PLAQUE INDICES INDICES USED FOR PLAQUE

AND DEBRIS ASSESSMENT:

MEASUREMENT OF CALCULUS
ORAL HYGIENE INDICES

OHI
SIMPLIFIED ORAL HYGIENE INDEX
PLAQUE INDEX (Silness-Le)
QUIGLEY-HEIN INDEX TURESKY PLAQUE
INDEX
CALCULUS SURFACE INDEX (CSI)
CALCULUS SURFACE SEVERITY INDEX (CSSI)
PATIENT HYGIENE PERFORMANCE INDEX
(PHP INDEX)
GLASS INDEX
NAVY PLAQUE INDEX
PLAQUE CONTROL RECORD (O'LEARY)
VOLPE MANHOLD INDEX
MARGINAL LINE CALCULUS INDEX (MLCI)

 OHI 1960 JOHN C. GREENE and JACK R. VERMILLION

2 components- DI, CI
For debris index, estimation by running the side of a No. 23
explorer (Shepherds hook)
A No.5 explorer is used for estimating the amount of supragingival
and subgingival calculus.
Buccal and lingual surfaces of each of the three segments of each
dental arch examined.
Segment 1: distal to the right cuspid on the maxillary arch
Segment 2: mesial to the right and left first maxillary bicuspids
Segment 3: distal to the left maxillary cuspid
Segment 4: distal to the left mandibular cuspid
Segment 5: mesial to the right and left mandibular first bicuspids
Segment 6: distal to the right mandibular cuspid
DEBRIS INDEX
SCORE
CRITERIA
0
no debris or stain
1
soft debris up to 1/3 of the tooth or stain
2
soft debris up to 2/3 of the tooth
3
soft debris more than 2/3 of the tooth
CALCULUS INDEX
SCORE
CRITERIA
0
No calculus present
1
Supragingival calculus up to 1/3 of the tooth surface
2
Supragingival calculus up to 2/3 of the tooth or
presence of individual flecks of subgingival calculus
around cervical portion
3
Supragingival calculus more than 2/3 of the tooth or a
continuous heavy band of subgingival calculus
DI= buccal score+lingual score/ no. of segments scored
CI= buccal score+lingual score/ no. of segments scored
OHI=DI+CI ; value ranges from 0 to 12
Higher the score, poorer the oral hygiene.

 SIMPLIFIED ORAL HYGIENE INDEX (Greene-Vermillion)

1964
SCORE
CRITERIA
0
no debris or stain
1
soft debris up to 1/3 of the tooth or stain
2
soft debris up to 2/3 of the tooth
3
soft debris more than 2/3 of the tooth
(CI-S)

SCORE
0
1
2

CRITERIA
No calculus present
Supragingival calculus up to 1/3 of the tooth surface
Supragingival calculus up to 2/3 of the tooth or
presence of individual flecks of subgingival calculus
around cervical portion
Supragingival calculus more than 2/3 of the tooth or a
continuous heavy band of subgingival calculus

Surfaces and teeth examined

16 buccal
11 labial
26 buccal
36 lingual
31 labial
46 lingual
INTERPRETATION:
For the DI-S and CI-S score,
Good- 0 to 0.6
Fair- 0.7 to 1.8
Poor-1.9to 3.0
For the OHI-S score,
Good- 0.0 to 1.2
Fair- 1.3 to 3.0
Poor- 3.1 to 6.0

 PLAQUE INDEX (Silness-Le)

which was introduced by Silness and Loe in 1964
-Used together with GI, and should precede the gingival examination.
-Used on all teeth (28, so wisdom teeth are excluded) or selected teeth (6)
-No substitution for any missing tooth.
-Used on all surfaces (4) (M, O, D, L) or selected surfaces (M, O, L).
-This index measures the thickness of plaque on the gingival one third.
-The six index teeth are:
624EBD
426DBE
Score Criteria
0
No plaque
1
A film of plaque adhering to the free gingival margin and adjacent
area of the tooth, which cannot be seen with the naked eye. But only
by using disclosing solution or by using probe.
2
Moderate accumulation of deposits within the gingival pocket, on
the gingival margin and/ or adjacent tooth surface, which can be
seen with the naked eye.
3
Abundance of soft matter within the gingival pocket and/or on the
tooth and gingival margin.
Calculation:
1- Individual: 2- Population:
PII = Total scores PII = Total scores
No. of surfaces examined No. of subjects examined

INTERPRETATION
Excellent
Good
Fair
Poor

0
0.1-0.9
1.0-1.9
2.0-3.0

QUIGLEY-HEIN INDEX TURESKY PLAQUE INDEX

QUIGLEY-HEIN used basic fuchsin
SCORE
CRITERIA
0
No plaque

1
2
3
4
5

Flecks of stain at gingival margin

definite line of plaque at the gingival margin
Gingival third of surface
Two thirds of surface
Greater than 2/3 of surface

Modified by Turesky et al
SCORE
CRITERIA
0
No plaque
1
Separate flecks of plaque at cervical margin
2
A thin continuous band of plaque at the gingival
margin
3
A band of plaque wider than 1 mm covering less
than one third of the crown of the tooth
4
Two thirds of surface
5
Greater than 2/3 of crown of the tooth
Score of 0 or 1 is considered low
Score of 2 or more is considered high
CALCULUS SURFACE INDEXCalculus Surface Index (CSI)
which was introduced by Ennever J, Sturzenberger C.P and Radike
A.W. in 1961.
CSI assesses the presence or absence of supra and/or subgingival
calculus by visual or tactile examination, regardless the quantity of
calculus.
4 or 6 mandibular anterior teeth are examined.
Criteria 0 Absence 1 Present
0= no calculus
1= calculus not extending 0.5mm in width and thickness
2= calculus not extending 1.0 mm in width and thickness
3= calculus extending 1.0mm in width and thickness

Each tooth divided into 4 areas.

Calculation:
CSI =Total number of scores 0 --------- 16 or 0 -------- 24
The CSI is one of the two indices that are used in short-term (i.e.
less than 6 weeks) clinical trials of calculus inhibitory agents.

 CALCULUS SURFACE SEVERITY INDEX (CSSI) was developed

by Ennever J, et al in 1961 as a companion index to their calculus
surface index. The CSSI measures the quantity of calculus present
on a scale of 0 to 3 on each surfaces examined for CSI.
PATIENT HYGIENE PERFORMANCE INDEX (PHP INDEX)
This index for assessing an individuals oral hygiene performance
was introduced by Podshadley A.G and Haley J.V. in 1968.
GLASS INDEX
The Glass index system was developed by Glass R. L. in 1965.
This index assesses the presence and extent of debris
accumulation, for evaluating tooth brushing efficacy.
NAVY PLAQUE INDEX
The NPI was developed by Grossman F.D. and Fedi P.F. in 1970.
This index was designed to assess the plaque control status among
naval personnels and to measure any subsequent changes.
-Rustogi modified navy plaque index

PLAQUE CONTROL RECORD (O'LEARY)

Four surfaces of each tooth scored + or for visible plaque after disclosing.

 VOLPE MANHOLD INDEX developed by Volpe A.R. and Manhold J.H. in

1962 to assess the presence and severity of calculus formation, specifically
new deposits of supragingival calculus, following an oral prophylaxis.
Measure the extent of supragingival calculus on the lingual surface of lower
front teeth by recording the calculus in mm-s. There are three readings on
each tooth.

MARGINAL LINE CALCULUS INDEX (MLCI) was developed by

Muhlemann H.R. and Villa P. in 1967. MLCI, is another index that is
frequently used in short-term clinical trials (i.e. less than 6 weeks) of
anticalculus agents.
This index was developed to assess the accumulation of supra gingival
calculus on the gingival third of the tooth or, more specifically, supragingival
calculus along the margin of the gingiva.
The tooth is devided into a mesial and a distal part. The percentage of the
distance covered by calculus is expressed as 0%, 12,5%, 25%, 50%, 75% and
100%

MEASUREMENT OF GINGIVAL INFLAMMATION Indices used for

gingival disease assessment:

Indices used for periodontal disease assessment:
COMMUNITY PERIODONTAL INDEX OF TREATMENT NEEDS
(CPITN)
SULCUS BLEEDING INDEX (SBI)
GINGIVAL BLEEDING INDEX (AINAMO-BAY) PLAKK RTK
(O'LEARY)
GINGIVAL INDEX (GI)
PERIODONTAL DISEASE INDEX (PDI)
PAPILLARY BLEEDING INDEX (PBI)

 Papillary Bleeding Index (PBI)

Score
Criteria
0
no bleeding
1
bleeding some seconds after probing
2
bleeding immediately after probing
3
bleeding on probing spreading towards the gingival margin
Sulcus Bleeding index (SBI) for assessment of gingival bleeding, developed
by Muhlemann H.R. and Son S. in 1971. This index system is a modification
of the papillary- Marginal Index. Of Muhlemann &Mazor (1958). The
purpose of this index is to locate areas of gingival sulcus bleeding upon
gentle probing and thus recognize and record the presence of early
inflammatory gingival disease.

GINGIVAL BLEEDING INDEX (AINAMO-BAY) PLAKK RTK

(O'LEARY)
four surfaces of each tooth scored + or - for bleeding on probing expressed in
percentage of the bleeding spots
Gingival Index (Le-Silness) (GI)
Gingival Crevicular Fluid Flow (GCF)
*Gingival Index (GI).... which was introduced by Loe and Silness in 1963
GI could be used in all teeth or selected teeth and in all surfaces or selected
surfaces.
The examination is done by blunt probe.
Partially erupted teeth, retained roots, teeth with periapical lesion and third
molars should be excluded and there is no substitution.
Score
0
1
2
3

Criteria
No inflammation.
Mild inflammation, slight change in color, slight edema, no bleeding
on probing.
Moderate inflammation, moderate glazing, redness, bleeding on
probing.
Severe inflammation, marked redness and hypertrophy, ulceration,
tendency to spontaneous bleeding.

INFERENCE:
0.1-1 Mild gingivitis
1.1-2 Moderate gingivitis
2.1-3 Severe gingivitis
Calculation:
1-Individual
2-Population
GI =
Total scores
GI = Total scores
No. of surfaces examined
No. of subjects examined
****If we want to calculate the maximum score for gingival index (4 surfaces and
6 teeth)..
GI = Total scores GI = 3 * 4 * 6 = 3 * 24 = 3
No. of surfaces examined 4 * 6 24

Indices used for periodontal disease assessment:

*Periodontal Disease Index (PDI) which was introduced by Ramfjord in 1959
Which is composed of three components.
All the three components will be scored separately using six Ramfjord selected
teeth.
6 1 4 E AD
4 1 6 DAE
1-Gingival and periodontal component.
1-The criteria ranged from o 1 2 3 4 5 6 normal gingivitis periodontitis
2-All areas (M, D, B, L) is scored as a one unit.
3-Only fully erupted teeth are scored
4-There is no substitution for excluded teeth.
Calculation: Total sores No. of teeth examined
2-Plaque component:
1-The criteria ranged from 0 - 3 .
Scoring criteria:
0 No plaque
1 Plaque present on some but not on all interproximal, buccal, and lingual
surfaces of the tooth.
2 Plaque present on all interproximal, buccal, and lingual surfaces, but
covering less than one half of these surfaces..
3 Plaque extending over all interproximal, buccal and lingual surfaces, and
covering more than one half of these surfaces.
2-All areas ( B , L , M , D ) are scored as one unit.
3-Only fully erupted teeth are scored.
4-There is no substitution for excluded teeth.
Calculation: Total scores No. of teeth examined 4
3- Calculus component:
1-The criteria ranged from 0 - 3
Scoring criteria:
0
Absence of calculus.
1
Supragingival calculus extending only slightly below the free
gingival margin (not more than 1 mm).
2
Moderate amount of supragingival and sub gingival calculus
or subgingival calculus alone.
3
An abundance of supra gingival and sub gingival calculus.

2-This index measured the extension of calculus.

3-Only facial and lingual surfaces are evaluated, and scored separately.
Calculation: Total scores No. of surfaces examined
*Community Periodontal Index of Treatment Needs (CPITN) which was
introduced by WHO / FDI in 1982
The mouth is divided into six parts (sextants).
The examination done by special probe (WHO probe).
The score is identified by examination of specified index teeth or all teeth.
616
616
C P I score criteria
0 No periodontal disease
.
1 Bleeding on probing
.
Calculus with plaque seen or felt by
2 probing.
3

Pathological pocket 4 5 mm.

Pathological pocket 6 mm or more.

When only 1 tooth or no tooth are

present.

TN score criteria
0 No need for treatment.
1 Personal plaque control (OHI).(1- 4).
2 Professional plaque control (scaling and polishing). (23 Deep scaling , root planning, surgical procedure. (3- 4)

Russells Periodontal Index

Developed by Russell A.L. in 1956
PI is a composite index because it records both the
reversible changes due to gingivitis and the more
destructive and presumably irreversible changes brought
about by deeper periodontal disease.
All the teeth are examined.
SCORE

CRITERIA

ADDITIONAL
RADIOGRAPHIC
FEATURES
Negative: neither overt Radiographic features
inflammation nor loss
essentially normal
of function due to
destruction of
supporting tissue
Mild Gingivitis: an
overt area of

inflammation in free
gingiva, which does
not circumscribe the
tooth.
Gingivitis:
inflammation
circumscribes the
tooth but no apparent
break in the epithelial
attachment.
Used only when
radiographs are
available
Gingivitis with pocket
formation: pocket
present, no
interference with
normal masticatory
function, the tooth is
firm in its socket and
has not drifted
Advanced destruction
with loss of
masticatory function:
the tooth may be
loose; may sound dull
on percussion with
metallic instrument;
may be depressible in
its socket

There is early notch like

resorption of the
alveolar crest.
Horizontal bone loss
involving entire alveolar
crest up to half the
length of the root.

Advanced bone loss

more than half of the
tooth root or a definite
infrabony pocket with
pdl widening. There
may be root resorption
or rarefaction at the
apex.

Calculation of the Index

PI score per person= sum of individual scores/ no. of
teeth present
INTERPRETATION
Clinical condition

Individual PI
score

Clinically normal
supportive tissues

0-0.2

Simple gingivitis

0.3-0.9

Beginning destructive
periodontal disease

1.0-1.9

Established destructive
periodontal disease

2.0-4.9

Terminal disease

5.0-8.0