1

GINGIVAL &
PERIODONTAL Presented By :
INDICES Dr. Priya Patel

Guided By : Dr. Hiral Parikh Dr. Charu Agrawal

Dr. Shilpa Duseja Dr. Mishal Shah 2
 CONTENTS
Introduction
Definitions
Objectives Of An Index
Ideal Requisites Of An Index
Criteria For Selecting An Index
Purposes And Uses Of An Index
Classification Of Indices
Indices For
Oral Hygiene
Plaque And Debris
Calculus
Gingival Inflammation
Gingival Bleeding
Periodontal Diseases
Tooth Mobility
Conclusion
References
3
 INTRODUCTION
until you can count it, weight it, or
express it in quantitative
fashion, you have scarcely
begun to think about the
problem in a scientific fashion
Lord Kelvin.

Quantitative measurement of a
disease most commonly relies
on Indices.
4
 DEFINITIONS
An index is an expression of clinical observation in numeric values. It is
usedEpidemiological
to describe theindices
status are attempts
of the to quantitate
individual clinical
or group with respect to
conditions on a graduated
a condition scale, The
being measured. thereby facilitating
use of comparison
numeric scale and a
among populations
standardized methodexamined by same criteria
for interpreting and methods.
observations
of a condition
Oral indices
results are essentially
in an index Irving
score set
thatGlickman
is moreof values,
1950usuallyand
consistent numerical with
less subjective
maximum
than a wordand minimumof
description limits,
that used to describe
condition. theMvariables
Esther Wilkinsor a
- 1987
specific conditions on a graduated scale, which use the same criteria
A
andnumerical
method value describing
to compare the relative
a specific variablestatus of a population
in individuals, samplesonor
a graduated
populations scale
with with
that samedefinite
variables upperas and lowerinlimits,
is found other which is
individuals,
designed to permit
samples and facilitate
or populations. comparison
George P Barneswith other
- 1985
populations classified by the same criteria and methods.
Russell. A. l 1956

5
Objectives Of An Index
Main purpose of an index in a dental
epidemiology is to increase understanding of
the disease process, thereby leading to
methods of control and prevention.
It attempts to discover populations at high and
low risk.
It helps to define specific problem
under investigation.
6
IDEAL REQUISITES OF AN INDEX

7
Clarity, Simplicity And Objectivity

8
Validity Reliability

9
Quantifiability Sensitivity

10
Acceptability

11
 Criteria For Selection Of An Index
o Simple to use and calculate
o Permit examination of many people in a short
period
o Require minimum armamentarium
o Should have criteria's which defines its
components clear and readily understandable
o Index should be free from subjective
interpretation
12
o Index should define clinical condition
objectively
o Should be highly reproducible when used by
one or more examiners
o Amenable to statistical analysis
o Strongly relate numerically to the clinical stage
of the specific disease under investigation
o Equally sensitive throughout the scale
o Should not cause discomfort to the patient.

13
 Purpose & Use Of Index
FOR INDIVIDUAL IN RESEARCH IN COMMUNITY
PATIENT
Determine base line Shows prevalence and
Recognize an oral data before incidence of a
problem experimental factors condition
Effectiveness of present are introduced
Assess the need of
oral hygiene practices
Measure the the community
Motivation in preventive effectiveness of
Compare the effects
and professional care for specific agents for
of a community
control and elimination of prevention control or
program and evaluate
diseases treatment of oral
the results
condition 14
 CLASSIFICATION OF INDICES
BASED ON THE DIRECTION IN WHICH THEIR SCORES CAN FLUCTUATE
IRREVERSIBLE INDICES
REVERSIBLE INDICES

DEPENDING UPON THE EXTENT TO WHICH AREAS OF ORAL CAVITY ARE

MEASURED
FULL MOUTH INDICES
SIMPLIFIED INDICES

BASED ON DISEASE ENTITY WHICH THEY MEASURE

Disease index
Symptom index
Treatment index
SPECIAL CATEGORIES AS
Simple index
Cumulative index
15
Indices For Assessing Oral Hygiene
And Plaque
Rules:

Only fully erupted permanent teeth scored

ORALerupted
Third molars & incompletely HYGIENE INDEX
teeth are ( OHI)
not scored

The Buccal & lingual

Developed debris
in 1960 by scores
John CareGreene
both taken on the
& Jack tooth in a segment
R vermillion.
having the greatest surface area covered by debris
To classify and assess oral hygiene status.
OHI comprises
Similarly of 2are
calculus scores components
taken on the tooth in a segment having the greatest
surface area covered
DEBRIS by supra & sub-gingival calculus.
INDEX(DI)
CALCULUS
Using INDEX(CI) hook) debris & calculus are estimated by
no.5 explorer(shepherds
METHODOLOGY
running on Buccal/labial or lingual surface noting occlusal or incisal extent of
the debris as it is removed from the tooth surface.

Mouth
Thus in thisisbuccal/labial
divided intoor6lingual
segments:
scores are not taken from same tooth
 PROCEDURE
Each segment examined for debris or calculus.
From each segment one tooth is used for calculating the
individual index for that segment.
The tooth used for the calculation must have the greatest
area covered by either debris or calculus.
Buccal/labial and lingual surfaces.
DI no:23 explorer (shepherds hook)
CI no:5 explorer
CRITERIA OF SCORING (DI)AND (CI)

17/48
 CALCULATION
DI = Buccal total score + Lingual Total score
No: of segments
CI = Buccal total score + Lingual Total score
No: of segments

OHI = DI+CI

DI & CI = 1- 6
OHI = 0-12
Higher the score poorer the oral hygiene

18/48
SIMPLIFIED ORAL HYGIENE INDEX
(OHI-S)
o 1964,John C Greene & Jack R vermillion.
o Oral hygiene index was determined to be simple and sensitive, it was
time- consuming and required more decision making. So effort was
made to make more simplified index with equal sensitivity.

DIFFERENCE

o Number of tooth surfaces scored 16 rather 12

o Method of selecting the surface
o The scores, which can be obtained

SURFACES AND TEETH TO BE EXAMINED

19/48
 SUBSTITUTION
16 -17 , 26 27, 36- 37 OR 38, 31-41, 46 47 OR 48 , 17 18. 11- 21
EXCLUSIONS - Natural teeth with full crown restorations and surfaces
reduced in height by trauma/caries not scored.
INSTRUMENTS: Mouth mirror,no:23 explorer(shepherds Crook)
Scoring and method are same as that of OHI.
CALCULATION (DI-S AND CI-S)

DI-S = Total score

No : of surfaces examined

CI-S = Total score

No : of surfaces examined

OHI-S = DI-S + CI-S

20/48
 INTERPRETATION

For DI-S & CI-S score

For OHI-S score -

Study of epidemiology of periodontal diseases.

21/48
 Plaque Index (Pii)
o Described by Silness P and Loe H in 1964.
o This index measures the thickness of plaque on the gingival one
third.
o Used as full mouth index/simplified index.
Advantages
o It is unique among indices used for the assessment of plaque
because of the coronal extent of plaque on the tooth surface area
and assesses only the thickness of the plaque at the gingival area
of the tooth
o Demonstrate good validity and reliability
Drawback :
o One criticism is the subjectivity in estimating plaque. To
overcome this, it is recommended that a single examiner to be
trained and used with each group of patients.
INDEX TEETH:16,12,24,36,32,44
o No substitution if any one of the above teeth are missing.
Areas examined: Distofacial , Facial, Mesio-facial and lingual
surface of tooth.
Instruments: Mouth mirror, Dental explorer.

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 PROCEDURE
Tooth is dried and examined visually.
Explorer Is passed across the tooth surface in the cervical third and
near the entrance of gingival sulcus. When no plaque adheres to the
point of explorer, the area is considered to have a 0 score. When
plaque adheres, a score of 1 is assigned. Plaque that is on the
surface of calculus deposits and on dental restorations of all types in
cervical third is evaluated and included.
SCORING CRITERIA
CALCULATION AND INTERPRETATION
PII for a tooth = Scores of 4 areas
4
PII for individual = Total scores
no: of teeth examined
PII for group = Total score
no: of individuals

23/48
Turesky Gilmore- Glickman Modification Of The
SCORE Quigley Hein Plaque Index
CRITERIA
0 No plaque
Quigley
1 G. Hein . J in 1962, reported aSeparate
Score plaque measurement
Criteria
flecks that focused
of plaque on
at the cervical
the gingival third of the tooth surface. margin
They examined only the facial surfaces
of the tooth
0 no plaque
of the anterior teeth, using basic fuchcin mouthwash as a disclosing agent.
The 2Quigley Hein1plaque index was modified
flecks by
of Turesky
stain of the
A thin continuous
gingivalN.D
S, Gilmore
band of plaque at the
and Glickman I in 1970. margin
cervical margin of the tooth
Modification was done 2 by strengthening Definitive line of
the objectivity of plaque on gingival
the original
3 This system of scoring plaque is
criteria. A margin
band of plaque
relatively easy to wider then 1mm
use because of the
objective definitions3 of each numericalcovering
Gingivalless
score. thirdthan 1/3rd of the crown of
of surface
Instruments used Mouth mirror and the tooth agent.
Disclosing
4 Two- thirds of surface
Method labial , buccal and lingual surfaces are assessed after using
4 Plaque covering atrdleast 1/3rd but less
disclosing agent. 5 Greater then 2/3 of the surface
then 2/3rd of the crown of the tooth
Scoring criteria -
Calculation and interpretation : Plaque covering 2/3rd or more of the
IS5 = TS/ No of surfaces examined crown of the tooth
0-1 = low
>2 = High
24/48
 GLASS INDEX
It was developed by GLASS R.L in 1965.
This index assesses the presence and extent of debris accumulation , for
evaluating tooth brushing efficacy..
CRITERIA
Code 0 no visible debris
Code 1 debris visible at gingival margin but discontinuous less than1mm
in height
Code 2 debris continuous at gingival margin greater than 1mm in height.
Code 3- debris involving entire gingival third of the tooth
Code 4- debris generally scattered over tooth surface
CALCULATION
Debris index score per person total debris score of all the teeth examined /
total no of teeth examined.
Glass criteria of scoring places more emphasis on the gingival third of the
tooth surface than does the OHI- S, and so this index is useful in clinical
trials of preventive and therapeutic agents.
25/48
 Shick And Ash Modification Of
Plaque Criteria
The original criteria of plaque component of RAMFJORDS periodontal disease
was modified by SHICK R.A and ASH M.M in 1961.
Scoring criteria only fully erupted teeth should be scored and missing teeth
should not be substituted.
Calculation PS = TOTAL SCORE/ NO. OF TEETH EXAMINED
Score Criteria
0 Absence of dental plaque
1 At the gingival margin covering less than 1/3rd of the gingival
half of the facial or lingual surface of the tooth
2 Dental plaque covering more than 1/3rd but less than 2/3rd of the
gingival half of the facial or lingual surface of the tooth.
3 Dental plaque covering 2/3rd or more of the gingival half of the
facial or lingual surface of the tooth

26/48
 Navy Plaque Index (Npi)
The navy plaque index was developed by GROSSMAN F.D & FEDI P.F
in 1970. This index was designed to assess the plaque control status
among naval personnels and to measure any subsequent changes.
METHOD :
The navy plaque index is obtained by scoring the amount of plaque
found on six selected teeth (index teeth) by using a disclosing solution.
The teeth examined are.
16, 21,24,36,41,44 and surfaces are facial and lingual of the each six
teeth, the facial surfaces are divided into three major areas as Gingival
Area (G), Mesial Proximal Area (M) and Distal Proximal Area (D).
The stained plaque in contact with the gingival is scored as follows-
Area M = 3
Area G = 2
Area D = 3 when plaque is found not in contact with gingival tissue but
is found on any tooth surface, one point is added to the facial or lingual
score.
Calculation the highest for any of the six teeth scored is the patients
NAVY plaque index score. All teeth scores are added to give the total NPI
score. 27/48
 INDICES USED FOR ASSESSMENT OF
CALCULUS

o CALCULUS SURFACE INDEX (CSI) - ENNEVER J,

Sturzenberger C.P and Radike A.W in 1961.

o MARGINAL LINE CALCULUS INDEX (MLCI)- Muhlemann H.R

and Villa P. in 1967.

o CALCULUS SURFACE SEVERITY INDEX (CSSI) - The calculus

surface severity index was developed by ENNEVER J , et al in
1961 as a companion index to their calculus surface index
(CSI)

28/48
 Indices Used For Assessing Gingival
Inflammation
score
score criteria
criteria
PAPILLARY
score MARGINAL ATTACHMENT
criteria INDEX (PMA)-
00 Normal
Normal
MAURY
0 MASSLER AND SCHOUR
Normal .L 1944.
1 Engorgement, slight inc in size, no
No. of1 gingival units effected werebleeding
counted rather then the
Slight engorgement severity
with loss ofof
1 Might papillary enlargement
inflammation. stippling, changes in color may or may
22 Obvious
not
Obvious beengorgement
present
increase in size ,,BO
bleeding on
METHODpressure
Pressue
A gingival
3 unit was divided into threeSwollen
compartments
collar,
spontaneous
3 2 Obvious engorgement
Excessive inc in size, with marked inc
Papillary gingiva, Marginal gingiva,inAttached
bleeding
redness
spontaneous gingiva
, beginning
and
bleeding infiltration
pocket formation
Presence
44 or absence of inflammation on each
Necrotic
Necrotic gingival
gingiva unit is recorded and usually
papilla
3
only maxillary and mandibular incisors, Advanced
canines of periodontitis
and premolars and deep
were examined.
5 Recession the free marginal
pockets.
5 gingiva
Atrophy below
and loss CEJ due to
SCORINGinflammatory
CRITERIA changes.
Papillary component (p) Marginal component (m) Attached component

29/48
 Calculation of the Index

PMA = P+M+A

USES
Clinical trials
On individual patients
Epidemiologic surveys

30/48
 Advantage

GINGIVAL INDEX The sensitivity and reproducibility is

good provided the examiner's
Developed by Loe H and Silness P in 1963. knowledge of periodontal biology
and pathology is optimal
For assessing severity of gingivitis.
Instrument: MOUTH MIRROR , PERIODONTAL PROBE.

METHOD The severity of gingivitis is scored on all teeth or on

selected index teeth.
INDEX TEETH

Tissues surrounding each tooth divided into 4 gingival scoring units.

DISTO-FACIAL PAPILLA
FACIAL MARGIN
MESIO-FACIAL PAPILLA
LINGUAL GINGIVAL MARGIN
31/48
 SCORING CRITERIA

Use
Severity of
gingivitis,
controlled
Calculation and interpretation clinical trials
GI score for a tooth = Scores from 4 areas of preventive
4 or therapeutic
GI score individual = Sum of indices of teeth agents
No: of teeth examined
GI score for group = Sum of all members
Total no of individuals
32/48
 Modified Ginigval Index
Lobene, Weatherford, Ross, Lamm and Menaker in 1986.
Assess the prevalence and severity of gingivitis.

SCORE CRITERIA
Important changes in GI
0 gingival probing to assess
Elimination of Normal
the presence or absence of
bleeding. 1 Mild inflammation, slight change in
Redefinition of scoring system for mild color,
andlittle changeinflammation.
moderate in texture of any
portion of gingival unit
Method -
To obtain MGI2 , labial and lingual surfaces
Mild inflammation of entire
of the gingival gingival
margins and
unit except 3rd molars are examined
the interdental papilla of all erupted teeth
and scored. 3 Moderate inflammation of gingival unit

SCORING 4 Severe inflammation of gingival unit

33/48
 Papillary Marginal Index (Pm)
Developed by MUHLEMANN H.R and MAZOR Z.S in 1958.

score criteria
0 normal
1 Bleeding from gingival sulcus on
gentle probing, tissue otherwise
become normal.
2 Bleeding on probing, change in
color due to inflammation, no
edema
3 BOP, color change, edematous
swelling
4 Ulceration with additional
symptoms

34/48
 Sulcus Bleeding Index (Sbi)
Developed by MUHLEMANN H.R AND SEN.S in 1971.
Modification of PAPILLARY MARGINAL INDEX of MUHLEMANN
and MAZOR Z .S.
SCORING CRITERIA
Score 0 health looking papillary and marginal gingiva no bleeding on
probing;
Score 1 healthy looking gingiva, bleeding on probing;
Score 2 bleeding on probing, change in color, no edema;
Score 3 bleeding on probing, change in color, slight edema;
Score 4 bleeding on probing, change in color, obvious edema;
Score 5 spontaneous bleeding, change in color, marked edema.
Four gingival units are scored systematically for each tooth: the labial and
lingual marginal gingival (M units) and the mesial and distal papillary
gingival (P units). Scores for these units are added and divided by four gives
the sulcus bleeding index.
35/48
 Gingival Bleeding Index (Gbi)
In 1974, Carter and Barnes introduced a Gingival Bleeding Index, which
records the presence or absence of gingival inflammation.
The mouth is divided into six segments and flossed in the following order;
upper right, upper anterior, upper left, lower left, lower anterior and lower
right.
Bleeding is generally immediately evident in the area or on the floss;
however, thirty seconds is allowed for re- inspection of each segment.
Bleeding is recorded as present or absent. For each patient a Gingival
Bleeding Score is obtained by noting the total units of bleeding.

Gingival Bleeding Index (GBI)-

AINAMO & BAY (1975), is performed through gentle probing of the
orifice of the gingival crevice.

36/48
 Papillary Bleeding Index
Introduced by Saxer and Muehlemann (1975), as cited by Muehlemann
(1977).
A periodontal probe is inserted into the gingival sulcus at the base of the
papilla on the mesial aspect, and then moved coronally to the papilla tip.
This is repeated on the distal aspect of the papilla.
The intensity of any bleeding is recorded as:
Score 0 no bleeding;
Score 1 A single discreet bleeding point;
Score 2 Several isolated bleeding points or a single line of blood appears;
Score 3 The interdental triangle fills with blood shortly after probing;
Score 4 Profuse bleeding occurs after probing; blood flows immediately
into the marginal sulcus.

37/48
 Eastman Interdental Bleeding Index
Caton & Polson (1985) developed the Eastman Interdental Bleeding
Index (EIB).
A wooden interdental cleaner is inserted between the teeth from the
facial aspect, depressing the interdental tissues 1 to 2 mm. This is
repeated four times and the presence or absence of bleeding within 15
s is recorded.
Path on insertion should be parallel to occlusal surface.
Insertion and removal of interdental cleaner is done 4 times and then
moved on to next interproximal area.

SCORE = no. of bleeding areas/total no. of areas 100

35/48
 Periodontal Index
RUSSELLS PERIODONTAL INDEX (RPI)
Developed by Russell A.L in 1956
To estimate deeper periodontal diseases.
All teeth present examined.
Gingival tissue surrounding each tooth assessed for gingival
inflammation and periodontal involvement.
Instruments : Mouth Mirror, plain probe.
SCORING CRITERIA
CALCULATION AND INTERPRETATION
PI score per person = Sum of individual scores
No: of teeth present
39/48
 Periodontal Disease Index (Pdi)
Developed by SIGURD P. RAMFJORD IN 1959.
MOST IMPORTANT FEATURE OF PDI IS MEASUREMENT
OF THE LEVEL OF THE PERIODONTAL ATTACHMENT
RELATED TO THE CEJ OF THE TEETH.

16
COMPONENTS - SCORING METHODS - 21
24
36
41
44
PLAQUE,
CALCULUS,
GINGIVAL &
PERIODONTAL

40/48
 PLAQUE COMPONENT OF THE PDI
SURFACES FACIAL, LINGUAL, MESIAL, DISTAL
INSTRUMENTS- MOUTH MIRROR, DENTAL EXPLORER
Score CRITERIA
SCORING
SCORE Criteria
CRITERIA
SHICK0 0AND ASH modification ofNo plaque
absence
plaque criteria
of dental
present plaque
Consist1 1of six teeth excluding the interproximal
Plaque
At thepresent area
gingival butand
notrestricting
margin on all
covering the
less
scoring of plaque to the gingival half, of the1/3facial
interproximal,
then andgingival
rd ofbuccal
the lingual surfaces
and lingual
half of theof
surfaces
the index teeth. Selected teeth are same facial of lingual
as that
or the tooth
of plaque component
surface of the tooth
Scoring2 criteria only fully eruptedPlaque
teethpresent
should on all interproximal,
be scored and missing
2 Dental plaque covering more than 1/3rd
teeth should not be substituted. buccal and lingual surfaces of the
but less than 2/3rd of the gingival half of
tooth , but covering half than one half
Calculation PS = TOTAL SCORE/ theNO.OF
facial orTEETH EXAMINED
lingual surface of the tooth
of these surfaces
3 Plaque
Dentalextending over all 2/3rd or more of
plaque covering
3 interproximal
the gingival, buccal andfacial
half of the lingual
or lingual
surfaces,
surfaceand covering
of the tooth more than one
half of these surfaces

41/48
 Calculus, Gingival And Plaque
Component (Pdi)
Calculus component assess the presence and extent of calculus on
the facial and lingual surfaces of the six index teeth.
Instruments MOUTH MIRROR, DENTAL EXPLORER
Scoring criteria
Score 0 Absence of calculus
Score 1 Supragingival calculus extending only slightly below FGM
Score 2 Moderate amount of supra and subgingival calculus or
subgingival alone.
Score 3 Abundance of supra and subgingival calculus

Calculation No of teeth examined/ total teeth.

42/48
 Gingival And Periodontal
Component
Gingival status is scored first.
Dried superficially by gently touching with absorbing cotton, and examined for
color change, form , consistency and bleeding.
Crevice depth is recorded in relation to CEJ.
Instruments used mouth mirror and university of Michigan probe number 0 probe.
Score 0 - Absence of signs of inflammation SCORING
Score 1 mild to moderate inflammatory changes not extendingCRITERIAaround the tooth.
Score 2 - mild to moderately severe gingivitis extending around the tooth.
Score 3 severe gingivitis characterized by marked redness , swelling , tendency to
bleed , and ulceration.
Score 4 gingival crevice in any of Calculation
the four areas , extending apically to CEJ but not
more then 3PDI
mm. TOTAL OF INDIVIDUAL TOOTH SCORES/NUMBER OF
Score 5 - gingival crevice in any ofTEETH EXAMINED
the four areas , extending apically to CEJ between
3-6mm.
Score 6 - gingival crevice in any of the four areas , extending apically more then 6 mm
from CEJ.
43/48
Community Periodontal Index Of
Treatment Needs (Cpitn)
Developed by joint committee of WHO & FDI in 1982.
To survey and evaluate periodontal treatment needs.
ADVANTAGES: PROCEDURE -
Simplicity Dentition divided into sextants
Speed Each sextant given a score
International uniformity.

INSTRUMENT USED - CPITN PROBE

44/48
 CPITN PROBE
WHO periodontal examination probe.
Used for
Measurement of pocket depth &
Detection of subgingival calculus.
Weight = 5gms
2 types:
CPITN-E(epidemiological probe)
Pocket depth measured through color coding; black mark starting from
3.5mm - 5.5mm
Ball tip diameter 0.5mm; easy detection of sub gingival calculus
CPITN-C ( clinical probe)
Variant probe basic probe
2 additional markings
8.5mm & 11.5 mm
Detailed assessment & recording of deep pockets. 45/48
 Best estimators of the worst periodontal condition of the mouth.
>20 years

Molars examined in pairs & highest score recorded.

Up to 19 years

CODING CRITERIA-

46/48
 Community Periodontal Index(cpi)
This index is based on the modification of the earlier used community
Loss of attachment
periodontal
index of treatment needs (CPITN).
INCLUSION
Criteria MEASUREMENT OF LOSS OF ATTACHMENT
of scoring
CodeANDo loss
ELIMINATION
of attachmentOF THE (CEJ
0-3mm TREATMENT NEEDS
not visible and category.
CPI score 0-3 ).
Code 1 loss of attachment
INSTRUMENTS USED 4-5MOUTH
mm (CEJMIRROR
within the, black band). C PROBE.
THE CPITN
Code 2 loss of CRITERIA
SCORING attachment 6- 8mm (CEJ between the upper limit of the black
band and the 8.5mm ring )
Score30loss
Code healthy.
of attachment 9- 11mm (CEJ between the 8.5mm and 11.5mm
Score 1 bleeding observed, directly or by using mouth mirror, after probing.
rings)
Code
Score4-2-loss of attachment
calculus detected12mm
duringorprobing,
more(CEJ
but beyond
all of thethe 11.5mm
black bandrings
on the). probe
excluded sextant (less than two teeth present )
Xvisible.
not3recorded
9Score pocket( 4CEJ
5 neither visible nor
mm ( gingival detectable
margin within )the black band on the probe)
Score 4 pocket 6 mm or more ( black band on the probe not visible)
X- excluded sextant
9 not recorded
47/48
 Assessment
1- slight mobility Of Tooth Mobility
PRICHARD (1972):

2- Moderate
extensive
3- MILLER(1985) hasindescribed
movement a lateralthe
or most commondirection
mesiodistal clinical method in which tooth is held
betweenwith
combined handles of thedisplacement
vertical two instrumentsin &
themoved back and forth or with metallic instrument
alveolus.
and one finger.
Criteria
SCORE 0- no detectable mobility
WASERMAN ET AL (1973):
SCORE 1- distinguishable tooth mobility
1- normal
SCORE 2- crown of tooth2-moves
slight-more
> than
mm1mm in any directionmovement
of bucco-lingual
SCORE 3 movement of3-more than 1mm
moderate- upintoany direction.
approximately 2mm movement bucco-lingually
GLICKMAN/ CARRANZA 4- severe-F.A (1972)
more than 2 mm
GRADE 1- slightly more then normal
GRADE 2- moderately more than normal
FLESZAR severe (1980)
GRADE 3INDEX mobility- faciolingually and orfor
devised a system mesiodistally
recording combined with vertical
displacement.
tooth mobility, as follows:
M0 - Firm Tooth
M1GENCO
- Slight R(1984).- mobilitymobility as
increasedassessed
Definite
M2DEGREE 1 to
Horizontal mobility
considerable of crown
increase is from detectable
in mobility but not to 1mm.
impairment
DEGREEof 2 function.
mobility of crown ranges from 1-2 mm horizontally.
Extreme
M3DEGREE 3 mobility,
mobility ofa crown
loose istooth that would
observed be or apical direction.
in vertical
Incomparable in function. 48/48
 LOVDALS INDEX(1994)
First degree Teeth that were somewhat more mobile than normal.
Second degree Teeth showing conspicuous mobility in transverse
but not axial direction.
Third degree Teeth being mobile in axial as well as on transverse
direction. Lindhe (1997)
Degree 1 movability of crown of tooth less than 1mm in horizontal
GRALESdirection
AND SHALES(1999)
Degree0 2No
GRADE movability
apparentof crown of tooth more than 1mm in horizontal
mobility
direction
GRADE 1- Mobility less than 1mm buccolingually
Degree 3 movability of crown of tooth in vertical as well
GRADE 2 Mobility between 1- 2mm
GRADE 3 Mobility >2mm buccolingually

LEONARD ABRANMS AND POTASHNICKS(1999)

Class 1 Mobility less than 1m
Class 2 mobility with in 1- 2mm
Class 3 mobility >2mm

49/48
 NYMAN'S INDEX
Zero degree Normal less than 0.2 mm
Degree 1 Horizontal / Mesiodistal mobility of 0.2 1mm
Degree 2 Horizontal / Mesiodistal mobility of 1-2 mm.
Degree 3 Horizontal / Mesiodistal mobility exceeding 2mm
and / or vertical mobility.

KIESER(2001)
GRADE 0 physiologic mobility
GRADE 1 Slight mobility
GRADE 2 Moderate mobility
GRADE 3 Marked mobility

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 CONCLUSION
Periodontal indices have contributed to identification, prevention
and treatment of periodontal disease over the years since their
inception. These indices are based on the prevailing understanding
of the pathogenesis and progression of periodontal disease.

Thus, with the better understanding of the periodontal disease

process these indices have changed from the simple Russells
Periodontal Index to the current Moustakiss Genetic Susceptibility
Index.

Each of these indices has its merits and limitations, so, an ideal index
which detects the ongoing progressive periodontal destruction and
also identifies the active and inactive sites of disease, is the need of
the hour
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References
Soben Peter. Indices in dental epidemiology,4th edition
Soben Peter. Indices in dental epidemiology , 3rd edition
Essentials Of Preventive and Community Dentistry 3ed.123-
231.
Kinane DF, Lindhe J. Pathogenesis of periodontitis.
Kunaal Dhingra and Kharidhi Laxman Vandana. Indices for
measuring periodontitis : A literature review, International
Dental Journal 2011; 61: 7684
In: Lindhe J, Karring T, Lang NP, Eds. Clinical Periodontology
and Implant Dentistry.
Maria Augusta Bessa Rebelo and Adriana Corra de Queiroz,
Federal University of Amazonas Brazil. Gingival indices : state
of art , Gingival Diseases Their Aetiology, Prevention and
Treatment
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