Effect of xylitol candies on plaque and gingival indices in physically disabled school pupils

OBJECTIVE: To evaluate the effectiveness of xylitol candies on plaque and gingival index scores on physically disabled school pupils in Kuwait. METHODOLOGY: Altogether 145 school pupils (105 in the xylitol group and 40 in the control group), with ages ranging from 10 to 27 years (mean age = 14.7 +/- 3.1 years), participated in this 18-month intervention program. The school health nurses distributed xylitol candies to the pupils three times during the school day. Plaque was scored according to the Silness and L?e Plaque Index, and gingivitis according to the L?e and Silness Gingival Index. RESULTS: The mean Plaque Index score decreased from 1.73 to 1.14 (p < 0.001), and the mean Gingival Index score from 1.74 to 1.16 (p < 0.001) in the study group. Significant differences were found between the xylitol and the control groups in the reduction of Plaque (p = 0.037) and Gingival Index scores (p = 0.008). There was high correlation between the individual Plaque and Gingival Index scores at baseline (r = 0.93) and at the final examinations (r = 0.95). CONCLUSION: Consuming xylitol candies three times during school days seemed to reduce both the Plaque and Gingival Index scores. This school-based delivery system offered a practical way to distribute and use xylitol candies among these disabled pupils. The regular use of xylitol candies may, therefore, support oral hygiene routines in disabled pupils.     

Incidence of phenytoin induced gingival overgrowth in epileptic children: a six month evaluation

Thirty children aged 8-13 years with epileptic disorders and receiving mono-drug therapy with Phenytoin, were selected from the Departments of Pediatrics and Neurology of PGIMER, Chandigarh to evaluate the development of gingival overgrowth induced by phenytoin over a period of six months. These children were evaluated at baseline at three monthly intervals for a period of six months for plaque (Silness and Loe, 1964), gingivitis (Loe and Silness, 1963) and probing depth of the gingival sulcus. Gingival overgrowth was noted as and when it developed using modified version of Harris and Ewalt Index, 1942. No attempt was made to modify the childrens' prevailing oral habits. The results indicated that gingival overgrowth in 57% of the children was in the mesio-distal dimension of the gingival papillae and occurred within six months of initiation of therapy with Phenytoin.     

Clinical index systems used to assess the efficacy of mouth-rinses on plaque and gingivitis

Abstract The American Dental Association's Council on Dental Therapeutics has adopted Guidelines for acceptance of hemo therapeutic products for the control of supragingival dental plaque and gingivitis. The most widely used plaque indices are the plaque index (PI) and the Turesky index. Gingivitis has usually been assessed by the Loe and Silness method, although the modified gingival index of Lobene and a bleeding index reported by Caton and Poison have also been used. To date. 2 products have been accepted by the Council as being effective in helping control supragingival plaque and gingivitis. These products were evaluated using clinical indices described in this review. The indices were selected from the many in the literature as being valid, reliable, and easily learned. Suggestions are made for criteria to be used in comparability studies.     

Immunoglobulin A, G and M levels in saliva in children between 3 - 12 years of age, healthy and with gingivitis

The aim of this study was to measure the level of immunoglobulin A, G and M in saliva of 3- to 12-year-old children, both healthy and diagnosed with gingivitis. Methods: A sample of 177 children was selected, of whom 24 were healthy and 153 were diagnosed with gingivitis according to Loe 's index. Samples of saliva were taken and the ELISA test was applied to obtain the immunoglobulin concentrations expressed in microg/ml. A relationship was established between the immunoglobulin levels, the disease (gingival index) and Loe 's bacterial plaque index. IgG levels were higher in healthy children. In the group with gingivitis, 95.8% of the children had incipient gingivitis with a low average index of bacterial plaque (1.33). A direct correlation was found between age and gingival index, while an inverse correlation was found between age and bacterial plaque index. The analysis of the behavior of immunoglobulin according to age showed that age was only significantly correlated to IgA levels. The analysis comparing immunoglobulin levels and clinical parameters for gingivitis showed a direct correlation between gingival index and lgM The gingival index was found that to increase with the age of the subject, even though bacterial plaque decreases. It was also found that age is a better predictor of lgA level than gingival index and bacterial plaque index are; and that gingival index is a better predictor of lgM level than age and bacterial plaque index are.     

COMPARISON OF PERIODONTAL PARAMETERS IN INDIVIDUALS WITH SYNDROMIC CRANIOSYNOSTOSIS

Craniosynostosis syndromes are characterized by premature closure of one or more cranial sutures, associated with other malformations, the most frequent of which are the Crouzon and Apert syndromes. Few studies in the literature have addressed the oral health of these individuals. The purpose of this study was to compare the periodontal status of individuals with Apert, Crouzon, Pfeiffer and Saethre-Chotzen syndromes before toothbrushing and compare the efficiency of plaque removal before and after mechanical toothbrushing. The probing depth, plaque index (according to Löe and O''Leary), clinical attachment level, gingival index (according to Silness and Löe) and amount of keratinized mucosa were evaluated before toothbrushing, and the O''Leary plaque index was assessed before and immediately after toothbrushing, on the same day, in 27 individuals aged 11 to 36 years. There was statistically significant difference in the mean probing depth and clinical attachment level among regions (p=0.00; p=0.01, respectively). The gingival index did not reveal statistically significant differences. With regard to the plaque index, the left region exhibited higher plaque index values than the right and anterior regions. No significant results were found in the analysis of keratinized mucosa. Comparison of the O''Leary plaque index before and after toothbrushing revealed statistically significant difference for all syndromes except for the Pfeiffer syndrome (p<0.05). In conclusion, there was no difference in the periodontal status among individuals with syndromic craniosynostosis. The posterior region was more affected than the anterior region as to the presence of plaque, loss of insertion and probing depth. Individuals with Pfeiffer syndrome exhibited greater toothbrushing efficiency than individuals with the other craniosynostosis syndromes.     

Short-term clinical effects of commercially available gel containing Acacia arabica: a randomized controlled clinical trial

Background:  Certain plants used in folk medicine serve as a source of therapeutic agent by having antimicrobial and other multi-potential effects. This prospective, randomized, placebo and positively controlled clinical trial was designed to evaluate the short-term clinical effects of a commercially available gel containing Acacia arabica in the reduction of plaque and gingival inflammation in subjects with gingivitis.
Methods:  Ninety subjects diagnosed with chronic generalized gingivitis were selected and randomly divided into three groups: Group I – placebo gel, Group II – gumtone gel and Group III – 1% chlorhexidine gel. Clinical evaluation was undertaken using the gingival index of Loe and Silness and the plaque index at baseline, 2 weeks, 4 weeks and 6 weeks. A subjective evaluation was undertaken by questionnaire.
Results:  Gumtone gel showed significant clinical improvement in gingival and plaque index scores as compared to a placebo gel. This improvement was comparable to 1% chlorhexidine gel. Unlike chlorhexidine gel, gumtone gel was not associated with any discolouration of teeth or unpleasant taste.
Conclusions:  Gumtone gel may be a useful herbal formulation for chemical plaque control agent and improvement in plaque and gingival status.     

The effectiveness of a toothpaste containing triclosan and polyvinyl-methyl ether maleic acid copolymer in improving plaque control and gingival health: a systematic review

OBJECTIVE: To compare the effectiveness of triclosan/copolymer and fluoride dentifrices in improving plaque control and gingival health. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE (1986 to March 2003) and EMBASE (1986 to March 2003). Personal files and the reference lists of all articles were checked for further studies. SELECTION CRITERIA: Trials were selected if they met the following criteria: random allocation of participants; participants were adults with plaque and gingivitis; unsupervised use of dentifrices for at least 6 months; and primary outcomes - plaque and gingivitis after 6 months. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted information. For each plaque and gingivitis index, the mean differences for each study were pooled as weighted mean differences (WMDs) with the appropriate 95% confidence intervals (CIs) using the random effect models. MAIN RESULTS: Sixteen trials provided data for the meta-analysis. The triclosan/copolymer dentifrice significantly improved plaque control compared with a fluoride dentifrice, with a WMD of -0.48 (95% CI: -0.64 to -0.32) for the Quigley-Hein index and WMD of -0.15 (95% CI: -0.20 to -0.09) for the plaque severity index. When compared with a fluoride dentifrice, the triclosan/copolymer dentifrice significantly reduced gingivitis with WMDs -0.26 (95% CI: -0.34 to -0.18) and -0.12 (95% CI: -0.17 to -0.08) for the Loe and Silness index and gingivitis severity index, respectively.     

Clinical and microbiologic effects of commercially available gel and powder containing Acacia arabica on gingivitis

Background: There is a need for an anti‐plaque agent that can be used on a daily basis without the side effects of antibacterial chemicals such as chlorhexidine. The present study was designed to evaluate the clinical and microbiologic effects of commercially available gel and powder containing Acacia arabica in subjects with gingivitis. Methods: One hundred and twenty subjects with chronic generalized gingivitis were selected and randomly divided into four groups: Group 1 – placebo group; Group 2 –Acacia arabica gel group; Group 3 –Acacia arabica powder group; and Group 4 – 1% chlorhexidine gel group. Microbial counts of plaque samples, the gingival index of Loe and Silness and the plaque index were evaluated at baseline, 6 weeks, 12 weeks and 24 weeks. Microbial counts of plaque samples were evaluated at all visits. Results: Acacia arabica gel and powder showed significant clinical improvement in gingival and plaque index scores as compared to a placebo. This improvement was comparable to 1% chlorhexidine gel. The difference between gel and powder with regard to clinical and microbiological parameters was not found to be significant at any time interval. Conclusions: Both Acacia arabica gel and powder may be useful herbal formulations for chemical plaque control in subjects with gingivitis.     

Comparison between electric toothbrushing and manual toothbrushing, with and without oral irrigation, for oral hygiene of orthodontic patients

This study evaluated the effectiveness of one electric toothbrush and oral irrigation system in comparison with manual toothbrushing in 20 orthodontic patients. Twenty patients performed four oral hygiene routines for at least 4 weeks each. The routines included manual toothbrushing alone, electric toothbrushing alone, manual toothbrushing plus irrigation, and electric toothbrushing plus irrigation. Baseline plaque and gingival scores were recorded, and both indices were again recorded after each routine. The index used to evaluate gingival health was a slight modification of the Silness and L?e gingival index, while the plaque index was similar to the patient hygiene performance (PHP) index developed by Podshadley and Haley. The average overall scores for plaque and gingival condition for all patients who used each of the four oral hygiene routines were compared with a repeated-measures, analysis-of-variance statistical evaluation. The values obtained from the analysis showed that there were no significant differences between the means for plaque and gingival health in each group. The probabilities that these conclusions are incorrect are 18% for plaque and 2% for gingival health. Testing for validity of the data was done by more than one researcher, with consistent results.     

Effects of supervised daily dental plaque removal by children after 3 years

The benefits of a school-based plaque removal program are presented. Children in grades 5-8 were included in a study which was designed to determine the effect on oral hygiene, gingival inflammation and dental caries of removing dental plaque through supervised daily flossing and toothbrushing in school. A fluoride-free dentifrice was used. Controls did not receive instruction in plaque removal procedures nor did they engage in plaque removal activities at school. For three school years the students in the treatment group practiced daily plaque removal, supervised by trained personnel. All participants were examined initially for plaque (PHP), gingival inflammation (DHC) and dental caries (DMFS). Girls in the treatment group showed a significant reduction (28%) in mean plaque scores and, for girls and boys, the mean changes in gingivitis scores were significantly reduced (40% and 17%, respectively). Adjusted mean incremental DMF surface scores were 13 % lower in the treatment group than in the control group. The difference between groups was not statistically significant and was accounted for entirely by the findings in mesial and distal surfaces (26%). This difference approached statistical significance (P= 0.07).     

Effect of mouth rinsing and toothbrushing with fluoride solutions on caries among Norwegian schoolchildren

ABSTRACT The caries experience and the plaque and gingival conditions of 14-year-old children participating in fortnightly fluoride (0.2% NaF) mouth rinsing (88 subjects) were compared with observations in children performing supervised toothbrushing with a fluoride (0.5% NaF) solution 4–5 times per year (n= 90). Most of the children, 84 and 90% respectively, had participated in these programs for the previous 6 years. Caries was assessed only on radiographs. The mean number of decayed surfaces was 5.8 (s.d. = 4.1, n= 88) and 5.4 (s.d. = 4.1, n= 90). The mean numbers of decayed and filled surfaces were 19.3 ± 9.2 and 27.9 ± 10.2 for subjects with rinsing or brushing. This significant difference could not be ascribed to sex, social class, years of residence in the towns, number of dentists performing the previous treatments, toothbrushing habits, use of fluorides at home, or amount of plaque. All children had gingivitis. There were no differences in the mean number of Plaque Index score 2 or the number of Gingival Index score 2 between the children with the different preventive programs. The girls ‘oral hygiene was better than the boys’, but the gingival conditions were the same. Sex, social class, and toothbrushing techniques tended to have a slight influence on the amount of plaque.     

Oral hygiene compliance and gingivitis expression in cigarette smokers

Abstract – The compliance with an oral hygiene intervention program and its effect on oral cleanliness and gingivitis was studied in smokers and non-smokers. The study group represented patients with regular dental attendance. It comprised 68 patients 21-60 yr of age, including 28 habitual smokers. The program included toothbrushing with an electric toothbrush for 12 months. Oral cleanliness was evaluated according to a percentage plaque index and gingivitis according to the percentage of bleeding sites. The compliance with the oral hygiene program was very high among smokers and non-smokers. Plaque index at baseline was very similar in smokers and non-smokers and remained so during the course of the investigation. Following the introduction of the oral hygiene program, plaque index decreased in both groups, and there were no statistically significant differences between the two groups. In spite of the similarity in plaque index, gingival bleeding was significantly lower in smokers than non-smokers. The results suggest that smokers and non-smokers do not differ with respect to habitual oral hygiene or compliance with hygiene programs. In smokers, however, the clinical gingivitis expression in response to plaque is suppressed.     

The effect of supervised oral hygiene on the gingiva of children

The effect of prolonged supervision of tooth brushing on gingival health and oral hygiene in a group of school children 12–13 years of age was investigated. The subjects were divided into one experimental group and one control group, each of 32 children. A specially trained dental nurse supervised the daily tooth brushing of the members of the experimental group. The control group members were not subjected to any form of supervised or controlled oral hygiene procedure. The gingival state and the oral hygiene were recorded according to index systems proposed by Löe & Silness (1963) and Silness & Löe (1964). The data obtained from an examination in 1965 were compared with those from a re-examination in 1966, i.e. after two years and three years of supervised tooth brushing. The two examinations revealed that: Mean GI values of 0.22 and 0.24 in the experimental group and 0.78 and 0.95 in the control group were obtained at the first and second examination. The difference between the two groups at each examination was found to be statistically significant at the 0.1 per cent level. An increase in gingivitis occurred during the year that elapsed between the two examinations. The increase was noted in both groups, but was small and statistically insignificant in the experimental group, whereas in the control group the difference was greater and statistically significant at the 5 per cent level. In the control group, the condition of the gingivae worsened during the study in all four regions examined. Of all tooth areas, 75 per cent showed an increase in gingivitis. In the experimental group, a significant decrease in gingivitis was noted in the anterior region of both the upper and the lower jaw, whereas the state of the gingivae found the molars had worsened. Of all areas examined, 56 per cent showed improved gingival health. The individual mean plaque index for all teeth in the experimental group was 0.70 compared with 1.62 in the control group The mean GI-differences between the examinations in 1965 and 1966 showed that, in spite of the great difference in GI found already at the first examination (GI in the experimental group only 1/4th of that in the control group), the gingival condition in the experimental group had improved compared with that in the control group during the test year.     

Smoking and caries experience in subjects with various form of periodontal diseases from a teaching hospital clinic

Abstract: Objective: The aim of this study was to assess the relationships between aggressive periodontitis (AgP), caries and smoking. Method and materials: A cross‐sectional study was conducted among patients who were specifically referred to the Dental Teaching Clinic in Irbid, Jordan for periodontal treatment. Self‐administered questionnaire related to socio‐demographic data and smoking habits was completed. The oral hygiene, gingival status, periodontal health and dental status of the participants was determined by using the plaque index of Silness and Loe [Acta Odontol Scand, 22 (1964), 121], the gingival index of Loe and Silness [Acta Odontol Scand, 21 (1963), 233], clinical attachment level (CAL) and decayed, missing and filled teeth (DMFT) index respectively. Result: The prevalence of smoking was greater in chronic periodontitis (CP) group (44.2%) than in either chronic gingivitis (CG) (27.4%) or AgP (29.9%) group. Self‐reported perio‐diseases in the close family was more prevalent (77%) among subjects diagnosed with AgP. The mean plaque scores were significantly higher for smoker than non‐smoker in AgP group only (P = 0.04), with significantly greater plaque and gingival scores in CG and CP groups than AgP group (P = 0.012, 0.004). A significantly greater mean gingival scores were noted among CG and CP groups than AgP group (P = 0.004). The mean CAL was higher in smokers than in non‐smokers in the three groups, with statistically significant differences in CP and AgP groups (P = 0.04, 0.01 respectively).The mean number of DMFT was significantly higher in smoker than in non‐smoker of all age groups (P = 0.016, 0.043 and 0.01). However, mean DMFT was significantly greater in CP and CG than AgP groups. Conclusion: It was concluded that (i) higher plaque and gingival index among smokers in all groups; (ii) significant difference in the CAL between smoker and non‐smoke in CP and AgP groups; (iii) significant increase in caries risk among smokers in all groups; (iv) smokers and non‐smokers of AgP group had significantly lower mean DMFT scores than those of CG or CP groups.     

Oral hygiene compliance and gingivitis expression in cigarette smokers

The compliance with an oral hygiene intervention program and its effect on oral cleanliness and gingivitis was studied in smokers and non-smokers. The study group represented patients with regular dental attendance. It comprised 68 patients 21-60 yr of age, including 28 habitual smokers. The program included toothbrushing with an electric toothbrush for 12 months. Oral cleanliness was evaluated according to a percentage plaque index and gingivitis according to the percentage of bleeding sites. The compliance with the oral hygiene program was very high among smokers and non-smokers. Plaque index at baseline was very similar in smokers and non-smokers and remained so during the course of the investigation. Following the introduction of the oral hygiene program, plaque index decreased in both groups, and there were no statistically significant differences between the two groups. In spite of the similarity in plaque index, gingival bleeding was significantly lower in smokers than non-smokers. The results suggest that smokers and non-smokers do not differ with respect to habitual oral hygiene or compliance with hygiene programs. In smokers, however, the clinical gingivitis expression in response to plaque is suppressed.     

A practice-based randomised controlled trial of the efficacy of an electric and a manual toothbrush on gingival health in patients with fixed orthodontic appliances

Objectives. The aim of the present study was to evaluate the efficacy of an electric toothbrush with a specially designed orthodontic brush head compared with a manual toothbrush in controlling plaque and gingivitis in patients with fixed orthodontic appliances over an 8-week period in a dental practice setting.

Methods. This was a randomised controlled, single blind, stratified, parallel group trial conducted in two specialist orthodontic dental practices by a specialist orthodontist. Group 1 comprised 41 subjects who used the electric toothbrush and Group 2 consisted of 43 subjects who brushed with a manual toothbrush around the orthodontic appliance for a timed 2 minutes twice daily for 8 weeks.

Plaque around the fixed appliance attachments was measured using an orthodontic modification to the Silness and Loe plaque index, while gingival condition was scored using the gingival index and Eastman interdental bleeding index.

Results. There was baseline balance for all clinical variables (p>0.05). Both groups had significantly less plaque after 8 weeks than at baseline (p<0.001) but the group using the electric brush also had significantly less interdental gingival bleeding, as determined by the Eastman interdental bleeding index both at week 4 (p<0.001) and week 8 (p=0.004). The majority of subjects (n=54, 64.3%) preferred the electric toothbrush.

Conclusions. In conclusion, the results from this study would suggest that use of an electric toothbrush with an orthodontic brush head may be of benefit in promoting gingival health in fixed orthodontic appliance patients; however, the long-term effects (over at least 6 months) need to be evaluated.     

Dental diseases in a Jordanian population on renal dialysis.

OBJECTIVE: The aim of this study was to examine the levels of periodontal disease and dental caries in individuals on renal dialysis in a Jordanian population. METHOD AND MATERIALS: A total of 47 individuals (mean age = 42.9 years, standard deviation [SD] 12.5) were examined for plaque deposits, gingivitis, periodontitis, and dental caries using the Silness and L?e plaque index (PII), L?e and Silness gingival index (GI), probing pocket depth (PPD), and decayed, missing, or filled teeth (DMFT), respectively. Gingival recession also was recorded using the distance from the cementoenamel junction to the gingival margin. Patients were categorized into three subgroups based on their renal dialysis histories: on dialysis for less than 1 year; on dialysis for 1 to 3 years; or on dialysis longer than 3 years. RESULTS: There were no statistically significant differences in PII, GI, PPD, and gingival recession among the three subgroups examined. The GI revealed that 55% scored more than 2, indicating moderate to severe gingivitis. None of the individuals in this study displayed an absence of gingival inflammation. DMFT index showed that there were statistically significant differences between subjects on renal dialysis for less than 1 year and subjects on dialysis for 1 to 3 years and more than 3 years. The group DMFT index mean was 8.5 (SD 2.88). CONCLUSION: Gingival and dental diseases are prevalent in the renal dialysis population. The dental community's awareness of the implication of poor oral health within this population should be elevated and daily oral health maintenance should be reinforced by the dialysis team.     

Effect of amine fluoride/stannous fluoride toothpaste and mouthrinse on dental plaque accumulation and gingival health

Objective: The aim was to investigate the influence of amine fluoride (AmF)/stannous fluoride (SnF₂) containing toothpaste and mouthrinse on plaque accumulation and gingival health of young adults after 4 weeks use. Subject and methods: Forty‐two young adults (mean age: 28.33 ± 7.19 years) were examined for the Plaque Index (PI; Silness and Löe, 1964 ) and Gingival Index (GI; Löe and Silness, 1963 ) scores, and divided randomly into two groups. Both groups used AmF/SnF₂ containing toothpaste twice a day for 3 min toothbrushing, and one group after toothbrushing rinsed with AmF/SnF₂ containing mouthrinse for 30 s. After 4 weeks the probands were re‐examined. Results: Statistically significant decrease in dental plaque (PI) and gingival (GI) index values were found at the end of the study. The reduction of PI and GI values was significant in all groups but it was higher in the combined (toothpaste + mouthrinsing) group, than using toothpaste only. Conclusion: The regular combined use of AmF/SnF₂ toothpaste and mouthrinse was more effective in the reduction of plaque accumulation and maintenance of gingival health than the toothpaste alone.     

Efficacy of mouthrinses in inhibiting dental plaque and gingivitis in man

The aim of the present trial was to determine the effect of different mouthwash preparations used as supplements to regular oral hygiene measures on dental plaque and gingivitis in humans. 96 volunteers were recruited for the study. Following a baseline examination, each subject was given a careful prophylaxis, following which the mouthrinse regimens were initiated. During the 6 weeks of trial, the subjects continued to exercise their regular non-supervised, self-performed plaque control measures. The 96 volunteers were assigned either to 1 or 3 different treatment groups or to a control group according to a randomized code. The members of the control group and the listerine group rinsed with 20 ml of the mouthrinse for 30 s, twice daily, while the members of the chlorhexidine groups (using either a 0.2% or a 0.1% solution) rinsed with 10 ml of the antiseptic solution for 60 s twice daily. Examinations regarding extrinsic stain and plaque were performed at baseline and after 3 and 6 weeks, while the conditions of the gingiva were examined at baseline and after 6 weeks. Extrinsic stain was evaluated using the Lobene index, plaque was assessed by the Turesky modification of Quigley-Hein index and the gingival condition was examined using the gingival index system of Loe & Silness. The results of the trial demonstrated that the 3 active mouthwash preparations used as supplements to regular tooth cleaning measures markedly improved both the oral hygiene status and the gingival conditions of the participating human volunteers, compared to the control rinse.(ABSTRACT TRUNCATED AT 250 WORDS)     

Oral hygiene and gingival condition among 12-year-old children in the Brussels Region

The study analyses oral hygiene and gingival status in a group of 12-yr-old children from the Region of Brussels. In 1998, a total of 496 children from eight selected schools participated in the sample. All children were interviewed about their socio-economic status and oral health care. Records of the plaque index and the gingival index were made. The mean plaque and gingivitis were 1.24 (+/- 0.03) and 1.32 (+/- 0.03), respectively. Seventy percent of the examined sites presented plaque and gingivitis. Privileged children showed lower means than non-privileged counterparts. Multiple linear regression showed that dental plaque was significantly associated to age, toothbrushing and appointment in case of discomfort or pain (P = 0.02). Age, gender, type of the toothbrush and use of dental floss were associated to gingivitis (P = 0.05). Daily home-based mechanical plaque removal is critical for the maintenance of gingival health and when efficiently performed it leads to remission of gingivitis. Dentists should be encouraged to give information and training on regular plaque removal to their patients.