Download DMFS index

Dr. Abdelmonem Altarhony
DMF Index II
Community dentistry II
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Objectives
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DMFT index
Caries detection
Criteria for caries
Calculation of DMFT
Root caries measurement
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DMFS index
• When the index is applied only to tooth
surfaces, it is called the DMFS index, and
scores per individual can range from 0 to 128
or 148, depending on whether the third
molars are included in the scoring.
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DMFS ( SURFACES)
Each tooth is recorded scored as 4 surfaces for anterior
teeth and 5 surfaces for posterior teeth.
Retained root ( completely decayed crown) is recorded as
4 D for anterior teeth, 5 D for posterior teeth.
Missing tooth is recorded as 4 M for anterior teeth, 5 M for
posterior teeth.
Tooth with crown is recorded as 4 F for anterior teeth, 5 F
for posterior teeth.
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Maximum individual score: ( third molars
included or not )
DMFT = 32
DMFS = ( 12 teeth anteriors ) ( 16 or 20 posteriors)
(12 X 4) + (20 X 5) =
48 + ( 80) or (100) =
128 or 148
Minimum score = Zero
DMFT and deft scores are objective thus
require high agreement between examiners.
DMFS and defs (surfaces) are more subjective
thus less reliable.
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Primary teeth index:
DMF Index variations:
1. dmf index:
• Written in lowercase letters,
• The dmft index expresses the number of affected teeth
in primary dentition, with scores ranging from 0 to 20
for children.
• The dmfs index expresses the number of affected
surfaces in primary dentition (five per posterior tooth
and four per anterior tooth), with a score range of 0 to
88 surfaces.
• Maximum scores: dmft = 20 , dmfs = 88
• Follow the basic principles and rules for the MDFT
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dmf index
• Use: The dmf index for use in children
before ages of exfoliation.
• It applied only to primary molars.
• m: missed related to caries if < 6 years
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2.deft index:
• It is applied to the primary dentition during mixed
dentition period,
d: decayed
e: indicated/extracted due
to caries only
f: filled
Is difficulty of distinguishing beween extracted/
naturally and exfoliated primary tooth
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Question 1
- How could you differentiate between tooth
missing due to caries and due to exfoliation?
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1 By age of the patient if it is near to exfoliation time
or not.
2 The shape of ridge is concave in carious missing
tooth and straight in exfoliated one and permanent
successor may be seen.
3 DMF/dmf index is higher in association with carious
missing tooth especially adjacent and the contra
lateral teeth.
4 Bad oral hygiene mainly associated with carious
teeth.
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Question 2
- How could you differentiate between tooth
missing due to caries and due to orthodontic
treatment?
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1 By type of teeth, in ortho. treatment most teeth should
be extracted are 4,5/c, d while in carious missing teeth
any teeth may be involved.
2 Bilateral and /or opposing missing generally associated
with ortho. treatment, while in carious missing teeth it is
not necessary.
3 DMF/dmf index is higher in association with carious
missing tooth especially adjacent and the contra lateral
teeth with bad oral hygiene mainly associated with
carious teeth.
4 Crowding or appliance may be seen in ortho.
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treatment.
3- dft / dfs
In which the missing teeth are ignored,
because in children it is difficult to make sure
whether the missing tooth was exfoliated or
extracted due to caries or due to serial
extraction.
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Mixed dentition:
Each child is given a separate index, one for
permanent teeth and another for primary
teeth.
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Information from the dental caries indices
can be derived to show the:
1.Number of persons affected by dental caries
(%).
2.Number of surfaces and teeth with past and
present dental caries (DMFT / dmft -- DMFS /
dmfs).
3.Number of teeth that need treatment, missing
due to caries, and have been treated ( DT/dt ,
MT/mt , FT/f t).
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Analyze the scores by using the following
formula:
Calculation of DMFT \ DMFS:
1- Individual DMFT
Total of each component i.e. D; M; F separately
Then total D + M + F = DMFT
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2- For Group of a population
Total DMFT ( SUM ) each individual = DMFT1 + DMFT2
+......
Mean DMFT =
Total DMF
Total No. of the subjects examined
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Index of treatment need
Percent of decayed teeth=
D
DMFT
Indicates the treatment required for
unmet filling needs
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Index of treatment failure or
prosthetic need
Percent of missing teeth=
M
Total DMFT
Indicates the number of teeth lost by
decay
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Care index of restorative provision
FNM=
Filling needs met
F
Total DMFT
Indicates treatment required for decay
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DMFSS:
• Modification to measure sealed teeth where S
category is added.
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Limitations of DMFT
• Values are not related to the number of teeth at
risk. The decayed, missing and filled teeth are equal
in weight in the DMF/dmf index.
• Invalid when teeth are lost for reasons other than
dental caries.
• Have little meaning unless age is also stated.
• Irreversibility of this index
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• many teeth now have been restored by
tooth-colored material such as composite,
that make it is difficult to be detected by
epidemiologist.
• It can be misleading in children…
• DMF cannot used for root caries.
• DMF cannot account for sealed teeth.
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Criteria to identify
caries:
1. Lesion clinically visible
2. Catch to explorer tip
3. Explorer tip can penetrate deep the soft
yelding tooth material
4. Discoloration or loss of translucence typical
of demineralized or undermined enamel
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• Initial stages of dental caries are reversible.
As long as the lesion is still incipient i.e. with
no cavitations remineralization is possible.
• The early identification of such early carious
lesion is extremely important because it is
during this stage that the carious process can
be arrested or reversed .
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• Treatment is by primary preventive practices
such as plaque control and topical fluoride
applications.
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• On the other hand, the
overt cavitations stage is
an irreversible one.
• It may be called “ the
point of no return" as it is
no longer expected that
remineralization can occur.
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• Traditionally visual-tactile method is used (i.e.
explorer as well as vision) .
– Mouth mirror
– Explorer
– Good illumination
• Recently, method for diagnosing caries have
moved more toward exclusively visual
method (i.e. without probing)
– Mouth mirror
– Good illumination
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Explorer should not be used
for several reasons:
• 1-the use of explorer ,even gentle probing
with a sharp explorer, is likely to damage the
surface zone of non-cavitated lesions.
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• 2- It may provide no more accuracy in
diagnosis because the surface enamel of noncavitated lesions feels hard and give no
indication for demineralization.
• 3- It may allow transmission of cariogenic
bacteria from infected sites.
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WHO Index for dental caries
Codes given by who
Permanent tooth code
0
1
2
3
4
5
6
7
8
9
10
Condition/Status
Sound
Decayed
Filled with decay
Filled no decay
Missing as a result of
caries
Missing any
other reason
Sealant/ varnish
Bridge abutment
or special crown
Unerupted tooth
Excluded tooth
Trauma
Primary tooth code
A
B
C
D
E
F
G
T
8131
• 0 Sound
Diagnostic criteria for Dental
Caries according to WHO,
1997
• Sound crown or root with no evidence of treated or
untreated caries
• It may have defects and still be recorded as 0
• ( white or chalky spots; discolored or rough spots that are
not soft; stained enamel pits or fissures; dark, shiny , hard,
pitted areas of moderate to severe fluorosis, or abraded
areas)
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• 1 Decayed
• Tooth or root with caries.
• Definite cavity, undermined enamel, or detectably softened or
leathery area of enamel or cementum .
• Tooth with temporary filling
• Teeth sealed but decayed
• Where any doubt exists, the surface is recorded
as sound.
• In cases where the crown of a tooth is completely decayed,
leaving only the root sign 1 for both crown and root.
• Where only the root is decayed is termed as 1.
1
1
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• 2 Filled & decayed
• Filled teeth with additional decay
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• 3 Filled
• Filled tooth with no decay
( crowning included related to previous decay not
aesthetics )
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• 4 Missed ( for decay)
• Missed tooth as result of caries
When roots are missed they are recorded as 7 or 9.
7/9
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• 5 Missed ( not decay)
• A permanent tooth missing for any other reason
( teeth extracted for orthodontia or because
periodontal disease teeth that are congenitally
missing, or because of trauma )
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• 6 Sealants
• Teeth where sealants have been placed or where
fissures were enlarged and composite material
placed
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• 7 Crowns or abutments
• The tooth is bridge abutment or special crown, veneers
or laminate covering the facial surface and there is no
evidence of caries or restoration.
• There is an implant replacing the root
• Tooth previously missed- extracted and replaced by
bridge pontics are scored 4 ( missed in result of caries) or
5 ( missed for other reasons not decay); their roots are
scored 9
Crown 4 or 5
Root 9
Implant 7
7
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90
• 8 Unerupted permanent tooth
• Crown: Space with unerupted permanent tooth,
where no primary tooth is present.
• It does not include missing teeth.
• Root: root surface is not visible in the mouth.
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• 9 Excluded tooth
• Crown: Erupted teeth that can not be examinated
because of orthodontic bands.
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10. Trauma
• Fractured crown with some of the surfaces
missed but with no evidence of decay
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In relation to DMFT
• D
• M
• F
codes 1 and 2
codes 4 or 5
code 3
• Code 6; 7; 8; 9 or T are not included in DMFT
calculations
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WHO oral health surveys
manual means of DMF-T index
very low = 0.0 - 1.0
low
= 1.2 - 2.6
medium = 2.7 - 4.4
high
= 4.4 - 6.5
very high = 6.5
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Root caries Index:
Root caries is strongly associated with the loss of periodontal
attachment.
Tooth at risk: enough gingival recession that expose part of
cement surface to oral environment
An important risk factor is:
• multiple medications among the elderly that can promote
xerostomia. (salivary diminution)
• History of coronal caries.
• low-fluoride communities.
• Smokers.
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ROOT CARIES
Prevalence of root caries tends to be inversely
related to the number of teeth remaining.
More Root caries
Less teeth
remaining
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Root Caries Index RCI
Root Caries Index (RCI), Katz,1979:
RCI is based on the requirement that gingival recession must
occur before root surface lesions begin. Therefore, only teeth
with gingival recession are included.
1. All teeth are examined in both the lower and upper arch.
2. To obtain the RCI, each of the four surfaces the mesial, distal,
buccal (labial), and lingual, of a root are examined for a
single tooth.
3. When multiple types of root surfaces are exposed, the most
severely affected root surface be recorded for that tooth.
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100
• RCI =
Root surface :decayed + filled
Root surface :d+ f+ sound
x100
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• A community RCI of 6.91 means that
all teeth with gingival recession,
6.9% were decayed or filled on the
root surface.
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New technologies in caries
diagnose
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Digital Radiography
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Measurements by electrical conducting
devices
• Tooth demineralization due to caries process causes increased
porosity of tooth structure. This porosity contains fluid
containing ions. This leads increased electrical conductivity,
conversely, leads to decreased electrical resistance or
impedance.
D Caroline Mohamed
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Quantitative light induced
fluorescence
•Autofluorescence masking effect was found to be helpful for
caries detection and the red fluorescence in the treatment mode
was found helpful in deciding 'when to stop the excavation
process.
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FIBEROPTIC
TRANSILLUMINATION
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Different index of light transmission for decayed & sound tooth.
Decayed tooth structure has decreased index & appears dark.
The tooth is illuminated using fiberoptics.
Have a high level intra & inter-examiner variability.
Digital imaging FOTI introduced, images captured by a CCD camera &
fed into the computer for image analysis.
• It can detect caries on all types of teeth & also detect incipient &
recurrent caries before their visibility on radiographs.
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Digital Imaging Fiber-Optic Transillumination
(DiFOTI)
• Analysis of occlusal and proximal surfaces
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Infrared laser
fluorescence
11756
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D Caroline Mohamed
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D Caroline Mohamed
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Carie Scan challenges fluorescence
caries detectors
• Handheld device that uses electronic impedance spectroscopy
to measure a tooth's mineral density and detect caries .
• "The process measures tooth mineral density or porosity of
the entire tooth," Gresser told DrBicuspid.com. "It goes
through the entire tooth; it doesn't just scan the surface."
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Thank you
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