Gingival bleeding is an objective, easily assessed sign of inflammation that is associated with several periodontal diseases. Many bleeding indices have been devised; some assess bleeding as simply present or absent, whereas others use grading in an attempt to assess severity of bleeding. The choice of which index to use depends on whether the purpose is an epidemiological survey, a clinical study, diagnosis and treatment, or patient motivation. Bleeding may be elicited manually with toothpicks, dental floss or a periodontal probe, but a controlled-force probe, although more expensive, causes less trauma and less false-positive bleeding from healthy tissues. As a predictor of periodontal disease progression, bleeding on probing has low sensitivity owing to a high frequency of false-positive responses, but has high specificity in that failure to bleed indicates health. There is evidence that smokers have less, or delayed, gingival bleeding when compared with non-smokers; therefore smoking needs to be controlled for in studies of gingival bleeding. Measurement of gingival bleeding tendency should be an integral part of a comprehensive oral examination. In clinical practice, the use of a graded bleeding index is more likely to identify sites that are at risk of further destructive activity. For monitoring individual patients, both for response to initial therapy and during maintenance, a modified Sulcus Bleeding Index (mSBI) with three bleeding scores is recommended in preference to dichotomous scoring of bleeding.

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Dental caries has a multifactorial aetiology in which there is an interplay of three principal factors: the host (saliva and teeth), the microflora (plaque), and the substrate (diet), and a fourth factor: time. There is no single test that takes into consideration all these factors and can accurately predict an individual's susceptibility to caries. The risk of dental caries can be evaluated by analysing and integrating several causative factors. These include caries experience (initial caries lesions and established caries defects, secondary caries and present caries activity), fluoride use, extent of plaque present, diet, bacterial and salivary activity and social and behavioural factors.

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