Is there a safe dental plaque index to prevent periodontal diseases related to plaque? A systematic review and meta-analysis.




Dental plaque index; Gingivitis; Chronic periodontitis; Systematic review; Health promotion.


Periodontitis is a chronic multifactorial inflammatory disease associated with a dysbiotic biofilm and characterized by progressive destruction of the tooth-supporting apparatus. This systematic review aimed to establish the quantitative association between dental plaque index and plaque-induced periodontal outcomes, as well as, clinical plaque index (PI) cut-off points. MEDLINE electronic searches were performed with at least two outcomes (healthy, G or P). 124 articles met the eligibility criteria and were included in meta‐analysis. Healthy (H) group had a PI three times lower than G group (ROM 3.21; 95% CI 2.35-4.39) and P group (ROM 3.34; 95% CI 2.97-3.76); P group had 32% higher PI than G group (ROM 1.32; 95% CI 1.15-1.50). The meta‐analyses of different PI (Silness and Löe, PI-SL; and percentage of faces, PI-%), PI-SL H group (MRAW 0.52) differed from G group (MRAW 1.58) and P group (MRAW 1.83) although it was not possible to distinguish the G group (95% CI 1.28-1.89) from the P group (95% CI 1.67-1.98). This was also observed in the PI-% (MRAW 22% H, MRAW 68% G and P group). PI was able to distinguish periodontal health individuals from whom with periodontal conditions associated with plaque. This systematic review proposes the following PI values cutoff points: H group lower than 0.7 (PI-SL), 30% (PI-%); G group 0.7 to 1.6 (PI-SL) or 31% to 60% (PI-%); and P group up to 1.6 (PI-SL) or 60% (PI-%). The results have clinical application on health promotion and disease prevention through population-based interventions.


Ainamo J. & Bay I. (1975, December). Problems and proposals for recording gingivitis and plaque. Int Dent J. 25(4):229-35.

Airila-Mansson S., Soder B. & Klinge B. (2005). Bone height changes in individuals with periodontal disease: a 17-year prospective longitudinal study. Journal of Clinical Periodontology. 32(7):822-827.

Akalin F. A., Toklu E. & Renda N. (2005). Analysis of superoxide dismutase activity levels in gingiva and gingival crevicular fluid in patients with chronic periodontitis and periodontally healthy controls. Journal of Clinical Periodontology. 32(3):238-243.

Akpinar A., Toker H., Ozdemir H., Bostanci V. & Aydin H. (2013). The effects of non-surgical periodontal therapy on oxidant and anti-oxidant status in smokers with chronic periodontitis. Archives of Oral Biology. 58(6):717-723.

Anovazzi G., Finoti L. S, Corbi S. C. T., Kim Y. J., Marcaccini A. M., Gerlach R. F.,et al. (2013). Interleukin 4 haplotypes of susceptibility to chronic periodontitis are associated with IL-4 protein levels but not with clinical outcomes of periodontal therapy. Human Immunology. 74(12):1688-1695.

Armitage G. C. (1999, December). Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 4(1):1-6.

Atabay V. E., Lutfioğlu M., Avci B., Sakallioglu E. E. & Aydoğdu A. (2017). Obesity and oxidative stress in patients with different periodontal status: a casecontrol study. Journal of Periodontal Research. 52(1): 51-60.

Ay Y. Z., Sütçü R., Uskun E., Bozkurt F. & Berker E. (2009). The impact of the IL-11:IL-17 ratio on the chronic periodontitis pathogenesis: a preliminary report. Oral Diseases. 15(1):93-99.

Ay Z. Y., Kırzıoğlu F. Y., Öztürk M. O., Sütçü R. & Kapucuoğlu N. (2012). The gingiva contains leptin and leptin receptor in health and disease. Odontology. 100(2):222-231.

Balci Yuce H., Karatas Ö., Tulu F., Altan A. & Gevrek F. (2018, October). Effect of diabetes on collagen metabolism and hypoxia in human gingival tissue: a stereological, histopathological, and immunohistochemical study. Biotechnic & Histochemistry. 65-73.

Baltacıoğlu E., Kehribar M. A., Yuva P., Alver A., Atagün Ö. S., Karabulut E. & Akalın F. A. (2014a). Total Oxidant Status and Bone Resorption Biomarkers in Serum and Gingival Crevicular Fluid of Patients With Periodontitis. Journal of Periodontology. 85(2):317-326.

Baltacıoğlu E., Yuva P., Aydın G., Alver A., Kahraman C., Karabulut E. & Akalın F. A. ( 2014b). Lipid Peroxidation Levels and Total Oxidant/Antioxidant Status in Serum and Saliva From Patients With Chronic and Aggressive Periodontitis. Oxidative Stress Index: A New Biomarker for Periodontal Disease? Journal of Periodontology. 85(10):1432-1441.

Banu S., Jabir N. R., Mohan R., Manjunath N. C., Kamal M. A., Vinod Kumar K. R., et al. (2015). Correlation of Toll-Like Receptor 4, Interleukin-18, Transaminases, and Uric Acid in Patients With Chronic Periodontitis and Healthy Adults. Journal of Periodontology. 86(3):431-439.

Bascones-Martínez A., Muñoz-Corcuera M. & Meurman J. H. (2009, December). Odontogenic infections in the etiology of infective endocarditis. Cardiovasc Hematol Disord Drug Targets. 9(4):231-5.

Becerik S., Afacan B., Oztürk V. O., Atmaca H. & Emingil G. (2011). Gingival crevicular fluid calprotectin, osteocalcin and cross-linked N-terminal telopeptid levels in health and different periodontal diseases. Dis Markers. 31(6):343-52.

Becerik S., Öztürk V. Ö., Celec P., Kamodyova N., Atilla G. & Emingil G. (2017, November). Gingival crevicular fluid and plasma oxidative stress markers and TGM-2 levels in chronic periodontitis. Archives of Oral Biology. 83:47-54.

Bhardwaj S., Prabhuji M. L. V. & Karthikeyan B. (2015). V. Effect of non-surgical periodontal therapy on plasma homocysteine levels in Indian population with chronic periodontitis: a pilot study. Journal of Clinical Periodontology. 42(3):221-227.

Borenstein M., Hedges L. V., Higgins J. P. & Rothstein H. R. (2010, April). A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 1(2):97-111.

Bostanci V., Toker H., Senel S., Ozdemir H. & Aydin H. (2014). Effect of Chronic Periodontitis on Serum and Gingival Crevicular Fluid Oxidant and Antioxidant Status in Patients With Familial Mediterranean Fever Before and After Periodontal Treatment. Journal of Periodontology. 85(5):706-712.

Bostanci V., Toker H., Senel S., Poyraz O., Akpinar A., Görgün E. P. & Bakar O. (2016). Evaluation of IL-1β, IL-1ra, and IL-10 levels and outcome of periodontal therapy in chronic periodontitis with familial Mediterranean fever. Clinical Oral Investigations. 21(1):469-475.

Buduneli N., Kardessler L., Issik H., Willis C. S., Hawkins S. I., Kinane D. F. & Scott D. A. (2006). Effects of smoking and gingival inflammation on salivary antioxidant capacity. Journal of Clinical Periodontology. 33(3):159-164.

Buduneli N., Larsson L., Bıyıkoğlu B., Renaud D. E., Bagaitkar J. & Scott D. A. (2011a). Fatty Acid Profiles in Smokers with Chronic Periodontitis. Journal of Dental Research. 90(1):47-52.

Buduneli N., Özçaka Ö. & Nalbantsoy A. (2011b). Salivary and Plasma Levels of Toll-Like Receptor 2 and Toll-Like Receptor 4 in Chronic Periodontitis. Journal of Periodontology. 82(6):878-884.

Çanakçi C. F., Çanakçi V., Tatar A., Eltas A., Sezer U., Çiçek Y. & Oztas S. (2009). Increased salivary level of 8-hydroxydeoxyguanosine is a marker of premature oxidative mitochondrial DNA damage in gingival tissue of patients with periodontitis. Archivum Immunologiae et Therapiae Experimentalis. 57(3):205-211.

Cetinkaya B., Guzeldemir E., Ogus E. & Bulut S. (2013). Proinflammatory and Anti-Inflammatory Cytokines in Gingival Crevicular Fluid and Serum of Patients With Rheumatoid Arthritis and Patients With Chronic Periodontitis. Journal of Periodontology. 84(1):84-93.

Chakraborty S., Tewari S., Sharma R. K. & Narula S. C. (2014). Effect of Non-Surgical Periodontal Therapy on Serum Ferritin Levels: An Interventional Study. Journal of Periodontology. 85(5):688-696.

Chapple I. L. C., Mealey B. L., Van Dyke T. E., Bartold P. M., Dommisch H., Eickholz P., et al. (2018, June). Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 89(Suppl 1):S74-S84.

Chen H., Zheng P., Zhu H., Zhu J., Zhao L., El Mokhtari N. E., et al. (2010). Platelet-activating factor levels of serum and gingival crevicular fluid in nonsmoking patients with periodontitis and/or coronary heart disease. Clinical Oral Investigations. 14(6):629-636.

Chen S. S., Wang K., Zhao J., Wu W. C., Wu Y. F. & Zhao L. (2016). Increased expression of triggering receptor expressed on myeloid cells 1 and 2 in inflamed human gingiva. Journal of Periodontal Research. 52(3): 512-521.

Choonharuangdej S., Chutinet A. & Kuphasuk Y. (2010). Crevicular Porphyromonas gingivalis-specific immunoglobulin A levels in healthy and periodontitisaffected Thai cohorts. Journal of Investigative and Clinical Dentistry. 2(1):43-50.

Cifcibasi E., Ciblak M., Kiran B., Badur S., Firatli E., Issever H. & Cintan S. (2015). The Role of Activated Cytotoxic T Cells in Etiopathogenesis of Periodontal Disease: Does It Harm or Does It Heal?. Scientific Reports. 5(1).

Dede O. F., Özden F. O. & Avcı B. (2013). 8-Hydroxy-Deoxyguanosine Levels in Gingival Crevicular Fluid and Saliva in Patients With Chronic Periodontitis After Initial Periodontal Treatment. Journal of Periodontology. 84(6):821-828.

Dede O. F., Balli U., Doğan B. Ş. & Güven B. (2016). Interleukin-32 levels in gingival crevicular fluid and saliva of patients with chronic periodontitis after periodontal treatment. Journal of Periodontal Research. 52(3):397-407.

Deepika P. C. R., & Saxena R.M. (2013, April). Comparison of glycosylated hemoglobin levels in severe periodontitis patients and healthy controls: a study in an Indian population. Quintessence Int. 44(4):319-25.

Delgado-Rodríguez M., & Sillero-Arenas M. (2018, October). Systematic review and meta-analysis. Med Intensiva (Engl Ed). 42(7):444-453.

Devanoorkar A., Dwarakanath C. D., Gundanavar G., Kathariya R. & Patil S. R. (2012). Evaluation of serum resistin levels in periodontal health and disease and effects of non surgical periodontal therapy on its levels. Dis Markers. 32(5):289-94.

Di Stefano M., Polizzi A., Santonocito S., Romano A., Lombardi T. & Isola G. (2022, May). Impact of Oral Microbiome in Periodontal Health and Periodontitis: A Critical Review on Prevention and Treatment. Int J Mol Sci. 5;23(9):5142.

Duarte, P. M., da Rocha M., Sampaio E., Mestnik M. J., Feres M., Figueiredo L. C., et al. (2010). Serum Levels of Cytokines in Subjects With Generalized Chronic and Aggressive Periodontitis Before and After Non-Surgical Periodontal Therapy: A Pilot Study. Journal of Periodontology. 81(7):1056-1063.

Duzagac E., Cifcibasi E., Erdem M. G., Karabey V., Kasali K., Badur S. & Cintan S. (2016). Is obesity associated with healing after non-surgical periodontal therapy? A local vs. systemic evaluation. Journal of Periodontal Research. 1(5):604–612.

Emingil G., Kuula H., Pirila E. & Atilla G., Sorsa T. (2006). Gingival crevicular fluid laminin-5 gamma2-chain levels in periodontal disease. Journal of Clinical Periodontology. 33(7):462-468.

Eren G., Türkoğlu O., Atmaca H. & Atilla G. (2016). Evaluation of gingival crevicular fluid cyclophilin a and extracellular matrix metalloproteinase inducer levels in different periodontal diseases. Archives of Oral Biology. 68: 162-166.

Ertugrul A. S., Dikilitas A., Sahin H., Alpaslan N., Bozoglan A. & Tekin, Y. (2013a). Gingival crevicular fluid levels of human beta-defensins 1 and 3 in subjects with periodontitis and/or type 2 diabetes mellitus: a cross-sectional study. Journal of Periodontal Research. 48(4):475-482.

Ertugrul A. S., Arslan U., Dursun R. & Sezgin Hakki S. (2013b). Periodontopathogen profile of healthy and oral lichen planus patients with gingivitis or periodontitis. International Journal of Oral Science. 5(2):92–97.

Figueiredo L. C., Rosetti E. P., Marcantonio E., Marcantonio R. A. C. & Salvador S. L. (2002). The Relationship of Oral Malodor in Patients With or Without Periodontal Disease. Journal of Periodontology. 73(11):1338-1342.

Fujita Y., Ito H., Sekino S. & Numabe Y. (2012). Correlations between pentraxin 3 or cytokine levels in gingival crevicular fluid and clinical parameters of chronic periodontitis. Odontology. 100(2):215-221.

Fukushima H., et al. (2017). PAR-2 expression in the gingival crevicular fluid reflects chronic periodontitis severity. Braz oral res. (31).

Gamel E. B., Hashim N. T., Satti A. & Gismalla B. G. (2017). Salivary TNFα levels in groups of subjects with rheumatoid arthritis and chronic periodontitis. BMC Res Notes. 10:34.

Genco R. J. & Borgnakke W. S. (2013, June). Risk factors for periodontal disease. Periodontol 2000. 62(1):59-94.

Ghallab N. A., Amr E. M. & Shaker O. G. (2015). Expression of Leptin and Visfatin in Gingival Tissues of Chronic Periodontitis With and Without Type 2 Diabetes Mellitus: A Study Using Enzyme-Linked Immunosorbent Assay and Real-Time Polymerase Chain Reaction. Journal of Periodontology. 86(7):882-889.

Gharbi A., Hamila A., Bouguezzi A., Dandana A., Ferchichi S., Chandad F., et al. (2019). Biochemical parameters and oxidative stress markers in Tunisian patients with periodontal disease. BMC Oral Health. 19(1):225.

Gheren L. W., Cortelli J. R., Rodrigues E., Holzhausen M. & Saad W. A. (2008). Periodontal therapy reduces arginase activity in saliva of patients with chronic periodontitis. Clinical Oral Investigations. 12(1):67-72.

Gimenez T., Bispo B. A., Souza D. P., Viganó M. E., Wanderley M. T., Mendes F. M., et al. (2016, October). Does the Decline in Caries Prevalence of Latin American and Caribbean Children Continue in the New Century? Evidence from Systematic Review with Meta-Analysis. PLoS One. 21;11(10):e0164903.

Godard A., Dufour T. & Jeanne S. (2011, December). Application of self-regulation theory and motivational interview for improving oral hygiene: a randomized controlled trial. J Clin Periodontol. 38(12):1099-105.

Goel K., Sharma S., Baral D. D. & Agrawal S. K. (2021, February). Current status of periodontitis and its association with tobacco use amongst adult population of Sunsari district, in Nepal. BMC Oral Health. 12;21(1):66.

Gokhale N. H., Acharya A. B., Patil V. S., Trivedi D. J. & Thakur S. L. A. (2013). Short-Term Evaluation of the Relationship Between Plasma Ascorbic Acid Levels and Periodontal Disease in Systemically Healthy and Type 2 Diabetes Mellitus Subjects. Journal of Dietary Supplements. 10(2):93-104.

Gokhale N. H., Acharya A. B., Patil V. S., Trivedi D. J., Setty S. & Thakur S. L. (2014). Resistin Levels in Gingival Crevicular Fluid of Patients With Chronic Periodontitis and Type 2 Diabetes Mellitus. Journal of Periodontology. 85(4):610-617.

Greene J. C., & Vermillion J. R. (1964, January). The Simplified Oral Hygiene Index. J Am Dent Assoc. 68:7-13.

Guentsch A., Pfister W., Cachovan G., Raschke G., Kuepper H., Schaefer O. & Eick S. (2014). Oral prophylaxis and its effects on halitosis-associated and inflammatory parameters in patients with chronic periodontitis. International Journal of Dental Hygiene. 12(3):199-207.

Gupta N., Gupta N. D., Gupta A., Khan S. & Bansal N. (2015). Role of salivary matrix metalloproteinase-8 (MMP-8) in chronic periodontitis diagnosis. Frontiers of Medicine. 9(1):72-76.

Haffajee A. D., Socransky S. S., Lindhe J., Kent R. L., Okamoto H. & Yoneyama T. (1991, February). Clinical risk indicators for periodontal attachment loss. J Clin Periodontol. 18(2):117-25.

Halladay C. W., Trikalinos T. A., Schmid I. T., Schmid C. H. & Dahabreh I. J. (2015, September). Using data sources beyond PubMed has a modest impact on the results of systematic reviews of therapeutic interventions. J Clin Epidemiol. 68(9):1076-84.

Hartenbach F. A. R. R., Silva-Boghossian C. M. & Colombo A. P. V. (2018, January). The effect of supragingival biofilm re-development on the subgingival microbiota in chronic periodontitis. Archives of Oral Biology. (85):51-57.

Haytural O., Yaman D., Ural E. C., Kantarci A. & Demirel K. (2015). Impact of periodontitis on chemokines in smokers. Clinical Oral Investigations. 19(5):979-986.

Hedges L. V., & Vevea J. L. (1998). Fixed- and random-effects models in meta-analysis. Psychological Methods. 3(4):486-504.

Hegde R., & Awan K. H. (2019, June). Effects of periodontal disease on systemic health. Dis Mon. 65(6):185-192.

Hendek M. K., Erdemir E. O. & Kisa U. (2015). Evaluation of Salivary Procalcitonin Levels in Different Periodontal Diseases. Journal of Periodontology. 86(6):820-826.

Hozo S. P., Djulbegovic B. & Hozo I. (2005, April). Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 20;5:13.

İlgenli T., Vardar-Sengul S., Gürkan A., Sorsa T., Stackelberg S., Köse T & Atilla G. (2006). Gingival crevicular fluid matrix metalloproteinase-13 levels and molecular forms in various types of periodontal diseases. Oral Diseases. 12(6):573-579.

Ishizuka M., Kato R., Moriya Y., Noguchi E., Koide Y., Inoue S., et al. (2017). Changes in apolipoprotein B and oxidized low-density lipoprotein levels in gingival crevicular fluids as a result of periodontal tissue conditions. Journal of Periodontal Research. 52(3):594-602.

Jaradat S., Hoder-Przyrembel C., Cubillos S., Krieg N., Lehmann K., Piehler S., et al. (2013). Beta-defensin-2 Genomic Copy Number Variation and Chronic Periodontitis. Journal of Dental Research. 92(11):1035-1040.

Javed F., Ahmed H. B., Saeed A., Mehmood A. & Bain C. (2014). Whole Salivary Interleukin-6 and Matrix Metalloproteinase-8 Levels in Patients With Chronic Periodontitis With and Without Prediabetes. Journal of Periodontology. 85(5):e130-e135.

Katarkar A., Saha A., Mukherjee S., Kundu D., Bandyopadhyay P. & Chaudhuri K. (2015). Telomerase Expression in Individuals With Chronic and Aggressive Periodontitis. Journal of Periodontology. 86(5):656-665.

Keles Z. P., Keles G. C., Avci B., Cetinkaya B. O. & Emingil G. (2014). Analysis of YKL-40 Acute-Phase Protein and Interleukin-6 Levels in Periodontal Disease. Journal of Periodontology. 85(9):1240–1246.

Kerdvongbundit V., Vongsavan N., Soo-ampon S. & Hasegawa A. (2003). Microcirculation and micromorphology of healthy and inflamed gingivae. Odontology. 91(1):19-25.

Khongkhunthian S., Techasatian P., Supanchart C., Bandhaya P., Montreekachon P., Thawanaphong S. & Krisanaprakornkit S. (2013). Elevated Levels of a Disintegrin and Metalloproteinase 8 in Gingival Crevicular Fluid of Patients With Periodontal Diseases. Journal of Periodontology. 84(4):520-528.

Khongkhunthian S., Kongtawelert P., Ongchai S., Pothacharoen P., Sastraruji T., Jotikasthira D. & Krisanaprakornkit S. (2014, August). Comparisons between two biochemical markers in evaluating periodontal disease severity: a cross-sectional study. BMC Oral Health. 30;14:107.

Konopka Ł., Pietrzak A. & Brzezińska-Błaszczyk E. (2012). Effect of scaling and root planing on interleukin-1β, interleukin-8 and MMP-8 levels in gingival crevicular fluid from chronic periodontitis patients. Journal of Periodontal Research. 47(6):681-688.

Köseoğlu S., Sağlam M., Pekbağrıyanık T., Savran L. & Sütçü R. (2015). Level of Interleukin-35 in Gingival Crevicular Fluid, Saliva, and Plasma in Periodontal Disease and Health. Journal of Periodontology. 86(8):964-971.

Kumar K. R. V, Ranganath V., Naik R., Banu S. & Nichani A. S. (2014). Assessment of high-sensitivity C-reactive protein and lipid levels in healthy adults and patients with coronary artery disease, with and without periodontitis - a cross-sectional study. Journal of Periodontal Research. 49(6): 836-844.

Kurşunlu S. F., Öztürk V. Ö., Han B., Atmaca H. & Emingil G. (2015). Gingival crevicular fluid interleukin-36β (-1F8), interleukin-36γ (-1F9) and interleukin-33 (1F11) levels in different periodontal disease. Archives of Oral Biology. 60(1):77-83.

Kurtiş B., Tüter G., Serdar M., Akdemir P., Uygur C., Firatli E. & Bal B. (2005). Gingival Crevicular Fluid Levels of Monocyte Chemoattractant Protein-1 and Tumor Necrosis Factor-Alpha in Patients With Chronic and Aggressive Periodontitis. Journal of Periodontology. 76(11):1849-1855.

Kwon T., Lamster I. B. & Levin L. (2021, December). Current Concepts in the Management of Periodontitis. Int Dent J. 71(6):462-476.

Laddha R., Mahajania M., Khadse A., Bajaj R., Jawade R. & Choube S. (2018, October). Assessment of Sirtuin 3 and Sirtuin 4 Level in Patients with Diabetes Mellitus and Periodontitis: A Clinical Study. J Contemp Dent Pract. 19(10):1199-1203.

Lakshmanan R., Jayakumar N. D., Sankari M., Padmalatha O. & Varghese S. (2014). Estimation of Pentraxin-3 Levels in the Gingival Tissues of Chronic and Aggressive Periodontitis Participants: An In Vivo Study. Journal of Periodontology. 85(2):290-297.

Larson J. S. (1991). The measurement of health: concepts and indicators. Greenwood.

Leite S. A. M., Casanovas R. C., Rodrigues V. P., Pereira A. F. V., Ferreira T. C. A. Nascimento F. R F., et al. (2019, September). The effect of nonsurgical periodontal therapy on hepcidin and on inflammatory and iron marker levels. Braz Oral Res. 9;33:e055.

Lertpimonchai A., Rattanasiri S., Arj-Ong Vallibhakara S., Attia J. & Thakkinstian A. (2017, December). The association between oral hygiene and periodontitis: a systematic review and meta-analysis. Int Dent J. 67(6):332-343.

Lihala R., Jayaram P., Chatterjee A. & Joshi A. (2019). Effect of non-surgical periodontal therapy on stress and salivary Chromogranin-A levels: A clinicobiochemical study. Indian Journal of Dental Research. 30(2):213-218.

Lin Y. C., Wu C. Y., Chang L. Y., Chen C. C., Chen H. H., Lai Y. L. & Hung S. L. (2017). Levels of high-mobility group box-1 in gingival crevicular fluid in nonsmokers and smokers with chronic periodontitis. Journal of the Formosan Medical Association. 116(12):933-939.

Löe H., & Silness J. (1963). Periodontal disease in pregnancy. I. Prevalenceand severity. Acta Odontol Scand. 21:533-51.

Mahajani M. J., Jadhao V. A., Wankhade P. S., Samson E., Acharya V. D. & Tekale P. D. (2017, November). Effect of Periodontal Therapy on Crevicular Fluid Interleukin-18 Level in Periodontal Health and Disease in Central Maharashtra (India) Population. J Contemp Dent Pract. 1;18(11):1085-1089.

Mariggio M. A., Guida L., Laforgia A., Santacroce R., Curci E., Montemurro P. & Fumarulo R. (2001). Nicotine effects on polymorphonuclear cell apoptosis and lipopolysaccharide-induced monocyte functions. A possible role in periodontal disease? Journal of Periodontal Research. 36(1):32-39.

Martinez G. L., Majster M., Bjurshammar N., Johannsen A., Figueredo C. M. & Boström E. A. (2017). Salivary Colony Stimulating Factor-1 and Interleukin-34 in Periodontal Disease. Journal of Periodontology. 88(8):e140-e149.

Muthu J., Muthanandam S., Mahendra J., Namasivayam A., John L. & Logaranjini A. (2015). Effect of Nonsurgical Periodontal Therapy on the Glycaemic Control of Nondiabetic Periodontitis Patients: A Clinical Biochemical Study. Oral Health Prev Dent. 13(3):261-6.

Naiff P. F., Ferraz R., Cunha C. F., Orlandi P. P., Boechat A. L., Bertho Á. L. & Dos-Santos M. C. (2014). Immunophenotyping in Saliva as an Alternative Approach for Evaluation of Immunopathogenesis in Chronic Periodontitis. Journal of Periodontology. 85(5):e111-e120.

Nguyen T. T., Ngo L. Q., Promsudthi A. & Surarit R. (2016). Salivary oxidative stress biomarkers in chronic periodontitis and acute coronary syndrome. Clinical Oral Investigations. 21(7):2345-2353.

Nimcharoen T., Aung W. P. P., Makeudom A., Sastraruji T., Khongkhunthian S., Sirinirund B., et al. (2019, January). Reduced ADAM8 levels upon non-surgical periodontal therapy in patients with chronic periodontitis. Archives of Oral Biology. 97:137-143.

Nogueira-Filho G., Rosa B. T., Santos P. F., Tunes U. R., Freire S. M., Meyer R. & Darveau R. P. (2014). Whole-Blood Cultures From Patients With Chronic Periodontitis Respond Differently to Porphyromonas gingivalis but not Escherichia coli Lipopolysaccharide. Journal of Periodontology. 85(2):e18-e23.

Novakovic N., Todorovic T., Rakic M., Milinkovic I., Dozic I., Jankovic S., et al. (2014). Salivary antioxidants as periodontal biomarkers in evaluation of tissue status and treatment outcome. Journal of Periodontal Research. 49(1):129-136.

Özçaka Ö., Nalbantsoy A. & Buduneli N. (2010). Salivary osteocalcin levels are decreased in smoker chronic periodontitis patients. Oral Diseases. 17(2):200-205.

Özcan E., Saygun N. I., Serdar M. A. & Kurt N. (2015). Evaluation of the salivary levels of visfatin, chemerin, and progranulin in periodontal inflammation. Clinical Oral Investigations. 19(4):921-928.

Özdemir B., Özmeric N., Elgün S. & Barış E. (2016). Smoking and gingivitis: focus on inducible nitric oxide synthase, nitric oxide and basic fibroblast growth factor. Journal of Periodontal Research. 51(5): 596-603.

Özmeriç N., Elgün S. & Uraz A. (2000). Salivary arginase in patients with adult periodontitis. Clinical Oral Investigations. 4(1):21-24.

Öztürk V. Ö., Belibasakis G. N., Emingil G. & Bostanci N. (2016). Impact of aging on TREM-1 responses in the periodontium: a cross-sectional study in an elderly population. BMC Infectious Diseases. 16(1).

Papathanasiou E., Teles F., Griffin T., Arguello E., Finkelma M., Hanley J. & Theoharides T. C. (2014). Gingival crevicular fluid levels of interferon-γ, but not interleukin-4 or -33 or thymic stromal lymphopoietin, are increased in inflamed sites in patients with periodontal disease. Journal of Periodontal Research. 49(1):55-61.

Pawar D. D. & Mehta D. S. (2015, May). Effect of phase 1 periodontal therapy on gingival crevicular fluid levels of matrix metalloproteinases-3 and -13 in chronic periodontitis patients. J Investig Clin Dent. 6(2):118-24.

Pejcic A., Kesic L., Ilic S., Pesic Z. & Mirkovic D. (2012). Association between chronic periodontitis and serum lipid levels. Military Medical and Pharmaceutical Journal of Serbia. 69(9):771-777.

Pereira A. L., Franco G. C., Cortelli S. C., Aquino D. R., Costa F. O., Raslan S. A. & Cortelli J. R. (2013). Influence of Periodontal Status and Periodontopathogens on Levels of Oral Human β-Defensin-2 in Saliva. Journal of Periodontology. - 84(10):1445-1453.

Pinho M. N., Oliveira R. D. R., Novaes Jr A. B. & Voltarelli J. C. (2009). Relationship between periodontitis and rheumatoid arthritis and the effect of non-surgical periodontal treatment. Brazilian Dental Journal. 20(5):355-364.

Pinho R. C. M, Dias R. S. A. M., Bandeira F., Rodrigues J. K. F., da Silva R. C., et al. (2019, February). Polymorphisms of the vitamin D receptor gene (FOKI, CDX2, and GATA) and susceptibility to chronic periodontitis in diabetic and non-diabetic individuals: A case-control study. J Investig Clin Dent. 10(1):e12370.

Purwar P., Khan M. A., Mahdi A. A., Pandey S., Singh B., Dixit J. & Sareen S. (2015). Salivary and Serum Leptin Concentrations in Patients With Chronic Periodontitis. Journal of Periodontology. 86(4):588-594.

Purwar P., Khan M. A., Gupta A., Mahdi A. A, Pandey S., Singh B., et al. (2015). The effects of periodontal therapy on serum and salivary leptin levels in chronic periodontitis patients with normal body mass index. Acta Odontologica Scandinavica. 73(8):633-641.

Qi Y., Feng W., Song A., Song H., Yan S., Sun Q. & Yang P. (2013). Role of Serum IL-23/IL-17 Axis in the Relationship Between Periodontitis and Coronary Heart Disease. The International Journal of Periodontics and Restorative Dentistry. 33(2):185-191.

Quigley G. A. & Hein J. W. (1962, July). Comparative cleansing efficiency of manual and power brushing. J Am Dent Assoc. 65:26-9.

Rice D. B., Kloda L. A., Levis B., Qi B., Kingsland E. & Thombs B. D. (2016, August). Are MEDLINE searches sufficient for systematic reviews and meta-analyses of the diagnostic accuracy of depression screening tools? A review of meta-analyses. J Psychosom Res. 87:7-13.

Richardson W. S., Wilson M. C., Nishikawa J. & Hayward R. S. (1995, Nov-Dec). The well-built clinical question: a key to evidence-based decisions. ACP J Club. 123(3):A12-3.

Roberts H. M., Ling M. R., Insall R., Kalna G., Spengler J., Grant M. M & Chapple I. L. C. (2015). Impaired neutrophil directional chemotactic accuracy in chronic periodontitis patients. Journal of Clinical Periodontology. 42(1):1-11.

Sakallıoğlu E. E., Lütfioğlu M., Sakallıoğlu U., Dıraman E. & Keskiner İ. (2008). Fluid dynamics of gingiva in diabetic and systemically healthy periodontitis patients. Archives of Oral Biology. 53(7):646-651.

Sánchez G., Miozza V., Delgado A., & Busch L. (2013). Relationship between salivary mucin or amylase and the periodontal status. Oral Diseases. 19(6):585-591.

Scannapieco F. A. (1995, June). Monitoring the efficacy of plaque control methods. Periodontol 2000. 8:24-41.

Silness J. & Löe H. (1964, February). Periodontal Disease in Pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 22:121-35.

Silva D. G., Stevens R. H., Macedo J. M. B., Albano R. M., Falabella M. E. V., Fischer R. G., et al. (2010). Presence of Helicobacter pylori in supragingival dental plaque of individuals with periodontal disease and upper gastric diseases. Archives of Oral Biology. 55(11): 896-901.

Silva H. A. B., Alves E. V. T., Spolidório L. C., Neto J. B. C., Eichler R. S., Carvalho M. H. C. & Holzhausen M. (2014). Expression of Protease Activated Receptor-1 in Chronic Periodontitis. Journal of Periodontology. 85(12):1763-1769.

Söder B., Yakob M., Meurman J. H., Andersson L. C. & Söder P. Ö. (2012, June). The association of dental plaque with cancer mortality in Sweden. A longitudinal study. BMJ Open. 11;2(3):e001083.

Staudte H., Sigusch B. W. & Glockmann E. (2005). Grapefruit consumption improves vitamin C status in periodontitis patients. British Dental Journal. 199(4):213-217.

Surna A., Kubilius R., Sakalauskiene J., Vitkauskiene A., Jonaitis J., Saferis V. & Gleiznys A. (2009). Lysozyme and microbiota in relation to gingivitis and periodontitis.Med Sci Monit. 15(2):CR66-73.

Sutton A. J., Abrams K. R., Jones D. R., Sheldon T. A. & Song F. (2000). Methods for Meta-Analysis in Medical Research. New York, NY:John Wiley.

Swaminathan V., Prakasam S., Puri V. & Srinivasan M. (2013, December). Role of salivary epithelial toll-like receptors 2 and 4 in modulating innate immune responses in chronic periodontitis. Journal of Periodontal Research. 48(6):757-65.

Tabari Z. A., Azadmehr A., Nohekhan A., Naddafpour N. & Ghaedi F. B. (2014). Salivary Visfatin Concentrations in Patients With Chronic Periodontitis. Journal of Periodontology. 85(8):1081-1085.

Tamaki N., Tomofuji T., Ekuni D., Yamanaka R., Yamamoto T. & Morita M. (2009). Short-Term Effects of Non-Surgical Periodontal Treatment on Plasma Level of Reactive Oxygen Metabolites in Patients With Chronic Periodontitis. Journal of Periodontology. 80(6):901-906.

Tarannum F. & Faizuddin M. (2016). Association between lipoxin A4 and interleukin-12 in gingival crevicular fluid: a preliminary investigation. Journal of Periodontal Research. 52(2): 210-217.

Tarannum F. & Faizuddin M. (2017). Effect of Alox-15 Polymorphism on GCF Levels of Lipoxin-A4 in Chronic Periodontitis: A Preliminary Study. Braz Dent J. 28(2).

Taşdemir Z., Etöz M., Köy Ö., Soydan D. & Alkan A. (2020, January). Masseter muscle thickness and elasticity in periodontitis. Journal of Oral Science. 29;62(1):43-47.

Taskan M. M., Karatas O., Yuce B. H., Kara I. G., Gevrek F. & Yarkac U. F. (2019, June). Hypoxia and collagen crosslinking in the healthy and affected sites of periodontitis patients. Acta Odontologica Scandinavica. 77(8):600-607.

Teles F. R., Teles R. P., Uzel N. G., Song X. Q., Torresyap G., Socransky S. S. & Haffajee A. D. (2012). Early microbial succession in redeveloping dental biofilms in periodontal health and disease. Journal of Periodontal Research. 47(1):95-104.

Tezel A., Yucel O., Orbak R., Kara C., Kavrut F., Yagiz H. & Sahin T. (2005). The gingival crevicular fluid ciprofloxacin level in subjects with gingivitis and periodontitis, and its effects on clinical parameters. Journal of Periodontal Research. 40(5):395-400.

To T. T., Gümüş P., Nizam N., Buduneli N. & Darveau R. P. (2015). Subgingival Plaque in Periodontal Health Antagonizes at Toll-Like Receptor 4 and Inhibits E-Selectin Expression on Endothelial Cells. Infection and Immunity. 84(1):120-126.

Toker H., Akpınar A., Aydın H. & Poyraz O. (2012). Influence of smoking on interleukin-1beta level, oxidant status and antioxidant status in gingival crevicular fluid from chronic periodontitis patients before and after periodontal treatment. Journal of Periodontal Research. 47(5):572-577.

Tonetti M. S., Greenwell H. & Kornman K. S. (2018, December). Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol. 2018 Jun;89 Suppl 1:S159-S172. doi: 10.1002/JPER.18-0006. Erratum in: J Periodontol. 89(12):1475.

Toyman U., Tüter G., Kurtiş B., Kıvrak E., Bozkurt Ş., Yücel A. A. & Serdar M. (2015). Evaluation of gingival crevicular fluid levels of tissue plasminogen activator, plasminogen activator inhibitor 2, matrix metalloproteinase-3 and interleukin 1-β in patients with different periodontal diseases. Journal of Periodontal Research. 50(1):44-51.

Tripathi V., Singh S. T., Sharma V., Verma A., Singh C. D. & Gill J. S. (2018, March). Assessment of Lipid Peroxidation Levels and Total Antioxidant Status in Chronic and Aggressive Periodontitis Patients: An in vivo Study. J Contemp Dent Pract. 19(3):287-291.

Trivedi S., Lal N., Mahdi A. A., Mittal M., Singh B. & Pandey S. (2014). Evaluation of Antioxidant Enzymes Activity and Malondialdehyde Levels in Patients With Chronic Periodontitis and Diabetes Mellitus. Journal of Periodontology. 85(5):713-720.

Trombelli L., Farina R., Silva C. O. & Tatakis D. N. (2018, June). Plaque-induced gingivitis: Case definition and diagnostic considerations. J Periodontol. 89 Suppl 1:S46-S73.

Turesky S., Gilmore N. D. & Glickman I. (1970). Reduced plaque formation by the chloromethyl analogue of Victamine C. J Periodontol. 41:41-3.

Türkoğlu O., Emingil G., Kütükçüler N. & Atilla G. (2009). Gingival Crevicular Fluid Levels of Cathelicidin LL-37 and Interleukin-18 in Patients With Chronic Periodontitis. Journal of Periodontology. 80(6):969-976.

Türkoğlu O., Emingil G., Kütükçüler N. & Atilla G. (2010). Evaluation of Gingival Crevicular Fluid Adrenomedullin and Human Neutrophil Peptide 1–3 Levels of Patients With Different Periodontal Diseases. Journal of Periodontology. 81(2):284-291.

Türkoğlu O., Kandiloğlu G., Berdeli A., Emingil G. & Atilla G. (2011). Antimicrobial peptide hCAP-18/LL-37 protein and mRNA expressions in different periodontal diseases. Oral Diseases. 17(1):60-67.

Tüter G., Özdemir B., Kurtiş B., Serdar M., Yücel A. A. & Ayhan E. (2013). Short term effects of non-surgical periodontal treatment on gingival crevicular fluid levels of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor 2 (PAI-2) in patients with chronic and aggressive periodontitis. Archives of Oral Biology. 58(4):391-396.

Tüter G., Kurtiş B. & Serdar M. (2002). Effects of Phase I Periodontal Treatment on Gingival Crevicular Fluid Levels of Matrix Metalloproteinase-1 and Tissue Inhibitor of Metalloproteinase-1. Journal of Periodontology. 73(5):487-493.

van der Weijden G. A. & Hioe K. P. (2005). A systematic review of the effectiveness of self-performed mechanical plaque removal in adults with gingivitis using a manual toothbrush. J Clin Periodontol. 32 Suppl 6:214-28.

van Enst W. A., Scholten R. J., Whiting P., Zwinderman A. H. & Hooft L. (2014, November). Meta-epidemiologic analysis indicates that MEDLINE searches are sufficient for diagnostic test accuracy systematic reviews. J Clin Epidemiol. 67(11):1192-9.

Vinayak M. J. & VandanaIndian K. L. (2007, Jan-Mar). The detection of eight putative periodontal pathogens in adult and rapidly progressive periodontitis patients: an institutional study. J Dent Res. 18(1):6-10.

Wan X., Wang W., Liu J. & Tong T. (2014, December). Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol. 19;14:135.

Wang H., Luo Z., Lei L., Sun Z., Zhou M., Dan H., et al. (2013). Interaction Between Oral Lichen Planus and Chronic Periodontitis with Th17-Associated Cytokines in Serum. Inflammation. 36(3):696-704.

Wei D., Zhang X. L., Wang Y. Z., Yang C. X. & Chen G. (2010). Lipid peroxidation levels, total oxidant status and superoxide dismutase in serum, saliva and gingival crevicular fluid in chronic periodontitis patients before and after periodontal therapy. Australian Dental Journal. 55(1):70-78.

Wei P. F., Ho K. Y., Ho Y. P., Wu Y. M., Yang Y. H. & Tsai C. C. (2004). The investigation of glutathione peroxidase, lactoferrin, myeloperoxidase and interleukin- 1beta in gingival crevicular fluid: implications for oxidative stress in human periodontal diseases. Journal of Periodontal Research. 39(5):287-293.

Yang J., Zhu Y., Duan D., Wang P., Xin Y., Bai L., et al. (2018, December). Enhanced activity of macrophage M1/M2 phenotypes in periodontitis. Archives of Oral Biology. 96:234-242.

Zheng P., Chen H., Shi S., Jepsen S. & Eberhard J. (2006). Periodontal parameters and platelet-activating factor levels in serum and gingival crevicular fluid in a Chinese population. Journal of Clinical Periodontology. 33(11):797-802.




How to Cite

AZEVEDO, C. L.; SILVA , L. R. V. da .; ALENCAR, C. O. .; BRAGA , M. M. .; BIAZEVIC , M. G. H. .; MICHEL CROSATO, E. . Is there a safe dental plaque index to prevent periodontal diseases related to plaque? A systematic review and meta-analysis. Research, Society and Development, [S. l.], v. 11, n. 7, p. e27511730100, 2022. DOI: 10.33448/rsd-v11i7.30100. Disponível em: Acesso em: 6 jul. 2022.



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