Comparison of oral hygiene diagnosis using oral clinical examination and photography based on global oral health scale

Document Type: Original Article(s)


1 Dentist, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran

2 Associate Professor, Oral and Dental Diseases Research Center AND Kerman Social Determinants on Oral Health Research Center AND Department of Oral Medicine, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran


BACKGROUND AND AIM: The present study aims in assessing the compliance in diagnosis of oral hygiene by means of clinical examination, oral photography, and Global Oral Health Scale criteria.METHODS: The total number of 100 patients referring to the school of dentistry was examined regarding the teeth decay, cavities, as well as gum and periodontal conditions. Finally, 20 patients were selected among them and the standard registered intraoral photos were provided from each of them in order to prepare an archive. The completed archive was examined by 60 specialists and specialist residents and 100 general dentists. The participants were requested to grade oral health of each patient based on the photographs. Grading system was as follows: very good (0), good (1), medium (2), and poor (3). The results of reviews were analyzed by Kruskal-Wallis test, t-test, chi-square, and Bonferroni correction via SPSS software. P-value of less than 0.05 was considered significant.RESULTS: 94 persons or 59.1% correctly diagnosed the oral hygiene of 7 to 12 patients based on the photography. However, the number of the correct diagnoses did not exceed more than 14 cases by none of the participants. The overestimation was observed in 84.1% (134 persons) of the participants about the case number 10 (one 1st-grade patient) and also underestimation in the case number 1 (one 3rd-grade patient). The female participants showed higher compliance regarding the 2nd grade (P = 0.001), while male participants showed higher compliance regarding the 1st grade (P = 0.002). In addition, statistically significant differences were attained with respect to the field of specialization of respondents. General dentists had the highest conformity rate in their answer to grade one, and periodontists and postgraduate students had highest conformity rates reported for grades 2 and 3.CONCLUSION: The results revealed that compared to the patients’ photography, utilizing the Global Oral Health Scale as an innovative indicator can be very useful, especially for the patients with perfect or weak oral hygiene, epidemiological studies, and comparisons of different populations.


  1. Baehni PC, Takeuchi Y. Anti-plaque agents in the prevention of biofilm-associated oral diseases. Oral Dis 2003; 9(Suppl 1): 23-9.
  2. Han K, Park JB. Age threshold for moderate and severe periodontitis among Korean adults without diabetes mellitus, hypertension, metabolic syndrome, and/or obesity. Medicine (Baltimore) 2017; 96(33): e7835.
  3. Albandar JM. Epidemiology and risk factors of periodontal diseases. Dent Clin North Am 2005; 49(3): 517-vi.
  4. Bourgeois DM, Llodra JC, Nordblad A, Pitts NB. Report of the EGOHID I Project. Selecting a coherent set of indicators for monitoring and evaluating oral health in Europe: Criteria, methods and results from the EGOHID I project. Community Dent Health 2008; 25(1): 4-10.
  5. Montero J, Yarte JM, Bravo M, Lopez-Valverde A. Oral health-related quality of life of a consecutive sample of Spanish dental patients. Med Oral Patol Oral Cir Bucal 2011; 16(6): e810-e815.
  6. Paquette DW. The periodontal infection-systemic disease link: A review of the truth or myth. J Int Acad Periodontol 2002; 4(3): 101-9.
  7. Weidlich P, Cimoes R, Pannuti CM, Oppermann RV. Association between periodontal diseases and systemic diseases. Braz Oral Res 2008; 22(Suppl 1): 32-43.
  8. Bahekar AA, Singh S, Saha S, Molnar J, Arora R. The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: A meta-analysis. Am Heart J 2007; 154(5): 830-7.
  9. Zhou X, Wang Z, Song Y, Zhang J, Wang C. Periodontal health and quality of life in patients with chronic obstructive pulmonary disease. Respir Med 2011; 105(1): 67-73.
  10. Pizzo G, Guiglia R, Lo Russo L, Campisi G. Dentistry and internal medicine: From the focal infection theory to the periodontal medicine concept. Eur J Intern Med 2010; 21(6): 496-502.
  11. Kaur S, Khurana P, Kaur H. A survey on acquaintance, orientation and behavior of general medical practitioners toward periodontal diseases. J Indian Soc Periodontol 2015; 19(3): 322-6.
  12. Relvas M, Diz P, Seoane J, Tomas I. Oral health scales: Design of an oral health scale of infectious potential. Med Oral Patol Oral Cir Bucal 2013; 18(4): e664-e670.
  13. Relvas M, Limeres J, Tomas I, Cabral C, Velazco C, Diz P. Evaluation of an oral health scale of infectious potential using a telematic survey of visual diagnosis. Med Oral Patol Oral Cir Bucal 2013; 18(4): e633-e640.
  14. Perrie H, Scribante J. A survey of oral care practices in South African intensive care units. S Afr Med J 2011; 27(2): 42-6.
  15. Ellis-Smith C, Evans CJ, Bone AE, Henson LA, Dzingina M, Kane PM, et al. Measures to assess commonly experienced symptoms for people with dementia in long-term care settings: A systematic review. BMC Med 2016; 14: 38.
  16. Azodo CC, Ezeja EB, Ehizele AO, Ehigiator O. Oral assessment and nursing interventions among Nigerian nurses-knowledge, practices and educational needs. Ethiop J Health Sci 2013; 23(3): 265-70.
  17. Heikkinen AM, Pakbaznejad Esmaeili E, Kovanen L, Ruokonen H, Kettunen K, Haukka J, et al. Periodontal initial radiological findings of genetically predisposed finnish adolescents. J Clin Diagn Res 2017; 11(7): ZC25-ZC28.
  18. Chalmers JM, Pearson A. A systematic review of oral health assessment by nurses and carers for residents with dementia in residential care facilities. Spec Care Dentist 2005; 25(5): 227-33.
  19. Haleem A, Siddiqui MI, Khan AA. Oral hygiene assessment by school teachers and peer leaders using simplified method. Int J Health Sci (Qassim) 2012; 6(2): 174-84.
  20. Virtanen E, Nurmi T, Soder PO, Airila-Mansson S, Soder B, Meurman JH. Apical periodontitis associates with cardiovascular diseases: A cross-sectional study from Sweden. BMC Oral Health 2017; 17(1): 107.
  21. Kiyak HA. Does orthodontic treatment affect patients' quality of life? J Dent Educ 2008; 72(8): 886-94.
  22. Jamieson LM, Paradies YC, Gunthorpe W, Cairney SJ, Sayers SM. Oral health and social and emotional well-being in a birth cohort of Aboriginal Australian young adults. BMC Public Health 2011; 11: 656.
  23. Levin L, Bechor R, Sandler V, Samorodnitzky-Naveh G. Association of self-perceived periodontal status with oral hygiene, probing depth and alveolar bone level among young adults. N Y State Dent J 2011; 77(1): 29-32.
  24. Page RC, Eke PI. Case definitions for use in population-based surveillance of periodontitis. J Periodontol 2007; 78(7 Suppl): 1387-99.
  25. Assaf AV, Meneghim Mde C, Zanin L, Mialhe FL, Pereira AC, Ambrosano GM. Assessment of different methods for diagnosing dental caries in epidemiological surveys. Community Dent Oral Epidemiol 2004; 32(6): 418-25.
  26. Kingman A, Albandar JM. Methodological aspects of epidemiological studies of periodontal diseases. Periodontol 2000 2002; 29: 11-30.
  27. Leroy R, Eaton KA, Savage A. Methodological issues in epidemiological studies of periodontitis--how can it be improved? BMC Oral Health 2010; 10: 8.