Russell developed an index for measuring periodontal disease that could be used in population surveys. It can be based solely upon the clinical examination, or it can make use of dental X-rays if they are available. It places greater emphasis on advanced disease.



(1) Each tooth is scored separately according to the following criteria.

(2) Rule: When in doubt, assign the lower score.


Criteria for Field Studies

Additional X-Ray Criteria


negative (neither overt inflammation in the investing tissues, nor loss of function due to destruction of supporting tissues)

radiographic appearance normal


mild gingivitis (overt area of inflammation in the free gingivae, but this area does not circumscribe the tooth)



gingivitis (inflammation completely circumscribes the tooth, but there is no apparent break in the epithelial attachment)



(not used in field study)

early, notchlike resorption of the alveolar crest


gingivitis with pocket formation (the epithelial attachment is broken, and there is a pocket. There is no interference with normal masticatory function, the tooth is firm in its socket, and has not drifted.

horizontal bone loss involving the entire alveolar crest, up to half of the length of the tooth root (distance from apex to cemento-enamel junction)


advanced destruction with loss of masticatory function (tooth may be loose; tooth may have drifted; tooth may sound dull on percussion with a metallic instrument; the tooth may be depressible in its socket)

advanced bone loss, involving more than half of the length of the tooth root, or a definite intrabony pocket with definite widening of the periodontal membranes. There may be root resorption, or rarefaction at the apex


(Table I, page 352, Russell)


individual score =

= AVERAGE(scores for all of the teeth in the mouth)


population score =

= AVERAGE(individual scores in population examined)



• minimum score: 0

• maximum score: 8

• The higher the score, the more marked the periodontal disease.


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