Periodontal epidemiological indices for children and adolescents: I. Gingival and periodontal health assessments.

Gingivitis and pedodontitis are usually reve~ible conditions in children and should be detected early and treatment rendered promptly. Hence appropriate clinical indices must be available to record these conditions accurately and to assess treatment success or failure. This paper reviews the existing gingival and periodontal indices and discueses their potential for clinical use in children. Introduction Gingivitis and periodontitis are generally thought of as diseases of adulthood. Pedodontists and general practitioners have traditionally paid little attention to the gingival and periodontal health status of children. 1 Due to the widespread use of water fluoridation, topical fluoride, fluoride dentifrices and other preventive measures, the prevalence of dental caries has shown a dramatic drop in countries that traditionally had very high caries levels -Switzerland, Australia and New Zealand2 for example. In the United States, where the dental caries rate has been moderate, there are indications that the caries rate in 1980 is considerably lower than two decades ago.s,4 However, the incidence of gingivitis in children has shown a significant increase. Similarly, gingival health in adults in Switzerland and other countries has shown little if any improvement despite efforts of the public health and dental professions. 5 Although plaque indices such as the simplified 6,7 oral hygiene index have been used for some time, a definitive recording of the gingivai and periodontal health in children has not usually been carried out in ~ pedodontic clinics or in private dental practices. Most clinical indices have been developed in order to assess the gingivai and periodontal health in experimental or epidemiological studies. Recordings of gingival and periodontal health in clinical practice may require a high degree of intraexaminer reproducibility and should be simple, accurate and meaningful tools in assessing the status of oral health or disease? ,9 The purposes of this paper are to review the existing gingival and periodontal indices, assessing their potential as indices for use in children, and to focus greater attention on the gingival and periodontal health of children and adolescents. The international designations for tooth numbers have been used in the paper in compliance with W.H.O. recommendations. Classification and Characteristics Indices may be classified into four categories; 1) gingival indices, 2) periodontal indices, 3) oral hygiene indices, and 4) miscellaneous indices such as retention index, alveolar bone loss and mobility index. According to Russell, 9 an index is a numerical value describing the relative status of the population on a scale with a definitive upper and lower level. By using indices which have been carefully defined, comparisons can be made between different population groups of the severity of a disease since the same criteria and methodologies have been adopted. An adequate index is both reliable and has validity. Unfortunately many disease entities are not easily quantifiable by objective means. Consequently the results of clinical trials are not only affected by the shortcomings of the indices themselves, but are also subject to examiner variations such as training, and clinical experience. Furthermore, the analysis of data is complicated by the fact that most index systems follow an ordinal scale and are non-parametric in nature. Gingivitis PMA Index (Schour and MassleV ~’) One of the first quantitative gingival indices is the PEDIATRIC DENTISTRY: Volume 3, Number 4 353 P-M-A Index developed by Schour and Massler in 1944-1947, probably derived from the index suggested by King.~4 The degree of gingivitis for each of the papillary (P), marginal (M) and attached (A) gingival units was defined as in Table 1. Table I. PMA Index of Schour and Massler. m~