Relationship between plaque score and video-monitored brushing performance after repeated instruction--a controlled, randomised clinical trial

Comparison of modified bass, rolling, and current toothbrushing techniques for the efficacy of plaque control - A randomized trial

OBJECTS

This study aimed to compare the effectiveness of the modified Bass technique (MBT), the Rolling technique and the current brushing technique(CBT) for plaque removal and to assess the acceptability of the first two brushing techniques.

METHODS

180 participants were randomly assigned to PowerPoint-based training with a demonstration of either the MBT plus basic toothbrushing, the Rolling technique plus basic toothbrushing, or the basics of tooth brushing alone (CBT group). The participants were asked to brush their teeth based on what they had learned. The Turesky modification of the plaque index of Quigley & Hein (TQHI) and marginal plaque index (MPI) were assessed at the baseline examination and after 1, 2, and 4 weeks. Brushing sequence, brushing technique, and brushing duration were measured immediately after training and at each subsequent interview.

RESULTS

After instruction (0 weeks), all groups showed a significant decrease in TQHI and MPI (p<0.001), followed by a gradual increase. There was no difference in the overall effect of plaque removal between the groups(p>0.05). MBT had a better effect on cervical plaque removal than the Rolling technique after 4 weeks (p<0.05). More participants in the Rolling group were able to fully master the brushing technique during the whole four weeks.

CONCLUSIONS

There was no difference in the overall plaque removal effect among the three groups. The MBT was most effective in removing plaque at the cervical margin but more difficult to master.

CLINICAL SIGNIFICANCE STATEMENT

This study was conducted to compare the teaching and plaque removal effects of two brushing techniques and to understand which method is better for plaque removal as well as adoption. This study provides a reference and basis for future clinical work and oral hygiene education.

The Influence of Coordinative Skills on the Oral Health of Children and Adolescents in Permanent Dentition

Removing dental plaque by using a toothbrush is the most important measure for oral hygiene. The aim of the present study was to estimate the impact of the coordination skills of children and adolescents on their oral health (plaque level, DMF/T: decayed, missing, filled teeth). Within a prospective cohort study, 996 children (10 to 18 years) were examined. The results of three coordination tests from the Motorik Modul (MoMo) were included to evaluate the coordination skills. Other parameters taken into account were age, sex, orthodontic treatment and socioeconomic status (SES). Univariate and various multivariate analyses were performed to evaluate relationships. Better results in precision coordination tests were significantly related to a better oral hygiene (backward balancing: logistic regression OR 0.86, 95%CI: 0.73−0.99, p = 0.051, proportional odds model OR 0.86, 95%CI: 0.75−0.99, p = 0.037; one-leg-stand: logistic regression OR 0.78, 95%CI: 0.63−0.96, p = 0.018, proportional odds model OR 0.77, 95%CI: 0.64−0.92, p = 0.003). Higher scores on one-leg-stand were significantly related to a lower caries prevalence (logistic regression OR 0.81, 95%CI: 0.66−0.99, p = 0.037; Poisson regression exp(ß) 0.82, 95%CI: 0.74−0.91, p < 0.001). Coordination test under a time constraint (jumping side-to-side) showed no significant relation. Oral hygiene was poorer in younger children, boys and low SES. Caries prevalence increased with low SES and increasing age. The present results suggest that oral health is influenced by coordinative skills.

Interdental biofilm reduction and composition after use of an activated and inactivated side-to-side toothbrush - a proof-of-principle clinical study

OBJECTIVES

To evaluate interdental biofilm reduction and composition after powered toothbrushing with a side-to-side (sonic) toothbrush compared to manual toothbrushing following single brushing exercises in periodontally healthy young adults.

MATERIALS AND METHODS

All participants brushed with a side-to-side toothbrush without toothpaste in four different modes: toothbrush (a) inactivated without instruction (OFF-NI), (b) activated without instruction (ON-NI), (c) inactivated with instruction (OFF-I), and (d) activated with instruction (ON-I) at consecutive visits (single brushing exercises). Before and after brushing, the Approximal Plaque Index (API) was assessed at three interdental spaces and plaque samples were taken from two interdental sites. Biofilm reduction and composition were analyzed microbiologically by total bacterial load and 16S rRNA sequencing.

RESULTS

Thirty participants (age: 22.9 ± 2.5 years) completed the study. Most participants showed no or incomplete plaque removal assessed by API following single brushing exercises, while the frequency of API reduction was higher after ON-NI compared to OFF-I (p = 0.023). Irrespective of the brushing mode, a significant reduction of total bacterial load was detected with lower bacterial counts after OFF-NI compared to ON-NI (p = 0.008) and ON-I (p = 0.007). Biofilm composition showed slight changes in the relative abundances of bacterial taxa, regardless of the brushing mode.

CONCLUSIONS

Manual and powered toothbrushing with a side-to-side toothbrush, with and without instruction, showed incomplete interdental biofilm removal in periodontally healthy young adults following single brushing exercises.

CLINICAL RELEVANCE

Data has to be validated in further studies on other groups, however, in periodontally healthy young adults, additional devices seem to be necessary for sufficient interdental cleaning.

An oral care programme for adults- Evaluation after 15 years

The present retrospective analysis sought to investigate the impact of the oral care programme (OCP) for adults provided at the Department of Conservative and Preventive Dentistry, Justus-Liebig-University of Giessen, Germany, on oral health parameters. The OCP was modular and included oral hygiene instruction/professional toothcleaning, nutrition counselling, fluoridation and re-motivation. From 1999–2014, data from 1665 patients (55.1% female, 44.9% male; median age 33 years, range 15;80) were available. Type/date of modules, % of proximal sites with plaque (PP) and with bleeding after probing (PB) and D_3/4MFT/D_3/4MFS were recorded. PP and PB values are given as median (min;max). Overall, 60.2% of the patients attended the OCP once, 19.1% twice, and 20.7% ≥ three times. Initially, PP/PB were 0.68(0;1)/0.08(0;1) resp. decreasing at visit two (0.62(0;1)/0.07(0;1) resp.; p≤0.001 each) with no further improvement over next visits. Patients with poor oral hygiene improved, but those with good oral hygiene worsened (p≤0.001 each). Shorter intervals between visits were more effective than longer intervals. Attendance patterns changed significantly over the years: earlier, patients attended more visits with different modules; later, patients preferred the oral hygiene module and the intervals between visits lengthened. Prevalence and incidence of caries was associated with higher PP levels. Attendance patterns changed over time and had a significant impact on the outcome of the OCP. The improvement of oral hygiene was limited and occurred within the first two visits; repeated sessions maintained this improvement. The results indicate the need for new strategies improving patients’ skills for efficient hygiene techniques.

Randomised controlled trial on differential learning of toothbrushing in 6- to 9-year-old children

OBJECTIVES

This study aimed to evaluate the effect of differential learning of toothbrushing compared to habitual toothbrushing and instruction/demonstration of toothbrushing on plaque reduction and gingival inflammation of primary school children.

METHODS

Children (6-9 years) were subjected to a toothbrushing training consisting of 15 days (3 × 5 days, interval 2 days, 3 min/day) and randomly assigned to one of three groups (each n = 18): habitual toothbrushing/control, instruction/demonstration of toothbrushing, differential learning of toothbrushing. The differential learning approach comprised 15 different movement exercises (1/day), while instruction/demonstration of toothbrushing was based on repetitive practice of toothbrushing. Plaque (Turesky-modified Quigley-Hein plaque index (T-QHI)) and papilla bleeding (papilla bleeding index (PBI)) scores were assessed prior to the first toothbrushing (t0, baseline) and 21 (t1), 42 (t2) and 63 (t3) days after beginning of the study. Primary statistical analyses were performed with cumulative logit regression models with repeated measures. The global significance level was set to 5% two-sided.

RESULTS

At all time points, PBI and T-QHI were significantly reduced by differential learning compared to instruction/demonstration of toothbrushing and habitual toothbrushing. Compared to baseline, differential learning improved PBI and T-QHI significantly at all time points. In the other groups, no significant reduction of PBI compared to baseline was observed. T-QHI was significantly reduced by habitual toothbrushing only at t1 and by instruction/demonstration of toothbrushing at t1 and t2. Differential learning had an improved effect on posterior compared to anterior teeth.

CONCLUSION

Differential learning of toothbrushing improved plaque reduction and reduced gingival inflammation compared to habitual toothbrushing and instruction/demonstration of toothbrushing in 6- to 9-year-old children in mixed dentition.

CLINICAL RELEVANCE

Toothbrushing skills of children might be improved by differential learning.

TRIAL REGISTRATION

ISRCTN14951343, https://www.isrctn.com/ISRCTN14951343?

Using smartphone video "selfies" to monitor change in toothbrushing behavior after a brief intervention: A pilot study

BACKGROUND

Attempts to refine toothbrushing (TB) technique, an ingrained habit in adults, can meet with some challenges. Recently, the role of proactive interference as a barrier to improving the learning of proper brushing has been proposed. This pilot feasibility study was designed to investigate TB behavior and to see how it changes after training. Smartphone video "selfies" (SPVSs) are increasingly being used in the medical field to assess, monitor, and determine the progression of diseases.

MATERIALS AND METHODS

We used SPVS to study TB skills in a small sample of volunteers. Over a period of 14 days, after a one-time group training session, we observed TB behavior of volunteers using self-captured SPVS.

RESULTS

Following the brief intervention, we observed an 8% of improvement in TB skills.

DISCUSSION

To the best of our knowledge, this is the first report using SPVS to study TB behavior. We demonstrated initial feasibility of using SPVS in the dental setting. We observed modest improvements in toothbrushing accuracy and quality, and we generated important experiences about the use of Selfies for TB monitoring and intervention, and some interesting insights about where in the toothbrushing is more or less effective.

CONCLUSION

Further investigation using a larger sample size is needed to thoroughly assess the effectiveness of this approach to improve TB skills and better understand the role of proactive interference.

What is the best predictor for oral cleanliness after brushing? Results from an observational cohort study

BACKGROUND

Brushing performance is an important factor for brushing success. Thus, observing brushing performance might help to explain deficits in oral hygiene. However, it is unknown how brushing behavior observed at one time relates to brushing capabilities observed at another time. The authors assessed the predictive validity of video-observed habitual brushing behavior for the capability to achieve oral cleanliness several weeks later.

METHODS

Study participants (N = 101) were video-recorded while cleaning their teeth. Two independent, calibrated examiners assessed brushing duration, evenness of distribution of brushing time across areas of the mouth as one indicator of brushing systematics, and duration of specific brushing movements. Weeks later (mean: 6.4 weeks; range: 1 to 24 weeks), 70 participants were asked to remove plaque to the best of their ability, and degree of oral cleanliness was assessed immediately afterward. A forward regression analysis was performed to assess the predictive values of brushing parameters.

RESULTS

Regression analysis revealed that evenness of distribution of brushing time and duration of circling movements explained 20.8% of variance of oral cleanliness (P < 0.001).

CONCLUSION

Evenness of distribution of brushing time and duration of circling movements are aspects of observed habitual brushing behavior that predict brushing capabilities in terms of oral cleanliness.

Drilling Deeper into tooth brushing skills: Is proactive interference an under-recognized factor in oral hygiene behavior change?

Proper tooth brushing is a seemingly simple motor activity that can promote oral health. Applying health theories, such as the Information-Motivation-Behavioral Skills (IMB) model, Motivational Interviewing (MI) and Integrated Health Coaching (IHC), may help optimize tooth brushing technique in those with suboptimal skills. Some motor activities, including tooth brushing, may over time become rote and unconscious actions, such that an existing habit can inhibit new learning, i.e., exert proactive interference on learning the new skill. Proactive interference may impede the acquisition of new tooth brushing skills; thus, in this report, we: (1) Review how the habit of tooth brushing is formed; (2) Postulate how proactive interference could impede the establishment of proper tooth brushing retraining; (3) Discuss the merits of this hypothesis; and (4) Provide guidance for future work in this topic within the context of an approach to behavior change that integrates IMB, MI and IHC methodology.

Toothbrushing and flossing behaviour in young adults--a video observation

OBJECTIVES

Video observation studies of habitual oral hygiene from the 1970s revealed a striking neglect of brushing oral surfaces and unsystematic brushing patterns with frequent movements between areas. These findings were not systematically followed up; furthermore, nothing is known about whether subjects are able to floss sufficiently. Therefore, the aim of this video study was to analyse the performance of habitual toothbrushing and flossing.

METHODS

A random sample of 101 18-year-olds was included. Toothbrush and floss were provided; habitual brushing/flossing was videotaped in a standardised setting and analysed with the video coding software INTERACT. Parameters of interest were toothbrushing duration, type of brushing strokes, brushing patterns, flossed interproximal spaces and flossing technique.

RESULTS

The mean brushing duration was 156.0 ± 71.1 s; duration differed only slightly between the upper and lower jaw as well as between the right, left and anterior areas. However, oral surfaces were brushed distinctly shorter than vestibular surfaces (27.1 ± 27.8 s versus 72.1 ± 31.8 s; p ≤ 0.001). Participants brushed different areas of the mouth with different types of strokes, predominantly with horizontal and circular strokes. Brushing movements frequently alternated between areas (45.1 ± 22.4) not randomly but accumulated within a jaw with a tendency to move from the right to the left. Half of the participants flossed, but only one performed sufficiently.

CONCLUSIONS

There was a significant neglect of brushing oral surfaces and insufficient use of floss. Brushing patterns were similar to those observed in the 1970s.

CLINICAL RELEVANCE

Understanding habitual oral hygiene behaviour is essential for improving oral hygiene instruction strategies.

Influence of the utilization time of different manual toothbrushes on oral hygiene assessed during a 6-month observation period: a randomized clinical trial

BACKGROUND

The aim of this randomized clinical trial (RCT) was to investigate whether 6-month continuous use of different manual toothbrushes (TBs) influences plaque removal and the degree of gingival inflammation compared to short utilization periods of 4 weeks each.

METHODS

In total, 96 participants were randomly allocated into two groups: continuous use during 6 months (non-renewal group) or a change in TB every 4 weeks during 6 months (renewal group). Each group was subdivided into four subgroups (groups A to H; n = 12 each) according to the head size (normal or short) and bristle hardness (medium or soft) of the TB used. The modified Quigley-Hein plaque index (QHI), papilla bleeding index (PBI), and gingival index (GI) were recorded at baseline and 2, 8, 12, 16, and 24 weeks after baseline. After 24 weeks, each participant received a new TB, and at week 26, the final QHI, PBI, and GI were determined. The statistical evaluation consisted of analysis of covariance (P <0.05).

RESULTS

With time, QHI, PBI, and GI were significantly different between the renewal and the non-renewal groups (QHI: P = 0.02; PBI: P = 0.04; GI: P <0.01), independent of subgroup. In the renewal group, QHI showed a significant decrease between baseline and each follow-up visit (P <0.01). In the non-renewal group, there was a significant decrease compared to baseline up to and including week 16 (P <0.01). PBI in the renewal group showed no significant differences between baseline and each follow-up visit (P >0.05). In the non-renewal group, only the normal head/soft subgroup exhibited a significant increase at week 24 (P = 0.02). The GI in the renewal group showed no difference between baseline and all follow-up visits, whereas in the non-renewal group, there was a significant decrease up to and including week 12 (P <0.05).

CONCLUSIONS

Six-month continuous use reduced the effectiveness of the TB with respect to plaque removal, and gingival inflammation appeared to increase.

Brushing force of manual and sonic toothbrushes affects dental hard tissue abrasion

OBJECTIVES

This study aimed to determine the brushing forces applied during in vivo toothbrushing with manual and sonic toothbrushes and to analyse the effect of these brushing forces on abrasion of sound and eroded enamel and dentin in vitro.

MATERIALS AND METHODS

Brushing forces of a manual and two sonic toothbrushes (low and high frequency mode) were measured in 27 adults before and after instruction of the respective brushing technique and statistically analysed by repeated measures analysis of variance (ANOVA). In the in vitro experiment, sound and eroded enamel and dentin specimens (each subgroup n = 12) were brushed in an automatic brushing machine with the respective brushing forces using a fluoridated toothpaste slurry. Abrasion was determined by profilometry and statistically analysed by one-way ANOVA.

RESULTS

Average brushing force of the manual toothbrush (1.6 ± 0.3 N) was significantly higher than for the sonic toothbrushes (0.9 ± 0.2 N), which were not significantly different from each other. Brushing force prior and after instruction of the brushing technique was not significantly different. The manual toothbrush caused highest abrasion of sound and eroded dentin, but lowest on sound enamel. No significant differences were detected on eroded enamel.

CONCLUSION

Brushing forces of manual and sonic toothbrushes are different and affect their abrasive capacity.

CLINICAL SIGNIFICANCE

Patients with severe tooth wear and exposed and/or eroded dentin surfaces should use sonic toothbrushes to reduce abrasion, while patients without tooth wear or with erosive lesions confining only to enamel do not benefit from sonic toothbrushes with regard to abrasion.