On clinical examination of a patient with the Papillary - Marginal – Attachment Index, the papillary gingiva showed an excessive increase in size with spontaneous bleeding. The marginal gingiva showed a swollen collar with spontaneous bleeding and beginning of infiltration into attached gingiva. The attached gingiva showed slight engorgement with loss of stippling and changes in color. The score for one tooth in particular for this patient would be:
The number of affected Papillary, Marginal Attached units are counted and the P, M and A numerical values are totaled separately, then added together.
Uses: 
• It provides a comprehensive method for evaluating anti-plaque procedures such as tooth brushing and flossing, as well as chemical anti-plaque agents 
 
INDICES USED FOR ASSESSING GINGIVAL AND PERIODONTAL DISEASE 
PAPILLARY-MARGINAL - ATTACHMENT INDEX (PMA INDEX) 
The papillary - marginal - attachment index (PMA index) was developed by Maury Massler and Schour I. in 1944.
The basic philosophy used in the development of the PMA, index was very similar to the DMF index, i.e, the number of gingival units affected were counted rather than the severity of the inflammation. 
Method 
A gingival unit was divided into three component parts 
1. Papillary gingiva (P) - the gingival portion between the teeth. 
2. Marginal gingiva (M) - the marginal collar surrounding the teeth. 
3. Attached gingiva (A) -the gingival portion overlying the bony alveolar process 

The presence or absence of Inflammation on each gingival unit is recorded respectively. 
Although all of the facial tissues surrounding all the teeth could be assessed in this manner, usually only the maxillary and mandibular incisors, canines and premolars are examined 
The routine examination procedure from the maxillary right second premolar around to the maxillary left second premolar and then from the mandibular left second premolar to the mandibular right second premolar is followed 

In general, mild gingivitis is confined to the papillary area, moderate gingivitis means spread to marginal gingiva and severe gingivitis is identified by its spread to the attached gingiva.
Scoring Criteria:
Papillary Component (P) 
0 Normal, no inflammation 
1 + Mild papillary engorgement, slight increase in size.
2+ Obvious increase in size of gingival papilla; bleeding on pressure.
3+ Excessive increase in size with spontaneous bleeding.
4+ Necrotic papilla.
5+ Atrophy and loss of papilla (through inflammation).
Marginal component (M)
0 Normal; no inflammation visible.
1+ Engorgement; slight increase in size, no bleeding.
2+ Obvious engorgement; bleeding upon pressure.
3+ Swollen collar; spontaneous bleeding; beginning infiltration into attached gingiva.
4+ Necrotic gingivitis.
5+ Recession of the free marginal gingiva below the CEJ due to inflammatory changes.
Attached component (A)
0 Normal; pale rose; stippled.
1+ Slight enlargement with loss of stippling; changes in color may or may not be present.
2+ Obvious enlargement of attached gingiva with marked increase in redness. Pocket formation present.
3+ Advanced periodontitis. Deep pockets evident.
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