ORAL HYGIENE INDEX SIMPLIFIED

To be submitted to: Professor Olegario G. Clemente, Jr.

Submitted by: Jhoana Camille B. Quilang Kristina Corazon L. Robles CDH-120 DBC

TERMINOLOGY Dental index - an objective mathematical description of a disease or condition based on carefully determined criteria under specified circumstances A numeric score that quantifies the magnitude of the disease measured. Should have the properties of validity and reliability Is considered valid when it accurately reflects the extent or degree to which the disease or condition is present. (e.g. the higher the; the more severe the disease) To be reliable, the index must give the same results, with very limited degrees of tolerance each time it is applied.

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Oral Debris The soft foreign matter loosely attached to the teeth, It consists of mucin, bacteria and food, and varies in color from greyish white to green or orange.

Oral calculus Deposit of inorganic salts composed primarily of calcium carbonate and phosphate mixed with food debris, bacteria and desquamated epithelial cells. Supragingival calculus deposits, usually white to yellowish-brown in color Sublingual calculus deposits apical to the free gingival margin. These deposits usually are light brown to black in color.

ORAL HYGIENE INDEX-SIMPLIFIED

The Simplified Oral Hygiene Index or OHI-S is a reversible index used to measure oral hygiene status. This index sets forth a simple method for quantifying the amount of plaque and calculus in its two components, the debris index and the calculus index. This simplified index is based on the six surfaces scored from four posterior and two anterior teeth. USES OF OHI-S: It has been widely used in studies of the epidemiology of periodontal disease. Used as a standard companion of the Periodontal Index in the world wide studies of the interdepartmental Committee on Nutrition for National Defense (ICNND). Useful in evaluation of dental health education programs in public school systems. Used in evaluating the cleansing efficiency of tooth brushes. Used to evaluate an individuals level of oral cleanliness and, to a more limited extent, in clinical trials. It is easy to use because the criteria are objective, the examination may be performed quickly, and a high level of reproducibility is possible with a minimum of training sessions.

ADVANTAGES OF OHI-S: It is good for small and large epidemiologic surveys; well-defined criteria and scoring system. Its well defined criteria for both tooth selection and scoring make it an index that can be determined rapidly and consistently. Quantify biological phenomenon Measure disease level

Assess individual improvement Program evaluation DEVELOPING THE INDEX

The Simplified Oral Hygiene Index (OHI-S) differs from the original OHI (The Oral Hygiene Index) in the number of the tooth surfaces scored (6 rather than 12), the method of selecting the surfaces to be scored, and the scores, which can be obtained. The criteria used for assigning scores to the tooth surfaces are the same as those for the OHI (The Oral Hygiene Index).

The OHI-S, like the OHI, has two components, the Simplified Debris Index (DI-S) and the Simplified Calculus Index (CI-S). Each of these indexes, in turn, is based on numerical determinations representing the amount of debris or calculus found on the preselected tooth surfaces.

HISTORICAL BACKGROUND

The Simplified Oral Hygiene Index was developed in 1964 by John C. Greene and Jack R. Vermillion, the developers of the original OHI. Even though the original OHI was determined to be simple, sensitive, and useful, it was time consuming and required more decision making. An effort was made to develop another equally sensitive index which would reduce both the number of decisions required on the part of the examiner and the time required for the inspection. PROCEDURE AND MATERIALS

Only a mouth mirror and a shepherds crook or sickle type dental explorer, and no disclosing agent, are used for the examination. Each tooth surface is divided horizontally into gingival, middle, and incisal thirds.

The six surfaces examined for the OHI-S are selected from four posterior and two anterior teeth.

In the posterior portion of the dentition, the first fully erupted tooth distal to the second bicuspid (15), usually the first molar (16) but sometimes the second (17) or third molar (18), is examined. The buccal surfaces of the selected upper molars and the lingual surfaces of the selected lower molars are inspected.

In the anterior portion of the mouth, the labial surfaces of the upper right (11) and the lower left central incisors (31) are scored. In the absence of either of these anterior teeth, the central incisor (21 or 41 respectively) on the opposite side of the midline is substituted.

Tooth

Surfac es

16 Maxillary right first molar Buccal 11 Maxillary right central Labial incisor 26 Maxillary left first molar Buccal 36 Mandibular left first molar Lingual 31 Mandibular left central Labial incisor 46 Mandibular right first molar Lingual For the OHI-S, each surface, buccal or lingual, is considered half the tooth circumference. Also, only fully erupted permanent teeth are scored. A tooth is considered fully erupted when the occlusal or incisal suface has reached the occlusal plane. Natural teeth with full crown restorations and surfaces reduced in height by caries or trauma are not scored. An alternate tooth is examined instead. After the six possible tooth surfaces are selected, then the scores are determined, recorded, and computed for the DI-S and CI-S respectively.

The OHI-S score per person is the total of the DI-S and CI-S scores per person.

Procedure for Simplified Debris Index (DI-S)

1. A dental explorer is placed on the incisal third of the tooth and moved toward the gingival third. The occlusal or incisal extent of the debris is noted as it is removed. 2. The DI-S score per person is obtained by totaling the debris score per tooth surface and dividing by the number of surfaces examined.

Criteria for classifying debris Score s 0 1 Criteria

No debris or stain present Soft debris covering not more than one third of the tooth surface, or presence of extrinsic stains without other debris regardless of surface area covered Soft debris covering more than one third, but not more than two thirds, of the exposed tooth surface. Soft debris covering more than two thirds of the exposed tooth surface.

2

3

Procedure for Simplified Calculus Index (CI-S) : explorer into the distal gingival crevice and drawing it subgingivally from the distal contact area to the mesial contact area.

1. The CI-S assessment is performed by gently placing a dental

2. The No. 5 explorer ( Shepards hook) is used to estimate the

surface area covered by the supragingival calculus and to probe for subgingival calculus The CI-S score per person is obtained by totaling the calculus scores per tooth surface and dividing by the number of surfaces examined.

Criteria for classifying calculus Scores 0 1 Criteria No calculus present Supragingival calculus covering not more than third of the exposed tooth surface. Supragingival calculus covering more than one third but not more than two thirds of the exposed tooth surface or the presence of individual flecks of subgingival calculus around the cervical portion of the tooth or both. Supragingival calculus covering more than two third of the exposed tooth surface or a continuous heavy band of subgingival calculus around the cervical portion of the tooth or both.

2

3

EVALUATION The clinical levels of oral cleanliness for debris that can be associated with group DI-S or CI-S scores are as follows: Good Fair Poor 0.0-0.6 0.7-1.8 1.9-3.0

The clinical levels of oral hygiene that can be associated with group OHI-S scores are as follows Good Fair Poor 0.0-1.2 1.3-3.0 3.1-6.0

CALCULATION EXAMPLE: After the scores for debris and calculus are recorded, the Index values are calculated. For each individual, the debris and calculus scores are totaled and divided by the number of surfaces scored. At least two of the six possible surfaces must have been examined. For a certain group of individuals, scores are obtained by computing the average of the individual scores. The average individual or group score is known as the DI-S or CI-S. The average individual or group debris and calculus scores are

combined to obtain the Simplified Oral Hygiene Index. The CI-S and DI-S values may range from 0 to 3; the OHI-S values from 0 to 6. These values are just half the score magnitude possible with the OHI (Oral Hygiene Index).

The following example shows how to calculate the index. The scores for debris and calculus should be tabulated separately and index for each calculated independently, but in the same manner.

Debris Right molar Bucc al Uppe r Lowe r 3 Lingu al Anterior Left molar Lingu al Total Bucc al 8 Lingu al -

Labia Labia Bucc l l al 2 3

-

2

-

1

-

2

1

4

Debris Index = (The buccal-scores) + (The lingual-scores) / (Total number of examined buccal and lingual surfaces). Debris Index = (9+4) / 6 = 2.2 Calculus Right molar Bucc Lingu Anterior Left molar Lingu Total Bucc Lingu

Labia Labia Bucc

al Uppe r Lowe r 1

al -

l 0

l -

al 1

al -

al 2

al -

-

1

-

2

-

2

2

3

Calculus Index = (The buccal-scores) + (The lingual-scores) / (Total number of examined buccal and lingual surfaces). Calculus Index = (4+3) / 6= 1.2

The average individual or group debris and calculus scores are combined to obtain simplified Oral Hygiene Index, as follows. Oral Index Hygiene = Debris Index Index + Calculus

2.2 + 1.2 = 3.4

BIBLIOGRAPHY Wong, A. (1993). Community Dental Health. (3rd ed.). Library of Congress Catalogue. Carranza Jr., F. (1990). Glickman's Clinical Periodontology. (7th ed.). WB Saunders Company. Peter, S. Essentials of Preventive and Community Dentistry. (2nd ed.). New Delhi: Arya Publishing House. Harris, N. O., & Christen, A. G. Primary Preventive Dentistry. (4th ed.). Connecticut: Appleton and Lange. Darby, M. L., & Walsh, M. M. Dental Hygiene, Theory, and Practice. Toronto: W.B. Saunders Company. Moslehzadeh, K. Retrieved February www.whocollab.od.mah.se/expl/ohisgv64.html 17, 2011, from