Factors associated with self-perception of gingival bleeding and dental plaque: a cross-sectional epidemiological study.

PURPOSE. The aim of this cross-sectional study was to correlate patients’ perception of gingival bleeding and dental plaque with the Full Mouth Bleeding Score (FMBS) and the Full Mouth Plaque Score (FMPS), as recorded by an expert examiner. A second aim was to investigate the factors that influenced the perception of the presence of gingival bleeding and dental plaque at different sites in the mouth. MATERIALS AND METHODS. The patients filled out a questionnaire investigating sociodemographic variables and behavioural factors such as the individuals’ perception of their oral health (including a visual analogue scale on the perception of own gingival bleeding [VAS-B]) and oral hygiene habits (including a visual analogue scale regarding the effectiveness of own oral hygiene manoeuvres in removing dental plaque [VAS-OH]). An operator, with the aid of a mirror, recorded the sites that, according to the patients’ perception, had plaque or bleeding. Then, an expert examiner, blinded to the patient’s perception, recorded the FMBS and FMPS. Descriptive statistics, correlation analyses and multilevel logistic models were employed. RESULTS. One hundred subjects were enrolled in this study. Mean VAS-B was 2.4±2.3, and mean VAS-OH was 6.6±1.7, while FMBS and FMPS were respectively 6.1±1.7 and 43.3±12.5. The correlation coefficient between VAS-B and FMBS was 0.51 (95%CI from 0.35 to 0.64, P <0.0001), and between VAS-OH and FMPS it was -0.25 (95%CI from -0.42 to -0.05, P = 0.0134). Only 7.6% of the bleeding on probing sites were recognized as bleeding sites by patients. Bleeding perception was higher in smokers (odds ratio = 3.67, 95%CI from 1.14 to 11.80, P=0.0292), and at the upper teeth (OR = 2.33, 95%CI from 1.16 to 4.68, P = 0.0170) and front teeth (incisors vs. premolars OR = 10.0, 95%CI 3.33 to 25.0, P <0.0001). Only 21.5% of plaque sites were recognized as such by patients. Plaque perception was higher at the molars (molars vs. incisors OR = 22.4, 95%CI from 15.8 to 31.7, P <0.0001) and at lingual sites (OR = 2.60, 95%CI from 2.09 to 3.23, P <0.0001). CONCLUSIONS. A fair correlation was observed between bleeding perception and FMBS. However, there was a discrepancy between the perception of the bleeding sites and the sites that actually bled on probing: the anterior or upper teeth were perceived as bleeding more, while much less bleeding was perceived at the lower and posterior teeth. A weak negative correlation was observed between patients’ oral hygiene self-report scores and the observed presence of dental plaque; patients perceived low bacterial plaque at premolars and incisors, as compared to molars.