Assessment of Oral Health Status Using Dental Indices 89

applied to the permanent dentition is of the DMFT index results. Therefore,

always designated or signified by the DMFT is used for children before
upper case letter, i.e. capital letters. age of exfoliation and DMF applied
The equivalent index for primary only to the primary molar teeth.
dentition is the DEFT and DEFS is DECAYED FILLED (DF) Index
always designated or signified by Definition
lower case letter, i.e. small letters.
The DF index is a quantitative
expression of a person’s or groups
Modification of DEF Index number of decayed and filled
It should be noticed that in DEF index deciduous teeth or tooth surfaces.
deciduous teeth missing due to caries When a survey is made of a
are not recorded because of the population of children having a mixed
difficulty in many children of dentition, “DF index” is also used to
distinguishing between extracted and describe the caries experience of
naturally exfoliated primary teeth. By deciduous teeth.
giving due considerations to these The symbol (d) stands for the number
two facts, DEF is modified into: 1. DMF of deciduous teeth present that are
index caries and not restored. The symbol
2. DF index. (f) stands for the number of restored
deciduous teeth because of caries.
Decayed missing filled Index The missing teeth are ignored. This is
Definition: DMF index is a quantitative the method of choice of the WHO,
expression of the caries experience or Oral Health Surveys, Basic Methods.
caries prevalence in the primary The DF index can be applied to the
teeth. It is the sum of decayed (d), whole tooth as the decayed—filled-
missing due to caries (m) and filled (f) tooth-DFT index or to the individuals
because of caries primary tooth (t), It surfaces as the decayed—filled-
is DMFT or tooth surfaces (s), it is surfaces-DFS index. When a survey is
DMFS. It is used in the same way as made of the population of children
DMF index. Only those teeth which between the age groups of 6 to 12
should be present according to the years having a mixed dentition, a
subject (patient) age at the time of DMFT index or DMFS index used for
examination are assessed in the permanent teeth along with DFT
missing component. For example, it index and DFS index to describe the
may be decided to classify missing caries experience of deciduous teeth.
deciduous canines and molars as The average should be computed
missing (m) only in children less than separately for each age and sex
nine years of age, because beyond grouping for children under 12 years
that age it may be impossible to of age. The DMFT index or DMFS
determine whether a given missing index for permanent dentition and
tooth has been extracted or has DFT index or DFS index for deciduous
exfoliated. If all missing primary teeth dentition, the data should be
not replaced by a permanent computed separately to describe
successor are considered as m-teeth caries experience in permanent and
regard less of age, an overestimation deciduous teeth respectively.
90 Clinical Manual for Public Health Dentistry and Practical Record Book

Close observation shows that DF the frequent removal of the

index and DMF index should be third molars because of
numerically the same: DEF index impactions or for other
allow for two grades of caries and reasons, not related to
neither count missing. Both DMF caries makes an accurate
index and DF index may therefore classification of the reason
under state the true extent of the for an absent tooth unlikely.
carious attack and thus lose validity. Even careful questioning of
For comprehensive purpose, however the patient does not always
the greater variability gained by provide a sound basis for
ignoring missing tooth can make both the dentist to reach a
indices more useful. decision.
2. This classification system does not
The DMF Classification System use a category. “Indicated for
extraction” for teeth that are
When a survey is made to a
present in the mouth but are
population of children by using DMF
decayed to the extent that they
and DF indices to describe the caries
are counted as teeth absent
experience of permanent and
because of caries. Professional
deciduous teeth, the examination
opinions can very widely in the
criteria, coding and tabulating
determination of when a tooth
procedures and methods presented in
should be extracted, particularly
this clinical manual and record book
when a decision is based upon a
may differ in one or more features
rapid visual inspection using a
from WHO criteria for caries index
mirror and an explorer. The
(1986). However, the following
numerical value of the DMF
considerations are called to the
number does not change when
reader’s attention.
the category is eliminated but the
1. The examination is performed to
‘M’ component may be less when
determine the classification of 28
compared to data obtained by a
teeth or tooth surfaces. The third
different method.
molars are excluded from the
3. The category, “indicated for
system for two reasons:
extraction” is not used for
i. In surveys of children under
deciduous teeth for the same
15 years of age (the group
reasons as described above. The
most commonly surveyed)
numerical value of the “DF index”,
the recording of four
is identical with the “DEF index”,
additional decisions by the
deciduous teeth affected by caries
examiner constitutes little
are classified into two categories
new information, because
rather than three.
the third molars erupt at
4. A separate category for a tooth
the age of between 18 to 25
that is both decayed and filled is
years.
not used. It has been customary.
ii. For surveys of young adults,
When a separate “DF” or “df”
15 to 35 years variations in
category has been used, to
the eruption pattern and
tabulate these teeth with the
 Assessment of Oral Health Status Using Dental Indices 91

count of the “D” or “d” teeth each tooth space, the examiner must
respectively. The additional make:
statistic describing carious teeth • Four decisions if a tooth is present
that have been filled at some in or
the post appeared to be of limited • Three decisions if a tooth is
usefulness in most DMF surveys. absent. The examiner’s final
5. A separate category and a code decision for each tooth or tooth
designation for teeth that should space is expressed as a code. The
be excluded from consideration in special rules to be followed in
a study of the caries experience of making decisions and the
a population group has been definition for each category of the
included. In other systems of code are included in the next
classification, a special notation is section. The decision process that
made on the record from requiring forms the basis for the coding
additional tabulation procedures. system is expressed schematically
6. The classification system and code (Figure 4.10).
does not include a method of
obtaining statistics on other oral
Examination Criteria and Rule for
condition that may be observed
during the DMFT examinations. If
Coding
statistics on other Special Rules
oral conditions are needed, a 1. A tooth is considered erupted
separate classification and when the occlusal surface or
recording system should be used. incisal edge is totally exposed or
7. The code designations used in this can be exposed by gently
classification are numerical reflecting any overlying gingival
designations selected, because: tissue with the mirror or explorer.
i. They are easy to learn ii. 2. A tooth is considered to be
Resemble a word used in present even through the crown
the criteria iii. Easy to has been destroyed and only the
tabulate manually or by roots are left.
punch card 3. Supernumerary teeth are not to
iv. They are also different in sound be classified, if a primary tooth is
when spoken verbally and retained and its permanent
therefore, easier for the successor is present, classify the
recorder to hear. permanent tooth.
Note: Other types of code designation Note: The following points should be
have been used or could be used. noted clearly for just to make the
student to understand the
Rational for the DMFT Classification examination and coding criteria and
The examiner’s task, during the to avoid any confusion and doubts to
survey examination is to classify the eliminate the errors in survey
condition of each of the 28 tooth procedures.
spaces for each patient examined. To
arrive at the proper classification for
92 Clinical Manual for Public Health Dentistry and Practical Record Book

General Rules 6. Naturally exfoliated tooth should

The general rules for examination and not be taken into considerations.
coding criteria are as follows: 7. Measurement of caries status for
1. No tooth or tooth space or tooth deciduous and permanent teeth
surface should be counted more should be recorded separately.
than once. It may be either The deciduous teeth are not
decayed, missing, filled or sound. included in DMF count.
2. The decayed, missing and filled 8. If anterior tooth is missing due to
tooth or tooth surface or tooth caries four surfaces and posterior
space should be recorded tooth five surfaces should be
separately since the components counted.
of DMF index are great interest. 9. If both a filling and caries lesions
3. A tooth may have several are present on the same surface
restorations but it is counted as that surface is considered as only
one filled tooth. one surface that too as carious.
Note: In DMFS index if the tooth 10. If a tooth is filled shows secondary
shows fillings on different caries count that tooth or surface
surfaces, i.e. mesial, distal and is considered as caries only in “D”
occlusal, lingual (or palatal) and category of DMF index tooth.
buccal. The filled tooth surfaces 11. If the restoration has displaced
should be counted separately in from the cavity and the tooth with
DMFS index. base cavity is considered as
4. The tooth treated with pit and decayed tooth.
fissure sealant and shows carious
lesion. Exclusions E
5. Third molars are not included in Excluded tooth or tooth space: Code a
DMF index. tooth “E” when one of the following
conditions is present.

Figure 4.10: Schematic presentation of coding system for DMFT index

 Assessment of Oral Health Status Using Dental Indices 93

1. The tooth has been fractured and or opacity around the edges and
damaged to the extent that in which the explorer can
dention is exposed. penetrate.
2. It may be sound, carious, or filled. 2. Pits and fissures in which the end
3. The tooth has been fractured and of the explorer catches should be
the fractured portion is restored classified as carious only if one of
with a filling, jacket, or crown. the following criteria is met:
4. The tooth has a root hand filling i. Tactile evidence of soft
due to trauma. carious material at the base
5. The tooth has a jacket crown of the pit and fissure.
because it is a poorly formed ii. Opacity around the edges
tooth, e.g. Peg lateral. or an underlying stain
6. The tooth has a restoration used typical of caries.
as abridge abutment.
Primary Tooth Present
7. A permanent tooth has been
removed for orthodontic, reasons Use the same criteria as for the
or for any reason other than classification of a permanent tooth
caries. present code as follows:
E Excluded tooth or tooth spaces
Permanent Tooth Present
P1 Sound deciduous tooth
Sound permanent tooth 1 : Code a tooth
“1” if there is no indication of caries P2 Filled deciduous tooth
and no fillings, jackets, crowns or P3 Carious deciduous tooth
bridge abutment. Other defects such
as hypoplasia, fluorosis, enamel Primary or Permanent Tooth Absent
defects may or may not be present. If
some surfaces of an apparently sound O Missing tooth
tooth are obscured by an orthodontic Code a tooth space as “0” when the
band assume that tooth is sound. absence of a tooth is due to one of
Filled permanent tooth 2 : Code “2” when the following:
a tooth has been filled either • Primary tooth missing for any
permanently or temporarily reason
regardless of the material used. A • Unerupted permanent tooth
tooth that is both filled and decayed is • Unerupted deciduous tooth
classified as code “3” decayed. In any • Impacted or congenitally missing
instance where the filling has fallen permanent or primary tooth.
out, code the tooth as “3”.
Extracted Permanent Tooth
Decayed tooth 3 : Code a tooth “3” X Code a tooth space as “x”.
when there is the following evidence
of caries present. • If according to the age of the
1. Visual evidence of undermined person, a permanent tooth should
enamel; there must be a definite be present but in all probability
cavitation with either discoloration has been extracted because of
caries.
94 Clinical Manual for Public Health Dentistry and Practical Record Book

• Special precautions. When not 3. When the quadrant is completed,

sure, the person should be the examiner pauses briefly, and
questioned regarding extractions. the recorded calls “check” to
The final decision should be based indicate that she has accounted
upon the examinations and the for every tooth space in the
person’s response. Clinical quadrant.
judgment is given preference in 4. The maxillary left quadrant is
the event that the response is not examined next, and proceeds in
conclusive. the same manner beginning with
the central incisor or tooth space
The DMFT Examination Procedure number 1 and proceeding to the
second molar or tooth space
In the examination process, the number 7 for that quadrant.
examiner visually inspects and 5. The examination then proceeds to
explores when necessary the facial, the mandibular left quadrant and
occlusal, lingual, and proximal then to the mandibular right
surfaces of all the teeth present quadrant.
(expect third molars), identifies the
6. At the end of the examination, the
tooth number of all the teeth that are
examiner should pause before
absent, and determine the reason for
releasing the patient in order to
absence. The examination is made
give the recorder an opportunity
using a plane glass mouth mirror and
to verify that she has recorded a
a sharp standard no. 23 explorer.
code in every space on the form
Compressed air (or a chip blower) is
and to ask for a repeat code if this
used to improve visibility when the
is necessary.
tooth surfaces are obscured by saliva
or debris. The patient should be
positioned so that the examiner has Do’s and Don’ts for the Examiner
optimum visibility of the quadrant to 1. Do’s; when all possible, keep your
be examined. The examination should hands out of the patient’s mouth.
be conducted as follows: This minimizes contamination.
1. Begin with the maxillary right 2. Don’ts probe gross carious lesions
quadrant with the central incisor with the explorer and cause
or tooth space number 1, and unnecessary discomfort to the
proceed in sequence to the patient. The explorer should be
second molar or tooth space used only on those areas where
number 7. doubt exists as to the presence or
2. As the examination proceeds, the absence of a carious lesions or
examiner calls the appropriate restoration.
diagnostic code for each tooth or 3. Do; question the patient regarding
tooth space. Since, the reasons for extraction, but if the
examination proceeds in sequence response is not conclusive, rely on
from anterior to posterior, the your judgment.
tooth number is not called 4. Do; speak distinctly to minimize
routinely. recording errors. Be sure the
 Assessment of Oral Health Status Using Dental Indices 95

recorder is located so that you water, adequacy of ventilation,

speak directly to patient. cooling/heating of the room, the
5. Do; encourage the recorder to number of electrical outlets, the
speak to ask for a repeat code or adequacy of artificial or natural
clarification when patient is not lightening room, central location of
sure. The completeness and the examination room.
accuracy of the examination The accompanying diagram
record is the examiner’s illustrates a satisfactory arrangement
responsibility. Check a new of an examination area in a school
recorder frequently to be sure that where four examiners will be used.
patient is recording accurately. The room is large, easily
6. Do; take advantage of the accommodating the four examination
educational opportunity when the units. A student waiting area is
patient asks questions or available outside the examination
expresses concern. room. The space is adequate enough
7. Do; keep a steady, even pace in for one student to wait behind each
your examination. Experienced examiner and be quickly seated upon
examiners will average 25 to 30 the departure of the previous student.
examinations per hour. You and Two doors to the room permit a
your recorder should take a rest smooth oneway flow way of traffic
break once or twice during each from the entrance, to the examination
morning and afternoon session. chair, and to the exit. The
arrangement of equipments, such as
The Selection and Arrangement of compressor and light minimizes the
hazards in the traffic pattern. The
the Examination area
tabulators are located in one corner of
The selection and arrangement of the the area to minimize distraction from
examination area is an important the noise. The sterilizers are located
aspect of the DMFT survey. The size in another corner away from the
of the area needed will be depend traffic pattern.
upon the number of examiners to be
used. Ideally, 80 to 100 square feet
should be allowed for each examiner. CALCULATIONS FOR DMF INDEX
Two or more entrances to the Instructions for Data Summary
examination room are necessary for
effective control of patients’ traffic. If
the location is to be used more than (For each person examined)
one day, the room should have doors
that lock in order to protect The Number of DMF Teeth (DMFT)
equipments and supplies. Patient • Total each code separately, i.e. 2,
waiting areas outside the entrances 3 and x.
are helpful in reducing noise and • Add together code 2, 3, and x and
traffic congestion in the examination record total.
room. Other factors that should be
considered in the selection of the
room are: availability of running
96 Clinical Manual for Public Health Dentistry and Practical Record Book

The Number of DMF Surfaces (DMFS) All other teeth have two caries
• Total the number of surfaces surfaces, except B (54), which is
involved in each code separately, broken down to the gum line because
i.e. 2, 3, and x. of dental caries.
• Add together the surfaces Summary
involved in 2, 3, and x and record Total teeth =
the total.
18
Example: An individual presents with Caries free teeth =6
dental caries on the mesial and Decayed teeth (D) code P3 = 12
occlusal surfaces of a posterior tooth, Filled teeth (F) code P2 = 0 = 0
caries on the mesial surface of
DFT = (D) + (F) =
anterior teeth are messing because of
P3 + P2 P3 + P2 = 12 + 0
caries, and there is an amalgam
= 12
restoration on the mesial-distal-
occlusal surfaces of posterior teeth. Interpretation: 12 of 18 teeth with caries
Teeth Surfaces lesions indicate a serious need for
Decayed teeth (D) dental treatment and a prevention
code “3” 2 3 program for the child.
Missing teeth of caries (M) Example individual DFS: Using the same
code “X” 2 9 2½ year-old-child to calculate DFS:
Filled teeth (F) code “2” 1 3
DFS = (D) + (F) = P3 + P2
DMFT = 2 + 2 + 1 = 5
DMFS = 3 + 9 + 3 = 15 Total number of carious surfaces
= 11 × 2 = 22
The Number of DF Teeth (DFT) Total B (54) =1×5=5
Total DFS = 27
• Total each code separately, i.e. P2
and P3 The Number of Decayed Permanent
• Add together code P2 and P3 and Teeth
record total.
Add code “3” (D-compound) and
The Number of DF Surfaces (DFS) record the total.
• Total the number of surfaces The Number of Permanent Teeth
involved in each code separately, Missing Because of Caries
i.e. P2 and P3.
• Add together the surfaces Add code “x” (m-component) and
involved in P2 and P3 and record record the total.
total.
The Number of Sound Permanent
Example: A 2½-year-old child has 18 Teeth Present
teeth. Add code 1 and record the total.
Teeth A (55) and J (65) are
unerupted. There is no sign of dental The Number of Filled Permanent Teeth
caries in the teeth M (73), N (72), O
Add code “2” (‘F’-Component) and
(71), P (81), Q (82), and R (83).
record the total.
 Assessment of Oral Health Status Using Dental Indices 97

The Number of Permanent Teeth – Average DMF scores can

Present also be presented by age
Add together code 1, 2, and 3 and groups.
record the total.
Number and Percentage of Persons by
Computing Instructions for Selected DMF Statistics
DMFT Statistics • Count the persons with number of
Group DMF: Add together the number DMF teeth such as, 1 DMF tooth,
DMF teeth for each person in the 2, 3, and on.
group and divide by the total number • Enter in table and compute
of persons. Round off to one number percentage.
beyond the decimal point. • Divide number of persons with
number of DMF separately.
Example: A population of 20
individuals with individual DMF scores Example: A population of 20
of 0, 0, 0, 0, 2, 2, 3, 3, 3, 4, 9, 9, 9, individuals with individual DMF scores
10, 10, 10, 11, 11, 12 and 16 equals a of 0, 0, 0, 0, 2, 2, 3, 3, 3, 4, 9, 9, 9,
group of total DMF of 124. 10, 10, 10, 11, 11, 12 and 16. The
• Total the DMFS for each individual number and percentage of individuals
examined. by DMF statistics are as follows.
• Divide the total DMFS by the Number of Number Percentage
number of individuals in the DMF teeth of s
group. persons
– 124/20 = 6.2 = the average 0 4 0%
DMF for the group, the
average number of DMF 2 2 100%
teeth per person. 3 3 100%
– The DMF average 4 1 25%
represents accumulated
dental caries experience for 9 3 33%
the group. 10 3 30%
– The difference in caries 11 2 18.18%
experience between two
groups of individuals within 12 1 8.33%
this population is notable 16 1 6.25%
and influence interpretation Total
of the results.
For the first 10 individuals, the Example: 20 individuals have 28 × 20
group average DMF is 10/10 = = 560 permanent teeth.
1.7 and for the second 10
individuals the average DMF is D 175
107/10 = 10.7. Scores for the –––––––––––––––––––– = –––––– =
two groups can be presented 31.25%. Total number present 560
separately because of the wide
difference.
98 Clinical Manual for Public Health Dentistry and Practical Record Book

Percentage of permanent teeth that are Teeth lost because of dental caries.
sound (Not affected by caries): Divide the
total number of sound teeth (code 1) Percentage of Permanent Teeth
by the total number of permanent Decayed
teeth present (code 1, 2 and 3). Divide the total number of decayed
Round off percentage to one number teeth (code 3) by the total number of
beyond the decimal point. permanent teeth present (code 1, 2
and 3).
Example: 20 individuals have 28 × 20
= 560 permanent teeth. Percentage of Persons Needing Care
D + M + F = DMF for Carious Permanent Teeth
= 175 + 55 + 18
= 248. Count the number of persons with 1
Sound permanent teeth = Total or more teeth coded “3” (i.e.
number of permanent teeth – Total decayed) divided by the total number
DMFT. 560 – 248 = 312. of persons in the groups. Round off
the percentage to one number
Sound permanent teeth 312 beyond the decimal point.
––––––––––––––––––––––––– = ––– = Example: A population of 20
55.71% Total no. of permanent teeth individuals, 10 individuals with one or
560 more permanent teeth.
10
Specific Treatment Need of a Group
–––– = 50%.
To calculate the percentage of DMF 20
teeth that need to be restored, divide
the total “D” component by the total Percentage of permanent teeth that
DMF. are filled:
Example: Divide the total number of filled teeth
(code 2) by the total number of
D = 175, M = 55, F = 18
permanent teeth present (code 1, 2
Total DMFT = 248
and 3, 0)
D 175 F
–––––––––– = –––– Total 18
DMF 248 ––––––––––––––––––––––– = –––– = 36%
Total no. of teeth present 50
= 0.70 or 70% of teeth
Percentage of Persons with no
needs restoration Previous Caries Experience
• To calculate the percentage of all
teeth that are missing: Count the number of persons with all
tooth spaces coded either 1, P1, or 0
Example: 20 individuals have 28 × 20 and divide by the total number of
= 560 permanent teeth. persons. Round off percent to one
place beyond decimal point.
M 55
––––––––––––––––––– = –––– = 0.09 or Ratio of filled teeth to DMF teeth
9% Total teeth examined 560 Divide the total number of filled
permanent teeth (code 2) by the total
 Assessment of Oral Health Status Using Dental Indices 99

number of DMF teeth (code 2, 3, and 6. Even in extreme conditions by

x). Express the ratio to two decimal carious status the DMF scores are
places, e.g. 0.54. same.
7. The rates of caries progression
Example:
cannot be assessed in terms of
how fast caries is progressing or
18
how far caries has progressed.
–––– = 7.25%
8. DMF index does not give the
248
account for treatment needs.
The Average Number of DF Teeth Per 9. Radiographs: DMFT used in large
Child surveys to have only quantitative
measure of caries experience
Add together number of DF teeth for
without using radiographs.
each child in the group and divide by
Radiographs are not
the total number of children. Round
recommended in surveys because
off to one number beyond the decimal
of the impracticality of using the
point.
equipments in all situations. It
should be realized, however, that
Limitations of DMF Index without radiographic information
DMF index has the following the need for restorative care will
limitations. be underestimated.
1. DMF index does not indicate the
density of dental caries attack.
Therefore, its values are not
DEAN’S FLUOROSIS INDEX (1942)
related to the number of teeth at
risk. • Introduced in 1934 by Trendley
2. In older adults the teeth can be H Dean as Dean’s classification
lost for reasons other than caries. system for dental fluorosis or
(e.g. periodontal disease). Hence, Dean’s fluorosis index.
the DMF is invalid in older adults. • It was modified in 1939 and 1942.
3. Orthodontic treatment: The 1942 modification of Dean’s
Children who are undergoing Fluorosis index is the one still
orthodontic treatment, DMF index recommended by WHO in its basic
can be misleading in children survey manual (WHO, 1997).
whose teeth (premolars) have Endemic dental fluorosis is a specific
been lost due to orthodontic disturbance of tooth formation caused
treatment. by excessive intake of fluoride during
4. Preventive fillings: DMF index the formative period of dentition.
can overestimate caries Clinical fluorosis is characterized by
experience in teeth which lusterless, opaque white patches in
“Preventive fillings“ have been the enamel, which may become
placed. striated, mottled and/or pitted or may
5. Root caries: DMF index cannot be stained yellow to dark brown the
be used to assess root caries affected teeth may show a
status.
10 Clinical Manual for Public Health Dentistry and Practical Record Book
0
pronounced accentuation of the Procedures
perikymata and in more
Table 4.15: Scores and criteria
Classification Criteria

NORMAL (0) The enamel represents the usual translucent semivitriform type of structure. The surface is
smooth, glossy and usually a pale-creamy-white color
QUESTIONABL The enamel discloses slight aberrations from the translucency of normal enamel, ranging
E from a few white flecks to occasional white spots. This classification is used in those
(0.5) instances where a definite diagnosis of the mildest form of fluorosis is not warranted and a
classification of “normal” not justified
VERY MILD (1) Small, opaque, paperwhite areas scattered irregularly over the tooth, but not involving as
much as approximately 25% of tooth surface. Frequently included in this classifications are
teeth showing no more than about 1 to 2 mm of white opacity at the tip of the summit of the
cusps of bicuspids or second molars
MILD (2) The white opaque areas in the enamel of teeth are more extensive, but do not involve as
much as 50% of the tooth
MODERATE (3) All enamel surfaces of the teeth are affected and surfaces subject to attrition show wear.
Brown stain is frequently a disfiguring feature
SEVERE (4) All enamel surfaces of the tooth are affected and hypoplasia is so marked that the general
form of the tooth may be affected. The major diagnostic sign of this classification is discrete
or confluent pitting Brown stains are widespread and teeth often present a corroded-like
appearance

Figures 4.11A to F: (A) Normal; (B) Questionable; (C) Very mild; (D) Mild; (E) Moderate; (F)
Severe
severe cases, discrete pits and larger • All the teeth are examined.
areas of hypoplasia (confluent pitting) • When the teeth are scored, the
of the enamel appear to such an examiner should start at the
extent that the morphology of the higher end of the index (severe)
tooth is lost. and eliminate each score
or category until he or she arrives
at the present condition.
 Assessment of Oral Health Status Using Dental Indices 10
1
• If there is any doubt a lower score
should be recorded.
• The recording is based on the two
teeth most affected.
• However, if the two teeth are not
equally affected, the score for the
less affected tooth is recorded
(Figures 4.11A to F and Table
4.15).