Inclusion Criteria:  patients attending El kasr el Aini hospital at the department of periodontology. patients whose above 18 years old of both genders patients consulting the outpatient clinic provide informed consent  Exclusion Criteria:  less than 18 years old patients having problems opening their mouth or undergoing inter maxillary fixation where oral examination will not be possible patients diagnosed with psychiatric problems or intoxicated with alcohol or drugs patients with gingival hyperplasia patients with extracted maxillary anterior teeth