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Deinzer R, Weik U, Eidenhardt Z, Leufkens D, Sälzer S. Manual toothbrushing techniques for plaque removal and the prevention of gingivitis-A systematic review with network meta-analysis. PLoS One 2024; 19:e0306302. [PMID: 38968165 PMCID: PMC11226064 DOI: 10.1371/journal.pone.0306302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/15/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND The meaning of the toothbrushing technique for the effectivity of toothbrushing in terms of plaque removal and parameters of gingivitis is unknown. This systematic review and network meta-analysis (NMA) aimed to synthesize evidence from randomized controlled trials (RCTs). METHODS We searched MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials, and the Web of Science for RCTs that compared any self-applied manual toothbrushing technique to any other technique or control and assessed plaque after toothbrushing and gingivitis. Where intervention effects were recorded repeatedly, the last post-intervention assessment was treated as the primary outcome date (POD), and the assessment closest to the intervention as the secondary outcome date (SOD). Age restrictions were not imposed. Participants with fixed orthodontic appliances were excluded. The evidence was evaluated using the Confidence in Network Meta-Analyses (CINeMA) approach, which is based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS Thirteen publications, including 15 studies, were identified. Ten studies assessing the Fones, Bass, and Scrub techniques provided data eligible for the NMA. The confidence rating of the evidence varied from very low to high in the case of plaque, and from very low to low in the case of gingivitis. Regarding PODs, Fones probably reduces plaque slightly compared with no training; the evidence is very uncertain that Fones may have little to no effect on gingivitis. Bass may result in little to no difference in plaque; the evidence that Bass may result in a slight increase in gingivitis is very uncertain. The evidence is very uncertain that Scrub may result in little to no difference in plaque at the SOD (no POD-data available) and that it may result in a slight increase in gingivitis. CONCLUSION There is limited evidence regarding the effects of toothbrushing techniques on plaque after brushing or gingivitis.
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Affiliation(s)
- Renate Deinzer
- Department of Medicine, Institute of Medical Psychology, Justus Liebig University of Giessen, Giessen, Germany
| | - Ulrike Weik
- Department of Medicine, Institute of Medical Psychology, Justus Liebig University of Giessen, Giessen, Germany
| | - Zdenka Eidenhardt
- Department of Medicine, Institute of Medical Psychology, Justus Liebig University of Giessen, Giessen, Germany
| | - Daniel Leufkens
- Department of Medicine, Institute of Medical Informatics, Justus Liebig University of Giessen, Giessen, Germany
| | - Sonja Sälzer
- Clinic for Conservative Dentistry and Periodontology, School for Dental Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
- Privat Practice in Hamburg, Hamburg, Germany
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Deinzer R, Eidenhardt Z, Sohrabi K, Stenger M, Kraft D, Sick B, Götz-Hahn F, Bottenbruch C, Berneburg N, Weik U. It is the habit not the handle that affects tooth brushing - a randomised counterbalanced cross over study with young and healthy adults. BMC Oral Health 2024; 24:757. [PMID: 38956565 PMCID: PMC11218271 DOI: 10.1186/s12903-024-04538-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 06/27/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE To assess the effect of the toothbrush handle on video-observed toothbrushing behaviour and toothbrushing effectiveness. METHODS This is a randomized counterbalanced cross-over study. N = 50 university students and employees brushed their teeth at two occasions, one week apart, using either a commercial ergonomically designed manual toothbrush (MT) or Brushalyze V1 (BV1), a manual toothbrush with a thick cylindrical handle without any specific ergonomic features. Brushing behaviour was video-analysed. Plaque was assessed at the second occasion immediately after brushing. Participants also rated their self-perceived oral cleanliness and directly compared the two brushes regarding their handling and compared them to the brushed they used at home. RESULTS The study participants found the BV1 significantly more cumbersome than the M1 or their brush at home. (p < 0.05). However, correlation analyses revealed a strong consistency of brushing behavior with the two brushes (0.71 < r < 0.91). Means differed only slightly (all d < 0.36). These differences became statistically significant only for the brushing time at inner surfaces (d = 0.31 p = 0.03) and horizontal movements at inner surfaces (d = 0.35, p = 0.02). Plaque levels at the gingival margins did not differ while slightly more plaque persisted at the more coronal aspects of the crown after brushing with BV1 (d = 0.592; p 0.042). DISCUSSION The results of the study indicate that the brushing handle does not play a major role in brushing behavior or brushing effectiveness.
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Affiliation(s)
- Renate Deinzer
- Department of Medicine, Justus-Liebig-University Giessen, Klinikstr. 29, Giessen, 35392, Germany.
| | - Zdenka Eidenhardt
- Department of Medicine, Justus-Liebig-University Giessen, Klinikstr. 29, Giessen, 35392, Germany
| | - Keywan Sohrabi
- Faculty of Health Sciences, University of Applied Sciences Giessen, Ostanlage 45, Giessen, 35390, Germany
| | - Manuel Stenger
- Department of Medicine, Justus-Liebig-University Giessen, Klinikstr. 29, Giessen, 35392, Germany
| | - Dominik Kraft
- Faculty of Health Sciences, University of Applied Sciences Giessen, Ostanlage 45, Giessen, 35390, Germany
| | - Bernhard Sick
- Intelligent Embedded Systems, University of Kassel, Wilhelmshöher Allee 73, Kassel, 34121, Germany
| | - Franz Götz-Hahn
- Intelligent Embedded Systems, University of Kassel, Wilhelmshöher Allee 73, Kassel, 34121, Germany
| | - Carlotta Bottenbruch
- Department of Medicine, Justus-Liebig-University Giessen, Klinikstr. 29, Giessen, 35392, Germany
| | - Nils Berneburg
- Department of Medicine, Justus-Liebig-University Giessen, Klinikstr. 29, Giessen, 35392, Germany
| | - Ulrike Weik
- Department of Medicine, Justus-Liebig-University Giessen, Klinikstr. 29, Giessen, 35392, Germany
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Deinzer R, Jordan AR. Periodontal health literacy in Germany-Results of a telephone survey. Int J Dent Hyg 2024. [PMID: 38575852 DOI: 10.1111/idh.12803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Assess the periodontal health literacy of German adolescents, adults and senior residents. BACKGROUND The prevalence of periodontitis is high. One explanation for this may be that people lack periodontal health literacy (PHL). METHODS This was a cross-sectional descriptive study. Former participants of the 5th German Oral Health Study (n = 333 16-year-olds, n = 307 39-48-year-olds, n = 332 69-78-year-olds) participated in a computer-assisted telephone interview. Open-ended questions (OEQs) were used to assess the participants' current knowledge. Corresponding single- and multiple-choice questions (SCQs and MCQs) supplemented the OEQs to allow detailed analyses of the nature of the knowledge gaps. RESULTS Less than 10% of the participants in the three age groups could explain the term 'periodontitis' or select the correct answer in an SCQ. Responding to the OEQs, 89% of 16-year olds, 64% of 39-48-year-olds, and 59% of 69-78-year-olds, could not name any consequence of periodontitis, and 83%, 51%, and 60%, respectively, could not name any risk factors. The OEQs regarding proper oral hygiene behaviour revealed that participants lacked awareness regarding important aspects of oral hygiene (e.g., systematics) or areas to which they should pay attention to (e.g., interdental spaces and gingival margins). CONCLUSIONS The survey revealed PHL deficits in German adolescents, adults, and seniors and a need for community-based measures to improve PHL in all age groups. Dental teams should be aware that their patients might lack the PHL necessary for understanding and adherence to professional dental advice, and that they might even lack PHL regarding the proper use of oral hygiene devices.
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Affiliation(s)
- Renate Deinzer
- Department of Medicine, Institute of Medical Psychology, Justus-Liebig-University Giessen, Giessen, Germany
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Weik U, Shankar-Subramanian S, Sämann T, Wöstmann B, Margraf-Stiksrud J, Deinzer R. "You should brush your teeth better": a randomized controlled trial comparing best-possible versus as-usual toothbrushing. BMC Oral Health 2023; 23:456. [PMID: 37415160 PMCID: PMC10327354 DOI: 10.1186/s12903-023-03127-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 06/11/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Most people's tooth brushing performance is deficient, even when they are encouraged to brush to the best of their abilities. The aim of the present study was to explore the nature of this deficit by comparing best-possible vs. as-usual brushing. METHODS University students (N = 111) were randomly assigned to receive one of two instructions: "brush your teeth as usual" (AU-instruction) or "brush your teeth to the best of your abilities" (BP-instruction). Video analyses assessed brushing performance. The marginal plaque index (MPI) assessed after brushing was used as an indicator of brushing effectiveness. A questionnaire assessed subjectively perceived oral cleanliness (SPOC). RESULTS Participants in the BP group brushed their teeth longer (p = 0.008, d = 0.57) and used interdental devices more often (p < 0.001). No group differences emerged in the distribution of brushing time among surfaces, the percentage of brushing techniques used beyond horizontal scrubbing, or the appropriate use of interdental devices (all p > 0.16, all d < 0.30). Plaque persisted at the majority of the sections of the gingival margins, and the groups did not differ in this respect (p = 0.15; d = 0.22). SPOC values in the BP group were higher than those in the AU group (p = 0.006; d = 0.54). Both groups overestimated their actual oral cleanliness by approximately twofold. CONCLUSIONS Compared to their usual brushing effort, study participants increased their effort when asked to brush their teeth in the best possible manner. However, that increase in effort was ineffective in terms of oral cleanliness. The results indicate that people's concept of optimized brushing refers to quantitative aspects (e.g., longer duration, more interdental hygiene) rather than qualitative aspects (e.g., considering inner surfaces and gingival margins, appropriate use of dental floss). TRIAL REGISTRATION The study was registered in the appropriate national register ( www.drks.de ; ID: DRKS00017812; date of registration: 27/08/2019 - retrospectively registered).
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Affiliation(s)
- Ulrike Weik
- Institute of Medical Psychology, Justus-Liebig-University Giessen, Klinikstr. 29, Giessen, D-35392 Germany
| | - Sadhvi Shankar-Subramanian
- Institute of Medical Psychology, Justus-Liebig-University Giessen, Klinikstr. 29, Giessen, D-35392 Germany
| | - Thorben Sämann
- Institute of Medical Psychology, Justus-Liebig-University Giessen, Klinikstr. 29, Giessen, D-35392 Germany
| | - Bernd Wöstmann
- Dental Clinic - Department of Prosthodontics, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - Renate Deinzer
- Institute of Medical Psychology, Justus-Liebig-University Giessen, Klinikstr. 29, Giessen, D-35392 Germany
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Eidenhardt Z, Busse S, Margraf-Stiksrud J, Deinzer R. Patients' awareness regarding the quality of their oral hygiene: development and validation of a new measurement instrument. BMC Oral Health 2022; 22:629. [PMID: 36550463 PMCID: PMC9773685 DOI: 10.1186/s12903-022-02659-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The present research aimed to develop and validate a standardised survey instrument for the assessment of patients' awareness of the quality of their oral hygiene performance. METHODS A digital questionnaire was developed that assesses both patients' naïve self-perceptions of oral cleanliness (SPOCn) after tooth brushing and patients' perceptions after being informed how oral cleanliness may be captured in dentistry (SPOCd). Three studies (N = 56 adults, N = 66 adolescents and one of their parents, N = 24 university students) assessed the instrument's feasibility (patient reports), reliability (internal consistency), validity (correlation with other constructs; sensitivity to manipulation of actual tooth brushing), and the correlation with actual oral cleanliness after tooth brushing. RESULTS All study groups accepted the questionnaire well; average answering times were less than 5 min. Cronbach's α exceeds 0.90; correlational analyses support the discriminant validity regarding oral hygiene related self-efficacy expectations and stages of change; manipulation of oral hygiene behaviour results in the expected changes of SPOC scores. Patients' SPOC correlate only moderately with actual oral cleanliness. The comparison between SPOCd scores and actual oral cleanliness indicate that they considerably overestimate their oral hygiene performance. CONCLUSIONS The SPOC questionnaire is an easy-to-use, well-accepted, reliable and valid instrument for the assessment of patients' awareness of the quality of their oral hygiene for research and clinical purposes. The results of the questionnaire may help to reveal unrealistic self-perceptions of patients regarding their oral hygiene. It can raise their awareness of the need to improve their skills and/or efforts in this regard. Trial registration The third study was an interventional study and was registered in the appropriate national register ( www.drks.de ; ID: DRKS00018781; date of registration: 12/09/2019).
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Affiliation(s)
- Zdenka Eidenhardt
- grid.8664.c0000 0001 2165 8627Department of Medicine, Institute of Medical Psychology, Justus-Liebig-University Giessen, Klinikstr. 29, 35392 Giessen, Germany
| | - Sebastian Busse
- grid.8664.c0000 0001 2165 8627Department of Medicine, Institute of Medical Psychology, Justus-Liebig-University Giessen, Klinikstr. 29, 35392 Giessen, Germany
| | | | - Renate Deinzer
- grid.8664.c0000 0001 2165 8627Department of Medicine, Institute of Medical Psychology, Justus-Liebig-University Giessen, Klinikstr. 29, 35392 Giessen, Germany
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Petker-Jung W, Weik U, Margraf-Stiksrud J, Deinzer R. What characterizes effective tooth brushing of daily users of powered versus manual toothbrushes? BMC Oral Health 2022; 22:10. [PMID: 35034614 PMCID: PMC8762860 DOI: 10.1186/s12903-022-02045-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Recent data show comparable deficits in oral cleanliness after tooth brushing in habitual users of powered toothbrushes (PT) and manual toothbrushes (MT). The present analysis explores the origin of these deficits by relating aspects of the observed tooth brushing behaviour to plaque after tooth brushing.
Methods Users of rotating-oscillating PT (N = 48) and of MT (N = 52) brushed their teeth the best they could while being filmed. Video analyses assessed brushing time, number of sextants brushed sufficiently long (7.5 s per surface; NSBSL), brushing of outer surfaces with closed jaws, and brushing movements. Correlation analyses examined the relationship between these parameters and plaque after brushing (Marginal Plaque Index (MPI); Turesky modification of Quigley Hein Index (TQHI)) and gingivitis (Papillary Bleeding Index (PBI)). Results In PT users, correlations between behaviour and MPI-scores were significant for the NSBSL (outer surfaces: rho = − 0.249; inner surfaces: rho = − 0.510) and brushing duration (outer surfaces: rho = − 0.399; inner surfaces: rho = − 0.509). In MT users, vertical movements on the outer surfaces were positively related to MPI (rho = 0.299). In contrast, circular movements correlated negatively with MPI in those who brushed all outer sextants sufficiently long (n = 47: rho = − 0.294). In both groups, PBI-scores on the inner surfaces were negatively correlated to NSBSL and brushing duration (rho = − 0.327 − rho = − 0.246). Conclusion NSBSL and brushing duration appear to play an important role for brushing effectiveness and gingival health in PT and MT users. Whether PT users apply brushing movements or not apparently does not affect the result. In MT users, circular movements seem to be more efficient than vertical movements on the outer surfaces. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02045-0.
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Affiliation(s)
- Waldemar Petker-Jung
- Department of Medicine, Justus-Liebig-University Giessen, Klinikstr. 29, 35392, Giessen, Germany.
| | - Ulrike Weik
- Department of Medicine, Justus-Liebig-University Giessen, Klinikstr. 29, 35392, Giessen, Germany
| | | | - Renate Deinzer
- Department of Medicine, Justus-Liebig-University Giessen, Klinikstr. 29, 35392, Giessen, Germany
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