Finding an upper limit of what might be achievable by patients: oral cleanliness in dental professionals after self-performed manual oral hygiene
Though patients have been shown to have difficulties in achieving oral cleanliness after self-performed oral hygiene, scientifically and empirically justified standards for the degree of oral cleanliness they should achieve are lacking. Oral cleanliness of dental staff was therefore assessed as an indicator of what might be an upper limit of what can be expected by patients.
Materials and methods
In a multicentre study, N = 64 university dentists, N = 33 dental students and N = 30 dental assistants were asked to perform manual oral hygiene to the best of their abilities. The presence or absence of dental plaque adjacent to gingival margins was assessed by the marginal plaque index (MPI). As full-crown index, the Turesky modification of the Quigley and Hein Index (QHIm) was applied.
Only three participants showed papillary bleeding and only one a clinical pocket depth of more than 3.5 mm. After self-performed oral hygiene, no differences between groups were observed with respect to plaque nor did results differ between those who habitually used a powered toothbrush only and those who did not. Most participants (96%) achieved oral cleanliness at more than 70% of their gingival margins and QHIm levels below .63. Half of the participants showed QHIm levels below .17 and oral cleanliness at 96% of gingival margins.
Conclusions and clinical relevance
Considering that half of the dental professionals achieved oral cleanliness at 96% of gingival margins and QHIm levels below .17 after thorough oral hygiene, this might reflect an upper limit of what can be expected by patients.
KeywordsOral hygiene Dental staff Dental plaque Periodontal diseases Prevention Oral health
We greatly appreciate the support of the following persons in conducting the study at the different university dental schools: Prof. Dr. Ulrich Lotzmann and Prof. Reiner Mengel, Department of Prosthodontics, Dental School, Philipps-University Marburg, Marburg, Germany; Prof. Dr. Ulrich Schlagenhauf, Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany; Prof. Dr. Petra Ratka-Krüger and Dr. Wolfgang Wölber, Section of Periodontology, Center for Dental Medicine, Department of Operative Dentistry and Periodontology, University Hospital of Freiburg, Freiburg, Germany; Prof. Dr. Christof E. Dörfer and PD Dr. Christian Graetz, Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany; Dr. Ina M. Schüler, Department of Preventive Dentistry and Paediatric Dentistry, Jena University Hospital, Jena, Germany; Prof. Dr. Stefan Rüttermann, Center for Dentistry and Oral Medicine (Carolinum), Department of Operative Dentistry, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany who supported the study at his former affiliation, the dental school of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study was financed by the institutional budget of RD.
All procedures performed in this study with human participants were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Board of the Medical Faculty of the University of Giessen (no. 203/12) and was found to comply with the WHO principles of research with humans.
Informed consent was obtained from all individual participants included in the study.
- 7.Jönsson B, Öhrn K, Oscarson N et al (2009) The effectiveness of an individually tailored oral health educational programme on oral hygiene behaviour in patients with periodontal disease: a blinded randomized-controlled clinical trial (one-year follow-up). J Clin Periodontol 36(12):1025–1034CrossRefPubMedGoogle Scholar
- 9.Ley P (1988) Communicating with patients: improving communication, satisfaction and compliance. Psychology and medicine series. Croom Helm, London [etc.]Google Scholar
- 10.Tonetti MS, Eickholz P, Loos BG et al (2015) Principles in prevention of periodontal diseases: consensus report of group 1 of the 11th European Workshop on Periodontology on effective prevention of periodontal and peri-implant diseases. J Clin Periodontol 42(Suppl 16):S5–11. doi: 10.1111/jcpe.12368 CrossRefPubMedGoogle Scholar
- 12.Saxer UP, Mühlemann HR (1975) Motivation und Aufklärung (motivation and education). Schweizerische Monatsschrift für Zahnheilkunde = Revue mensuelle suisse d'odonto-stomatologie/SSO 85(9):905–919Google Scholar
- 13.Rateitschak KH, Rateitschak EM, Wolf HF (1989) Parodontologie, 2nd edn. Farbatlanten der Zahnmedizin, vol 1. Georg Thieme, Stuttgart, New YorkGoogle Scholar
- 15.Quigley GA, Hein JW (1962) Comparative cleansing efficiency of manual and power brushing. J Am Dent Assoc (65):26–29Google Scholar
- 17.Bortz J, Lienert GA, Boehnke K (2008) Verteilungsfreie Methoden in der Biostatistik: Mit 247 Tabellen, 3., korrigierte Auflage. Springer-Lehrbuch. Springer Medizin Verlag Heidelberg, Berlin, HeidelbergGoogle Scholar
- 19.van der Velden U (2006) The significance of supragingival plaque accumulation in periodontal disease. Int J Dent Hyg 4 Suppl 1:11–4; discussion 50–2. doi: 10.1111/j.1601-5037.2006.00196.x