Oral Hygiene Indices

Oral Hygiene Status

• Indices that measure oral hygiene can educate and motivate patients in the clinic
• In community settings, data can assess daily oral care and monitor oral hygiene education programs

Biofilm Index (BI)

• Assesses biofilm thickness in the gingival area
• Can evaluate the entire dentition or selected teeth
• Four gingival areas (distal, facial, mesial, and lingual) are examined systematically for each tooth
• Modified procedures examine only the facial, mesial, and lingual areas, with a double score assigned to the mesial reading
• Teeth are dried and visually examined using light, a mouth mirror, and a probe or explorer
• Evaluate biofilm on the cervical third, ignoring biofilm on the middle or incisal thirds
• Probe used to test the surface when no biofilm is visible, passing it across the tooth surface in the cervical third near the sulcus
• Use disclosing agent to assist evaluation for the 0–1 scores
• Biofilm on calculus and restorations in the cervical third included in the evaluation

Biofilm Index Scoring

• 0: No biofilm
• 1: Film of biofilm adhering to the free gingival margin, recognized after disclosing agent or explorer
• 2: Moderate accumulation of soft deposits within the gingival pocket, seen with the naked eye
• 3: Abundance of soft matter within the gingival pocket
• Each area of a tooth is scored from 0 to 3
• Tooth score: Total area scores divided by 4
• Group score: Total scores for individual teeth in the group divided by the number of teeth
• Individual score: Add the scores for each tooth and divide by the number of teeth examined, ranges from 0 to 3

Biofilm Index Rating

• Excellent: 0
• Good: 0.1–0.9
• Fair: 1.0–1.9
• Poor: 2.0–3.0
• Group score: Add the scores for each member of a group and divide by the number of individuals

Biofilm Control Record (BCR)

• Records biofilm presence on individual tooth surfaces to help patients visualize progress
• All teeth are included, with missing teeth marked by a horizontal line
• Records four surfaces: Facial, lingual, mesial, and distal

Procedure

• Apply disclosing agent, instructing the patient to swish and rub it over the tooth surfaces before rinsing
• Examine each tooth surface for biofilm at the gingival margin
• Record biofilm by marking the appropriate spaces on the diagram for facial, lingual, mesial, and distal surfaces

Scoring

• Total the number of teeth present and multiply by 4 to obtain the number of available surfaces
• Count the number of surfaces with biofilm
• Multiply the number of biofilm-stained surfaces by 100 and divide by the total number of available surfaces to derive the percentage of surfaces with biofilm
• Goal: Ten percent or less biofilm-stained surfaces
• Additional instruction needed if biofilm is regularly left in the same areas

Biofilm-Free Score (BFS)

• Determines the location, number, and percentage of biofilm-free surfaces
• Interdental bleeding can also be documented
• All erupted teeth are included, with missing teeth marked on the record form
• Four surfaces are recorded for each tooth: Facial, lingual, mesial, and distal

Procedure

• Apply disclosing agent, instructing the patient to swish and rub the solution over the tooth surfaces before rinsing
• Examine each tooth surface for biofilm
• Use a tooth chart form, recording biofilm in red ink
• Record proximal bleeding on probing; improvement in gingival health shown as fewer bleeding areas

Scoring the Biofilm-Free Score

• Total the number of teeth present
• Total the number of surfaces with biofilm that appear in red on the tooth diagram
• To calculate the biofilm-free score:
  • Multiply the number of teeth by 4 to determine the number of available surfaces
  • Subtract the number of surfaces with biofilm from the total available surfaces to find the number of biofilm-free surfaces
  • Divide the number of biofilm-free surfaces by the total number of available surfaces and multiply by 100 to obtain the percentage
• 100% is ideal, check individual surfaces if patient maintains percentage under 85%

Papillary Bleeding Scoring

• Total the number of small circles marked for bleeding
• A patient with 32 teeth has 30 interdental areas
• Evaluate total interdental bleeding; in health, bleeding on probing does not occur

Patient Hygiene Performance (PHP)

• Assesses the extent of biofilm and debris over a tooth surface

Selection of Teeth

• Maxillary: No. 3, No. 8, No. 14
• Mandibular: No. 19, No. 24, No. 30
• Substitutions made when a first molar is missing (use second or third molar or adjacent central incisor for a missing incisor)
• Examine the facial surfaces of incisors and maxillary molars and the lingual surfaces of mandibular molars

Procedure

• Apply disclosing agent
• Each tooth surface is subdivided into five sections (mesial, middle, distal, gingival, and occlusal/incisal)
• Each subdivision is scored for the presence of stained debris
  • 0: No debris
  • 1: Debris present

Scoring

• Add the scores for each of the five subdivisions, with the scores ranging from 0 to 5
• Total the scores for the individual teeth and divide by the number of teeth examined
• The PHP ranges from 0 to 5
  • Excellent: 0
  • Good: 0.1–1.7
  • Fair: 1.8–3.4
  • Poor: 3.5–5.0
• To obtain 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)

• Assesses oral cleanliness by estimating the tooth surfaces covered with debris and/or calculus

Components

• Simplified debris index (DI-S)
• Simplified calculus index (CI-S)
• Scores may be used separately or combined for the OHI-S

Selection of Teeth and Surfaces

• Posterior: Facial surfaces of maxillary molars and lingual surfaces of the mandibular molars
• Anterior: Facial surfaces of the maxillary right and the mandibular left central incisors
• Score either the facial or lingual surfaces of the selected teeth, including the proximal surfaces to the contact areas

Procedure

• At least two of the six possible surfaces must be examined to calculate an individual score
• Use probe to move across the tooth surface to estimate surface area covered by debris
• Use an explorer to estimate surface area covered by supragingival calculus deposits and identify subgingival deposits by exploring and/or probing

Simplified Debris Index (DI-S) Criteria

• 0: No debris or stain present
• 1: Soft debris covering not more than one-third of the tooth surface
• 2: Soft debris covering more than one-third but not more than two-thirds of the exposed tooth surface
• 3: Soft debris covering more than two-thirds of the exposed tooth surface

Simplified Calculus Index (CI-S) Criteria

• 0: No calculus present
• 1: Supragingival calculus covering not more than one-third of the exposed tooth surface
• 2: Supragingival calculus covering more than one-third but not more than two-thirds of the exposed tooth surface, or individual flecks of subgingival calculus
• 3: Supragingival calculus covering more than two-thirds of the exposed tooth surface, or a continuous heavy band of subgingival calculus.

Scoring the OHI-S

• Determine separate DI-S and CI-S, dividing each total score by the number of teeth scored (6)
• DI-S and CI-S values range from 0 to 3
• Combine the DI-S and CI-S values to calculate the OHI-S, ranging from 0 to 6

OHI-S Evaluation

• Individual DI-S and CI-S and combined OHI-S
  • Excellent: 0
  • Good: 0.1–0.6 (DI-S, CI-S), 0.1-1.2 (OHI-S)
  • Fair: 0.7–1.8 (DI-S, CI-S), 1.3-3.0 (OHI-S)
  • Poor: 1.9–3.0 (DI-S, CI-S), 3.1-6.0 (OHI-S)
• Compute the average of the individual scores by totaling the scores and dividing by the number of individuals to calculate a group score