Identification and evaluation of adequate oral hygiene behavior: The development of the MondiX®

It is well-established among (oral) health professionals that oral hygiene behavior is an essential aspect of general health throughout life. Nevertheless, adequate oral hygiene behavior (OHB) is not simply a matter of daily removal of dental plaque by ‘just tooth brushing and flossing'. The MondiX® was developed as an index for assessing and evaluating oral hygiene behavior. Based on the worldwide consensus of oral health professionals, the MondiX® contains the most relevant details of oral hygiene behavior as recommended by the American Dental Association (ADA). Although there is little evidence for the effectiveness of all the detailed components, the ADA recommends a daily regimen of at least brushing (using a soft (or electric) toothbrush; brushing for at least two minutes twice a day; once after breakfast and once before going to sleep; brushing softly, without pressure; brushing stepwise by making small strokes –sort of massage– near the gum); thorough interdental cleaning (i.e., use of floss, tooth sticks, or interdental brushes at least once a day); using toothpaste containing fluoride; and tongue cleaning. The MondiX© has been applied in many different populations, has a good internal consistency, and the total scores are in general normally distributed. To promote public health, the MondiX® is a useful instrument to adjust oral hygiene related interventions specifically to the targeted individuals and populations.