Epidemiological Indicies

A researcher conducts a study in which 200 persons with oral cancer and 200 without oral cancer are identified and provide their informed consent to participate. Following this step, information is collected about past exposure to a group of variables (like alcohol, tobacco, pizza, etc) suspected of being responsible for the disease.

What is the epidemiological research design? why

case control

- retrospective (looking @past)

- comparison group

Knowledge of the effectiveness of fluoride is measured in a sample of a patient population of a community children's clinic to determine if further education is needed. This is done with a survey, using a questionnaire for parents and children to complete when they present to the clinic for their appointments. In addition, demographic factors and other variables are measured to test their association with fluoride knowledge.

What is the epidemiological research design? why

cross-sectional

- survey

- no comparison group

- measured once

- asks about risk factors/associations

A new protocol is put into place in a large dental clinic to control exposures to bloodborne infection in clinic employees. The rate of exposure is measured over time to determine the rate of new cases. The purpose is to see if the protocol is successfully controlling exposures.

What is the epidemiological research design? why

cohort

- prospective (looks forward)

- one group

- outcome measured more than once

Pre Test:

D = 8

M = 1

F = 2

DMF = 11

Post-Test (1 year later):

D = 2

M = 3

F = 8

DMF = 11

Was this oral health promotion program successful? why

yes, the rate of active disease (decay) went down

Root Caries Index (RCI)

- purpose

evaluates the risk and extent of root caries (with gingival recession)

expressed as % of D & F root surfaces

What are the limitations to DMF/def?

- combines treated and untreated disease

- M component difficult to assess

- provides detailed information which is difficult for public/legislators to understand

- can only be used by dental professionals

Oral Hygiene Index (OHI):

- purpose

- scoring

assesses the oral cleanliness of a person

scored by debris index (DI): 0-3

& calculus index (0-3)

closer to 12 = poorer health

dentition is divided into 6 sextants; each sextant is examined for calculus and debris using the tooth with the most debris or calculus on the buccal/lingual surface

Simplified Oral Hygiene Index (OHI-S):

- purpose

- scoring

which teeth

measures continual extent of debris/calculus = oral hygiene status

based on 6 teeth instead of the worst in the sextant: 3, 8, 14, 19, 24 & 30

scored by debris index (DI): 0-3

& calculus index (0-3)

closer to 6 = poorer health

Patient Hygiene Performance (PHP):

- purpose/ how

- scoring

assesses patient performance after brushing (teeth are disclosed)

3, 8, 14, 19, 24 & 30 are divided into 5 surfaces and scored. Total number of surfaces with plaque divided by number of teeth examined (6) gives you the score

score ranges from 0-5

closer to 5 = worse health

Volpe-Manhold Index (VMI):

- purpose

how

- scoring

measures supragingival calculus formation following a prophy

uses 6 lower anterior teeth only: lingual distal and medial surfaces evaluated. Calculus build-up is measured by probe in increments of 0.5 (range 0 to 5mm). Each tooth's score is made up of the sum of the 3 surfaces measured. Total score is the sum of all tooth scores

no range specified in slides, but higher number indicates worse health

Loe & Silness Plaque Index (PI I):

- which teeth

how

- scoring

scores the thickness of plaque at gingival margin

- sensitive index for gingivitis research

- developed for use with gingival index, GI used first in case disclosing agent is used

- time consuming since it uses all teeth

All teeth are dried and teeth are individually scored, then all scores are divided by the number of teeth examined

score ranges from 0-3

closer to 3 = poorer health

Loe & Silness Gingival Index (GI):

- purpose

andmeausres

- scoring

how

measures severity and quality of inflammation at the gingival margin

- measures ONLY gingivitis and ONLY looks at gingival tissue

scores gingiva from 0 to 3 on M, D, B, L on teeth (all or predetermined selection)

score ranges from 0-3

closer to 3 = poorer health

Modified Gingival Index (MGI):

- purpose

- scoring

one of the most widely used indices for clinical trials for therapeutic agents

modified loe and silness GI, no sulcus probing and redefine scoring system (adds in differentiation for mild inflammation to help with sensitivity of the index)

score ranges from 0-4

closer to 4 = poorer health

Sulcus Bleeding Index (SBI):

- purpose

- scoring

measures bleeding on probing

measures F, M, L and D of each tooth, must wait 30 seconds to score

score ranges from 0-5

closer to 5 = poorer health

Gingival Bleeding Index (GBI):

- purpose

- scoring

easy estimation of gingivitis in patients

measures bleeding with unwaxed flossing, normal C-shape technique, floss is moved up and down for one stroke; have to wait 30 seconds before scoring

Dichotomous index

What are periodontal disease indices used for?

used to score gingival disease & period together

- based on outdated theory that gingivitis + periodontitis were different stages of the same disease

What are the peridontal indices that are no longer used today?

and charsteristics of them

Russell's Periodontal Index (PI):

- classic composite indeed used for surveys

- scored 0 to 8

- does not include CAL

Periodontal Disease Index PDI):

- index used for longitudinal research

- measures gingivitis and peril

- uses CAL as a measure

- ramjford teeth

Periodontal Screening and Recording (PSR):

- purpose

- scoring

screening tool of perio status in a clinical setting

- designed to motivate patient to seek necessary assessment and treatment

- measures periodontal tx needs

score ranges from 0-4

* is put next to a code to indicate duration involvement, mobility, mucogingival problems and/or marked recession

closer to 4 = poorer health

Describe the PSR procedure

- each tooth is probed using a special probe with a ball at the end to feel calculus

- probe is marked at 3.5, 5.5 (black), 8.5 & 11.5

- each sextant receives a code that represents the worst prove depth found in that sextant

- if the worst code (4) is found in a sextant, there is not need to continue probing

What are the treatment code interpretations for the PSR index?

TN0 = preventive care; biolfim control

TN1 = preventative care; biolfim control

TN2 = preventive care; calculus and biolfim removal

TN3 = comprehensive perio assessment & treatment planning; counseling regarding tx plan; non-surgical perio tx (SRPs)

TN4 = same as #3; treatment plan for surgical perio tx

Community Periodontal Index of Treatment Needs (CPITN):

- purpose

- scoring

determines periodontal NEEDS vs periodontal status of the population

similar to PSR with same codes, uses WHO people

Community Peridontal Index:

- purpose

- scoring

used to evaluate periodontal status of the community

same technique as PSR

score ranges from 0-4

closer to 4 = poorer health

How do PSRs differentiate from CPIs?

1. CPI also measures attachment loss

2. PSRs indicate treatment needed based one scoring

What does the DMF account for?

present and PAST decay, the whole "caries experience"

D = restorable, decorated teeth/surfaces (includes recurrent decay)

M = missing due to caries

F = restored (filled) teeth/surfaces with no dental caries present

T = teeth

S = surfaces

How are restored teeth with recurrent caries scored in DMF?

scored as decayed (D)

What teeth are NOT scored in DMF scoring?

- teeth that are not erupted

- third molars

- congenitally missing teeth

- teeth removed for reasons other than caries (ortho, impaction, trauma, perio)

- retained primary teeth with permanent successors present

Basis Screening Survey aka Screening Training Project (STP):

- purpose

- scoring

gathering community level oral health status and access to care data

gathers information per person basis, NOT per tooth

dichotomous measure

Most dental indices are ordinal, what is the exception?

DMF index

How is DMF scoring used for primary teeth?

def:

d = decayed

e = extraction indicted due to caries

f = filled

missing primary teeth are ignored

dmf:

used before age of exfoliation on primary molars and canines only