DMF Index II Community dentistry II Dr. Abdelmonem Altarhony DMF Index II Community dentistry II

Objectives DMFT index Caries detection Criteria for caries Calculation of DMFT Root caries measurement

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.

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.

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.

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

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

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

Question 1 - How could you differentiate between tooth missing due to caries and due to exfoliation?

By age of the patient if it is near to exfoliation time or not. The shape of ridge is concave in carious missing tooth and straight in exfoliated one and permanent successor may be seen. DMF/dmf index is higher in association with carious missing tooth especially adjacent and the contra lateral teeth. Bad oral hygiene mainly associated with carious teeth.

Question 2 - How could you differentiate between tooth missing due to caries and due to orthodontic treatment?

By type of teeth, in ortho 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. Bilateral and /or opposing missing generally associated with ortho. treatment, while in carious missing teeth it is not necessary. 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. Crowding or appliance may be seen in ortho. 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. 50

Mixed dentition: Each child is given a separate index, one for permanent teeth and another for primary teeth.

Information from the dental caries indices can be derived to show the: Number of persons affected by dental caries (%). Number of surfaces and teeth with past and present dental caries (DMFT / dmft -- DMFS / dmfs). Number of teeth that need treatment, missing due to caries, and have been treated ( DT/dt , MT/mt , FT/f t).

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

2- For Group of a population Total DMFT ( SUM ) each individual = DMFT1 + DMFT2 +...... Mean DMFT = Total DMF Total No. of the subjects examined

Index of treatment need Percent of decayed teeth= D DMFT Indicates the treatment required for unmet filling needs

Index of treatment failure or prosthetic need Percent of missing teeth= M Total DMFT Indicates the number of teeth lost by decay

Filling needs met F FNM= Total DMFT Care index of restorative provision Filling needs met F FNM= Total DMFT Indicates treatment required for decay 60

DMFSS: Modification to measure sealed teeth where S category is added.

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

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.

Criteria to identify caries: Lesion clinically visible Catch to explorer tip Explorer tip can penetrate deep the soft yelding tooth material Discoloration or loss of translucence typical of demineralized or undermined enamel

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 .

Treatment is by primary preventive practices such as plaque control and topical fluoride applications.

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.

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 method (i.e. without probing) Mouth mirror Good illumination visual

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.

3- It may allow transmission of cariogenic provide no more accuracy in diagnosis because the surface enamel of non- cavitated lesions feels hard and indication for demineralization. give no 3- It may allow transmission of cariogenic bacteria from infected sites. 80

WHO Index for dental caries Codes given by who Permanent tooth code Condition/Status Primary tooth code Sound A 1 Decayed B 2 Filled with decay C 3 Filled no decay D 4 Missing as a result of caries E 5 Missing any other reason - 6 Sealant/ varnish F 7 Bridge abutment or special crown G 8 Unerupted tooth 9 Excluded tooth 10 Trauma 81 T

Diagnostic criteria for Dental Caries according to WHO, 1997 0 Sound 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)

1 Decayed as sound. 1 Where any doubt exists, the surface is recorded 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

2 Filled & decayed Filled teeth with additional decay

3 Filled Filled tooth with no decay ( crowning included related to previous decay not aesthetics )

4 Missed ( for decay) Missed tooth as result of caries When roots are missed they are recorded as 7 or 9. 7/9

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 )

6 Sealants Teeth where sealants have been placed or where fissures were enlarged and composite material placed

7 Crowns or abutments Root 9 Implant 7 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 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.

9 Excluded tooth Crown: Erupted teeth that can not be examinated because of orthodontic bands.

10. Trauma Fractured crown with some of the surfaces missed but with no evidence of decay

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

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

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.

ROOT CARIES Prevalence of root caries tends to be inversely related to the number of teeth remaining. More Root caries Less teeth remaining

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. All teeth are examined in both the lower and upper arch. 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. When multiple types of root surfaces are exposed, the most severely affected root surface be recorded for that tooth. 100

Root surface :decayed + filled Root surface :d+ f+ sound RCI = Root surface :decayed + filled Root surface :d+ f+ sound x100

A community RCI of 6.91 means that all teeth with gingival recession, 6.9% were decayed or filled on the root surface.

New technologies in caries diagnose

Digital Radiography

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

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.

FIBEROPTIC TRANSILLUMINATION 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.

Digital Imaging Fiber-Optic Transillumination (DiFOTI) Analysis of occlusal and proximal surfaces 116

Infrared laser fluorescence 117

D Caroline Mohamed 118

D Caroline Mohamed 119

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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