L19-OHI

Oral Hygiene Index-OHI-

Jurusan Kedokteran Gigi Universitas Jenderal Soedirman

Suatu pengantar...• Oral health means being free of chronic

mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the mouth and oral cavity

(WHO, 2007)

Oral Hygiene• Is a basic factor for oral health• Poor OH leads to dental-plaque

collections, which in turn can cause gingivitis eventually leading to periodontal diseases.

• That’s why many clinical studies have been carried out focusing on the role of OH in prevention and control of oral diseases.

Oral hygien

e

Oral health

Oral diseas

es

Review on dental plaque please...and, ...

• A number of Plaque indices has been developed for assessing individual level of plaque control and are also been used in several epidemiological studies.

Epidemiology of periodontal disease

Descriptive and analytic studies• 1947 – PMA Index (Schour and Massler’s) was

later modified by Parfitt (1957) – WHO 1950 inflamasi gingiva• 1956 – PI / Periodontal Index (Russell)• 1959 – PDI / Periodontal Disease Index

(Ramfjord)• 1960 – Oral Hygiene Index (Greene &

Vermillion)• 1986 – ESI/ Extent & Severity Index (Carlos,

et.al.)

Experimental epidemiology• Both OHI and OHI-S (Greene & Vermillion, 1964) 1961 – CSI (Ennever, et.al.) 1962 – V-M Index (Volpe & Manhold), (Volpe,

et.al, 1965) 1962 – Quigley & Hein (scoring 1-0 in the OHI

system) 1963 – Gingival Index (Lӧe & Silness) 1964 – Plaque Index System (Silness & Lӧe) 1967 – Bleeding after probing (Lӧe) 1967 – Retention Index (Bjӧrby & Lӧe) 1967 – Calculus (Bjӧrby & Lӧe)

Assesment of treatment needs• In epidemiological surveys of earlier years

periodontal data were ussually given as mean scores for the population studied (Greene, 1963; Scherp, 1964; Ramfjord et al. 1968; Carranza, 1984).

Macamnya :• PTNS (Johansen et al. 1973)• Dichotomous scoring (Ainamo & Bay, 1975)• PSE (Oliver, 1977)• CPITN / Community Periodontal Index of Treatment

Need (WHO, 1978) adopted by FDI (1985)

5 index menurut WHO (2009) yg paling populer (umum) adalah :• Oral Hygiene Index - (GV, 1960)• Simplified OHI (OHI-S) - (GV, 1964)• Silness-Lӧe Index (SL, 1964)• Quigely Hein Index (Turesky, 1970)• Plaque control record (O’Leary, T.Drake

R, Naylor, 1972)

- Oral Hygiene Index -(Greene and Vermillion, 1960)

• OHI = DI + CI• Gigi geligi dibagi menjadi 6 segmen (lihat

gambar)• tiap segmen dilakukan DI dan CI, yang

diwakilkan oleh hanya 1 gigi yang memiliki debris atau kalkulus terbanyak.

• Skoring dilakukan setiap permukaan bukal/labial dan lingual

• Pemberian skor diambil dr gigi permanen yg sudah erupsi penuh

Pembagian segmen dalam OHI

Kriteria DI dan CI

Criteria for classifying debris

Scores

Criteria

0 No debris or stain present

1Soft debris covering not more than one third of the tooth surface, or presence of extrinsic stains without other debris regardless of surface area covered

2Soft debris covering more than one third, but not more than two thirds, of the exposed tooth surface.

3 Soft debris covering more than two thirds of the exposed tooth surface.

Criteria for classifying calculus

Scores Criteria

0 No calculus present

1 Supragingival calculus covering not more than third of the exposed tooth surface.

2Supragingival 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.

3Supragingival calculus covering more than two third of the exposed tooth surface or a continuos heavy band of subgingival calculus around the cervical portion of the tooth, or both.

Perhitungan DI dan CI :

Total skor bukal RA&RB + Total skor lingual RA&RB

------------------------------------------------------------------------------------Jumlah segmen

•Untuk DI yg dihitung hanya debris•Untuk CI yg dihitung hanya calculus

Debris Kalkulusright ant left totalUpper

BL

Lower

total

right ant left totalUpper

BL

Lower

total

Perhitungan DI & CI :

Total skor bukal RA&RB + Total skor lingual RA&RB =

----------------------------------------------------------------------------------------------------Jumlah segmen

0 - 36= ------------

0 - 6

OHI = DI + CIKriteria OHI : skor 0 - 2,4 = baik 2,5 - 6 = cukup 6,1 - 12 = buruk

- OHI-S (Simplified) -(Greene and Vermillion, 1964)

• OHI-S = DI + CI• DI dan CI menggunakan kriteria

skoring yg sama seperti pd OHI• Perbedaan dgn OHI :

Penilaian bukal hanya pd 16, 26 Penilaian lingual hanya pd 36, 46 Penilaian labial pd gigi 11 dan 31

Perhitungan DI dan CI :

Total skor bukal&labial + Total skor lingual-------------------------------------------------------------

-----------------------Jumlah permukaan (Bukal&lingual) yg

diskor

•Untuk DI yg dihitung hanya debris•Untuk CI yg dihitung hanya calculus

OHI-S = DI-S + CI-S

Kriteria Oral hygiene (OHI-S) pasien :• Skor 0 – 1,2 = Baik• Skor 1,3 – 3 = Sedang• Skor 3 – 6 = Buruk

- Silness-Löe Plaque Index -(Silness and Löe, 1964)

• Skoring dilakukan pada 16, 12, 24, 36, 32, 44

• Missing teeth are not substituted• Skoring pd keempat permukaan pd gigi-gigi

tersebut (bukal, lingual, mesial dan distal)• Nilai skoring termasuk soft deposit maupun

mineralized deposit• Kriteria skoring 0-3 pd tiap permukaan per

gigi

Plaque index systemScores Criteria

0 No plaque

1A film of plaque adhering to the free gingival margin and adjacent area of the tooth. The plaque may be seen in situ only after application of disclosing solution or by using the probe on the tooth surface.

2Moderate accumulation of soft deposit s within the gingival pocket, or the tooth and gingival margin which can be seen with the naked eye.

3 Abundance of soft matter within the gingival pocket and/or on the tooth and gingival margin.

• Plaque index ditentukan per gigi yaitu rata-rata skor per gigi, sbb : skor bukal+lingual+mesial+distal

4• Plaque index pasien = rata-rata

index ke-enam gigi, sbb : index 16+12+24+36+32+44

6

- Quigley Hein Index -(Modified by Turesky et al, 1970)

• Index ini sama perhitungannya dengan index Quigley Hein, perbedaan terletak pada kriteria yg telah dimodifikasi.

• Skoring 0-5 dilakukan pd permukaan bukal dan lingual seluruh gigi RA dan RB yg tidak direstorasi. (M3 tidak dihitung)

The plaque index systemScore

sCRITERIA

0 No plaque

1 Separate flecks of plaque at the cervical margin of the tooth.

2 A thin continuos band of plaque (up to one mm) at the cervical margin of the tooth.

3 A band of plaque wider than one mm but covering less than one-third of the crown of the tooth.

4 Plaque covering at least one-third but less than two-thirds of the crown of the tooth.

5 Plaque covering two-thirds or more of the crown of the tooth

Kalkulasi• Index merupakan perhitungan total

skor seluruh permukaan gigi yg diskoring dibagi dengan jumlah permukaan yg diperiksa (max 56)

- The Plaque Control Record - (O' Leary T, Drake R, Naylor, 1972)

• The Plaque Control Record was developed to give the therapist, hygienist, or dental educator a simple method of recording the presence of the plaque on individual tooth surfaces.

• These surfaces are : Mesial, Distal, Buccal, Lingual.

• At the control appointment a suitable disclosing solution such as Bismarck Brown, Diaplac or similar is painted on all exposed tooth surfaces.

• After the patient has rinsed, the operator (using an explorer or a tip of a probe) examines each stained surface for soft accumulations at the dentogingival junction.

• When found, they are recorded by making a dash/red colour in the appropriate spaces on the record form. Those surfaces, which do not have soft accumulations at the dentogingival junction, are not recorded.

• After all teeth are examined and scored, the index is calculated by dividing the number of plaque containing surfaces by the total number of available surfaces.

CALCULATION EXAMPLE:Assume a patient with the following plaque accumulation: • Upper jaw: 34 plaque containing

surfaces• Lower jaw: 36 plaque containing

surfaces

Permukaan gigi yg diperiksa : RA 52, RB 48

Plaque Index =(The number of plaque containing

surfaces) (The total number of available surfaces)

= (34 + 36) / (52 + 48) = 70 / 100 = 0.70

Lakukan persentase= 0.70 x 100 % = 70%Jadi, pasien tsb memiliki skor plak 70 %.

• Plaque Control Record dapat digunakan utk melihat kemajuan kontrol plak pasien antar kunjungan s.d. skor indeks plak ≤ 10%

CPITN (Community Periodontal Index of Treatment Need)

WHO (1978) adopted by FDI (1985)

• CPITN determines not only the severity of gingivitis (bleeding) and periodontitis (pocket probing depth), but also provides information concerning the type of disease process and therefore also the extent of therapy that is necessary.

• The CPITN does not consider the attachment loss on individual teeth, rather only the clinical situations requiring treatment :

1. Gingival inflammation2. Bleeding3. Calculus4. Pocket probing depth

Kriteria CPITN dan Kebutuhan Perawatan

SKOR

STATUS PERIODONTAL

KEBUTUHAN PERAWATAN

0 Periodontal sehat TN 0 (tidak membutuhkan

perawatan)1 Perdarahan pada

probingTN 1 = perbaikan OH

2 Adanya kalkulus, bila probe dimasukkan pada kedalaman 3,5-5,5 mm

TN 2 = 1 + scaling

3 Kedalaman poket 4-5 mm

TN 2 = 1 + scaling

4 Kedalaman poket > 6 mm

TN 3 = 1 + 2 + perawatan kompleks

• RA dan RB dibagi menjadi 6 segmen, penggunaan indeks gigi (penelitian epidemiologi)

• Tiap segmen dicatat 1 gigi yg terparah kondisinya.

• Setiap segmen, minimal 2 gigi yg masih berfungsi; jika hanya 1 gigi diikutkan pada segmen di sebelahnya

17, 16 11 26, 27

47, 46 31 36,37

Selesai...

Skills lab – 2Skoring Plak, Rabu 14 Des @Gdg.E

• Gunakan jas lab selama skills lab• Masing-masing wajib membawa alat

lengkap, sudah dicuci bersih dan siap digunakan.

• Lembar kerja individual (disediakan), wajib diisi dan dikumpulkan untuk dinilai.

• Dalam 1 kelompok, silahkan saling berpasangan (probandus-pemeriksa)

• Di ruang lab. Dental, lakukan skoring (pertama kali), tuliskan hasilnya dan mintalah trainer untuk memeriksa tidak dinilai.

Cara Skoring• Pemeriksa cuci tangan• Pemeriksa menggunakan sarung tgn & masker• Beri instruksi dan penjelasan kpd probandus• Teteskan 1 tetes disclosing solution di bawah

lidah• Instruksikan untuk menutup mulut• Instruksikan agar probandus meratakan

disclosing solution ke seluruh permukaan gigi dengan cara : lidah menyapu permukaan lingual-palatal, kemudian bukal-labial-bukal

• Probandus disarankan untuk tidak berkumur dahulu (meludah boleh).

• Lakukan skoring dimulai dari 18-28-38-48 sambil dicatat hasilnya pada lembar skoring

• Setelah selesai, segera laporkan kepada trainer untuk diperiksa

• Selesai diperiksa, probandus diperbolehkan kumur

• Instruksi menyikat gigi, lakukan pengamatan

• Lakukan DHE kepada probandus• Bergantian lakukan prosedur ini.• Lakukan skoring pada model yang

disediakan• Lembar kerja mahasiswa

dikumpulkan kepada trainer masing-masing.

Skill-lab 3OHI, Kamis, 15 Des @gdg.E

• Seluruh mahasiswa menggunakan jas lab

• Lakukan pemeriksaan antar teman, catat OHI, OHI-S, SL-PI, QHI.

HASIL PEMERIKSAAN HASIL PEMERIKSAAN

SEG ELEMEN DEBRIS CALCULUS SEG ELEMEN DEBRIS CALCULUSB L TOT B L TOT B L TOT B L TOT

1

17            

4

37            16             36            15             35            14             34            

2

13            

5

33            12             32            11             31            21             41            22             42            23             43            

3

24            

6

44            25             45            26             46            27               47              

   SKOR OHI : SKOR OHI-S :

Wajib Bawa• Spidol Merah (skl-2), bolpoint• Kain putih sebagai alas meja kerja• Kacamulut, sonde, pinset, ekscavator pd baki

putih• Bengkok / nierbekhen• Sarung tangan dan masker• Handuk bersih• Slabber• Dentrifice (pasta gigi)• Sikat gigi• Gelas kumur