Russell's Periodontal Indfex & CPITN Probe Seminar For Public Health Dentistry

1. Russel’s Periodontal Index
&
CPITN...
DEPARTMENT OF PUBLIC HEALTH DENTISTRY
Presented By:
Priyanka Vadhera
Roll No.: 6083059
Batch- 2012
Under the Guidance of:
Dr. Sukhchen Bagga
Dr. Geetika

2. CONTENTS
 Scope & Purpose
 Treatment Needs
 Procedure for CPITN
 Sextants
 Index Teeth
 Recording Data
 WHO Periodontal Examination
Probe - CPITN Probe
→Probing Procedure
 Codes & Criteria
 Examination Procedure
 Choice of Age Groups
 Classification of Treatment Needs
 Calculation of CPITN
 Modification of CPITN
 Introduction
 What is an Index?
 Features of an Index
 Ideal Requisites of an Index
 Criteria for Selection of an Index
 Classification of Indices
 Russel’s Periodontal Index
 Introduction
 Method
 Scoring Criteria
 Russel’s Rule
 Calculation of the Index
 Uses
 Drawbacks
 CPITN
 Introduction

3. Introduction
• The simplest form of measuring a disease is by a
count of the no. of cases of its occurence, but
with the oral diseases, simple counts of cases are
of limited use because of the high prevalence of
these conditions in many of the world’s
population.
• Dental Index or indices can be considered as the
main tool of epidemiological studies in dental
diseases to find out the incidence, prevalence &
severity of diseases, based on which preventive
programmes are adopted for their control &
prevention.

4. What is an Index?
• According to Russel A.L. -
“An index is defined as a numerical
value describing the relative status of a
population on a graduated scale with
definite upper & lower limits, which
permits & facilitates comparison with
other groups classified by same criteria &
method.”

5. Features of an Index
For an index to be accurate, following
properties are needed:-
• Simplicity: Easy to use needing no
expensive equipment.
• Objectivity: Unambiguous with mutually
exclusive categories.
• Validity: Ability to detect the condition
when present.

6. • Reliability: Different examiners record the
same result.
• Precision: Ability to distinguish between.
• Acceptabilty: Safe & not demeaning to.
• Amenablity to analysis: Data should be
analysable & interpretable.

7. IDEAL REQUISITES OF AN INDEX
Ideally an Index should possess the following
properties:-
• Clarity, Simplicity & Objectivity
• Validity
• Reliability
• Quantifiablity
• Senstivity
• Acceptabilty

8. Criteria for Selection of an Index
• Simple to use & calculate.
• Should permit the examination of many
people in a short period of time.
• Should require minimum
armamentarium & expenditure.
• Should be highly reproducible in
assessing a clinical condition when used
by one or more examiners.

9. • Should not cause discomfort to the
patient & should be acceptable to the
patient.
• Should define clinical conditions
objectively.
• Should be equally sensitive throughout
the scale, if it relates the severity of a
variable.

10. Classification Based upon the direction in which
their scores can fluctuateBased
upon the direction in which their
scores can fluctuate
Irreversible Index
Eg: DMFT Index
Reversible Index
Eg: Loe & Silness Gingival Index
Depending upon extent to
which areas of oral cavity
are measured
Full Mouth Indices
Eg: Russel’s Periodontal Index
Simplified Indices
Eg: OHI-S
Based on the entity which
they measure
Disease Index
‘D’ (decay) portion of DMFT Index.
Symptom Index
Measuring gingival/sulcular bleeding.
Treatment Index
Eg: ‘F’ (filled) portion of DMFT Index
Special Categories
Simple Index
Eg: Silness & Loe Plaque Index
Cumulative Index
Eg: DMFT Index for Dental Caries

11. RUSSEL’S
PERIODONTAL
INDEX

12. Introduction
• The Periodontal Index (PI) was developed by
Russel A.L. in 1956.
• Thus index was developed over a trial period
of ten years, because of a lack of sophisticated
methodologies to assess the prevalence &
severity of gingivitis & destructive periodontal
disease.
• The PI is a composite index because it records
both the reversible changes due to gingivitis &
the more destructive & presumably
irreversible changes brought about by deeper
periodontal disease.

13. • The PI is probably the most widely used
periodontal index in epidemiological
surveys around the world.
• It was intended to estimate deeper
periodontal diseases by measuring the
presence or absence of gingival
inflammation & its severity, pocket
formation, & masticatory fiunction.
• The scale of values range from 0-8 with
increasing prevalence & severity of
disease.

14. Method
 Instruments Used: Mouth mirror & Plain
probe.
• All the teeth present are examined.
• All of the gingival tissue circumscribing each
tooth (i.e, all of the tissue circumscribing a
tooth is considered a scoring or gingival
unit) is assessed for gingival inflammation &
periodontal involvement.

15. Scoring Criteria
Russel chose the scoring values
(0,1,2,6,8) in order to relate the stages of
the disease in an epidemiological survey
to the clinical conditions observed.

16. Scoring Criteria Table

17. Clinical Condition Group PI scores Stage of Disease
Clinically normal
supportive tissues
0-0.2
Simple gingivitis 0.3-0.9
Beginning destructive
periodontal disease
0.7-1.9 Reversible
Established destructive
periodontal disease
1.6-5.0 Irreversible
Terminal disease 3.8-8.0 Irreversible
Clinical Condition Individual PI Score
Clinical 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
Group Periodontal Index (PI) Score & Clinical Manifestations:
Individual Periodontal Index (PI) Score & Clinical Manifestations:

18. Russel’s Rule
The Russel’s Rule states that-
“When in doubt, assign the lower
score.”

19. Calculation of the Index
• The PI score per individual is obtained
by adding all of the individual scores &
dividing by the no. of teeth present oe
examined. i.e,
PI score per person =
𝑆𝑢𝑚 𝑜𝑓 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙 𝑠𝑐𝑜𝑟𝑒𝑠
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑡𝑒𝑒𝑡ℎ 𝑝𝑟𝑒𝑠𝑒𝑛𝑡

20. Uses
• Used in epidemiological surveys.
• More data can be assembled using PI
than any other index of periodontal
disease.
• Used in National Health Survey, the
largest ongoing health survey in United
States.

21. Drawbacks
• Since only a mouth mirror & no calibrated
probe or radiograph is used, when
performing the PI examination, the results
tend to underestimate the true level of
periodontal disease, especially early bone
loss, in a population.
• The number of periodontal pockets without
obvious supragingival calculus is
underestimated in the PI.

22. CPITN

23. Introduction
• The “Community Periodontal Index of
Treament Needs” (CPITN) was developed for
the “joint working family” of the “WHO”&
“FDI” by Jukka Ainamo, David Barmes, George
Beagrie, Terry Cutress, Jean Martin & Jeniffer
Sardo-Infirri in 1982.
• It was developed primarily to survey &
evaluate periodontal treatment needs rather
than determining past &B present
periodontal status i.e, the recession of
gingival margin & alveolar bone.

24. Scope & Purpose
• The CPITN procedure is recommended for epidemiological
surveys of periodontal health.
• It provides guidance on the planning & monitoring of the
effectiveness of periodontal care programme & dental personnel
required
• The CPITN records the common treatable conditions, namely
– Periodontal Pockets
– Gingival Inflammation
– Dental Calculus
– Other Plaque Retentive Factors
• It doesn’t record irreversible changes such as recession or other
deviations from periodontal health such as tooth mobilty or loss
of periodontal attachment.

25. Advantages
Major advantages of CPITN are:
• Simplicity
• Speed
• International uniformity
Limitations
Limitations of CPITN are:-
• Partial recording
• Exclusion of spome important signs of past
periodontal breakdown- notably attachment loss
• Absence of any marker of disease activity or
susceptibilty

26. Procedure for CPITN
• The dentition is divided into six parts
called Sextants.
• Each sextant is given a score.
• For epidemiololgical purposes, the score is
identified by examination of specified
Index teeth.
• For clinical practice, the highest score in
each sextant is identified after examining
all teeth.

27. • Essentially the CPITN considers the
periodontal treatment needs of each
sextant with respect to:-
i. No need for care (score 0)
ii. Bleeding gingivae on gentle probing
(score 1)
iii. Presence of calculus & other plaque
retentive factors (score 2)
iv. Presence of 4-5mm pockets (score 3)
v. Presence of 6mm or deeper pockets
(score 4)

28. • The mouth is divided into six sextants defined by
tooth numbers as shown below:-
• The third molars are not included, except where
they arer functioning in place of second molars.
• The treatment need in a sextant is recorded only
if there atre two or more teeth present & not
indicated for extraction.
• When only one tooth is present in a sextant, it is
included in the adjacent sextant.
Sextant

29. Index Teeth
• In epidemiological surveys for adults, aged
20 years or more, only 10 teeth, known as
the Index Teeth are examined.
• The ten specified index Teeth are:-
• The molars are examined in pairs & only
one score, the highest is recorded. Only
one score is recorded for each sextant.
17 16 11 26 27
47 46 31 36 37

30. • For young people upto 19 years, only six
Index Teeth are examined. The second
molars are excluded as Index Teeth at
these ages because of the high frequency
of false pockets.
• The six Index Teeth selected are:-
• When examining children less than 15
years, pockets are not recorded although
probing for bleeding & calculus are carried
out as a routine.
16 11 26
46 31 36

31. Recording Data
• The following ‘box chart’ is
recommended as the epidemiological &
dental office chart for recording the
CPITN Data:

32. WHO-CPITN Probe
• It has a 0.5mm ball at the tip & millimeter
markings at 3.5, 5.5, 8.5 & 11.5 and color
coding from 3.5 to 5.5.
• Used for measurement of CPITN.
• Introduced by WHO in 1978.
• Weight: 5gms
• Designed for two purposes:
i. Measurement of pocket depth.
ii. Detection of subgingival calculus.

33. Probing Procedure
• A tooth is probed to determine pocket depth & to detect
subgingival calculus & bleeding response.
• Working force shouldn’t exceed 20gms – a practical test for
establishing this force is to gently insert the probe point
under the finger nail without causing pain or discomfort.
• Pain to the patient during probing is in most cases
indicative of the use of a too heavy probing force.
Probing Force
Working
Component
Determines
pocket depth
Sensing
Component
Determines
subgingival
calculus

34. • The probe is inserted between
the tooth & gingiva, & the
sulcus depth is noted against
the color code or marking.
• The ball end of the probe
should be kept in contact with
the root surface.
• Direction of probe during
insertion should be whenever
possible in the same plane as
the long axis of the tooth.
• Recommended sites for
probing: mesial, mid-line &
distal on both facial &
lingual/palatal surfaces.
• The total extent of the
pocket should be examined
in at least six points on each
tooth, the mesio-buccal,
mid-buccal, disto-buccal &
corresponding lingual sites.
• After probing, the gingiva or
gum of the examined tooth
should be inspected for the
presence or absence of
bleeding before the subject
is allowed to swallow or
close their mouth. Bleeding
may be delayed for upto 10-
30secs after probing.

35. Codes & Criteria
CODE TREATMENT COMPLEXITY
CODE-0 No periodontal disease.
CODE-1 Bleeding observed during or after probing.
CODE-2 Calculus or other plaque retentive features either seen or felt during
probing.
CODE-3 Pathological pocket 4-5mm in depth. Gingival margin situated on black
band of the probe.
CODE-4 Pathological pocket 6mm or more in depth. Black band of the probe is not
visible.
CODE-X When only one or no teeth are present in a sextant (thord molars are
excluded unless they function in place of second molars).

36. Examination Procedure
• The aim is to determine the highest
score applicable to each sextant wit
the least no. of measurements.
• For a sextant to be validly scored,
the requirement is that more than
one functional tooth should be
present.
• If ‘no’, then score ‘X’ & move to
next sextant.
• If ‘yes’, examine index teeth (in
epidemiological procedure) or all
teeth (in clinical screening
procedure) for presence of 6mm or
deeper pockets, 4 or 5mm pockets,
calculus or other plaque retentive
facors, bleeding only, in that order.
Choice of Age Groups
• While applying CPITN, the
WHO standard age grouping
should be used, i.e, single
years to 19 but including a
group of 15-19 years, 20-24
years, 25-29years, 30-34
years, 35-44years, 45-
54tears, 55-64years, 65-74
years, & 75-84years & over.

37. Classification Of Treatment Needs
Treatment
Needs
Code Interpretation
TN-0 CODE-0 No treatment is needed.
TN-1 CODE-1 Improvement of personal oral hygiene.
TN-2 CODE-2 Professional cleaning of teeth & removal
of plaque retentive factors along with oral
hugiene instructions.
CODE-3 Scaling & root planning along with oral
hygiene instructions.
TN-3 CODE-4 Complex treatment like deep scaling, root
planing & more complex surgical
procedures.

38. Calculation of CPITN
• CPITN for a population group can
be calculated as follows:
• Step 1: Count the no. of charts
with different codes & add up the
codes individually (i.e, codes
0,1,2,3,4).
• Step 2: To obtain the prevalence
(percentage) of subjects with
codes 0,1,,2,3,4 as their score,
divides the counts of codes
respectively, by the total no. of
dentate subjectsexamined &
multiply by 100.
• To obtain the ‘mean no. of
sextants’ (MNS) for each condition
per person, divide the total no. of
sextants with highest score for
ther person by the no. of dentate
subjects examined.
Modifications of CPITN
• These include: Simplified
Periodontal Examination
(SPE), later termed the Basic
Periodontal Examination
(BPE), & the Periodontal
Screening & Recording
(PSR).
• The PSR that has attachment
loss incorporated into its
procedurial method is
predominantly used in the
United States & Canada & is
promoted by the American
Academy of Periodontology
& the American Dental
Association.

39. THANK YOU..!
