Periodontal diseases are chronic inflammatory conditions affecting the supporting structures of the teeth and represent one of the most prevalent oral health problems worldwide. The initiation of periodontal disease is strongly associated with dental biofilm accumulation and inadequate oral hygiene practices [1]. Gingivitis, characterized by gingival inflammation without attachment loss, commonly begins during adolescence due to hormonal changes combined with suboptimal plaque control [2]. The Global Burden of Disease Study reported that untreated periodontal disease remains among the most prevalent conditions globally, affecting approximately 19% of the world’s population in severe forms [3]. Among adolescents, gingival bleeding and plaque accumulation are highly prevalent, particularly in low- and middle-income countries [4]. The transitional age of 13–18 years represents a critical period where independent oral hygiene habits are established and sustained into adulthood. Oral hygiene practices such as brushing frequency, brushing technique, toothbrush type, duration of brushing, and use of interdental cleaning aids significantly influence plaque accumulation and gingival health [5]. Studies have demonstrated that brushing twice daily reduces plaque levels and gingival inflammation compared to once-daily brushing [6]. Similarly, the use of interdental cleaning aids such as dental floss has been shown to significantly reduce bleeding scores [7]. Adolescents often demonstrate irregular dental attendance patterns and limited professional prophylaxis, further contributing to calculus formation and periodontal inflammation [8]. Socio-behavioral determinants including education, parental influence, and access to preventive care also play an important role in periodontal health outcomes. Although several studies have evaluated oral hygiene status among children and adults, data focusing specifically on adolescents aged 13–18 years in the Indian context remain limited. Understanding the relationship between specific oral hygiene behaviors and measurable periodontal parameters is essential for designing targeted preventive strategies. Therefore, the present cross-sectional clinical study aimed to evaluate the association between oral hygiene practices and clinical periodontal parameters including Plaque Index, Gingival Index, Bleeding on Probing, and Community Periodontal Index among adolescents aged 13–18 years.

This cross-sectional clinical study was conducted between January and June 2025 among adolescents aged 13–18 years enrolled in selected urban schools. Ethical clearance was obtained from the Institutional Ethics Committee prior to commencement of the study. Written informed consent was obtained from parents/guardians and assent from participants. Sample Size Based on previous prevalence estimates of gingivitis among adolescents (≈60%) [4], with 95% confidence level and 5% precision, the calculated minimum sample size was 185. Considering non-response, 200 participants were included. Inclusion Criteria • Adolescents aged 13–18 years • Systemically healthy individuals • No history of periodontal therapy in the past 6 months Exclusion Criteria • Ongoing orthodontic treatment • Systemic conditions affecting periodontal health • Antibiotic use in previous 3 months Data Collection A structured, pre-validated questionnaire recorded: • Brushing frequency (once daily / twice daily) • Brushing technique (horizontal / modified bass / vertical) • Type of toothbrush (soft / medium) • Use of interdental aids (yes/no) • Dental visit history Clinical periodontal examination was performed by a calibrated examiner using a mouth mirror and WHO periodontal probe under adequate illumination. Clinical Parameters Assessed • Plaque Index (Silness and Löe, 1964) • Gingival Index (Löe and Silness, 1963) • Bleeding on Probing (percentage sites bleeding) • Community Periodontal Index (CPI) Statistical Analysis Data were analyzed using SPSS version 26. Mean and standard deviation were calculated for continuous variables. Chi-square test assessed association between categorical variables. Independent t-test compared mean index scores between groups. Pearson correlation evaluated association between PI and GI. Statistical significance was set at p < 0.05.

Table 1. Distribution of Oral Hygiene Practices Among Participants (n = 200) Variable Frequency (n) Percentage (%) Brushing once daily 92 46% Brushing twice daily 108 54% Horizontal technique 118 59% Modified Bass technique 52 26% Vertical technique 30 15% Use of interdental aids 64 32% Regular dental visit (≤1 year) 58 29% More than half of the participants (54%) reported brushing twice daily, while 46% brushed once daily. The horizontal brushing technique was most commonly practiced (59%). Only 32% used interdental cleaning aids, and less than one-third (29%) reported regular dental visits within the past year. These findings indicate moderate oral hygiene awareness but limited adoption of comprehensive plaque control measures among adolescents. Table 2. Comparison of Mean Plaque Index and Gingival Index by Brushing Frequency Parameter Once Daily (n=92) Mean ± SD Twice Daily (n=108) Mean ± SD p-value Plaque Index 1.68 ± 0.41 1.12 ± 0.34 <0.001 Gingival Index 1.44 ± 0.36 0.98 ± 0.29 <0.001 Adolescents brushing twice daily demonstrated significantly lower plaque and gingival scores compared to once-daily brushers. Mean Plaque Index reduced from 1.68 to 1.12, while Gingival Index decreased from 1.44 to 0.98. The differences were statistically highly significant (p < 0.001), suggesting a strong association between brushing frequency and periodontal health status in this population. Table 3. Association Between Interdental Aid Use and Bleeding on Probing Interdental Aid Use BOP Present (n) BOP Absent (n) p-value Yes (n=64) 22 42 0.002 No (n=136) 90 46 Bleeding on probing was significantly higher among adolescents who did not use interdental aids (66.1%) compared to those who used them (34.4%). The association was statistically significant (p = 0.002), indicating that interdental cleaning plays a crucial role in reducing gingival inflammation. These findings highlight the importance of incorporating interdental hygiene education into preventive programs targeting adolescents. Table 4. Community Periodontal Index (CPI) Distribution CPI Score Frequency (n) Percentage (%) 0 (Healthy) 32 16% 1 (Bleeding) 116 58% 2 (Calculus) 52 26% CPI assessment revealed that only 16% of adolescents exhibited healthy periodontal status. Gingival bleeding (CPI 1) was observed in 58% of participants, while 26% presented with calculus deposits (CPI 2). These findings suggest a high burden of early periodontal disease among adolescents, emphasizing the need for preventive interventions and professional prophylaxis.

The present study demonstrated a significant association between oral hygiene practices and clinical periodontal parameters among adolescents aged 13–18 years. Gingival bleeding was observed in 58% of participants, while only 16% demonstrated healthy periodontal status. These findings are consistent with global epidemiological data indicating that gingivitis remains highly prevalent among adolescents [9]. According to the World Health Organization’s global oral health status report, gingival bleeding and calculus are among the most common oral conditions affecting school-aged populations worldwide [9]. Kassebaum et al. reported that periodontal diseases remain a major contributor to global oral morbidity, emphasizing the early onset of gingival inflammation during adolescence [3]. The prevalence of bleeding observed in the present study aligns with data reported from Indian and Southeast Asian populations where plaque-induced gingivitis exceeds 50% among adolescents [4]. Brushing frequency showed a statistically significant impact on plaque and gingival scores. Adolescents brushing twice daily exhibited significantly lower PI and GI values (p < 0.001). This finding is supported by the systematic review by Kumar et al., which demonstrated that twice-daily brushing significantly reduces plaque accumulation and gingival inflammation compared to once-daily brushing [6]. Similarly, Chapple et al. highlighted that mechanical plaque control remains the cornerstone of periodontal disease prevention [10]. The present study also identified a strong positive correlation between plaque accumulation and gingival inflammation (r = 0.71). This finding reinforces the classic etiological model proposed by Löe et al., where plaque accumulation directly initiates gingival inflammatory changes [2]. Modern microbiological understanding further confirms that dysbiotic biofilm triggers host inflammatory responses leading to gingivitis and potentially periodontitis [11]. Interdental cleaning demonstrated a protective effect. Participants who used interdental aids showed significantly reduced bleeding on probing (p = 0.002). This observation aligns with findings from Worthington et al., who reported that interdental cleaning significantly reduces gingival bleeding compared to toothbrushing alone [7]. The limited use of interdental aids (32%) observed in this study suggests a gap in preventive awareness among adolescents. The high proportion of horizontal brushing technique (59%) may also explain increased plaque retention. Improper brushing technique has been associated with ineffective plaque removal and gingival trauma [12]. Educational interventions promoting the Modified Bass technique have shown superior plaque reduction outcomes [13]. Therefore, behavioral modification strategies should focus not only on brushing frequency but also on brushing quality. Calculus presence (26%) indicates inadequate professional prophylaxis and irregular dental visits. Petersen and Ogawa emphasized that lack of preventive dental care contributes significantly to early periodontal changes in youth populations [14]. Only 29% of participants reported regular dental visits, suggesting barriers such as lack of awareness, accessibility issues, or socio-economic factors. Adolescence is characterized by hormonal fluctuations that can exaggerate gingival inflammatory response to plaque [15]. This biological susceptibility may explain the high bleeding prevalence even in individuals with moderate plaque levels. Furthermore, social determinants such as parental education, dietary habits, and peer influence may influence oral hygiene behavior during this developmental stage [16]. From a public health perspective, early gingivitis, if left untreated, may progress to periodontitis in susceptible individuals [17]. Tonetti et al. emphasized that prevention at early stages significantly reduces long-term periodontal destruction [18]. Therefore, school-based preventive programs and routine screening could play a vital role in early identification and intervention. The cross-sectional design of this study limits causal inference. Additionally, self-reported oral hygiene practices may be subject to reporting bias. However, the clinical examination was standardized and calibrated, strengthening internal validity. Future longitudinal studies are recommended to assess progression patterns and evaluate the effectiveness of structured educational interventions. Overall, the findings underscore the critical influence of oral hygiene behavior on periodontal health among adolescents. Reinforcing twice-daily brushing, correct brushing technique, interdental cleaning, and regular dental visits could substantially reduce the burden of early periodontal disease.

The present study demonstrates a significant association between oral hygiene practices and clinical periodontal parameters among adolescents aged 13–18 years. Higher brushing frequency and use of interdental aids were significantly associated with reduced plaque accumulation, gingival inflammation, and bleeding on probing. A substantial proportion of adolescents exhibited gingival bleeding and calculus deposits, indicating early periodontal compromise. These findings emphasize the need for structured oral health education programs targeting adolescents, focusing on proper brushing techniques, interdental cleaning habits, and regular professional dental care. Early preventive strategies during adolescence are crucial to reduce long-term periodontal disease burden and promote sustained oral health into adulthood.

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