WOMEN'S INTERAGENCY HIV STUDYORAL PROTOCOLFORM OP 9: PAPILLARY ASSESSMENT SCORECOMPLETING THE FORMGENERAL INFORMATIONAffix the Participant ID label in the space indicated.Record the visit number which should be the same as the WIHS core visit.Be sure the form version is the most current version date.Record your initials.Record the date.PAPILLARY ASSESSMENT SCOREIf participant is edentulous (OP6 #1 is coded as 1), form OP9 is left blank.Papillary Assessment Score Key Y = Exclude (if either adjacent tooth is missing). 0 = The interdental papilla is free from any sign of erythema, edema, necrosis or cratering. There is no spontaneous bleeding. The papilla is clinically normal. 1 = Erythema is present. 2 = Edema is present as manifested by swelling, loss of stippling, or glazing of the surface epithelium.*3 = Ulceration, necrosis or pseudomembranous exudate is present. 4 = Cratering is present as evidence of past tissue destruction.*5 = Alveolar bone is visibly exposed.Upper archB1 - B13. Using the key provided, assess the interdental papillae beginning with the upper left quadrant and proceeding to the right. The appropriate score(s) for each papilla is/are indicated by circling the appropriate code(s) assigned by the examiner.WIHS Oral Protocol - OP 9 - Papillary Assessment Score Procedures 10/01/98Page 1 of 3Lower ArchB14 - B26 Using the key provided, assess the interdental papillae beginning with the lower left quadrant and proceeding to the right. The appropriate score(s) for each papilla is/are indicated by circling the appropriate code(s) assigned by the examiner.* If the papillary score(s) is/are 3 or 5 or both, collect subgingival plaque samples. These codes have been shaded on the form as an additional reminder. Refer to Form OP10 for specific instructions on collection procedures.EQUIPMENT Dental mirrorPROCEDUREAn interdental papilla is that part of the free gingiva occupying the gingival embrasure between adjacent teeth. All interdental papillae anterior to the second molars are examined from the buccal and lingual aspects. One or more score(s) is/are assigned to each papilla, as appropriate. Scores are to be recorded under the column labeled as the tooth that is mesial to the papilla. The papilla between the two centrals is scored under the column labeled midline.A maximum of 13 papillary areas are available for observation in each dental arch. Each papilla isexamined visually from both the buccal and lingual aspect for signs of redness, swelling, necrosis, cratering and exposed bone.The examination begins in the upper left quadrant and proceeds around the arch to the upper right. The procedures are then repeated for the lower arch.Each papillary site is considered as a single unit, to be examined from both buccal and lingual aspects. If one or more of the conditions below is/are present on either aspect, the site is scored accordingly. If no clinical changes are observed on either aspect, the site is scored 0. Scores are not recorded separately for buccal and lingual views. Multiple conditions should be recorded when they occur, i.e., the presence of each condition in the scoring system should be recorded as present or absent on each site. Any combination of scores is permitted, except that sites scored 0 (normal) may not have any additional scores. Papillary sites are scored as “Y” if either of the adjacent teeth is missing unless another tooth has moved forward to form a papilla. WIHS Oral Protocol - OP 9 - Papillary Assessment Score Procedures 10/01/98Page 2 of 3Papillary Assessment Score KeyY = Exclude (if either adjacent tooth is missing)0 = The interdental papilla is free from any sign of erythema, edema,necrosis or cratering. There is no spontaneous bleeding. The papilla is clinically normal.1 = Erythema is present.2 = Edema is present as manifested by swelling, loss of stippling, or glazing of the surface epithelium.*3 = Ulceration, necrosis or pseudomembranous exudate is present.4 = Cratering is present as evidence of past tissue destruction.*5 = Alveolar bone is visibly exposed.* NOTE: If the papillary score equals 3 or 5, collect subgingival plaque samples. Refer to Form OP10 for specific instructions oncollection procedures.WIHS Oral Protocol - OP 9 - Papillary Assessment Score Procedures 10/01/98Page 3 of