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. 2019 Nov 14;9(2):e958. doi: 10.1002/mbo3.958

Table 1.

Anamnestic questionnaire

Patient number
Anamnestic questionnaire
Age
Gender
Current health Status
Do You suffer from chronic gastroesophageal reflux?
Do You suffer from diabetes?
Do You suffer from renal disease (chronic kidney failure)?
Did You undergo antibiotic treatment during the last 3 months?
If so, do You remember the medication?
Habits
Do You drink alcohol regularly? (more than three times a week)
Do You smoke?
Do You brush Your tongue? If yes, with what frequency?
Periodontal health status
Does the patient wear a removable prosthetic device?
Number of present teeth
Number of missing teeth
PSR INDEX
PSR™
Code 0 indicated periodontal health (neither bleeding on probing nor defective restoration margins and gingival sulcus depths <3.5 mm)
Code 1 indicated bleeding on probing, no defective restoration margins and a gingival sulcus depth <3.5 mm at a minimum of one site within the sextant
Code 2 indicated bleeding on probing, the presence of supra‐ or subgingival calculus, defective restoration margins, and a gingival sulcus depth <3.5 mm at a minimum of one site within the sextant
Code 3 indicated bleeding on probing and a pocket depth of 3.5–5.5 mm at a minimum of one site within the sextant

Code 4 indicated that a pocket depth >5.5 mm was present at a minimum of one site within the sextant

(American Dental Association and American Academy of Periodontology, 1992)

VSCs Analysis result