A comparison of 3 clinical indices for measuring gingivitis

Abstract

A clinical study was conducted among 200 adult males and females to compare the intrusive gingival index (GI) for estimating gingivitis with the nonintrusive and only visually applied papillary-marginal-gingivitis index (PMGI). The GI examinations were performed by a senior examiner with long experience and a junior examiner, while the PMGI was graded by only a senior examiner with long experience. A 4th examiner was included for grading bleeding sites by gentle intrusion at the orifice of the gingival crevice. Following the baseline examination by all examiners, the subjects were randomly assigned to either a group that received an oral prophylaxis immediately or to a group that received an oral prophylaxis 6 weeks after the baseline. All subjects were regraded by all examiners 4 days after the 2nd group received a prophylaxis. This delayed prophylaxis design created a difference in the responses between treatment groups. Both the GI examiners and the PMGI examiner concluded there was significantly less gingivitis in the group receiving a prophylaxis second. There were also significantly fewer bleeding sites in the group receiving a prophylaxis second as determined by both GI examiners and the bleeding-sites examiner.

Gingival Indices: State of Art

“…When probing is used for bleeding response, the force used, the probe size and probe position are factors that must be taken into consideration (reviewed in Listgarten, 1980). Regarding "bleeding on pressure", Bollmer et al (1986) compared the intrusive gingival index (GI) for estimating gingivitis with a nonintrusive visual index. The results indicated that the methods were similar and the number of bleeding sites per subject did not diminish after manipulation.…”

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“…In one study, it was found that transient bacteremia was induced by toothbrushing in 96 healthy subjects with varying degrees of gingival inflammation; therefore both the degree and extent of gingivitis were assessed (11) . Although the indices used did not include registration of gingival bleeding, changes in color and contour have been observed to precede bleeding on probing (21,22) . GE was divided into 4 subgroups for ease of description and analysis.…”

“…A number of gingival indices were developed which rely upon bleeding following "gentle probing'' as an earlier sign of gingivitis such as the Russell's periodontal index (15,16,17) , sulcular bleeding index (SBI), the papillary bleeding index (PBI), the gingival index (GI) (18) and their modifications (19) , as well as the extent & severity index (ESI) (20) . However, the value of bleeding as the most sensitive indicator of gingivitis has been questioned, with some authors noticing that in the early gingivitis, changes in color and contour have been observed to precede bleeding on probing (21,22) . For that reason, a simple modification of the PMA index was used to assess the prevalence of gingivitis for the present group of patients (23,24,25) .…”

Comparing Measures of Reliability for Indices of Gingivitis and Plaque

“…Varma8 further analyzed the data presented by Bollmer et al 7 Calculating intraclass correlation coefficients, he looked at the distribution of weighted and unweighted kappas. His conclusion was that log-linear models would gradually replace the current use of the kappa statistic.…”

“…Bollmer et al 7 compared the GI and PMGI for measuring gingivitis. His group presented mean full mouth scores and mean site scores on a severity scale and di-J Periodontol September 1996 chotomous scale for the above indices.…”