Biofilm-Free Score & Oral Hygiene

• Ideally, a biofilm-free score of 100% is the goal for patients.
• If a patient consistently scores under 85%, pinpoint the specific areas where biofilm accumulates to provide targeted oral hygiene instructions.
• This helps prevent localized periodontal infections.

Biofilm-Free Score Calculation Example:

• A patient has 24 teeth scored, with 37 surfaces showing biofilm.
• The total number of available surfaces is calculated by multiplying the number of teeth by 4 (24 teeth × 4 = 96 surfaces).
• Subtract the number of surfaces with biofilm from the total available surfaces to find the number of biofilm-free surfaces (96 surfaces − 37 surfaces = 59 biofilm-free surfaces).
• Divide biofilm free surfaces by the total number of surfaces to get the percentage (59/96 = 61.5%)

Biofilm-Free Score Interpretation:

• A score of 61.5% is considered poor, indicating a need for more thorough oral hygiene education.

Papillary Bleeding on Probing:

• This involves counting the instances of bleeding from interdental areas when probed.
• A patient with 32 teeth typically has 30 interdental areas to assess, taking into account areas adjacent to edentulous spaces.
• Bleeding on probing is not expected in healthy gingival tissues.

Patient Hygiene Performance (PHP):

• The PHP assesses the extent of biofilm and debris on tooth surfaces, focusing on loosely attached soft foreign material.
• Specific teeth are selected for evaluation: maxillary right first molar (#3/16), maxillary right central incisor (#8/11), maxillary left first molar (#14/26), mandibular left first molar (#19/36), mandibular left central incisor (#24/31), and mandibular right first molar (#30/46).
• If a first molar is missing or compromised, the second molar is used as a substitute, or even the third molar if the second is also missing. A central incisor is substituted if the original is missing,
• Only certain surfaces are examined: the facial surfaces of incisors and maxillary molars, and the lingual surfaces of mandibular molars.
• These surfaces are then subdivided into five sections for scoring purposes.
• Each tooth surface is divided vertically into mesial, middle, and distal thirds, and horizontally into gingival, middle, and occlusal/incisal thirds.
• Each of the five subdivisions is scored for the presence of stained debris: 0 indicates no debris (or questionable), and 1 indicates debris is definitely present; "M" is noted when all three molars or both incisors are missing, "S" indicates if a substitute tooth is used.
• To calculate a debris score for an individual tooth, the scores for each of the five subdivisions are added together, resulting in a range from 0 to 5.
• To obtain the PHP for an individual, the scores for all examined teeth are totaled and divided by the number of teeth examined, yielding a PHP range from 0 to 5.

PHP Score Evaluation:

• Excellent: 0 (no debris)
• Good: 0.1–1.7
• Fair: 1.8–3.4
• Poor: 3.5–5.0

PHP Calculation Example:

• A patient's debris scores for selected teeth are totaled (e.g., 5 + 3 + 4 + 5 + 2 + 3 = 22).
• The total is divided by the number of teeth examined (22 / 6 = 3.67).
• A PHP of 3.67 indicates poor hygiene performance.

PHP for a Group:

• To calculate the average PHP score for a group, total the individual scores and divide by the number of people examined.

Simplified Oral Hygiene Index (OHI-S):

• The OHI-S assesses oral cleanliness by estimating the surfaces of teeth covered with debris and/or calculus.
• It comprises two components: the Simplified Debris Index (DI-S) and the Simplified Calculus Index (CI-S).
• These can be used separately or combined for the overall OHI-S score.
• The index focuses on six specific teeth.