Impact of Oral Hygiene Instruction in Gingivitis Patients

Impact of Video-Based Versus Model-Based Oral Hygiene Instruction on Clinical Parameters and Disease Awareness in Gingivitis Patients: A Randomized Clinical Trial

The aim of this study is to comparatively evaluate the effectiveness of two different oral hygiene instruction methods given in addition to Phase 1 periodontal treatment in patients diagnosed with gingivitis, on periodontal clinical parameters and patient awareness scores, and to examine the relationship between the change in awareness score and clinical improvement. The main question it aims to answer is:

Is video-based visual oral hygiene training as memorable and motivating as hands-on training using a model?

A total of 80 patients who were diagnosed with gingivitis were included in the study. The oral health of the patients was assessed by a researcher using periodontal indices, and patients were asked to complete a 10-question questionnaire to assess their own periodontal health and oral hygiene status (T0). Following baseline measurements, all patients received standard Phase 1 periodontal treatment by another clinician. At the end of treatment, patients were randomly assigned to two different oral hygiene instruction (OHI) groups of 40 each:

Group 1 (Video Group): Oral hygiene instruction in this group was provided through standard video content; Group 2 (Model Group): Oral hygiene instruction was given through practical demonstration using three-dimensional dental models.

Patients were called for a follow-up appointment one month after the Phase 1 periodontal treatment (T1). All initial clinical indices were measured and recorded, and patients were asked to complete the same awareness questionnaire again.

The periodontal indices to be evaluated at time points T0 and T1 in the study was determined as follows:

• Plaque index (Löe & Silness) to evaluate the individual oral hygiene performance of the patient. Plaque index measurements are given on a scale of 0 (no plaque) to 3 (presence of plaque or tartar buildup), and higher scores indicate less success in individual oral hygiene practices for the patient.
• Gingival index (Sillness & Löe) evaluates the inflammatory response of the gingiva due to plaque accumulation. In this measurement, the inflammation of the gums is evaluated using a numerical value between 0 (no edema, healthy gums) and 3 (red, bleeding, and swollen gums), and the higher the score, the greater the severity of gum disease.
• Pocket depth measurement on probing to assess the amount of destruction caused by periodontal disease at the base of the gingival groove. It is a measurement that gives a numerical value in millimeters, and as the measured number increases, it indicates greater tissue destruction caused by periodontal disease and a deeper periodontal pocket.
• Bleeding on probing is used to determine whether periodontal disease is in an active destructive phase at the base of the gingival groove. The bleeding on probing index is used to detect and record bleeding that may occur upon contact of the probe with the base of the periodontal pocket, and is scored as "present" or "absent".

The numerical value recorded as the awareness score is obtained from the patients' answers to 10 questions in the survey. Each question is answered with a value between "0" (disagree) and "4" (strongly agree), and the total value obtained from the answers to the 10 questions represents the sum. As the score approaches the minimum value of 0, it indicates that the individual has fewer complaints related to gum disease, while a total score close to the maximum value of 40 indicates that the individual suffers more from the discomfort caused by gum disease.

Periodontal measurements and patient awareness questionnaire scores from both time points were recorded, and pairwise comparisons, analysis of covariance, and correlation analyses were conducted to analyze the observed change and evaluate the response of the two groups to treatment.

Inclusion Criteria:

• Having an average whole-mouth gingival index (GI) score above 2.0

Exclusion Criteria:

• Individuals with an average gingival index below 2.0,

  • Individuals with periodontal pockets deeper than 4 mm in one or more areas,
  • Individuals with fixed prosthetic restorations in any tooth,
  • Individuals who have received periodontal treatment within the last 6 months,
  • Individuals who smoke or use similar tobacco products,
  • Individuals who have used antibiotics for any reason within the last 3 months,
  • Individuals who are unable to perform adequate oral hygiene practices,
  • Individuals who have lost 5 or more teeth other than wisdom teeth,
  • Individuals under 18 or over 65 years of age were not included in the study.