Preventive Dentistry:
Dr.Raed F. Al-Huwaizi
Lecture 2
Oral Health assessment (Dental caries):
Clinical examinations are conducted by using plane mouth dental mirror
and sharp explorer. A systemic approach of the examination for dental
caries should be performed starting from the upper right second molar 17
proceeding in an orderly manner from one tooth or space to the adjacent
tooth or space reach upper left second molar 27 and passing to the lower
left second molar 37 ending with the lower right second molar 47.
Examinations starts with the mesial surface followed by occlusal, distal,
buccal and lingual surface of all teeth examined. A tooth is considered
present in the mouth when any part of it is visible or can be touched with
the tip of the explorer without displacing soft tissue, if the same space was
occupied by both primary and permanent tooth, permanent tooth status
were recorded.
Measurement of dental caries:
The best known dental index that is used in measuring dental caries and
received a universal acceptance is;
Decayed- Missing- Filled teeth (surfaces) index
DMFT and DMFS == for permanent dentition
This index based on the fact that the dental hard tissue are not self healing
so establishing caries on tooth either remains decayed or if treated either
extracted or filled, therefore it measures total life-time caries experience.
In this index all teeth examined except:
- Third molar.
- Unerupted teeth.
- Congenitally missing teeth.
- Supernumerary teeth.
- Teeth removed for reason other than dental caries.
- Primary tooth when permanent tooth occupies the same space.
Criteria for recording:
Sound tooth: Recorded so, when there is no evidence of treated or
untreated clinical caries (i.e, the stage of caries that precedes cavitations).
In addition, teeth with the following defects in the absence of other
positive criteria were recorded as sound too:
- White or chalky spots.
- Discolored or rough spots.
- All questionable lesions were recorded as sound.
Decayed tooth (surface): D, d recording in case of;
- Caries that probe sticks
- Temporary filling
- Filled tooth with decay; when tooth (surface) contained one of
permanent restorations and one or more area that are decayed. No
distinction was between primary or secondary caries (whether or not the
carious lesion was in physical association with the restoration).
When a doubt exists, caries lesion was not recorded as present.
Missing tooth due to caries (M,m):
This score is used for teeth that have been extracted because of caries
only. For primary tooth, it was recorded so, when normal exfoliation
would not be a sufficient explanation for its absence. Differentiation
between unerupted and extracted tooth was made by the;
- Evaluation of the status of corresponding contralateral tooth.
- The appearance of the alveolar ridge in the area of the tooth space in
question.
- The caries status of other teeth in the mouth.
The cases that are not recorded as missing: when a tooth was missing
because of;
- Trauma
- Unerupted tooth
- Normal exfoliation
- Orthodontic treatment
Filled tooth with no decay (F, f recording)
Recording so when one or more permanent restorations were present and
no area of the tooth was affected whether by primary or secondary
(recurrent) caries. Cosmetic filling not recorded as filling in this index.
# Note:
Surface examined in DMFS, dmfs index are;
5 surfaces for posterior teeth
4 surfaces for anterior teeth
Example;
- Missing posterior tooth due to caries recorded as 5 surface missing while
missing anterior tooth recorded as 4 surfaces missing.
- Crown restoration due to caries for posterior tooth recorded as 5
surfaces filling while for anterior tooth recorded as 4 surfaces filling.
- Retained root recorded as 5 surfaces decayed for posterior tooth and 4
surfaces decayed for anterior tooth.
Calculation:
Individual DMF;
1- Total each component separately D,M,F.
2- Total D+M+F= DMF
The maximum score for dmft=20, minimum= 0
The maximum score for dmfs=88, minimum= 0
The maximum score for DMFT= 28, minimum= 0 (excluding third molars)
The maximum score for DMFS= 128, minimum= 0 (excluding third molars)
In mixed dentition:
Primary and permanent teeth are evaluated separately.
DMF and dmf index are never added together.
Oral cleanliness and gingival health condition:
Dental plaque thickness adjacent to gingival margin was assessed by using
plaque index (Pl I) of Silness and Loe (this index measures the thickness of
dental plaque not the distribution of plaque on the tooth surface).
Ramfjord index teeth were examined to represent the whole dentition.
Only fully erupted tooth (when the occlusal or incisal surface has reached
the occlusal plane was involved). A fully erupted permanent tooth was
always substituted a primary tooth, if the index tooth was missing or
partially erupted, the area was excluded and not substituted by an
adjacent tooth. The six index teeth for the permanent dentition were the
upper right 1st molar, upper left central incisor, upper left 1st premolar,
lower left 1st molar, lower right central incisor, and lower right 1st
premolar. In case of primary dentition the six selected teeth are upper
right second deciduous molar, upper left central incisor, upper left 1st
primary molar, lower left 2nd primary molar, lower right central incisor,
and lower right 1st primary molar. Each of the 4 areas of the selected
teeth was scored (buccal, mesial, lingual and distal) the area of
examination is the cervical area and free gingival margin. The criteria for
plaque index are:
- 0: no plaque
- 1: A film of plaque adhering to the free gingival margin and adjacent area
of the tooth. The plaque may be recognized only running a probe across
the tooth surface.
- 2: Moderate accumulation of soft matter 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 deposits within the gingival pocket and/ or the
gingival margin and adjacent tooth surface.
Gingival index: described by Loe and Silness was used, the Ramfjord teeth
were examined and the sequence of examination was similar to that of
oral cleanliness. The criteria for the gingival index are:
- 0: Normal gingival
- 1: Mild inflammation, slight change in color, slight edema, no bleeding on
probing.
- 2: Moderate inflammation: redness, edema and glazing, bleeding on
probing.
- 3: Severe inflammation: marked redness and edema, ulceration,
tendency to spontaneous bleeding.
#Note: Excluding from the recording the eruption gingivitis and
inflammation caused by infection.
Calculus: is assessed according to the method described by Green and
Vermillion, in which simplified oral hygiene index was applied. The
sequence of examination was the same as that selected in oral cleanliness
assess, using Ramfjord index teeth, criteria for the calculus index:
- 0: No calculus present.
- 1: Supra gingival calculus covering not more than one third of the
exposed tooth surface.
- 2: Supra gingival calculus covering more than one third but not more
than 2/3 of the exposed tooth surface or the presence of individual flecks
of sub gingival calculus around the cervical portion of the tooth or both.
- 3: Supra gingival calculus covering more than 2/3 of the exposed tooth
surface or a continuous heavy band of sub gingival calculus around the
cervical portion of the tooth or both.
Calculation:
The plaque index, gingival index and calculus index for individual was
measured by summation of individual scores and then divided by number
of surface examined.
The maximum score = 3 while the minimum score= 0.
#Note: When examine the patients, always start with oral cleanliness and
gingival health condition assessments then caries status assessments.
Nutritional status assessment using Body Mass Index (BMI):
What is BMI?
Body mass index (BMI) is a number calculated from a child’s weight and
height. For children BMI is used to screen for overweight, at risk of
overweight, or under weight. It is easy to perform method screening for
weight categories that may lead to health problems. For children and
teens, BMI is age- and gender- specific and is often referred to as BMI- for
–age.
What is a BMI percentile?
After BMI is calculated for children and teens, the BMI number is plotted
on the CDC BMI – for – age growth charts ( for either girls or boys) to
obtain a percentile ranking. Percentile are the most commonly used
indicator to assess the size and growth patterns of individual children. The
percentile indicates the relative position of the child’s BMI number among
children of the same sex and age. The growth charts show the weight
status categories used with children and teens (underweight, healthy
weight, at risk of weight and overweight).
