and loss ot periodontal attachment. Ram fjord's technique for measuring pocket depth and periodontal attachment loss has heen used in national surveys such as the National Health and Nutritional Examination Surveys.
yield scores that represent the severity of periodontal disease in individuals or populations, hut these scores do not provide information on the extent of disease. The extent and severity index (ESI) of periodontal disease was developed to provide separate estimates of the extent and severity of periodontal disease in individuals and populations. '" Unlike the PI and IM)l, the ESI does not assess gingival intlainmation. Instead, il estimates the loss ol periodontal attac hmerit using Ihe periodontal probing method developed by Ram fjord for the PDI." A threshold of disease has to be established to calculate the extent score lor an individual. In their initial study of the I SI, Carlos et al considered a site to be diseased when attachment loss exceeded I mm.20 (Because the measurements are always rounded down to the next lowest millimetei, greater than I mm means -2 nun.) Ibran individual. Ihe extent score is the percentage of sites examined thai have attachment loss greater than I mm. I he severity score lor an individual is the average loss ol attachment per site among the disease sites. I he I SI is expressed as a bivariate statistic: ESI (Extent. Severity), lor example, an individual's ESI of (20, 4.0) would be interpreted as 20% of sites examined had disease. and of the diseased sites, the average loss of attachment was t.O mm I he ESI lor a population would be the average extent and severity scores lor the indiv iduals examined.
When ESI scores from two sites per tooth in the whole mouth were compared with an assessment of one upper and one lower quadrant, the developers ol the ESI found that little information was lost from the hall-mouth assessment However, the I SI has been used lor full-mouth examinations on as many «is six sites per tooth.
NIDCR Protocol lor Periodontal Disease Assessment. I he Nil H R periodontal disease assessment, «is used in Nil WI S III, contains three parts: a periodontal destruction assessment, gingival assessment, and calculus assessment.vS Ihe gingival assessment was previously described in the section on gingivitis. The periodontal destruction examination involves an assessment of loss of periodontal attachment and furcation involvement. Loss nl attachment is the distance (in millimeters) from the cementoenamel junction to the bottom of the gingival sulcus. "Ibis distance is measured at the facial and mcMotacial sites of teeth in two randomly selected quadrants, one maxillary and one mandibular, using the indirect measurement method developed by Ramfjord." Probing is carried out with the use of the Nll)( R probe, which is color coded and has markings at 2, A, 6, S, 10, and 12 mm. In MIANES III, loss of attachment was reported in millimeters tor each site measured. Periodontal pocket depth, which is the distance from the free gingival margin to the bottom of the sulcus, also was reported in millimeters for each site.
furcation involvement is assessed on eight teeth, the maxillary first and second molars, the maxillary lust premolars, and the mandibular first and second molars. The assessment requires the use of «i #17 dental explorer lor the maxilltiry teeth and a cowhorn explorer tor the mandibular teeth. I he extent of furcation involvement is assessed .it the mesial, facial, and distal of the maxillary molars, the mesial and distal of the premolars, and ihe facial and lingual of the mandibular molars. It furcation involvement does not exist, the site is scored «is ().
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