 Hello everyone, welcome back to another session in dentistry and more. So let's continue our indexes session. So today's session is about patient hygiene performance index or PHB index which is introduced by Port Shardley agent Hallie JV in 1968. So this is similarly as oral hygiene index simplified version. So this is also having the same index as teeth 16, 1, 1, 2, 6, 3, 6, 3, 1 and 4, 6 and the same surface all buccal or labial only 3, 6 and 4, 6 are having lingual it is same as OHI S simplified. So this is also having six index teeth. So this is nothing but a plaque and debris syntax. So we will be checking plaque and debris whereas in OHI S 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 fluid particles, musins or bacteria but plaque is a very tenacious adherent on hard 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 and 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 mesial one third, distal one third and the middle one third will be again divided into three dinchival, middle and occlusion or incisor. 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 add all the scores and divide by five because five divisions are there. So here it is one one one one so four scores are there so debris score for that tooth is four by five because five subdivisions becomes pointed. 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. So finally we get a score excellent zero good point one to one point seven fair one point eight to three point four four three point five to five. So this is like OHA is index OHA is index is also we have good fair score the score is little different but in OHAs we were checking debris index and calculus index but here we are checking plaque index plaque score and debris score. So next we will move on to plaque index. So plaque index it was given by sillness and law in 1964 which actually checked the thickness of plaque at the cervical margin of tooth. Cervical margin plate will be checking whose plaque 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 plaque score. The scoring criteria is as follows zero one two three zero is no plaque one is a philium of plaque which is adhering to free ginger margin and adjacent area of tooth plaque 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. So two and three we can see with naked eyes one we need to apply disclosing solution. So calculation we have zero to three score for each surface so individual tooth scores added then divided by four because we have four surface, mesial, distal, facial and lingual. So for plaque index for group of teeth or for individual we need to add up all the scores then divided by the number of teeth examined then plaque 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 point one to point nine where is one to one point nine four is two to three uses which is very reliable technique for evaluating both mechanical and the plaque procedures and chemical agents also can be used in longitudinal studies and clinical trials. Now we have another plaque index which is known as cuteline hyen plaque index later it was modified by Tureski Gilmore click map. So the original index cuteline in 1962 they reported a plaque measurement that focused on the ginger with the so mostly majority of the plaque indices will be focusing on the ginger with the tooth only the facial surface of anterior teeth were examined using basic fits in mouthwash as a disclosing agent but in 1970 it was modified by Tureski Gilmore and clickman. 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 buccal surface because a posterior teeth also were involved but in the cubal hyen it was only anterior surface the facial surface of anterior teeth were examined but later modified into all the teeth with lingual and labial surfaces. So that was modification done by 1970. So these were the scoring criteria 0, 1, 2, 3, 4, 5. 0 is no plaque, 1 is separate flecks of plaque at the cervical margin, 2 is thin continues band up to 1mm, 3 is band of plaque wider than 1mm but covering less than 1 third of ground, 4 is plaque covering at least 1 third but less than 2 third and 5 is plaque covering more than 2 third of the ground and the index is based on the numerical score is 0 to 5. So we can calculate the individual tooth score or we did in last and we can calculate the patient total performance or total score by dividing their keeping denominator total teeth examined so we get a score. So now we have few gingival indexes the periodontal index and CPITN we already covered in our earlier sessions. Now let us see what is gingival index it was developed by Lowe and Silnes in 1963 the same authors of gingival index but gingival sorry plaque index plaque index was by Silnes and Lowe gingival index Lowe and Silnes same authors but one is having more contribution so he kept as a first author. So this is one of the most widely accepted used gingival indexes it has a severity of gingival it is at 4 possible areas may say lingual, distal and facial. So only quality changes are assessed method is all surfaces of all teeth or selected teeth can be checked so selected teeth can be 1 6 1 2 2 4 3 6 3 2 and 3 4 here the change in index teeth is lateral incisor and second premotor like oil JS or PHB index. So the teeth and gingival first dried with the blast of air or cotton rolls the tissues are divided into 4 gingival scoring units distro facial papillae, facial margin, meso facial papillae and entire lingual margin a bland perioprop will be used to assess the bleeding potential of the tissue. So this is a score 0 1 2 3 0 is no inflammation homogengebo one is mild inflammation slight change in color slight edema no bleeding on probing 2 is moderate inflammation moderate glazing redness edema and bleeding on probing 3 severe inflammation and mild redness hypertrophy and spontaneous bleeding 2 is bleeding 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 examined that is 4 the gingival index score of the tooth is obtained. So just like how we did in our previous index 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 scores divided by number of teeth will give them individual score interpretation 0.1 to 1 mild gingivitis 1.1 to moderate 1 1 2 3 severe gingivitis and modified gingival index it was developed by Lopin by the Fort Rose Lamb and Manakar in 1986 which assess the prevalence and severity of gingivitis just strictly based on on invasive approach that is visual examination only without any probing so that is the difference there is no probing to obtain modified gingival index label and lingual surface of gingival margin and the interdental papilla of all eruptor teeth except third molars examined and scored. So this is scores here 1 2 3 4 1 is mild inflammation 2 is mild inflammation entire gingival in unit this is little change in the texture and only any portion of the gingival unit is affected there is 3 moderate inflammation and there will be redness edema and hypertrophy for a severe inflammation and spontaneous splitting this is all clinical examination no there is no invasive technique. The next index is papillary marginal attachment index or PMA just given by Mori, Messler and Schor in 1944 this 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 3 compartments that is papillary gingiva marginal gingiva attached gingiva suppressance or absence of inflammation on each gingival unit is recorded usually only on maxillary and mandibular incisors can 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 is 0 normal mild papillary enlargement we are seeing recent size excessive recent size necrotic papilla and atrophy and loss of papilla for 5 whereas marginal component 0 normal 1 is engorgement noblading 2 is bleeding on pressure 3 swollen collar beginning infiltration for his necrotic gingiva and 5 is recession of free marginal gingiva below C H G due to the inflammatory changes whereas A component that is PMA A component attached component we have only 4 score that is 0 1 2 3 here we have 6 scores actually only 5 scores 1 2 3 4 5 0 will not be counted anyway so total 6 scores here we have 4 scores 0 1 2 3 0 is normal 1 is slight engorgement with loss of stippling 2 is obvious engorgement with marked increase in retinas and pocket formation and 3 is advanced periodontitis so calculation will add up all the 3 P plus M plus A we will get the final scores it is used in clinical trials individual patients and surveys now we have bleeding index given by AINAM 1 way 1975 ginger all bleeding index which is based on recording from all 4 tooth surface of teeth recorded as bleeding present plus and bleeding absent negative so these 4 surfaces are buckle lingual miscellaneous still so a negative or minus sign is equivalent to 0 and 1 plus sign is equivalent to 2 and 3 so ginger bleeding index is calculated as a percentage of affected sites so in experimental studies and team basis in individual patients also it can be used we have circus bleeding index which is developed by mulliman adjavan sannas in 1971 it is a modification of papillary marginal index of mulliman and major z so scoring criteria is 0 1 2 3 4 and 5 0 is healthy looking papillary and marginal ginger no bleeding on probing and is healthy looking ginger 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 ginger all units has scores systematically for each tooth the labial lingual the miscellaneous still ginger scores of these units are added by divided by 4 gives sulcus bleeding index but modified sulcular 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 prob is passed along ginger version 1 is isolated bleeding sports visible 2 is blood forms a confluent red line on margins 3 is heavy or profuse bleeding so that was about bleeding index and ginger index so i'll come up with a new session in this channel thank you