|Year : 2013 | Volume
| Issue : 1 | Page : 9-12
An index developed for the determination of oral hygiene motivation success
Taner Arabaci, Turgut Demir
Department of Periodontology, Faculty of Dentistry, Atatürk University, Erzurum, Turkey
|Date of Web Publication||6-Apr-2013|
Department of Periodontology, Faculty of Dentistry, Atatürk University, TR-25240, Erzurum
Source of Support: None, Conflict of Interest: None
Introduction: The purpose of this article is to develop a new index system to identify the individual oral hygiene score (OHS) and the level of the motivation success by using some scales, which are an indicator of the individual oral hygiene status. In this way, the level of personal oral hygiene would be determined and a standard motivation success scale would be presented by comparing the oral hygiene levels measured before and after the motivation application. The Hypothesis: In this hypothesis, an index was primarily formed in order to obtain an individual OHS with the total values of plaque index (PI), gingival index (GI), and calculus index (CI) scores. Motivation success levels of the individuals were calculated and classified by using the rate of change of OHS between the sessions. Evaluation of the Hypothesis: This index system would form a basis for future strategies in preventive dentistry. Standard and common scores in one individual or a wide population will be attained easily and effectively.
Keywords: Index system, motivation, motivation success level, oral hygiene
|How to cite this article:|
Arabaci T, Demir T. An index developed for the determination of oral hygiene motivation success. Dent Hypotheses 2013;4:9-12
| Introduction|| |
Periodontal diseases are indicated to be inflammatory diseases, that affect the gingiva and other tissues supporting the teeth, and are major cause of tooth loss in adult humans. ,, Additionally, caries is also one of the important dental disease causing tooth loss nowadays. , Main factor of both the diseases is deposits and bacterial dental plaque accumulated on the tooth surfaces. , Thus, regular removal of dental plaque from the tooth surfaces by both personal oral hygiene practices such as tooth brushing and professional periodontal treatment are the most important steps of oral care.  Periodontal therapy starts by training the patient on oral hygiene and mechanical removal of deposits from the tooth surfaces.  Following the mechanical periodontal treatment, it is very important to sustain individual oral hygiene practice in terms of maintenance of dental and periodontal health.  Thus, it is obligatory to rise consciousness about appropriate plaque control by teaching the patient oral hygiene practices in terms of either success of treatment, maintenance of oral health, or practices of preventive dentistry. Making daily plaque control a habit, is enabled through patients motivation.  Despite motivation and training, the properties of patient regarding plaque control might get back to pretreatment level in course of time and may not apply what had been taught until the patient goes for a session. Even though, the patient has very good motivation in the beginning, the patient's efforts concerning daily oral care might decrease in time. Thus, it is important for continuation of oral health to determine motivation level of patients at intervals during active periodontal treatment and periodical sessions, and continue motivation programs by taking this into consideration.
Literature does not involve a common index that is used in determining the level and success of motivation. Numerous researchers, ,, try to make an assessment by interpreting the index systems, which are prepared for various purposes except for determining the motivation level. Many studies, ,,, have made an evaluation by interpreting different periodontal indices including approximal plaque index (API),  plaque index (PI),  gingival index (GI),  bleeding on probing (BOP),  calculus index (CI), debris index (DI), and oral hygiene index (OHI);  which are aimed at ascertaining the motivation level of patients between the sessions throughout the periodontal treatment. Even though these periodontal indices; obtained from individuals who are invited to sessions; give information about the periodontal condition of the person, they might occasionally be misleading with regards to, whether they perform the oral hygiene practices at sufficient and appropriate level or not. Moreover, the separate evaluation of these indices might give contradictory results about motivation level of individual and success of motivation being applied, even in the same individual. For example, it is a frequently encountered contradictory situation that the PI index value of an individual, who comes to the control session, is recorded as low in spite of the patient's low motivation in the event that he neglects the personal plaque control until the session day and performs it on the day of the session. Thus, it is important to determine whether or not plaque control is adequate for determining level of personal motivation success and form a common index presenting the periodontal health condition, which is expected to recover as a consequence. The purpose of this article is to develop a new index system to identify a personal oral hygiene score (OHS) and the level of the motivation success by using some scales, which are an indicator of the individuals oral hygiene practices during the periodontal treatment. In this way, the level of personal oral hygiene would be determined, and a standard motivation success scale would be presented by comparing the oral hygiene levels measured before and after the motivation application.
| The Hypothesis|| |
The most important matter in the evaluation of individual oral hygiene performances is the measurement of deposits on tooth surfaces and clinical condition of gingiva using various indices. While PI, DI, and CI are used for measurement of deposits on dental surfaces, the clinical condition of gingiva could be determined with the GI or BOP indices. Undoubtedly, concomitance of these indices will give accurate results for assessment of oral hygiene. In this hypothesis, current periodontal indices including PI, GI, and CI; which have a scoring between 0-3 were preferred in order to obtain a new and common OHS index. PI was used to determine the efficiency of tooth-brushing activity, GI was used to determine gingival health and CI was used to evaluate whether or not there is a disruption in plaque removal during the interim period after the professional periodontal treatment and motivation program. Ramfjord teeth (the maxillary right first molar, left central incisor or lateral, left first premolar, mandibular left first molar, right central incisor or lateral, and right first premolar; teeth numbers 16, 21, 24, 36, 41, 44) were selected in order to predict the full-mouth oral hygiene status and potentially to shorten the examination time.  All the measurements were performed on vestibular and oral surfaces of each tooth by a type of Williams periodontal probe, the mean values of the indices were calculated, and the total value of the PI, GI, and CI indices was accepted as the OHS of the individuals (PI + GI + CI = OHS; ranges between 0-9). According to this score, the oral hygiene conditions of individuals could be determined as follows:
- OHS < 1: Optimum oral hygiene,
- 1 ≤ OHS < 3: Good oral hygiene,
- 3 ≤ OHS < 6: Insufficient oral hygiene,
- 6 ≤ OHS: Poor oral hygiene.
| Evaluation of the Oral Hygiene Motivation Success|| |
Determination of the oral hygiene motivation success level of individuals was based on the calculation of change rate of OHS values of patients between the treatment sessions (minimum 4 weeks between the first and second session). Motivation success rate (MSR) and oral hygiene motivation success index (OHMSI) scores were calculated by using the following formula.  [Table 1] shows the calculation of OHS, MSR and OHMSI in a population sample.
Where, OHS-1 is the OHS value before treatment and OHS-2 is the OHS value at the second session.
According to this formula, if MSR values:
- MSR < 25: OHMSI score is 1; OHMSI status is Unsuccessful;
- 25 ≤ MSR <50: OHMSI score is 2; OHMSI status is Poor;
- 50 ≤ MSR <70: OHMSI score is 3; OHMSI status is Moderate;
- MSR ≥ 70: OHMSI score is 4; OHMSI status is Good.
While it is sufficient to interrupt individual oral hygiene practices for a short-term for the formation of soft accessories such as debris and bacterial plaque on tooth surfaces, a long-term negligence of the oral hygiene is required for the formation of calculus. Following the professional prophylaxis, mineralization might emerge within a few days,  and could become apparent in clinical presentation-which relatively resembles limestone-in some individuals within a short time like 2 weeks.  After performing professional cleaning, the period between the initial and second session-when the motivation level would be determined-was set as 4 weeks, which was sufficient for the formation of tartars and its clinical presentation.
| Evaluation of the Hypothesis|| |
Individual oral hygiene practices are required to be regular and sufficient for a healthy dental and periodontal condition. One of the most important factors regarding oral hygiene performance of individuals is motivation. While today it is aimed to enable the oral hygiene practices of individuals to reach the optimum with help of various motivation techniques; a scoring system, which measures the motivation levels of individuals as a result of motivation programs performed, has not been developed yet.
Considering the literature, the indices that were developed for determination of oral hygiene are as follows; OHI developed by Greene and Vermillione (1960),  and simplified oral hygiene index (OHI-S) modified by Greene and Vermillione (1964).  This index is determined through measurement of debris and tartar accumulated on tooth surfaces by using DI and CI. However, this index does not involve findings of bleeding that gives information about clinical condition of the gingival. The number of studies, which were conducted for the purpose of determining oral hygiene levels, success status of motivation methods, factors affecting the motivation, and efficiency of different plaque removal agents, is limited and some certain periodontal indices (only with PI or PI and GI) were used in these studies. ,,, PI, GI, and BOP was also evaluated with these indices.  On the other hand, the indices used in these studies are the index systems that present the existence of plaque and its effect on the gingival health. The reason for selecting these indices is based on the fact that primary reason of periodontal disease is the bacterial plaque (PI), and a good oral hygiene along with decrease in plaque amount would provide a recovery on inflamed tissue (GI). In various studies, different indices are evaluated and interpreted individually as a consequence of it, whether motivation is sufficient or not is decided. It is not possible to obtain a common single score for motivation rating. Within the index system presented in our hypothesis PI, GI, and CI were used in order to perform a scoring about oral hygiene condition of individuals. The indices, which are available in literature and scored by giving values between 0-3, were selected in an attempt to obtain a standard scoring. Concomitance of these indices is thought to enable more significant and accurate results regarding the level of individual oral hygiene.
The most important contribution of this hypothesis to the literature is that it has developed an index, which is not available in the literature and evaluates the motivation success. The most important parameter to be used in measurement of motivation success is undoubtedly the oral hygiene condition of an individual. The purpose of this hypothesis was to determine oral hygiene motivation success of individuals by using the percentage change between OHSs, which were measured before and after professional oral care and motivation program. Concomitance of these indices, which gives information about both, existence of plaque on the tooth surface and clinical condition of the gingival, would make contribution to the reliability of using this index system in personal and epidemiological studies for assessment of motivation success. The parameters obtained with this index system will form a basis for future strategies in therapeutic and preventive dentistry.
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