Clinical Oral Investigations

, Volume 23, Issue 2, pp 651–659 | Cite as

Predictors of dental plaque and gingivitis in patients receiving integrated dental treatment—a longitudinal retrospective study

  • Bárbara Rocha Christofoli
  • Natália Caldeira Silva
  • João Augusto Peixoto Oliveira
  • Marilene Issa Fernandes
  • Alex Nogueira HaasEmail author
Original Article



The identification of predictors of supragingival biofilm accumulation may improve the results of therapeutic strategies for dental caries and periodontal diseases in general clinical practice. This study aimed to determine predictors of changes in visible plaque (VP) and gingival bleeding (GB) during integrated dental care.

Materials and methods

A retrospective longitudinal study was conducted by a census of patients receiving integrated dental care in a general clinical practice ambulatory at the Federal University of Rio Grande do Sul (Brazil). The sample comprised 91 charts of patients attended over a 6-months period. Gender, age, patient’s main complaint, oral hygiene pattern, and clinical data were recorded from charts for the last two dental visits in the ambulatory. Changes in VP and GB were modeled by multiple linear regression and beta coefficients (b) were reported.


The mean follow-up time was 13 months. Significant reductions in VP (32.8 ± 27.9 to 17.4 ± 19.4%; p < 0.001) and GB (27.1 ± 23.8 to 18.5 ± 17.3%; p < 0.001) were observed. Higher plaque reductions were predicted by higher baseline VP levels (p = 0.02), shorter time (< 12 months) elapsed between VP recordings (b = 14.1%, p = 0.02), interproximal cleansing (b = 11.9%, p = 0.03), lower number of sessions for oral hygiene instruction (b = 13.7%, p = 0.02), and presence of pockets ≥ 6 mm (b = − 12.4%, p = 0.02). GB was predicted by time of follow-up > 12 months and baseline VP.


Plaque and gingivitis improved in patients under integrated dental care. Factors related to motivation, oral hygiene practices, and baseline periodontal status might be used as predictors of VP and GB changes.

Clinical relevance

Visible plaque and gingivitis reduced in a sample of patients treated under integrated dental care. Some predictors may determine for which patients the treatment may be maximize and those who will need greater efforts to achieve the therapeutic goal for oral hygiene.


Dental plaque Gingivitis Risk factors Cohort study 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Loe H, Theilade E, Jensen SB (1965) Experimental gingivitis in man. J Periodontol 36:177–187CrossRefGoogle Scholar
  2. 2.
    Costalonga M, Herzberg MC (2014) The oral microbiome and the immunobiology of periodontal disease and caries. Immunol Lett 162(2 Pt A):22–38CrossRefGoogle Scholar
  3. 3.
    Sanz M, Beighton D, Curtis MA, Cury JA, Dige I, Dommisch H, Ellwood R, Giacaman RA, Herrera D, Herzberg MC, Könönen E, Marsh PD, Meyle J, Mira A, Molina A, Mombelli A, Quirynen M, Reynolds EC, Shapira L, Zaura E (2017) Role of microbial biofilms in the maintenance of oral health and in the development of dental caries and periodontal diseases. Consensus report of group 1 of the Joint EFP/ORCA workshop on the boundaries between caries and periodontal disease. J Clin Periodontol 44 Suppl 18:S5–S11CrossRefGoogle Scholar
  4. 4.
    Oppermann RV et al (2015) Epidemiology of periodontal diseases in adults from Latin America. Periodontol 2000 67(1):13–33CrossRefGoogle Scholar
  5. 5.
    Albandar JM, Kingman A (1999) Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. J Periodontol 70(1):30–43CrossRefGoogle Scholar
  6. 6.
    Marsh PD, Head DA, Devine DA (2015) Ecological approaches to oral biofilms: control without killing. Caries Res 49(Suppl 1):46–54CrossRefGoogle Scholar
  7. 7.
    Kalesinskas P, Kačergius T, Ambrozaitis A, Pečiulienė V, Ericson D (2014) Reducing dental plaque formation and caries development. A review of current methods and implications for novel pharmaceuticals. Stomatologija 16(2):44–52Google Scholar
  8. 8.
    Haas AN, Wagner TP, Muniz FWMG, Fiorini T, Cavagni J, Celeste RK (2016) Essential oils-containing mouthwashes for gingivitis and plaque: meta-analyses and meta-regression. J Dent 55:7–15CrossRefGoogle Scholar
  9. 9.
    Renz A, et al (2007) Psychological interventions to improve adherence to oral hygiene instructions in adults with periodontal diseases. Cochrane Database Syst Rev (2): CD005097Google Scholar
  10. 10.
    Stenman J, Lundgren J, Wennström JL, Ericsson JS, Abrahamsson KH (2012) A single session of motivational interviewing as an additive means to improve adherence in periodontal infection control: a randomized controlled trial. J Clin Periodontol 39(10):947–954CrossRefGoogle Scholar
  11. 11.
    Broadbent JM, Thomson WM, Boyens JV, Poulton R (2011) Dental plaque and oral health during the first 32 years of life. J Am Dent Assoc 142(4):415–426CrossRefGoogle Scholar
  12. 12.
    Euzebio Alves VT, de Andrade AK, Toaliar JM, Conde MC, Zezell DM, Cai S, Pannuti CM, de Micheli G (2013) Clinical and microbiological evaluation of high intensity diode laser adjutant to non-surgical periodontal treatment: a 6-month clinical trial. Clin Oral Investig 17(1):87–95CrossRefGoogle Scholar
  13. 13.
    Betsy J, Prasanth CS, Baiju KV, Prasanthila J, Subhash N (2014) Efficacy of antimicrobial photodynamic therapy in the management of chronic periodontitis: a randomized controlled clinical trial. J Clin Periodontol 41(6):573–581CrossRefGoogle Scholar
  14. 14.
    Haas AN, de Castro GD, Moreno T, Susin C, Albandar JM, Oppermann RV, Rösing CK (2008) Azithromycin as an adjunctive treatment of aggressive periodontitis: 12-months randomized clinical trial. J Clin Periodontol 35(8):696–704CrossRefGoogle Scholar
  15. 15.
    Wilder RS, Bray KS (2016) Improving periodontal outcomes: merging clinical and behavioral science. Periodontol 2000 71(1):65–81CrossRefGoogle Scholar
  16. 16.
    Rothman KJ, Greenland S (2005) Causation and causal inference in epidemiology. Am J Public Health 95(Suppl 1):S144–S150CrossRefGoogle Scholar
  17. 17.
    Beck JD (1998) Risk revisited. Community Dent Oral Epidemiol 26(4):220–225CrossRefGoogle Scholar
  18. 18.
    Sakki TK, Knuuttila ML, Anttila SS (1998) Lifestyle, gender and occupational status as determinants of dental health behavior. J Clin Periodontol 25(7):566–570CrossRefGoogle Scholar
  19. 19.
    Kumar S, Tadakamadla J, Johnson NW (2016) Effect of toothbrushing frequency on incidence and increment of dental caries: a systematic review and meta-analysis. J Dent Res 95(11):1230–1236CrossRefGoogle Scholar
  20. 20.
    Ainamo J, Bay I (1975) Problems and proposals for recording gingivitis and plaque. Int Dent J 25(4):229–235Google Scholar
  21. 21.
    Axelsson P, Nystrom B, Lindhe J (2004) The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. Results after 30 years of maintenance. J Clin Periodontol 31(9):749–757CrossRefGoogle Scholar
  22. 22.
    Research, Science and Therapy Committee of the American Academy of Periodontology (2001) Treatment of plaque-induced gingivitis, chronic periodontitis, and other clinical conditions. J Periodontol 72(12):1790–1800CrossRefGoogle Scholar
  23. 23.
    van der Weijden F, Slot DE (2011) Oral hygiene in the prevention of periodontal diseases: the evidence. Periodontol 55(1):104–123CrossRefGoogle Scholar
  24. 24.
    Melo P, Marques S, Silva OM (2017) Portuguese self-reported oral-hygiene habits and oral status. Int Dent J 67(3):139–147CrossRefGoogle Scholar
  25. 25.
    Kassebaum NJ, Bernabé E, Dahiya M, Bhandari B, Murray CJ, Marcenes W (2014) Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res 93(11):1045–1053CrossRefGoogle Scholar
  26. 26.
    Marcenes W, Kassebaum NJ, Bernabé E, Flaxman A, Naghavi M, Lopez A, Murray CJL (2013) Global burden of oral conditions in 1990-2010: a systematic analysis. J Dent Res 92(7):592–597CrossRefGoogle Scholar
  27. 27.
    Salzer S et al (2015) Efficacy of inter-dental mechanical plaque control in managing gingivitis—a meta-review. J Clin Periodontol 42(Suppl 16):S92–S105CrossRefGoogle Scholar
  28. 28.
    Brown LJ, Loe H (1993) Prevalence, extent, severity and progression of periodontal disease. Periodontol 2000 2:57–71CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Bárbara Rocha Christofoli
    • 1
  • Natália Caldeira Silva
    • 1
  • João Augusto Peixoto Oliveira
    • 1
  • Marilene Issa Fernandes
    • 1
  • Alex Nogueira Haas
    • 1
    Email author
  1. 1.Periodontology, Faculty of DentistryFederal University of Rio Grande do SulPorto AlegreBrazil

Personalised recommendations