INDEXES TO MEASURE GINGIVAL BLEEDING

GINGIVAL BLEEDING IS AN OBJECTIVE, easily assessed sign of inflammatio n that is associated with several periodontal diseases. Many bleeding indices have been devised; some assess bleeding as simply present or a bsent, whereas others use grading in an attempt to assess severity of bleeding. The choice of which index to use depends on whether the purp ose is an epidemiological survey, a clinical study, diagnosis and trea tment, or patient motivation. Bleeding may be elicited manually with t oothpicks, dental floss, or a periodontal probe, but a controlled-forc e probe, although more expensive, causes less trauma and less false-po sitive bleeding from healthy tissues. As a predictor of periodontal di sease progression, bleeding on probing has low sensitivity owing to a high frequency of false-positive responses, but has high specificity i n that failure to bleed indicates health. There is evidence that smoke rs have less, or delayed, gingival bleeding when compared with non-smo kers; therefore smoking needs to be controlled for in studies of gingi val bleeding. Measurement of gingival bleeding tendency should be an i ntegral 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 indiv idual patients, both for response to initial therapy and during mainte nance, a modified Sulcus Bleeding Index (mSBI) with three bleeding sco res is recommended in preference to dichotomous scoring of bleeding.