Gingival and Periodontal Indices.pptx

Gingival and Periodontal Indices

1. Gingival and Periodontal Indices By: Dr. Sama Ahmed and Tasneem Salah

2. CONTENT

3. 3

4. 4

5. 5

6. 1. Plaque Index (PI) The PI as developed by Silness and Loe (1964) Uses: Assesses the thickness of plaque at the cervical margin of the tooth (closest to the gum). The measurement of the state of oral hygiene Based on recording both soft debris and mineralized deposits on the teeth. Procedure : 1. Four areas, distal, facial or buccal, mesial, and lingual surfaces, are examined. 2. Teeth examined 6 2 4 OR entire dentition. 4 2 6 3. Each tooth is dried and examined visually using a mirror, an explorer, and adequate light. 4. The explorer is passed over the cervical third to test for the presence of plaque. 6

7. 1. Plaque Index (PI) 5. A disclosing agent may be used to assist evaluation. 6. Missing teeth are not substituted. 7. Four different scores are possible. 8. Each of the four surfaces of the teeth (buccal, lingual,mesial and distal) is given a score from 0 to 3. 7

8. 8

9. PI Score for Tooth The scores from the four areas of the tooth are added and divided by four in order to give the plaque index for the tooth. PI for an Individual The index for the patient is obtained by summing the indices for all six teeth and dividing by six. Interpretation for PI Scores Four ratings may be assigned: 0 = Excellent oral hygiene 0.1-0.9 = Good oral hygiene 1.0-1.9 = Fair oral hygiene 2.0-3.0 = Poor oral hygiene 9 1. Plaque Index (PI)

10. 10 Advantages of Plaque Index: Providing more data on self-care habits of patient.

11. 11 2. Plaque Formation Rate Index (PFRI): The PFRI index was developed by Axelsson at 1989 uses: Describes accumulation of dental plaque at 24 hours after a professional dental cleaning. This index can help identify patients at increased risk for caries (used in periodontal risk assessment). Procedure: 1-Selection of teeth and areas examined: On each tooth 6 Surfaces (1) Buccal (2) Distobuccal (3) Mesiobuccal (4) Lingual (5) Distolingual (6) Mesiolingual

12. 12 2. Plaque Formation Rate Index (PFRI): 2. Teeth are cleaned professionally by dental hygienist or dentist. 3. Patient does not brush or clean the teeth for the next 24 hours. 4. 24 hours after cleaning the teeth are examined for adherent plaque. Score:

13. 13 2. Plaque Formation Rate Index (PFRI): PFRI = (total number of surfaces showing plaque) X 100% (number of teeth examined) X(6 surfaces examined) Minimum PFRI: 0% Maximum PFRI: 100% Advantages: 1. Useful for monitoring patients' plaque control performance, 2. Easy to accomplish, economical (Only a mouth mirror and explorer are necessary) 3. Reproducible. 4. Completed chart indicates locations where plaque accumulates and where improved brushing and flossing techniques are required.

14. 14 3. Oral hygiene index(OHI): Designed by Greene & Vermillion at 1964 Uses: To assess oral cleanliness by estimating tooth surface covered with debris or calculus. Components Debris Index Calculus index The 2 scores may be used separately or combined Procedure: 1. Selection of teeth and areas examined: Divide the dentition into sextants. Posterior sextants begin distal to canine. Each segment examined for debris or calculus. From each segment 1 tooth (with Buccal and lingual surfaces readings)used for calculating individual index for that segment with twelve surfaces

15. 15 3. Oral hygiene index(OHI): 2. Debris score: The explorer is placed on the incisal third of the tooth and moved towards the gingival third. 3. Calculus scores: Identify subgingival deposits by placing the explorer into the distal gingival crevice and drawing it subgingivally from the distal contact area to the mesial contact area. The average individual or group debris and calculus scores are combined to obtain Oral hygiene index A perfect score would be 0, and the worst score possible is 12

16. 16

17. 17

18. 18

19. 19 4. The Simplified Oral Hygiene Index (OHI-S): It offers a more rapid method for evaluation of oral cleanliness of population groups but lacks in degree of sensitivity in comparison to the original OHI index. It differs from the original index in: Number of tooth surfaces scored [6 rather than 12]. The method of selecting the tooth surfaces to be scored The scores which can be obtained. Components Debris Index Calculus index The 2 scores may be used separately or combined

20. 20 4. The Simplified Oral Hygiene Index (OHI-S): Procedure: A)Selection of teet h : The six surfaces examined for the OHI-S are selected from four posterior and two anterior teeth. In the posterior teeth, the first fully erupted tooth distal to the second bicuspid, usually the 6 but sometimes the 7or 8, is examined on each side of each arch. In the anterior portion of the mouth upper right central incisor and lower left central incisor are scored. In the absence of either of these anterior teeth, the central incisor on the opposite side of the midline is substituted. Only fully erupted permanent teeth are scored. Natural teeth with full crown restorations and surfaces reduced in heights by caries or trauma are not scored, instead an alternate tooth is examined.

21. 21 4. The Simplified Oral Hygiene Index (OHI-S): B) Surfaces to be Seen: Six surfaces are examined: [from four posterior teeth and two anterior teeth] Upper molars: The buccal surfaces of selected teeth is inspected. Lower molars: The lingual surfaces of the selected teeth are checked. Upper and Lower Central incisor: labial surface is scored

22. 22

23. 23

24. 4. The Simplified Oral Hygiene Index (OHI-S): Interpretation: The CI-S and DI-S values may range from 0 to 3; the OHI-S values from 0 to 6. These values are just half the score magnitude possible with the OHI (Oral Hygiene Index). Individually DI-S and CI-S is scored as follows: 0.0 to 0.6 = Good oral hygiene 0.7 to 1.8 = Fair oral hygiene 1.9 to 3.0 = Poor oral hygiene 24 An OHI-S is scored as follows: 0.0-1.2 = Good oral hygiene 1.3 -3.0 = Fair oral hygiene 3.1 -6.0 = Poor oral hygiene

25. 5. Patient Hygiene Performance Index (PHP Index): The PHP index was developed by by Podshadley AG, and Haley JV (1968) Uses: To assess the extent of plaque and debris over a tooth surface as an indication of oral cleanliness. Most useful for individual patients who have significant plaque accumulation . Teeth and Surfaces Examined according to FDI: 6 1 6 6 1 6 Surfaces Facial surfaces: Incisors and maxillary molars. Lingual surfaces: Mandibular molars 25

26. 26 Substitutions for Missing Teeth: • The second molar is used if the 1st molar - Is missing - Less than three–fourth erupted - Has a full crown - Is broken down • The third molar is used when the second molar is missing. • The adjacent incisor the of the opposite side is used, when the central incisor is missing. Procedure: • Disclosing solution is applied. • Patient is asked to swish for 30 seconds and expectorate but not rinse. • Examination is made using a mouth mirror. • Each tooth surface to be evaluated is subdivided into five sections as follows . Vertically: Three divisions mesial, middle and distal. Horizontally: The middle third is subdivided into gingival, middle and occlusal or incisal thirds. • Each area with plaque is scored a point so each tooth score can range from 1 to 5 points.

27. 27 Scoring: Debris scores for individual tooth: Add the scores for each of the five subdivisions. The scores range from 0 to 5. PHP for an individual: Total the scores for the individual teeth and divide by the number of the teeth examined. PHP Index for a group: To obtain the average PHP score for a group or a population, total the individual score and divide by the number of people examined. Interpretation: Nominal scale for evaluation of scores: Rating scores 1. Excellent = 0 (No debris) 2. Good = 0.1-1.7 3. Fair = 1.8-3.4 4. Poor = 3.5- 5.0

28. 28

29. 1. Gingival bleeding index (GBI): GBI was developed by Ainamo & Bay, 1974 Measure of gingivitis as indicated by bleeding following dental flossing. Uses: Initial patient evaluation. Over time to assess response to interventions to improve the health. 29

30. 30 Procedure: 1. Selection of Teeth The mouth is divided into 6 segments. Areas involving the third molars are not scored because of variations in arch position, access and vision. An area is non-scoreable when tooth positions, diastemas or other factors compromise the desirable interproximal relationships. 2. Method Unwaxed dental floss is alternately passed interproximally into the gingival sulcus on both sides of the interdental papillae. With the floss extended as far as possible towards the buccal and lingual, the floss is carried to the bottom of the sulcus. The floss is then moved in an incisogingival motion for one double stroke. Care is taken not to cause laceration of the papillae. A new length of clean floss is used for each interproximal unit. Bleeding is generally immediately evident in the area or on the floss, but 30 seconds are allowed for reinspection of each segment. If bleeding is copious, the patient should rinse between segments.

31. 31 Bleeding Assessment: No attempt is made to quantify the degree of bleeding. Bleeding is assessed only as present or absent. Scoring Codes for GBI: Not bleeding : None (blank) Bleeding : B Not-scoreable : X Result Total scoreable areas = 26 - (number of non-scoreable areas) Gingival Bleeding Score (total bleeding areas) = Sum of number of bleeding areas Interpretation The fewer the number of bleeding sites, the less the extent of gingivitis. Ideally the score should be 0. If the patient is to be followed over time, previous bleeding sites are monitored to see if they become non-bleeding. The goal of interventions is to reduce the score as much as possible.

32. 2. Eastman interdental bleeding index (EIBI) 32 (EIBI) was developed by Caton and Polson 1985 use: To assess presence of inflammation in intrdental area by presence or absence of bleeding. Procedure: 1. Selection of teeth and Area examined Each interdental area around entire dentition 2. method: wooden interdental cleaner inserted gently then immediately removed into each interdental area to depress papilla 1-2 mm insertion should be horizontal (parallel to occlusal Surface), take care not to be angled into apical direction 2-inseart and remove 2 times → move to next interproximal area 3-record presence or absence of bleeding

33. 33 Scoring number of bleeding sites: may be totaled for an individual score for comparison with scores over series of appointments % score (EIBI expressed by %) = No. of bleeding sites X l00 Total no. of areas Advantage: This index is easy and could be used by pt to monitor their own gingival status between visits to dentist

34. 3. Papillary, Marginal, and Attached gingival index(PMA): The oldest reversible index which was developed (PMA) was developed by Schour I and Massler M (1944). Uses: It was used to assess the extent of gingival changes in large groups for epidemiological studies. Visual recording gingival conditions used primarily in children. The presence or absence of inflammation is recorded in three areas of gingiva around the teeth. 34 Method: All the teeth can be assessed starting from maxillary second molar of one side to the second molar of the other side and then mandibular second molar of the same side to the second molar of the other side. Third molars are not included. Adequate light and mouth mirror are used. Probe usually a blunt probe is used for pressing on gingiva.

35. 35 procedure 1. Selection of Teeth and Surfaces Three gingival units are examined for each tooth P : Papillary portion between the teeth Papilla is numbered by the tooth just distal to it. Papilla is not present when teeth are separated by a diastema or there is an edentulous area. 3. Inflammation usually begins within the papilla at the col area. Papillary changes=Mild gingivitis. M : Marginal collar around the teeth. 1. It is located between papillae, attached by junctional epithelium, and demarcated from attached gingiva by the free gingival groove. Papillary and marginal gingival inflammation=Moderate gingivitis. A : Attached gingiva overlying the alveolar bone 1. Stippled gingiva between the free gingival groove and the mucogingival junction. Spread of inflammation from papillary and marginal gingivitis into the attached gingiva=Severe gingivitis.

36. 36 Scoring Criteria: Papillary =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 = 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 cementoenamel junction as a result of inflammatory changes. Attached = A 0 = Normal; pale rose, stippled 1+ = Slight engorgement with loss of stippling, change in color may or may not be present. 2+ = Obvious engorgement of attached gingiva with marked increase in redness, pocket formation present 3+ = Advanced periodontitis, deep pockets evident.

37. 37 Scoring P-M-A for individual Count the number of P, M and A units scored and record separately as: P-M-A =?-?-? Keeping the total separate, as on adding the sum will not represent the area of the gingiva where the inflammation is present. P-M-A for a group: The average of the P, M and A is computed by totalling each for all individuals and then dividing each number of individuals examined.

38. 4. GINGIVAL INDEX (GI) : GI was developed by Loe and Silness (1963). Uses: It assesses the severity of gingivitis based on color, consistency, and bleeding on probing. It describes the clinical severity of gingival inflammation as well as its location. Method: A probe is used to press on the gingiva to determine its degree of firmness, and to run along the soft tissue wall adjacent to the entrance to the gingival sulcus. 38

39. 39 Procedure: Selection of Teeth and Surfaces: 1. Teeth: 1. Maxillary right first molar. 2. Maxillary right lateral incisor. 3. Maxillary left first bicuspid. 4. Mandibular left first molar. 5. Mandibular left lateral incisor. 6. Mandibular right first bicuspid. 2. Surfaces: Buccal, lingual, mesial and distal. Score: Score 0: Normal gingiva/absence of inflammation Score 1: Mild inflammation: Slight change in color, slight edema. No bleeding on probing. Score 2: Moderate inflammation: Redness edema and glazing. Bleeding on probing. Score 3: Severe inflammation: Marked redness and edema. Ulceration and a tendency for spontaneous bleeding

40. 40 Each surface is given a score, and then the scores are totaled which gives the score for area and divided by four gives score for the tooth. Totaling all scores and dividing by the number of teeth examined provides GI score per person. Interpretation:

41. 41

42. 1. Community periodontal index of treatment needs (CPITN) CPITN was developed 1977 by WHO Uses: Initially: used as a screening procedure for epidemiological purposes Later: promoting periodontal health awareness programs monitoring changes in periodontal needs of individuals in clinic. planning for prevention and control of periodontal diseases 42

43. 43 Procedure: 1. Selection of teeth and Area examined: Divide the dentition into sextants. Evaluate all teeth . Posterior sextants begin distal to canine . A sextant must have two or more functional teeth . A functional tooth is not indicated for extraction. When only one functional tooth is present, it is assessed with the adjacent sextant. *The sextant with no teeth or one tooth is recorded as missing and marked X on the record form. Third molars are included only when they function in place of second molars

44. 44 Index Teeth In epidemiological surveys, for adults aged 20 years or more, only 10 index teeth are examined (5 teeth on the maxilla and 5 teeth on the mandible). These have been identified as the best estimators of the worst periodontal condition of the mouth. MAX 17 16 11 26 27 MAND 47 46 31 36 37 The molars are examined in pairs and only one score, the highest is recorded. Only one score is recorded for each sextant. For young people, up to 19 years only, six index teeth MAX 16 11 26 MAND 46 31 36 Recording Data The following box chart is recommended as the epidemiologic and dental office chart for recording CPITN data.

45. 45 2. The Probe The probe has color coding between 3.5 and 5.5 mm markings at intervals from the tip. The working tip has a ball 0.5 mm in diameter. The functions of ball tip are: i . To aid in detection of calculus and other tooth surface roughness. ii. To facilitate assessment of the base of the pocket and reduce the risk of over measurement. A variant of this basic probe has two additional lines at 8.5 mm and 11.5 mm from the working tip. The additional lines may be of use when performing a detailed assessment and recording of deep pockets for the purpose of preparing treatment plan for complex periodontal therapy. The two instruments can be identified as : CPITN- E for the epidemiologic probe with 3.5 and 5.5 mm markings. CPITN- C for the clinical probe with the additional 8.5 and 11.5 mm markings.

46. 46

47. 47 4. Codes and criteria: The codes are listed in the descending order of treatment complexity as follows: Code X: When only one tooth or no tooth is present in the sextant (third molars are excluded unless they function in place of second molars). Code 4: Pathological pocket of the 6 mm or more, that is, the black area of the CPITN probe is not visible. Note: If the designated tooth or teeth are found to have a 6 mm or deeper pocket in the sextant being examined, a code of 4 is given to the sextant. Recording of Code 4 makes further examination of that sextant unnecessary. There is no need to record the presence or absence of pathological pockets of 4 or 5 mm, calculus or bleeding. Code 3: Pathological pocket of 4 or 5 mm that is when the gingival margin is on the black area of the probe. Note: If the deepest pocket is found at the designated tooth or teeth in a sextant is 4 or 5 mm, a code 3 is recorded. There is no need to examine for calculus or gingival bleeding. Code 2: Calculus or other plaque retentive factors such as ill fitting crowns or poorly adapted edges of restoration are either seen or felt during probing. Note: The black band remains fully visible. Code 1: Bleeding observed during or after probing (either immediate or delayed). Code 0: Healthy tissue: The black band on the probe remains fully visible. There is no bleeding after probing. No calculus, restoration overhangs or other plaque retention factors are present.

48. 48 Treatment Needs TN 0: A recording of code 0 (health) or X (missing) for all six sextant indicates that there is no need for treatment. TN 1: A code of 1 or higher indicates that there is need for improving the personal oral hygiene of that individual. TN 2: a. Code of 2 or higher indicates a need of professional cleaning of the teeth and removal of plaque retentive factors. Patient require oral hygiene instructions b. Shallow to moderate pocketing (4 or 5 mm, code 3). Oral hygiene and scaling will reduce inflammation and bring 4 or 5 mm pockets to values of or below 3 mm. Thus, sextants of these pockets are placed in the same treatment category as scaling and root planning, i.e., Treatment Needs 2 (TN2) TN 3: A sextant scoring code 4 (6 mm or deeper pockets) may or may not be treated successfully by means of deep scaling and efficient personal oral hygiene measures. Code 4 is therefore assigned as complex treatment which can involve deep scaling, root planning and more complex procedures.

49. 49

50. 50 Substitution for Excluded and Missing Index Teeth The ten CPITN index teeth are first molar and second molars in the posterior sextant and a central incisor in each of the two anterior sextant. When one or more index teeth are missing at the time of examination, substitute teeth are selected using the following rules: 1. Two or more functioning teeth must be present in a sextant for it to qualify for scoring. 2. If in posterior sextant, one of the two index teeth is not present or has to be excluded, then the recording is based on the examination of remaining index tooth. 3. If both index teeth in posterior sextant are absent or excluded from examination, all the remaining teeth in that sextant are examined and highest score recorded. 4. In the anterior maxillary sextant, if tooth 11 is excluded, substitute 21. If 21 is also excluded, then identify the worst score for the remaining teeth. Similarly substitute tooth 41 if 31 is missing. 5. In subjects under 20 years of age, if the first molar is not present or has to be excluded the nearest adjacent premolar is examined. 6. If all teeth in a sextant are missing or only one functional tooth remains, the sextant is coded as missing 7. A single tooth in a sextant is considered as a tooth in the adjacent sextant and subject to the rules for that sextant. If single tooth is an index tooth, then the worst index tooth score is recorded.

51. 51 Probe Application Using a WHO probe Light probing force should be used (20-25 grams) since this amount of force is resisted by healthy epithelial attachment and it is sufficient to elicit bleeding from the area of inflammation. Pain to the patient during probing is an indication of a heavy sensing force. The probe should be “walked around” the sulcus/pockets in each sextant, and the highest score recorded. As soon as a code 4 is identified in a sextant, the clinician may then move directly on to the next sextant, though it is better to continue to examine all sites in the sextant. This will help to gain a fuller understanding of the periodontal condition and will make sure that furcation involvements are not missed. If a code 4 is not detected, then all sites should be examined to ensure that the highest score in the sextant is recorded before moving on to the next sextant.

52. 52 Advantage international uniformity and clarify treatment needs for each score. Limitations partial recording, exclusive of important signs of past periodontal disease e.g., attachment loss and it does not record any maker of disease activity. However, CPITN procedure provides an overview of magnitude of periodontal health of population That’s why the British Society of Periodontology modified the next index

53. 2. Basic Periodontal Examination (BPE) Index BPE Index was developed by (BSP, 2011) BSP recommend that periodontal screening becomes a routine part of the dental clinical examination in all co-operative children and adolescents. They developed the BPE index Based on the Community Periodontal Index of Treatment Needs (CPITN). BPE should be used for screening only and should not be used for diagnosis . The BPE is a simple and rapid screening tool that is used to indicate the level of further examination needed and provide basic guidance on treatment needed. These BPE guidelines are not prescriptive but represent a minimum standard of care for initial periodontal assessment. 53

54. 54

55. 55

56. 56

57. 57

58. 58 In addition, it is recommended that: BPE should not be used around implants (4 or 6-point pocket charting should be used) Radiographs should be available for all Code 3 and Code 4 sextants. The type of radiograph used is a matter of clinical judgement but crestal bone levels should be visible. Many clinicians would regard periapical views as essential for Code 4 sextants to allow assessment of bone loss as a percentage of root length and visualisation of the periapical tissues When a 6-point pocket chart is indicated it is only necessary to record sites of 4mm and above (although 6 sites per tooth should be measured) Bleeding on probing should always be recorded in conjunction with a 6-point pocket chart or patients with BPE codes of 3 or 4, more detailed periodontal charting is required. We call this a 6PPC (6-point pocket chart) The probe is again “walked around” each tooth. We then measure and record 6 points around each tooth, this gives us a much clearer picture of the pockets that are deeper and may need further treatment to stabilize this condition. A 6PPC is carried out yearly so we can compare areas within the mouth that are improving or may need further attention.

59. 59 Advantage: Simple and rapid screening tool that is used to indicate the level of examination needed and to provide basic guidance on treatment need Disadvantage: Not a diagnostic tool  

60. 3. Periodontal screening and recording system (PSR): PSR was developed by AAP and ADA in 1992 latest update 2017 Index reveals for the practitioner current state of gingival (bleeding) as well as previously occurring pathologic processes in the form of pocket depth and associated attachment loss. uses: assess state of periodontal health in a rapid and effective manner. motivate patient to seek necessary complete periodontal assessment and treatment. Procedure: Selection of teeth and Area examined: As CAPITN Steps : Same as CAPITN 60

61. 61 Scoring: As CAPITN except:   Criteria Tt need * Added to a sextant score whenever the following is found: 1-furcation involvement, 2-mobility, 3-mucogingival problems, or 4-recession extending to the colored area of the probe (indicating 3.5mm or greater). -If an abnormality exists in the presence of Codes 0, 1, or 2 , =>the clinician should make a specific notation and/or treatment for that condition as needed. -If an abnormality exists in the presence of Code 3 or 4, =>a comprehensive periodontal examination and charting are necessary to determine an appropriate care plan . But since those criteria are very rare findings in children this index is of limited use of the PSR system in children. It is necessary to differentiate pseudo-pockets from true periodontal pockets with these younger patients.

62. 62

63. 1. Genetic Susceptibility Index for Periodontal disease: Epigenetic changes: (‘changes in gene function that occur without a change in the sequence of nuclear DNA’) may be caused by the dental biofilm and smoking. Genetic markers denote susceptibility toward disease manifestation => genetic susceptibility index (GSI) was developed. It is still Experimental . The GSI derived from genotypes of SNPs (Single nucleotide polymorphisms) GSI scores correlate well with disease presence. When the overall score is <1, the predisposition toward healthy status is 85% and when it is higher than 4, the predisposition toward disease is 88%. In addition, when score value ranges between 1 and 2, there is a 50 ⁄ 50 chance toward either disease or healthy 63

64. 2. Oral Hygiene Score (OHS) Motivation success rate (MSR) and Oral hygiene motivation success index (OHMSI): 64

65. 65

66. 66 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. 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. 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.

67. 67 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. 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.

68. 68

69. 69

70. 70

71. 71

72. 72

73. References: Marya , C. M. (2011). A textbook of public health dentistry. JP Medical Ltd https://www.bsperio.org.uk/assets/downloads/BSP_BPE_Guidelines_2019.pdf Arabacı T, Demir T. An index developed for the determination of oral hygiene motivation success. Dent Hypotheses 2013;4:9-12. 73

74. Thank you