Gingival Bleeding Index of Carter and Barnes

Procedure:

(1) The mouth is divided into 6 segments (upper right, upper anterior, upper left, lower left, lower anterior, lower right).

(2) The American dentition notation is used, with maxillary dentition numbered 1 to 16 going from right to left, and mandibular dentition going 17 to 32 from left to right.

(3) Areas involving the third molars are not scored because of variations in arch position, access and vision.

(4) Unwaxed dental floss is alternately passed interproximally into the gingival sulcus on both sides of the interdental papillae. With the floss extended as far as possible towards the buccal and lingual, the floss is carried to the bottom of the sulcus. The floss is then moved in an inciso-gingival motion for one double stroke. Care is taken not to cause laceration of the papillae.

(5) A new length of clean floss is used for each interproximal unit.

(6) Bleeding is generally immediately evident in the area or on the floss, but 30 seconds are allowed for reinspection of each segment. If bleeding is copious, the patient should rinse between segments.

(7) An area is nonscoreable when tooth positions, diastemas or other factors compromise the desirable interproximal relationships.

Bleeding assessment:

(1) no attempt is made to quantify the degree of bleeding

(2) bleeding is assessed only as present or absent

total scoreable areas =

= 26 - (number of nonscoreable areas)

Gingival Bleeding Score =

= total bleeding areas =

= SUM(number of bleeding areas)

total nonbleeding areas =

= SUM(number of nonbleeding areas)

= (total scoreable areas) - (total bleeding areas)

Interpretation:

• The fewer the number of bleeding sites, the less the extent of gingivitis. Ideally the score should be 0.

• If the patient is to be followed over time, previous bleeding sites are monitored to see if they become nonbleeding. The goal of interventions is to reduce the score as much as possible.