1. DECAYED ,
MISSING, FILLED
TOOTH INDEX &
DECAYED
MISSING FILLED
SURFACES INDEX
By Dr Nishant Singh
Department of Public Health Dentistry
2. WHAT IS AN INDEX ?
� “A numerical value describing
the relative status of a
population, on a graduated
scale with definite upper and
lower limits designed to permit
and facilitate comparison with
other populations classified by
the same criteria and methods.
� Russel A.L
3. � Epidemiological indices are attempt to
quantitate clinical condition on a
graduated scale , thereby facilitating
comparison among populations
examined by the same criteria and
methods. --- Irving Glickman
WHAT IS AN INDEX ?
4. CLASSIFICATION OF INDICES
� Based on the direction which it can
fluctuate .
� Upon the extent which the areas of oral
cavity are examined.
� According to the entity they measure
� General indices
5. Based on the direction which it
can fluctuate
� Reversible Index : Measure condition that
can be changed, e.g Periodontal Index
� Irreversible Index : Index that measure
conditions that will not change , e.g
Caries Index
7. � Mixed Dentition
1. (dft) & ( DMFT)
2. (dfs) & ( DMFS)
� Other Indices
1. Stone’s Index
2. Czechoslovakian Caries Index
3. Modified DMFT Index
TYPES OF CARIES INDEX
9. DECAYED, MISSING, FILLED, TEETH
INDEX (DMFT Index)
� It was proposed by Henry T . Klein ,
Carrol E. Palmer & Knutson JW in
1938.
� Developed to determine the
prevalence of Coronal Caries
� Is a simple rapid versatile, universally
accepted and widely used index for
several decades .
10. � It is used to determine total dental caries
experience past and previous .
� The DMFT is a irreversible Index (meaning it
measures total life time caries experience
� The tooth either remains decayed or if it is
treated it is extracted or filled.
DECAYED, MISSING, FILLED, TEETH
INDEX (DMFT Index)
14. � No tooth must be
counted more than
once i.e. it is either
decayed , missing ,
filled or sound.
� Decayed , Missing ,
and Filled teeth
should be recorded
separately since
the component of
DMF are of great
interest .
� When counting
decayed teeth, also
include teeth which
have restorations
with recurrent
decay.
PRINCIPLES AND
RULES WHILE
RECORDING DMFT
15. � Care must be taken to list as missing only those
teeth which have been lost due to decay
� Also included should be those teeth which are so
badly decayed that they are indicated for
extraction
� The following should not be counted as missing
a)Unerupted Tooth
b)Missing Tooth due to extraction
c)Congenitally missing tooth
d)Teeth extracted for orthodontic purpose
PRINCIPLES AND RULES
WHILE RECORDING DMFT
16. � A tooth may have several restorations but it should be
counted as one tooth.
� Deciduous teeth are not included in DMF are
included in dmf
� A tooth is considered as erupted when the occlusal
surface or incisal edge is totally exposed or can be
exposed gently by reflecting the overlying gingival
tissue with the mirror or explorer.
� A tooth is considered to be present even though the
crown has been destroyed and only the roots are left.
PRINCIPLES AND RULES
WHILE RECORDING DMFT
17. CODDING CRITERIA FOR DMF
INDEX : CODE
E Excluded tooth or tooth
space
1 Sound permanent
teeth
2 Filled permanent teeth
3 Decayed permanent
teeth
18. CALCULATION OF INDEX
INDIVIDUAL DMFT TOTAL D+M+F= DMF
GROUP AVERAGE TOTAL DMF/ TOTAL NO OF
SUBJECTS EXAMINED
PERCENT NEEDING CARE TOTAL NUMBER OF DECAYED
TOOTH/ TOTAL NUMBER
EXAMINED
PERCENTAGE OF TEETH LOST TOTAL NUMBER OF TEETH
LOST / TOTAL NUMBER
EXAMINED
PERCENTAGE OF FILLED
TEETH
TOTAL NUMBER OF FILLED
TEETH/ TOTAL DMF
MISSING PERMANENT
TEETH/100
TOTAL NUMBER OF MISSING
TEETH * 100 /TOTAL NUMBER
EXAMINED
19. � The maximum possible
1. DMFT Score is 32 (if third molars included )
1. DMFT Score is 28 ( if third molars are not
included)
CALCULATION OF INDEX
20. Advantages of DMFT
� Because of its wide spread use world
wide over the past 60 Years , it provides a
reasonable accurate historical account
of changes in prevalence of dental caries
21. Limitations of DMFT
� DMFT values are not related to the
number of tooth at risk.
� DMFT Index can be invalid in older adult
as because teeth can be lost due to
other than carries .
� DMFT can be misleading in children
whose teeth have been lost due to the
orthodontic reason.
22. � DMFT Index can over estimate caries
experience in teeth which “ preventive
fillings” have been placed.
� DMFT Index is of little use in studies of root
caries
Limitations of DMFT
23. WHO MODIFICATIONS OF DMFT
1986
� All third molars are included
� Temporary restorations are
considered as decayed
� Only, carious cavities are
considered as ‘D’. The DMF index
can be applied to denote the
number of affected teeth (DMFT) or
to measure the surfaces affected by
dental caries (DMFS).
24. Other Methods of DMF
Examination
� Short Hand Method
� Intended for use in surveys basic
prevalence is assessed.
� Based on examination of selected teeth
only
� Objective is to decrease the time taken
for each examination and still provide
valid DATA.
25. �WHO has defined short hand
method as
� Recommends the use of “half-mouth” DMF in
its basic survey techniques.
� Objective is to obtain caries prevalence in a
population which has not been surveyed
previously.
� Half the upper arch is only scored. Then the
lateral lower half arch and then the result is
doubled . It is quicker and easier than full
mouth DMF INDEX.
27. DECAYED – MISSING – FILLED
TOOTH SURFACE INDEX (DMFS)
� Presented by Henry T. Klein ,
Carrole. E. Palmer & Knutson J.W in
1938 .
� It is more sensitive.
� Usually the index of choice in a
clinical trial of carries preventive
agent .
28. � Used to determine the total dental caries
experience past and present by
recording tooth surface involved in place
of teeth.
DECAYED – MISSING – FILLED
TOOTH SURFACE INDEX (DMFS)
30. DMFS INDEX – THE INDEX OF
CHOICE
� This is because relative incidence is more
likely to be detected over the limited
time period of a clinical trail.
� But DMFS takes longer time and may
sometimes produce inconsistency in
diagnosis and may require the use of
radiographs to be fully accurate .
31. � DMFS is a more detailed index than DMFT
by summing the total number of decayed
missing and filled permanent tooth
surfaces .
� As in case of the DMFS Index is simple
versatile and more sensitive , has
practically , universal acceptance , is one
of the best known dental indices today.
DMFS INDEX – THE INDEX OF
CHOICE
32. CALCULATION OF DMFS INDEX
1. INDIVIDUAL DMFS
INDEX
DMFS SCORE = D+M+F
2. TOTAL SURFACE CPUNT
FOR A DMFS INDEX ( If 28
teeth are examined)
• 16 POSTERIOR TEETH
(16*5=80)
• 12 ANTERIOR TEETH
(12*4=48)
• TOTAL =128 SURFACES
3. TOTAL SURFACE COUNT
FOR DMFS INDEX ( If 32
teeth are examined)
• IF THIRD MOLARS ARE
INCLUDED (4*5)=20
• TOTAL = 148 SURFACES
33. � For Posterior teeth : Five Surfaces Examined &
Recorded (Facial, Lingual, ,Mesial ,Distal, Occlusal)
� For Anterior teeth : Four Surfaces Examined &
Recorded (Facial, Lingual, Mesial, Distal)
34. Disadvantage
� DMFS examination takes longer time is more
likely to produce inconsistencies in diagnosis
and may require the use of radiographs to be
fully accurate.
� To save time in larger surveys DMFS can be
used half mouth , applied to opposite
diagonal quadrants and score doubled.
� This is based on the assumption that caries
incidence is bilateral.
35. � A tooth scores exactly same under extremes
of clinical condition ; a tooth with small
restoration in one pit rates as the same as a
tooth that has been extracted .
� Provide little or no additional information in
prevalence studies where the extent of caries
is being compared between the groups .
� Has a wide range of of possible value hence
larger standard deviation and standard error.
Disadvantage
36. � One of the difficulties encountered in use
of this surface index is that the score
allotted to the teeth that is indicated for
extraction, which may have been
attacked one surface only, although its
extraction results in the loss of four or five
surfaces , according to the tooth.
Disadvantage
37. � Another difficulty is the score to be given
to two surfaces fillings in posterior teeth,
where the initial attack was probably on
one proximal surface and the occlusal
surface was involved latter , to provide
adequate Class II type cavity restoration.
Disadvantage
38. Established Modification :
� Procedural modifications can be made to
the DMFS index allow for factors such as
secondary caries , crowned teeth , bridge
pontics, and any other particular attribute
required for study.
� To save time in large surveys, the DMFS can
be used half-mouth , applied to opposite
diagonal quadrants and score doubled an
approach that assume that caries incidence
is bilateral.