Dr Abdelmonem Altarhony DMF Index I Community dentistry

Dr. Abdelmonem Altarhony DMF Index I Community dentistry II 1

Objectives • • • DMFT index Caries detection Criteria for caries Calculation of DMFT Root caries measurement 2

Dental caries • Caries is a point in a persons life at which the process of demineralization of tooth structure by acid from bacteria in the tooth biofilm overwhelms the patient’s ability to remineralize tooth structure. • The end stage of dental caries disease process is cavitation. 3

DENTAL INDICES Index • Graduated numerical scale with upper & lower limits, with scores on the scale corresponding to specific criteria • designed to permit and facilitate comparison with other populations classified by the same criteria and methods. 4

Reversib le (GI) Types of indices : Comple x (PI) Irreversib le (DMF) 5

Requirements of an ideal index: 1 Validity : measure what’s intended to measure 2 Reliability: consistent at different times under a variety of conditions 3 Clarity, simplicity & objectivity: readily memorized after some practice 4 Quantitability: amenable to statistical analysis 5 - Sensitivity: detect small shift 6 - Acceptability: not painful 6

COMMONNLY USED INDICES IN DENTISTRY • • • DMFT/dmft OHI-S CPITN Plaque index of Silness and Loe Gingival index of Silness and Loe 7

Tooth chart positioning 8

FDI Dental Federation notation system 9

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Indices used for dental caries assessment 1 Indices used for coronal caries. A. Permanent teeth. B. Primary teeth. 2 - Indices used for root caries. 14

Permanent teeth index: Decayed-Missing-Filled Index ( DMF ) Klein, Palmer and Knutson, 1938 and modified by WHO: The DMF is an irreversible index, applied only to permanent teeth. And always significant by upper case letters. 1 DMF teeth index (DMFT) measures the prevalence of dental caries/Teeth. 2 DMF surfaces index (DMFS) which measures the severity of dental caries. 15

DMFT Indices • The Decayed, Missing, Filled (DMF) index has been used for more than 70 years and is well established as the key measure of caries experience in dental epidemiology. 16 20

MDF-T components: • D component: an irreversible index used to measure past and present caries experience of a population with permanent teeth. Decayed teeth which include: 1. Carious tooth. 2. Filled tooth with recurrent decay. 3. Only the root are left. 4. Defect filling with caries. 5. Temporary filling. 6. Filled tooth surface with other surface decayed. 17

Sound 18

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. 19

D 20

Decayed D 21

M component Missing teeth due to caries. Tooth that were extracted for reasons other than caries should be excluded, which include: 1. Orthodontic treatment. 2. Impaction. 3. Periodontal disease. 4. Unerupted teeth. 5. Congenitally missing. 6. Avulsion teeth due to trauma or accident. 7. Primary teeth retained in the permanent dentition. 22

M I S S E d 23

• Missed 24

F component: • Filled teeth due to caries. • Permanent restorations present and no secondary (recurrent) caries or other area of the tooth with primary caries. • A tooth with a crown placed because of previous decay. Teeth restored for reason other than dental caries should be excluded, which include: 1. Trauma (fracture). 2. Hypoplasia (cosmatic purposes). 3. Bridge abutment (retention). 4. Sealed root canal due to trauma. 25

Filled • Filled tooth with no decay 26 30

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Principle and rules in recoding: 1 -DMFT: 1 A tooth may have several restorations but it counted as one tooth, F. 2 A tooth may have restoration on one surface and caries on the other, it should be counted as decayed D. 3 No tooth must be counted more than once, D M F or sound. 28

Note A tooth is considered to be erupted when the cusp tip of the occlusal surface or incisor edge is exposed. The excluded teeth in the DMF index are: 1 Supernumerary teeth. 2 The third molar. Klein, Palmer and Knutson only. 29

• The DMF Index is applied to the permanent dentition. • When the index is applied to teeth, it is called the DMFT index, and scores per individual can range from 0 to 28 or 32, depending on whether the third molars are included in the scoring. 30

F Bitewings D 31

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. • Follow the basic principles and rules for the MDFT 32 40

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Mixed dentition: Each child is given a separate index, one for permanent teeth and another for primary teeth. 34

Analyze the scores by using the following formula: Calculation of DMFT : 1 - Individual DMFT Total of each component i. e. D; M; F separately Then total D + M + F = DMFT 35

2 - For Group of a population Total DMFT ( SUM ) each individual = DMFT 1 + DMFT 2 +. . . Mean DMFT = Total DMF Total No. of the subjects examined 36

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Non-cavitated lesion Cavitated lesion 38

• 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. 39

• Treatment is by primary preventive practices such as plaque control and topical fluoride applications. 48

• 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. 49

• 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 42

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. 43 51

Even gentle probing with a sharp explorer turned non-cavitated lesion into cavitation. thus turning what could have been a reversible lesion (non-cavitated) into one that is irreversible. D Caroline Mohamed 52 44

The value of early detection • Is the ability to control the disease process in order to contain, arrest or remineralize lesions, in order to avoid or delay the burden or costs associated with a spiral of restoration and restoration. • If a lesion is left until a filling is needed, the clinical opportunity for effective prevention is LOST! D Caroline Mohamed 45

Identify Tooth decay. . 46

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Thank you 48