Indices to measure gingival bleeding
The author initially defines gingival bleeding as an objective sign of inflammation in gingival tissues. Gingival bleeding is not a diagnosis, as it does not distinguish between different forms of periodontal disease. The author notes that gingival bleeding is associated with many forms of periodontal disease. There are many indices which have been developed. Some assess severity of bleeding, while others simply note whether bleeding is absent or present. The decision as to which indices to use depends on whether the purpose is an epidemiological survey, a clinical study, diagnosis and treatment, or patient motivation. Bleeding can be stimulated through many ways including, but not limited to, a periodontal probe, a toothpick, or dental floss; however, the author mentions that a controlled force probe will give less false positive bleeding from healthy gingiva. Periodontal probing has low sensitivity when trying to predict periodontal disease progression due to the many false positive responses, but has high specificity in that the failure to bleed indicates health.
Smoking needs to be controlled, however, since smokers have less or delayed breeding when compared with nonsmokers. 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 clinical use, the simpler the index, the more likely it will be used. For monitoring individual patients, both for response to initial therapy and during maintenance, a modified sulcus bleeding index with three bleeding scores is recommended in preference to a dichotomous scoring of bleeding. The author also advises the use of a controlled-force probe using a force of 0.25N or less in research and clinical settings. [I.S.]
Newbrun, E., J Periodont, 67:555,1996