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Extracts of the Third edition of "Oral Health Surveys - Basic methods", Geneva 1987.
(Please observe that the Fifth edition is available, see Methods and Indices)

This extract concerns: Community Periodontal Index of Treatment Needs (CPITN). Pages 31 - 32.

Community Periodontal Index of Treatment Needs (CPITN)

(boxes 25-30)

Indicators. Three indicators of periodontal status are used for this assessment:

  1. presence or absence of gingival bleeding
  2. supra- or subgingival calculus
  3. periodontal pockets-subdivided into shallow (4-5mrn) and deep (6mm or more).

A specially designed lightweight probe with a 0.5-mm ball tip is used, bearing a black band between 3.5 and 5.5 mm from the ball tip. A list of manufacturers of this probe can be obtained from Oral Health, World Health Organization, 1211 Geneva 27, Switzerland.

Sextants. The mouth is divided into sextants defined by teeth numbers 18-14, 13-23 24-28, 38-34, 33-43, and 44-48. A sextant should be examined only if there are two or more teeth present and not indicated for extration. When only one tooth remains in a sextant, it should be included in the adjacent sextant.

Index teeth. For adults aged 20 years and over, the teeth to be examined are:

Teeth to be examined
17 16   11   26 27
47 46   31   36 37

The two molars in each posterior sextant are paired for recording, and if one is missing, there is no replacement. If no index teeth or tooth is present in a sextant qualifying for examination, all the remaining teeth in that sextant are examined.

For young people up to the age of 19 years, only six teeth - 16,11, 26, 36, 31 and 46 - are examined. This modification is made in order to to avoid classifying the deepened crevices associated with eruption as periodontal pockets. For the same reason, when examining children under the age of 15, recording for pockets should not be attempted, i.e., only bleeding and calculus should be considered. If no index tooth is present in a sextant qualifying for examination, single fully erupted incisors or premolars may be substituted.

Sensing gingival pockets. An index tooth should be probed, using the probe as a "sensing" instrument to determine pocket depth and to detect subgingival calculus and bleeding response. The sensing force used should be no more than 20 grams. A practical test for establishing this force is to place the probe point under the thumb nail and press until blanching occurs. For sensing subgingival calculus, the lightest possible force that will allow movement of the probe ballpoint along the tooth surface should be used.

When inserting the probe, the ballpoint should follow the anatomical configuration of the surface of the tooth root. If the patient feels pain during probing, this is an indicative of the use of too much force.

The probe tip should be inserted gently into the gingival pocket and the depth of insertion read against the colour coding. The total extent of the pocket should be explored: At least 6 points on each tooth should be examined: mesio-buccal, mid-buccal, disto-buccal, and the corresponding lingual sites.

Examination and recording. The incisor and either the first molars (up to 19 years) or the pairs of first and second molars (above 19 years) should be sensed and the highest score recorded in the appropriate box. Codes in descending order of severity are:

4: pocket > 6 mm (black area of probe not visible)

3: pocket 4 or 5 mm (gingival margin situated on black area of

2: calculus felt during probing but all the black area of the

l: bleeding observed, directly or by using mouth mirror, after

0: healthy

(Three gradings are illustrated in photographs in "Oral Health Surveys".)

When non-index teeth are examined, the highest score found in the sextant is recorded in the appropriate box. If there are not at least two teeth remaining and not indicated for extraction in a sextant, the appropriate box should be cancelled by a cross ( x ).

Last updated by Marie Nordström