendition time and exfoliation will be done by 12 years so we can use DMF missing due to carries DF means in this in this index the missing teeth are ignored we because of this controversy the M category is removed and we say DFT or DFS index disadvantages it is difficult to determine whether the primary tooth has been extracted or shed naturally that is a most disadvantage so that is all about the dental carries index there are many indices sick index ICDS criteria many indices are therefore assessing dental carries so this is the pioneer of classification of dental carries so periodontal indices we will be checking results indices then CPITN CPI index so these three are the periodontal index we will be covering there are lots and lots of indices in periodontal health oral hygiene dental carries there is lots of help indices are there but we are checking only specifically needed for our exam purpose so let's see results periodontal index this is one of the first index which has come to assess the periodontal health which was put forward by Russell a 1956 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 it is very worse in periodontal 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 the results rule when in doubt assign the lesser score so let's see the criteria and radiographics findings so we use a normal periodontal 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 freezing jiva that is one 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 addition in 6 epithelial attachment is broken and there is a pocket there is no interference with normal mastrigatory function so that is important even if it is slightly mobile and the normal mastrigation is happening we should q6 and tooth is 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 mastrigatory 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 a saint 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's nothing it's very easy we need to add up all this course so scores will be individual so all the teeth will be getting a 1 1 score based on this criteria then add up all the teeth goes and developed by number of teeth so this is an interpretation just like oh hi s 0 to 0.2 it is normal supportive tissue 0.3 to 0.9 simple gingovitis 1 2 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 CP IT and index after that people started using this index in 1982 this is known as community periodontal index for treatment it's introduced by chukka i namo in w h join fta join 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 would be done on the patient rather than the results which is giving past and present periodontal status like recession and loss of albumin so treatment needs implies that cpa 10 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 oh is dividing the tooth mouth into six sextants i told you segment sextant if it is one of six it is gonna known as uh sextant okay so one two three four five six just like our hrs connect to connect connect to connect premolar to molar on the right and left side and we're on 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 um our hrs index 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 cp itn probe so this probe as discussed uh described by w cho does two purposes one is measurement of pockets and the detection of subgeneral 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 it has 0.5 among deep 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 genital margin is coming within the black band that is pocket because genital sulcus it will be more than 3.5 mm if it has to come between the black uh 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 how what is the depth of pocket so clinical we have more uh 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 predominant one is bleeding two is calculus three is pocket that is genital margin is between the black band so genital margin will be here for three one is uh bleeding and two is calculus okay so four is pocket six mm or more black band will not be visible so genital margin will be here so black band will not be visible it will be completely immersed in the genital pocket x is when wax when only one tooth or no teeth are present in the sextant okay so x week we need to give for sextant whereas no tooth suppose it's sextant is no tooth 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 prop its codes its treatment needs types of CPI probes and its procedure and its um sextants and little bit about its history so we covered results index CPI TN index and next will be CPI index okay next we have a communal periodontal index that is CPI index which is a modification of CPI TN index actually the modification is we included a loss of attachment segment and remove the treatment needs category and CPI is crowding criteria is same as CPI TN and run with CPI TN 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 TN 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 TN zero there is no problem one is bleeding two is calculus three the pocket is 4 to 5 mm that is genital 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 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 4 then only we can go for a CEJ assessment or loss of attachment assessment either the CEJ should be visible or the minimum score 4 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 genital margin to bottom of sulcus here bottom of sulcus and CEJ so code zero is loss of attachment 0 to 3 mm that is cemento enamel junction is covered by the genital margin and CPI score will be 0 to 3 CEJ visible or CPI score is 4 loss of attachment for 1 to 4 I used so just what I mentioned the CEJ is visible or if CPI score is 4 the codes are used that is 1 2 3 4 code is nothing but 0 to 3 there is no loss of attachment so let's see what is code 1 that is 3.5 to 5.5 mm loss of attachment CEJ is within the black pan okay so the CEJ is within the black pan so we are checking the measurement between CEJ and bottom of sulcus the CPI where it is measuring the genital margin to bottom of sulcus so genital 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 stress cells or CP ITN so here the black band is within the CEJ so that is code 1 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 upper 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 these 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 redundant so only remember that we are checking code 1 2 3 4 only under these two criteria if the CEJ is visible or CPI score should be 4 then only we will be checking 1 to 4 otherwise it will be 0 so that's all about periodontal indices we are covered dresel indices CPI TN indices and CPI and loss of attachment. Hello everyone welcome back to a new session on dentistry and more so today we have fluorosis index so fluorosis index we are not dealing all indices we are just seeing Dean's fluorosis index so let's see some basic factors about fluorosis we have already studied what is fluorosis it is nothing but hyperplasia or hypermenalization of tooth enamel or dentine produced by chronic ingestion of excessive amount of fluoride that is more than 2 ppm or 1 ppm while teeth are developing so it is affecting only one the mineralization of teeth is happening so we have seen all these history of fluoride the Colorado Springs the great Frederick McKay and GV Black so this is how a motile enamel or fluorosis looks like the fluoridated water arrow pin points the discolored cracks or pitted areas so before that we need to differentiate what is fluorosis and what is non fluoride enamel opacities so how a fluoride affects a tooth and other reasons for enamel opacities while the area affected you can see the fluorosis will always be near the cusp tip or incisal edge but in other non fluoride thing it will be smooth surface and it will be centered and affects the whole crown shape of the region will be always pencil shading because it follows incremental lines where the reposition of minerals occur this will be round and oval demarcation is like shades of imperceptibly into surrounding normal but there will be a clear demarcation between the normal and adjacent from this opacities color will be pepper white this will be creamy yellow and dark orange teeth affected that teeth calcify slowly molas and primolas rare on lower incisor and very rare on deciduous teeth but this can happen non fluoride opacities can happen on any tooth deciduous tooth may be involved gross hypoglycia will be will not be there enamel has glaze difference on enamel surface we etched rough to explore detection will be strong light line of light should be tangential strong light line of sight should be perpendicular to tooth surface okay so we have many incisors we are not checking in detail we will be seeing only deans fluorosis index so this is a famous trend liestine who has performed shulada survey and 21 cities study he has put forward the deans classification of dental fluorosis for assessing presence and severity of mortal enamel so the silent features of fluorosis indexes it is a seven point scale and although non numbers were used it was considered to be an ordinary scale ordinary scale means it is kept in order the lowest one means not affected and the highest one means very severely affected it goes in order so one two three four five six as it goes higher more severity is reported so that is ordinary scale and all those showing hypoglycia other than modeling of enamel were placed in normal category and children were not lived in the community continuously but not obtained the domestic water from other than public supply are removed from the category so how do we check a patient with mouth mirror and throw good natural light with subject facing the window and each individual receives a score corresponding to clinical appearance of two most affected so we put score for each tooth of that patient and we take up the two highest affected tooth suppose two highest affected tooth are the scores are three and four we take the lowest score that is three if the two highest scores are similar four and four we take four if it is three and three we take three so out of 28th whichever tooth has got the highest that scores will take not the tooth the scores we take if it is one and point five the highest score we take point five if the highest two scores are one and one we take one so whichever two score is coming highest we take up so if the score three has repeated more than twice we definitely take three so the highest two scores are taken and if there is a doubt lowest score is recorded so this is the original criteria in 1934 the normal questionable very mild mild moderate moderately severe and severe but in 42 the modified version combined moderately severe and severe so it becomes six point ordinal scale so these two combined so it was before it was seven point ordinal scale now it is six point ordinal scale now this is one this one is extensively used and w two recommended in basic survey manual 97 that is fourth edition and scoring system is between zero to four so let's see what is the scores normal zero means there are translucent semi which forms smooth glossy pale creamy color but the questionable point five is slight change that is slight aberration from translucent occasional there will be occasional white sports very mild means small opaque paper white area scattered over 25 percentage of the tooth and it will be less than one to two mm opacity at the tip of the summit of kuz this is mild at least 50 percent of the tooth will be affected this paper white area will be more extensive entry all the enamel surface are affected surface maybe attrition are involved and brown staining might be there severity four that is core four means all the enamel surfaces are affected there will be major diagnostics and this discrete or confluent between discrete means the borders are very demarcated confluent means the borders cannot be distinguished and there will be corroded like appearance that is severity and the score and why it is four because there is zero and there is a point five and rest are one two three four five two three four not five one two three four and zero and point five so it is a six point ordinal scale so that's all about deans fluorosis index so I explained its little bit of history the classification modification so come on