Clinical use of Indices

• What is an index?

  An index is an expression of clinical observation in numerical values

  
  

  Used to describe the status of the individual or group with respect to condition being measured
• Why do we use indices in clinical dentistry?

  • aid in diagnosing
  • baseline
  • screening
  • response to treatment
  • epidemiology
• how do we utilise indices?

  - patient treatment plan

  - motivate patient

  - studies

  - prevalence/ incidence of disease

  • Screen & assess for disease, oral hygiene measures, levels of decay

  • Baseline recordings

  • Educate & motivate the patient

  • Monitor progress/compliance with treatment / advise

  • Evaluation of treatment success

  • Clinical trial
• Numerical coding or scoring system is..

  more consistent & less subjective
• Indices allow results to be...

  reproduced
• Using indices removes

  objectivity
• Examples of Indicies

  Basic Periodontal Examination (BPE)

  Bleeding Index

  Plaque Index

  Clinical Attachment Levels

  Furcation Index

  Mobility Index
• What is the criteria for ideal index?

  Clear-cut criteria, simple & unambiguous

  Free as possible from subjective interpretation

  Reproducible

  Require minimal equipment

  Simply & speedy to calculate

  Amenable to statistical analysis
• What is the Plaque index?

  
• What is a gingival index?

  
• What is the Dean Index?

  (Fluorosis indicies)

  
• What is the TF Index?

  (Fluorosis Indices)

  
• What is the Tooth Wear Index?

  
• What is the Basic Erosive Wear Examination?

  
• What are the DMF Indices?

  USED IN RESEARCH

  
• What is the procedure for

  DMFT & dmft?

  
• What is the procedure

  DMFS & dmfs?

  
• What is the criteria for 'D' = Decayed teeth in the DMFT Index?

  1. Carious teeth

  2. Filled teeth with current caries

  3. Retained roots

  4. Defect of a filling with caries present

  5. Temporary fillings

  6. Filled tooth surface where another surface has caries
• Advantages of the BPE

  - quick and easy

  - anyone can interpret the results
• What are the 'decayed' subclasses in DMFT/S?

  Decayed may be subdivided

  
  

  D1 - an enamel lesion

  D2 - a lesion with a cavity in the enamel

  D3 - a lesion with a cavity into the dentine

  D4 - a lesion judge to be into the pulp
• With 'M' Missing teeth due to caries, what is excluded?

  1. Teeth extracted for reasons other than caries e.g. orthodontic treatment

  2. Impaction

  3. Periodontal disease (teeth lost)

  4. Unerupted teeth

  5. Congenitally missing teeth (hypodontia)

  6. Extraction of teeth due to trauma or an accident
• Is a crown placed due to previous decay recorded in the 'F' Filled teeth category? What teeth are excluded?

  Yes

  
  

  Teeth excluded in the index:

  1. Trauma

  2. Hypoplasia#

  3. Bridge abutment

  4. A sealed root canal due to trauma

  5. Fissure sealant

  6. PRR

  7. Supernumerary
• What are advantages of DMFT/S?

  Used frequently and internationally for dental epidemiology:

  General dental health of a population

  Trends in caries rate

  Index expresses caries incidence quantitatively.

  Advantages of the DMFT Index

  Objectivity

  Time efficiency

  Dichotomy (decayed, missing)
• What are the disadvantages/Flaws with DMFT/S?

  • comparisons difficult between countries
  • Difference in scoring criteria
  • Standards of dental care
  • Over estimations
  • Score of 12 DMFT linked to different outcomes
  • recording issues: one score per tooth, secondary caries
  • Interpretation of ‘missing - reason?
  • economics Influence
  • extension of cavity preps for retention purposed?
  • Sealants/PRR/Composite/resin/Bridge abutments
• What is the BEWE?


  Basic Erosive Wear Examination

  • D. Bartlett, C Ganss & A Lussi 2008
  • In response to the increase incidence of erosion
  • 5% 15 year olds & 11% adults have tooth wear (Dixon et al 2012)
  • ‘DBOH’ states over three quarters (77%) of adult have tooth wear.
• What is the procedure for the BEWE?

  Diagnose the presence of tooth wear; eliminate teeth with trauma and developmental defects

  Examine all surfaces of teeth for tooth wear

  Identify in each sextant the most severely affected tooth with wear

  Conduct BEWE score on that tooth

  
• What is the criteria for grading erosive wear?

  • 0 - no erosion
  • 1 - initial loss of surface texture
  • 2 - distinct defect, hard tissue loss <50% of SA
  • 3 - hard tissue loss >50% of SA

  scores in sextants like BPE, using worst site, total gives complexity level of individual
• How is the risk/complexity level of BEWE used as a guide to clinical management?

  • 0 - no risk - <2 - routine maintenance, repeat every 3 years
  • 1 - low risk - 3-8 - OHI and diet advice, routine maintenance , repeat every 2 years
  • 2 - medium risk - 9-13 - OHI and diet advice, identify aetiological factors, try to eliminate, fluoridation measures?, avoid restoration placement, monitor with study models/photos, repeat every 6-12 months
  • 3- high risk - >14 - as above + special care for extreme cases
• Facts about BEWE as an Index?

  A useful screening tool for erosive tooth wear

  Indicates treatment & management needs plus review intervals

  Simple to perform

  Allows for longitudinal monitoring of tooth loss

  Becoming more widely accepted and used

  Erosive loss on the increase in the population

  Litigation

  'protect patient and the profession' (Bartlett et al 2017)
• Plaque Index (Silness & Loe 1964):

  Code 0 - no plaque present

  Code 1 - film of plaque, visible by removal on probe or disclosing

  Code 2 - mod plaque accumulation within pocket or at gingival margin, seen by naked eye

  Code 3 - heavy plaque accumulation filling niche between gingival margin & tooth surface, ID space filled with debris
• Modified Quingley-Hein Plaque Index (Lobene 1982):

  Code 0 - no plaque

  Code 1 - discontinuous line at gingival margin

  Code 2 - continuous line at gingival margin up to 1mm

  Code 3 - continuous line > 1mm up to 1/3 of tooth

  Code 4 - continuous line > 1/3 and < 2/3

  Code 5 - continuous line > 2/3
• Gingival Index?

  • code 0 - normal gingiva
  • code 1 - mild inflammation, slight colour change and odema, no BOP
  • code 2 - moderate inflammation, redness, odema, glazing, BOP
  • code 3 - severe inflammation, marked redness, odema, ulcerations?, tendency of spontaneous haemorrhage
• Modified Gingival Index?

  • code 0 - absence of inflammation
  • code 1 - mild inflammation, not all portions of gingival margin, slight change in colour and texture
  • code 2 - mild inflammation all portions of gingival margin
  • code 3 - moderate inflammation, bright surface inflammation, erythema, odema, hypertrophy or gingival margin or papillary
  • code 4 - severe inflammation, erythema, odema, hypertrophy of marginal or papillary unit, spontaneous bleeding, congestion, ulcerations
• Dean Index?

  • 0 - normal
  • 0.5 - questionable
  • 1 - very mild
  • 2 - mild
  • 3 - moderate|
  • 4 - severer
• TF Index?

  A) TF 1

  B) TF 3

  C) TF 1

  D) TF 2

  E) TF 3

  F) TF 7

  G) TF 8

  H) TF 9

  I) TF 7

  J) TF 6

  K) TF 5

  L) TF 5-7

  M) TF 7

  N) TF 4

  O) TF 4

  P) TF 4

  Q) TF 5

  
• Dean Index

  A) normal

  B) mild

  C) questionable

  D) moderate

  E) very mild

  F) severe