Improving oral hygiene skills by computer-based training: a randomized controlled comparison of the modified Bass and the Fones techniques

Periodontal health literacy in Germany-Results of a telephone survey

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.

Manual toothbrushing techniques for plaque removal and the prevention of gingivitis-A systematic review with network meta-analysis

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.

Orthodontists' instructions for oral hygiene in patients with removable and fixed orthodontic appliances

INTRODUCTION

The aim of this questionnaire-based survey was to evaluate information on frequencies, instructions and products relating to oral hygiene (OH) in orthodontic practices.

METHODS

Using a computer-generated randomization list, 1000 orthodontists were selected and sent a questionnaire. The size and number of inhabitants of the federal states of Germany were considered. The federal states with the highest return rate (Baden-Wuerttemberg [BW], Bavaria [B], Hesse [H], Lower Saxony [LS], Nordrhein-Westphalia [NRW]) were considered and differences between the 16 federal states were divided into North, South, East and Central Germany.

RESULTS

The response rate of the questionnaires was 52.4%. The majority (53.8%) worked in one practice alone. Most (59.1%) have been orthodontists for 5-25 years. For vestibular multibracket appliances (MBA) in BW, B, H and LS over 90% recommended interdental brushes (IDB). In NRW 91.4% recommend fluoride gel. In B and H more than 80% chose electric toothbrush (ETB), in BW, LS and NRW more than 80% manual toothbrush (MTB). For lingual MBA (LMBA) in BW, H, LS and NRW with approximately 50% each fluoride gel, IDB and MTB were chosen. In B fluoride gel, IDB and ETB. For removable apparatus (RA), five federal states recommended MTB (>80%) and ETB (BW, B, H > 80%; NRW > 70%; LS > 60%).

CONCLUSION

Electric toothbrushes are recommended for the use with all appliances, only with removable appliances manual toothbrushes are favoured. For vestibular MBA it is strongly advised to use IDB additionally.

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.

Patients' awareness regarding the quality of their oral hygiene: development and validation of a new measurement instrument

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).

A comparative evaluation of oral health status among institutionalized totally blind children using different methods - A randomized clinical trial

Background

To compare and evaluate the oral hygiene status among institutionalized visually impaired children using the Verbal, Braille, and Audio-Tactile method.

Materials and Methods

The present study was a single-blinded, randomized clinical trial with a total of 96 visually impaired children both male and female, aged 6-16 years old were included in this study from a residential school for blind. They were divided into three groups: Group 1 - Verbal method, Group 2 - Braille method, and Group 3 - Audio-Tactile method. Baseline oral hygiene scores were recorded using the debris index, calculus index, gingival index and hand scaling was performed for all the children. Fone's brushing technique was taught to all the groups and fluoridated toothpaste was given to the children with 3 and 6 months of follow-up. Periodic reinforcement of oral hygiene instructions was done for each group. The collected data were tabulated and analyzed using the ANOVA test with (P < 0.01).

Results

There was significant improvement in debris index, gingival index, and calculus index in all the three groups by the end of 6 months. All the three indices showed improvement in oral hygiene.

Conclusion

Visually impaired children could maintain a respectable level of oral hygiene when taught specialized methods. However, periodic reinforcement is mandatory for good oral hygiene maintenance. Hence, it is recommended to use the combination of Verbal, Braille, and Audio-Tactile method for the best treatment outcomes in these special children.

Oral Hygiene Instruction – How it Affects the Caries Experience, Oral Hygiene Status, and sCD14 Levels?

Background:

Caries experience, oral hygiene status, and salivary sCD14 level are three essential factors to analyse individual dental caries development risk. Therefore, regular and effective oral hygiene instruction (OHI) is essential for dental caries prevention.

Objective:

This study aims to analyse the differences in caries experience, oral hygiene status, and sCD14 levels before and after OHI.

Methods:

An observational study with intervention before and after oral hygiene instruction was conducted on 40 samples of each group taken with an accidental sampling method. The sample was calculated using the sample size formula to determine the difference between two paired means; confidence level 95%; power test 90%. The OHI materials include microbial aspects, plaque control methods and instruments, and directives for visiting the dentist. Caries' experience was obtained using DMF-T index; oral hygiene status using simplified oral hygiene instruction (OHI-S); sCD14 levels obtained from unstimulated saliva using an ELISA kit. Data analysis used the Kolmogorov-Smirnov normality test, paired t-test, and Wilcoxon signed-rank test.

Results:

Kolmogorov normality test showed that the caries experience data were normally distributed, while oral hygiene status and sCD14 were not. The paired-t difference test result for caries experience cannot be determined because the data showed a similar value. The Wilcoxon signed-rank test result for oral hygiene status showed no significant difference, while the sCD14 showed a significant difference.

Conclusion:

Oral hygiene instruction showed a similar value of caries experience before and after oral hygiene, and also no difference was found in oral hygiene status; however, the sCD14 levels showed a difference after oral hygiene instruction.

What characterizes effective tooth brushing of daily users of powered versus manual toothbrushes?

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.

Good role models? Tooth brushing capabilities of parents: a video observation study

BACKGROUND

Research in adolescents reveals that they are not capable to remove dental plaque effectively. Inconsistent application of brushing techniques and neglect of certain areas while brushing are very common. As parents play a major role in the oral health education, the present study aimed to examine and describe the tooth brushing performance of the parents of adolescents.

METHODS

Parents of adolescents (N = 66) were asked to perform oral hygiene to the best of their capabilities in front of a video camera and dental plaque was recorded before and afterwards. Papillary bleeding was also assessed.

RESULTS

The tooth contact time (i.e. net brushing duration) averaged 155 s ± 58 s. Gingival margins showed persistent plaque at 68% ± 14% of the sections assessed. Papillary bleeding was found at 52% ± 18% of the papillae. Parents brushed inner surfaces lesser than the outer surfaces (41 s ± 24 s vs. 73 s ± 33 s) and 29% of the parents completely missed the inner surfaces of at least one sextant. On the outer surfaces parents predominantly applied circular movements (66% ± 25% of brushing time). Vertical brushing prevailed on the inner surfaces (52% ± 30%). However, horizontal scrubbing was also very common (46% ± 31%).

CONCLUSIONS

Parents' tooth brushing performance was neither effective in terms of plaque removal nor did they fully comply with tooth brushing recommendations such as considering all inner surfaces when brushing or application of other than horizontal movements to lateral surfaces. Regarding oral hygiene, parents should not only be a good role model in terms of timing, frequency and duration of tooth brushing but should also be able to demonstrate how to brush teeth completely and effectively. The current research indicates that they might lack the latter skill.

Effects of remote digital monitoring on oral hygiene of orthodontic patients: a prospective study

Background

Remote digital monitoring during orthodontic treatment can help patients in improving their oral hygiene performance and reducing the number of appointments due to emergency reasons, especially in time of COVID-19 pandemic where non-urgent appointments might be discouraged.

Methods

Thirty patients scheduled to start an orthodontic treatment were divided into two groups of fifteen. Compared to controls, study group patients were provided with scan box and cheek retractor (Dental Monitoring®) and were instructed to take monthly intra-oral scans. Plaque Index (PI), Gingival Index (GI), and White Spot Lesions (WSL) were recorded for both groups at baseline (t₀), every month for the first 3 months (t₁, t₂, t₃), and at 6 months (t₄). Carious Lesions Onset (CLO) and Emergency Appointments (EA) were also recorded during the observation period. Inter-group differences were assessed with Student's t test and Chi-square test, intra-group differences were assessed with Cochran’s Q-test (significance α = 0.05).

Results

Study group patients showed a significant improvement in plaque control at t₃ (p = 0.010) and t₄ (p = 0.039), compared to control group. No significant difference was observed in the number of WSL between the two groups. No cavities were detected in the study group, while five CLO were diagnosed in the control group (p = 0.049). A decreased number of EA was observed in the study group, but the difference was not significant.

Conclusions

Integration of a remote monitoring system during orthodontic treatment was effective in improving plaque control and reducing carious lesions onset. The present findings encourage orthodontists to consider this technology to help maintaining optimal oral health of patients, especially in times of health emergency crisis.

Toothbrushing Performance and Oral Cleanliness after Brushing in 12-Year-Old Children

Objectives:

Nationwide prevention programs in Germany aim to promote oral health. The group prevention program starts in kindergarten and ends when the children are about 12 y old. While in a recent study, toothbrushing behavior of 12-y-old children was analyzed, the present study’s objective was to examine the children’s ability to achieve oral cleanliness and to analyze how toothbrushing behavior and compliance with the toothbrushing recommendations taught in the group prevention programs predict oral cleanliness.

Methods:

Twelve-year-old randomly selected children (N = 174) were asked to brush their teeth to the best of their abilities, and simultaneously a video was recorded for behavioral analyses. Plaque levels were measured before and immediately after toothbrushing. In addition, dental status and gingival bleeding were assessed.

Results:

After brushing to the best of their abilities, there was plaque on 50% (±24.72%) of all measured sites at the gingival margin (Marginal Plaque Index). Regression analyses revealed approximately 22% of the variance of marginal plaque on the outer surfaces to be explained by the time brushed by circular movements (β = −0.41;P < 0.001) and the number of sextants brushed for at least 7.5 s (β = −0.171; P < 0.05). Circular movements explained most additional variance (ΔR² = 0.113; P < 0.001). With respect to inner surfaces, none of the behavioral aspects explained any variance of oral cleanliness.

Conclusion:

Despite regular group prevention measures, 12-y-old children show limited skills to clean their teeth adequately. Furthermore, none of the recommended behaviors relates to oral cleanliness after toothbrushing at inner surfaces. As a consequence, it is necessary to explore further which behavioral sequences effectively improve oral cleanliness.

Knowledge Transfer Statement:

This study illustrates that children’s compliance to toothbrushing recommendations is not necessarily related to toothbrushing effectiveness. Clinicians should therefore assess the effectivity of recommendations individually and provide individual guidance for improvement.

Influence of teeth anatomical characteristics on the efficacy of manual toothbrushing manoeuvres

Purpose

The aim of the study was to investigate the efficacy of two toothbrushing techniques on the amount of plaque accumulation and to evaluate how the changes were correlated to the anatomical characteristics of the anterior maxillary arch.

Methods

Thirty subjects of both genders were included, they were asked not to brush for 12 h. Afterwards, they were asked to manually brush the left side of their maxillary arch with the modified Bass technique and the right side adopting the roll technique. The comparison of photographs taken before and after the manoeuvres, using a plaque disclosing agent, allowed the researchers to measure the changes in plaque accumulation measured using the Quigley and Hein plaque scoring classification. Linear regression analysis was used to evaluate the correlation between such changes and the teeth and arch anatomical characteristics.

Results

A mean reduction of 9.6 ± 5.2% considering both arches after brushing was observed. The changes in plaque accumulation were not different between the two techniques. The length of the line obtained joining the contact point between the central incisors and the contact point between the second premolar and the first molar on the left side and the distance between that line and the lateral incisor on the same side positively correlated to the decrease in the plaque scores (P = 0.046 and P = 0.044, respectively).

Conclusion

Both tested techniques were effective in plaque removal in the anterior maxillary arches. However, the research for the anatomical factors influencing the amount of efficacy of the toothbrushing manoeuvres was inconclusive. We can hypothesise that the adoption of one adequate technique could be more important than the teeth characteristics.

Comparison of modified Bass, Fones and normal tooth brushing technique for the efficacy of plaque control in young adults- A randomized clinical trial

Background

To compare the anti plaque efficacy of Modified Bass, Fones and Normal brushing techniques in young adults.

Material and Methods

An investigator blinded randomized controlled trial with parallel design was adopted to compare the anti plaque efficacy of three tooth brushing techniques. The study population consisted of 120 dental students aged between 18 and 30 years.

Results

At the baseline, the mean plaque scores were 0.74 ± 0.39, 0.77 ± 0.34 and 0.98 ± 0.36 respectively, for Modified Bass, Fones and Normal brushing technique. After 24 hours without any oral hygiene activity, the plaque scores increased to 1.04 ± 0.30, 1.11 ± 0.32 and 1.21 ± 0.40, respectively. After 1 week of using the intervention, the mean plaque scores were 0.78 ± 0.36, 0.94 ± 0.34 and 1.03 ± 0.43, respectively and increased to 1.13 ± 0.44, 1.14 ± 0.40 and 1.08 ± 0.34 after 28 days. The mean gingival scores were 0.23 ± 0.66, 0.02 ± 0.52 and 0.42 ± 0.74 for Modified Bass, Fones and Normal Brushing technique during baseline visit and after 28 days.

Conclusions

There was a significant reduction in the amount of plaque with the three brushing techniques. Although the short-term outcomes with the Modified Bass method were promising, a long-term effect was not evident. Further, there was no significant difference in plaque control between the three groups. Key words:Gingival scores, plaque scores, tooth brushing techniques, young adults.

Oral cleanliness in daily users of powered vs. manual toothbrushes - a cross-sectional study

Background

Toothbrushing is a daily routine. Still, when adults are asked to manually perform oral hygiene to the best of their abilities, a considerable amount of plaque persists. Little is known about the performance of people who use a powered toothbrush. The present study thus analysed whether the capability to achieve oral cleanliness is better in people for whom powered toothbrushing is a daily routine.

Methods

University students, who either performed powered (N = 55) or manual (N = 60) toothbrushing for more than 6 months on a daily basis were asked to clean their teeth to the best of their abilities by their own device. Plaque was assessed prior to and immediately after brushing. Furthermore, gingival bleeding, recessions, periodontal pocket depths and dental status were assessed. Oral hygiene performance was video-taped and analyzed with respect to brushing duration, sites of brushing and application of interproximal cleaning devices.

Results

No differences between groups were found with respect to plaque before and after brushing, clinical parameters and overall brushing duration (all p > 0.05, all d < 0.156). After brushing, plaque persisted at approximately 40% of the sections adjacent to the gingival margin in both groups.

Conclusions

No advantage of daily powered toothbrushing as compared to daily manual toothbrushing was seen with respect to oral hygiene or clinical parameters. The capability to achieve oral cleanliness was low, irrespective of the type of toothbrush under consideration. Additional effort is thus needed to improve this capability.

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0790-9) contains supplementary material, which is available to authorized users.

Toothbrushing behavior in children - an observational study of toothbrushing performance in 12 year olds

Background

Many countries offer systematic group prevention programs in kindergarten and school in order to promote children’s oral health. Little is known, however, about the actual toothbrushing abilities of children when group prevention programs end.

Methods

In Germany, all children take advantage from a nationwide group prevention program (called “Gruppenprophylaxe”) lasting from kindergarten up to sixth grade (12 years of age). Standardized recommendations are given concerning brushing systematics and brushing movements. N = 174 children at the age of 12 were thus randomly selected from two German towns and were asked to perform toothbrushing to the best of their abilities in front of a mirror which also served as a camera. Brushing behavior was analyzed by video analysis.

Results

Children brushed their teeth for an average of 200 s ± 80.48 s (mean ± SD). Still, more than 55% missed at least one sextant when brushing inner surfaces, 16% missed them all. Only 7.5% of the children brushed both inner and outer surfaces by the intended movements (vertical movements on the inner surfaces and circular movements on the outer surfaces) for at least 90% of the respective brushing time. Instead, horizontal brushing was very common on the lateral surfaces.

Conclusions

The present analysis indicates that children have low efficiency to adopt the tooth-brushing recommendations given in prevention programs. This is surprising as great endeavors are made to help children internalize the recommendations. Future research is needed to better understand which factors impede adoption of toothbrushing recommendations in children and which efforts are necessary to improve their toothbrushing abilities.

Electronic supplementary material

The online version of this article (10.1186/s12903-019-0755-z) contains supplementary material, which is available to authorized users.

Comparative Evaluation of Plaque Removal Effectiveness of Manual and Chewable Toothbrushes in Children: A Randomized Clinical Trial

OBJECTIVE

In children, manual dexterity poses a problem with the use of manual tooth brushes (MB), resulting in inefficient plaque removal. Recently, novel chewable brushes (CB) have been introduced which could overcome this problem but are less researched in children. The objective of this study is to assess and compare the plaque removal effectiveness of CB with that of MB.

MATERIALS AND METHODS

A total of 60 patients aged 8 to 10 years were enrolled in a single-blinded randomized clinical trial. At baseline, disclosing solution was applied and the Turesky modification of the Quigley-Hein index (TQHI) plaque index and Loe and Silness gingival index were recorded. The subjects were randomly divided into two groups as group I (MB) and group II (CB) and they were instructed to use their respective brushes for a period of 1 week. For statistical comparison, the difference (prebrushing minus postbrushing) in average scores was calculated. Data were evaluated by the independent t test and paired t test, with p < 0.05.

RESULTS

The overall plaque scores reduced from 1.71 ± 0.4 to 0.79 ± 0.24 when using CB and from 1.64 ± 0.64 to 1.13 ± 0.47 when using MBs. On lingual tooth surfaces, CB showed a plaque reduction of 38.70 ± 11.04 to 12.60 ± 4.79 compared to less reduction from 37.43 ± 14.26 to 28.73 ± 11.37 for MB. The overall gingival scores were also reduced from 0.33 ± 0.51 to 0.09 ± 0.07 when using CB and from 0.30 ± 0.33 to 0.19 ± 0.23 when using MB. Differences in scores between the two brushes were statistically significant (p = 0.0001).

CONCLUSION

It was concluded that the experimental CB was able to remove a significant amount of plaque, particularly on the lingual surfaces, and reduced gingival index scores, thereby improving oral hygiene and gingival health status.

HOW TO CITE THIS ARTICLE

Kayalvizhi G, Radha S, et al. Comparative Evaluation of Plaque Removal Effectiveness of Manual and Chewable Toothbrushes in Children: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2019;12(2):107-110.

High Plaque Levels after Thorough Toothbrushing: What Impedes Efficacy?

OBJECTIVES

Previous studies have shown high levels of dental plaque after toothbrushing and poor toothbrushing performance. There is a lack of evidence about what oral hygiene behavior predicts persistent plaque. The present cross-sectional study thus relates toothbrushing behavior to oral cleanliness after brushing and to gingivitis.

METHODS

All young adults from a central town in Germany who turned 18 y old in the year prior to the examination were invited to participate in the study. They were asked to clean their teeth to their best abilities while being filmed. Videos were analyzed regarding brushing movements (vertical, circular, horizontal, modified Bass technique) and evenness of distribution of brushing time across vestibular (labial/buccal) and palatinal (lingual/palatinal) surfaces. Dental status, gingival bleeding, and oral cleanliness after oral hygiene were assessed.

RESULTS

Ninety-eight young adults participated in the study. Gingival margins showed persistent plaque at 69.48% ± 12.31% sites (mean ± SD) after participants brushed to their best abilities. Regression analyses with the brushing movements and evenness of distribution of brushing time as predictors explained 15.2% (adjusted R² = 0.152, P = 0.001) of the variance in marginal plaque and 19.4% (adjusted R² = 0.194, P < 0.001) of the variance in bleeding. Evenness of distribution of brushing time was the most important behavioral predictor.

CONCLUSION

Even when asked to perform optimal oral hygiene, young German adults distributed their brushing time across surfaces unevenly. Compared with brushing movements, this factor turned out to be of more significance when explaining the variance of plaque and bleeding.

KNOWLEDGE TRANSFER STATEMENT

Results of this study can help clinicians and patients understand the meaning of specific behavioral aspects of toothbrushing for oral cleanliness and oral health.

One-to-one oral hygiene advice provided in a dental setting for oral health

BACKGROUND

Effective oral hygiene measures carried out on a regular basis are vital to maintain good oral health. One-to-one oral hygiene advice (OHA) within the dental setting is often provided as a means to motivate individuals and to help achieve improved levels of oral health. However, it is unclear if one-to-one OHA in a dental setting is effective in improving oral health and what method(s) might be most effective and efficient.

OBJECTIVES

To assess the effects of one-to-one OHA, provided by a member of the dental team within the dental setting, on patients' oral health, hygiene, behaviour, and attitudes compared to no advice or advice in a different format.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 November 2017); the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 10) in the Cochrane Library (searched 10 November 2017); MEDLINE Ovid (1946 to 10 November 2017); and Embase Ovid (1980 to 10 November 2017). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were also searched for ongoing trials (10 November 2017). No restrictions were placed on the language or date of publication when searching the electronic databases. Reference lists of relevant articles and previously published systematic reviews were handsearched. The authors of eligible trials were contacted, where feasible, to identify any unpublished work.

SELECTION CRITERIA

We included randomised controlled trials assessing the effects of one-to-one OHA delivered by a dental care professional in a dental care setting with a minimum of 8 weeks follow-up. We included healthy participants or participants who had a well-defined medical condition.

DATA COLLECTION AND ANALYSIS

At least two review authors carried out selection of studies, data extraction and risk of bias independently and in duplicate. Consensus was achieved by discussion, or involvement of a third review author if required.

MAIN RESULTS

Nineteen studies met the criteria for inclusion in the review with data available for a total of 4232 participants. The included studies reported a wide variety of interventions, study populations, clinical outcomes and outcome measures. There was substantial clinical heterogeneity amongst the studies and it was not deemed appropriate to pool data in a meta-analysis. We summarised data by categorising similar interventions into comparison groups.Comparison 1: Any form of one-to-one OHA versus no OHAFour studies compared any form of one-to-one OHA versus no OHA.Two studies reported the outcome of gingivitis. Although one small study had contradictory results at 3 months and 6 months, the other study showed very low-quality evidence of a benefit for OHA at all time points (very low-quality evidence).The same two studies reported the outcome of plaque. There was low-quality evidence that these interventions showed a benefit for OHA in plaque reduction at all time points.Two studies reported the outcome of dental caries at 6 months and 12 months respectively. There was very low-quality evidence of a benefit for OHA at 12 months.Comparison 2: Personalised one-to-one OHA versus routine one-to-one OHAFour studies compared personalised OHA versus routine OHA.There was little evidence available that any of these interventions demonstrated a difference on the outcomes of gingivitis, plaque or dental caries (very low quality).Comparison 3: Self-management versus professional OHAFive trials compared some form of self-management with some form of professional OHA.There was little evidence available that any of these interventions demonstrated a difference on the outcomes of gingivitis or plaque (very low quality). None of the studies measured dental caries.Comparison 4: Enhanced one-to-one OHA versus one-to-one OHASeven trials compared some form of enhanced OHA with some form of routine OHA.There was little evidence available that any of these interventions demonstrated a difference on the outcomes of gingivitis, plaque or dental caries (very low quality).

AUTHORS' CONCLUSIONS

There was insufficient high-quality evidence to recommend any specific one-to-one OHA method as being effective in improving oral health or being more effective than any other method. Further high-quality randomised controlled trials are required to determine the most effective, efficient method of one-to-one OHA for oral health maintenance and improvement. The design of such trials should be cognisant of the limitations of the available evidence presented in this Cochrane Review.

Toothbrushing: to the best of one's abilities is possibly not good enough

BACKGROUND

Weaknesses in toothbrushing performance can be seen when young adults are instructed to perform habitual toothbrushing. Nothing is known about toothbrushing behavior when instructed to perform to the best abilities. The present study analyzes such behavior and compares it to habitual behavior.

METHODS

A random sample of N = 98 young adults born in 1995 was examined in 2014/2015.They were asked to perform oral hygiene to the best of their abilities in front of a camera. Videos were analyzed regarding details of brushing behavior. A quality index was developed which describes the extent of the neglect of brushing on palatinal and vestibular surfaces. Data were compared to those of an earlier study of young adults (born in 1992, examined in 2011, N = 101) who were asked to perform oral hygiene as they habitually do.

RESULTS

The 1995 cohort (best abilities) brushed their teeth significantly longer than the 1992 cohort (habitual brushing). This was due to significant longer brushing at vestibular and occlusal surfaces. Neglect of palatinal surfaces was similar in both cohorts. Groups did not differ regarding brushing movements. 40% of the brushing time on lateral surfaces was spent with scrubbing movements despite opposing advice in common oral hygiene instructions.

CONCLUSIONS

Toothbrushing to the best of one's abilities might still not be good enough. Young adults apparently lack a reasonable concept of what is meant by high quality toothbrushing. More efforts should thus be undertaken to explain them (and adults) this concept.

Role of Text Message Reminder on Oral Hygiene Maintenance of Orthodontic Patients

INTRODUCTION

Fixed orthodontic treatment is frequently associated with increased plaque accumulation leading to gingivitis and white spot lesions (WSLs).

AIM

This study evaluated the role of text message reminder on oral hygiene of orthodontic patients.

MATERIALS AND METHODS

A total of 60 patients under fixed orthodontic treatment were randomly divided into two equal groups as control group and study (text message) group. Text message group received reminders about oral hygiene, while the control group did not receive any messages. Oral hygiene of both the groups was evaluated at baseline, 2, and 3 months using plaque indices (PIs) along with WSL status. Data were statistically analyzed using Statistical Package for the Social Sciences (SPSS) statistical software, version 19, with chi-square test and t-test.

RESULTS

At the baseline, plaque score was higher in the study group over control group (p > 0.038), whereas it was decreased after 3 months in the test group (p > 0.001). For WSL, there was no significant difference at baseline, but it was significantly lower in study group (p > 0.003).

CONCLUSION

Oral hygiene status improved with text message reminder.

Finding an upper limit of what might be achievable by patients: oral cleanliness in dental professionals after self-performed manual oral hygiene

AIMS

Though patients have been shown to have difficulties in achieving oral cleanliness after self-performed oral hygiene, scientifically and empirically justified standards for the degree of oral cleanliness they should achieve are lacking. Oral cleanliness of dental staff was therefore assessed as an indicator of what might be an upper limit of what can be expected by patients.

MATERIALS AND METHODS

In a multicentre study, N = 64 university dentists, N = 33 dental students and N = 30 dental assistants were asked to perform manual oral hygiene to the best of their abilities. The presence or absence of dental plaque adjacent to gingival margins was assessed by the marginal plaque index (MPI). As full-crown index, the Turesky modification of the Quigley and Hein Index (QHIm) was applied.

RESULTS

Only three participants showed papillary bleeding and only one a clinical pocket depth of more than 3.5 mm. After self-performed oral hygiene, no differences between groups were observed with respect to plaque nor did results differ between those who habitually used a powered toothbrush only and those who did not. Most participants (96%) achieved oral cleanliness at more than 70% of their gingival margins and QHIm levels below .63. Half of the participants showed QHIm levels below .17 and oral cleanliness at 96% of gingival margins.

CONCLUSIONS AND CLINICAL RELEVANCE

Considering that half of the dental professionals achieved oral cleanliness at 96% of gingival margins and QHIm levels below .17 after thorough oral hygiene, this might reflect an upper limit of what can be expected by patients.

Computer-Based Oral Hygiene Instruction versus Verbal Method in Fixed Orthodontic Patients

STATEMENT OF PROBLEM

Fixed orthodontic appliances in the oral cavity make tooth cleaning procedures more complicated.

OBJECTIVES

This study aimed to compare the efficacy of computerized oral hygiene instruction with verbal technique among fixed orthodontic patients referred to the evening clinic of Orthodontics of Shiraz Dental School.

MATERIALS AND METHODS

A single-blind study was performed in Orthodontic Department of Shiraz, Islamic Republic of Iran, from January to May 2015 following the demonstrated exclusion and inclusion criteria. The sample size was considered 60 patients with 30 subjects in each group. Bleeding on probing and plaque indices and dental knowledge were assessed in the subjects to determine pre-intervention status. A questionnaire was designed for dental knowledge evaluation. The patients were randomly assigned into the computerized and verbal groups. Three weeks after the oral hygiene instruction, indices of bleeding on probing and plaque index and the dental knowledge were evaluated to investigate post-intervention outcome. The two groups were compared by chi-square and student t tests. The pre- and post-intervention scores in each group were compared using paired t-test.

RESULTS

In the computerized group, the mean score for plaque index and bleeding on probing index was significantly decreased while dental health knowledge was significantly increased after oral hygiene instruction, in contrast to the verbal group.

CONCLUSIONS

Within the limitations of the current study, computerized oral hygiene instruction is proposed to be more effective in providing optimal oral health status compared to the conventional method in fixed orthodontic patients.

WITHDRAWN: Community-based population-level interventions for promoting child oral health

BACKGROUND

Dental caries and gingival and periodontal disease are commonly occurring, preventable chronic conditions. Even though much is known about how to treat oral disease, currently we do not know which community-based population-level interventions are most effective and equitable in preventing poor oral health.

OBJECTIVES

Primary • To determine the effectiveness of community-based population-level oral health promotion interventions in preventing dental caries and gingival and periodontal disease among children from birth to 18 years of age. Secondary • To determine the most effective types of interventions (environmental, social, community and multi-component) and guiding theoretical frameworks.• To identify interventions that reduce inequality in oral health outcomes.• To examine the influence of context in the design, delivery and outcomes of interventions.

SEARCH METHODS

We searched the following databases from January 1996 to April 2014: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resource Information Center (ERIC), BIOSIS Previews, Web of Science, the Database of Abstracts of Reviews of Effects (DARE), ScienceDirect, Sociological Abstracts, Social Science Citation Index, PsycINFO, SCOPUS, ProQuest Dissertations & Theses and Conference Proceedings Citation Index - Science.

SELECTION CRITERIA

Included studies were individual- and cluster-randomised controlled trials (RCTs), controlled before-and-after studies and quasi-experimental and interrupted time series. To be included, interventions had to target the primary outcomes: dental caries (measured as decayed, missing and filled deciduous teeth/surfaces, dmft/s; Decayed, Missing and Filled permanent teeth/surfaces, DMFT/S) and gingival or periodontal disease among children from birth to 18 years of age. Studies had to report on one or more of the primary outcomes at baseline and post intervention, or had to provide change scores for both intervention and control groups. Interventions were excluded if they were solely of a chemical nature (e.g. chlorhexidine, fluoride varnish), were delivered primarily in a dental clinical setting or comprised solely fluoridation.

DATA COLLECTION AND ANALYSIS

Two review authors independently performed screening, data extraction and assessment of risk of bias of included studies (a team of six review authors - four review authors and two research assistants - assessed all studies). We calculated mean differences with 95% confidence intervals for continuous data. When data permitted, we undertook meta-analysis of primary outcome measures using a fixed-effect model to summarise results across studies. We used the I2 statistic as a measure of statistical heterogeneity.

MAIN RESULTS

This review includes findings from 38 studies (total n = 119,789 children, including one national study of 99,071 children, which contributed 80% of total participants) on community-based oral health promotion interventions delivered in a variety of settings and incorporating a range of health promotion strategies (e.g. policy, educational activities, professional oral health care, supervised toothbrushing programmes, motivational interviewing). We categorised interventions as dietary interventions (n = 3), oral health education (OHE) alone (n = 17), OHE in combination with supervised toothbrushing with fluoridated toothpaste (n = 8) and OHE in combination with a variety of other interventions (including professional preventive oral health care, n = 10). Interventions generally were implemented for less than one year (n = 26), and only 11 studies were RCTs. We graded the evidence as having moderate to very low quality.We conducted meta-analyses examining impact on dental caries of each intervention type, although not all studies provided sufficient data to allow pooling of effects across similar interventions. Meta-analyses of the effects of OHE alone on caries may show little or no effect on DMFT (two studies, mean difference (MD) 0.12, 95% confidence interval (CI) -0.11 to 0.36, low-quality evidence), dmft (three studies, MD -0.3, 95% CI -1.11 to 0.52, low-quality evidence) and DMFS (one study, MD -0.01, 95% CI -0.24 to 0.22, very low-quality evidence). Analysis of studies testing OHE in combination with supervised toothbrushing with fluoridated toothpaste may show a beneficial effect on dmfs (three studies, MD -1.59, 95% CI -2.67 to -0.52, low-quality evidence) and dmft (two studies, MD -0.97, 95% CI -1.06 to -0.89, low-quality evidence) but may show little effect on DMFS (two studies, MD -0.02, 95% CI -0.13 to 0.10, low-quality evidence) and DMFT (three studies, MD -0.02, 95% CI -0.11 to 0.07, moderate-quality evidence). Meta-analyses of two studies of OHE in an educational setting combined with professional preventive oral care in a dental clinic setting probably show a very small effect on DMFT (-0.09 weighted mean difference (WMD), 95% CI -0.1 to -0.08, moderate-quality evidence). Data were inadequate for meta-analyses on gingival health, although positive impact was reported.

AUTHORS' CONCLUSIONS

This review provides evidence of low certainty suggesting that community-based oral health promotion interventions that combine oral health education with supervised toothbrushing or professional preventive oral care can reduce dental caries in children. Other interventions, such as those that aim to promote access to fluoride, improve children's diets or provide oral health education alone, show only limited impact. We found no clear indication of when is the most effective time to intervene during childhood. Cost-effectiveness, long-term sustainability and equity of impacts and adverse outcomes were not widely reported by study authors, limiting our ability to make inferences on these aspects. More rigorous measurement and reporting of study results would improve the quality of the evidence.

Community-based population-level interventions for promoting child oral health

BACKGROUND

Dental caries and gingival and periodontal disease are commonly occurring, preventable chronic conditions. Even though much is known about how to treat oral disease, currently we do not know which community-based population-level interventions are most effective and equitable in preventing poor oral health.

OBJECTIVES

Primary • To determine the effectiveness of community-based population-level oral health promotion interventions in preventing dental caries and gingival and periodontal disease among children from birth to 18 years of age. Secondary • To determine the most effective types of interventions (environmental, social, community and multi-component) and guiding theoretical frameworks.• To identify interventions that reduce inequality in oral health outcomes.• To examine the influence of context in the design, delivery and outcomes of interventions.

SEARCH METHODS

We searched the following databases from January 1996 to April 2014: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resource Information Center (ERIC), BIOSIS Previews, Web of Science, the Database of Abstracts of Reviews of Effects (DARE), ScienceDirect, Sociological Abstracts, Social Science Citation Index, PsycINFO, SCOPUS, ProQuest Dissertations & Theses and Conference Proceedings Citation Index - Science.

SELECTION CRITERIA

Included studies were individual- and cluster-randomised controlled trials (RCTs), controlled before-and-after studies and quasi-experimental and interrupted time series. To be included, interventions had to target the primary outcomes: dental caries (measured as decayed, missing and filled deciduous teeth/surfaces, dmft/s; Decayed, Missing and Filled permanent teeth/surfaces, DMFT/S) and gingival or periodontal disease among children from birth to 18 years of age. Studies had to report on one or more of the primary outcomes at baseline and post intervention, or had to provide change scores for both intervention and control groups. Interventions were excluded if they were solely of a chemical nature (e.g. chlorhexidine, fluoride varnish), were delivered primarily in a dental clinical setting or comprised solely fluoridation.

DATA COLLECTION AND ANALYSIS

Two review authors independently performed screening, data extraction and assessment of risk of bias of included studies (a team of six review authors - four review authors and two research assistants - assessed all studies). We calculated mean differences with 95% confidence intervals for continuous data. When data permitted, we undertook meta-analysis of primary outcome measures using a fixed-effect model to summarise results across studies. We used the I2 statistic as a measure of statistical heterogeneity.

MAIN RESULTS

This review includes findings from 38 studies (total n = 119,789 children, including one national study of 99,071 children, which contributed 80% of total participants) on community-based oral health promotion interventions delivered in a variety of settings and incorporating a range of health promotion strategies (e.g. policy, educational activities, professional oral health care, supervised toothbrushing programmes, motivational interviewing). We categorised interventions as dietary interventions (n = 3), oral health education (OHE) alone (n = 17), OHE in combination with supervised toothbrushing with fluoridated toothpaste (n = 8) and OHE in combination with a variety of other interventions (including professional preventive oral health care, n = 10). Interventions generally were implemented for less than one year (n = 26), and only 11 studies were RCTs. We graded the evidence as having moderate to very low quality.We conducted meta-analyses examining impact on dental caries of each intervention type, although not all studies provided sufficient data to allow pooling of effects across similar interventions. Meta-analyses of the effects of OHE alone on caries may show little or no effect on DMFT (two studies, mean difference (MD) 0.12, 95% confidence interval (CI) -0.11 to 0.36, low-quality evidence), dmft (three studies, MD -0.3, 95% CI -1.11 to 0.52, low-quality evidence) and DMFS (one study, MD -0.01, 95% CI -0.24 to 0.22, very low-quality evidence). Analysis of studies testing OHE in combination with supervised toothbrushing with fluoridated toothpaste may show a beneficial effect on dmfs (three studies, MD -1.59, 95% CI -2.67 to -0.52, low-quality evidence) and dmft (two studies, MD -0.97, 95% CI -1.06 to -0.89, low-quality evidence) but may show little effect on DMFS (two studies, MD -0.02, 95% CI -0.13 to 0.10, low-quality evidence) and DMFT (three studies, MD -0.02, 95% CI -0.11 to 0.07, moderate-quality evidence). Meta-analyses of two studies of OHE in an educational setting combined with professional preventive oral care in a dental clinic setting probably show a very small effect on DMFT (-0.09 weighted mean difference (WMD), 95% CI -0.1 to -0.08, moderate-quality evidence). Data were inadequate for meta-analyses on gingival health, although positive impact was reported.

AUTHORS' CONCLUSIONS

This review provides evidence of low certainty suggesting that community-based oral health promotion interventions that combine oral health education with supervised toothbrushing or professional preventive oral care can reduce dental caries in children. Other interventions, such as those that aim to promote access to fluoride, improve children's diets or provide oral health education alone, show only limited impact. We found no clear indication of when is the most effective time to intervene during childhood. Cost-effectiveness, long-term sustainability and equity of impacts and adverse outcomes were not widely reported by study authors, limiting our ability to make inferences on these aspects. More rigorous measurement and reporting of study results would improve the quality of the evidence.

Effectiveness of Computer-Based Training on Toothbrush Skills of Patients Treated With Crowns: A Randomized Controlled Trial

BACKGROUND

This study was conducted to assess plaque removal skills in patients with fixed dental prostheses (FDP), and effectiveness of computer-based training (CBT) of different brushing techniques (Fones versus Bass technique in their common modifications).

METHODS

Ninety-three patients with FDP were randomly allocated to one of three training groups: 1) C (control group); 2) F (Fones technique group); and 3) B (Bass technique group). All patients received CBT of the basics of toothbrushing. Group C received no further instructions while groups F and B received additional CBT of the modified Fones or the modified Bass technique, respectively. Plaque levels were assessed immediately after patients had been asked to perform oral hygiene to the best of their abilities.

RESULTS

Prior to training, persistent plaque deposits were found at 80% of marginal sites of natural teeth immediately after patients had performed oral hygiene. Considerably fewer plaque deposits were found on FDP (43%). No significant group differences were observed 6 and 12 weeks after training, either for natural teeth or for FDP (all P >0.05).

CONCLUSIONS

Plaque removal skills are low in patients with FDP. Apparently, they do not profit from CBT of the techniques studied here. Studies observing their actual brushing behavior should be conducted to elucidate reasons for their deficits and to explore why CBT does not work in this group of patients.

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.

Effect of Reinforcement of Oral Health Education Message through Short Messaging Service in Mobile Phones: A Quasi-Experimental Trial

Objective. This paper aims to assess the effectiveness of reinforcement of oral health education message through short messaging service (SMS) in mobile phones. Material and Methods. 400 subjects from two colleges (200 from each college) belonging to 18–20 years age group possessing mobile phones were randomly selected and baseline examination of oral hygiene and gingival status was carried out using Oral Hygiene Index (OHI) and Gingival Index (GI). Oral health education was provided to all the subjects. Oral health education message was reinforced through short messaging service (SMS) in mobile phones for the subjects belonging to the intervention group. There was no such reinforcement for the control group. Follow-up examinations were done at the end of 1st, 2nd, 3rd, and 6th month. After the 3rd month, subjects of the intervention group did not receive oral health education message through short messaging service (SMS) and were followed up after next three months. Compiled data was analyzed using SPSS version 16 statistical software. Result. Mean OHI and GI scores in intervention group were significantly (p < 0.01) less than those of control group after the 2nd, 3rd, and 6th month. Conclusion. Reinforcement of oral health education message through short messaging service (SMS) is effective media to improve oral health.

Training in different brushing techniques in relation to efficacy of oral hygiene in young adults: a randomized controlled trial

AIM

This study aims to assess plaque scores after oral hygiene in an unselected sample of young German adults and to compare the effects of computer-based training of the Fones versus the modified Bass technique on these scores.

MATERIAL AND METHODS

Seventy 18- to 19-year olds received computer-based training of the Fones technique, the modified Bass technique or basic instructions of oral hygiene alone (control group). The marginal plaque index (MPI; percentage of sections adjacent to the gingiva showing plaque) and BOP were assessed at baseline and after 6, 12 and 28 weeks. MPI was assessed immediately after participants had been asked to perform oral hygiene to the best of their abilities.

RESULTS

At baseline, MPI levels of 83.3% ± 12.5 (mean ± SD) were observed. After 12 weeks, groups differed significantly (p < 0.05) with respect to MPI: Fones group: 70.3% ± 14.7; Bass group: 77.91 ± 14.37; control group: 79.3% ± 9.2. No differences in BOP were found.

CONCLUSIONS

High plaque levels at gingival margins after oral hygiene were observed in an unselected sample of young German adults. After 12 weeks, plaque levels after oral hygiene were slightly reduced in the group who had received training of the Fones technique but effects trailed off afterwards. The study failed to prove effects of the training on signs of gingival inflammation.

Establishment of a new marginal plaque index with high sensitivity for changes in oral hygiene

BACKGROUND

Although several plaque indices exist, they rarely assess in detail the plaque adjacent to the gingival margin, an area most important for periodontal health. This study aims to develop a new marginal plaque index (MPI) and to assess its validity and treatment sensitivity compared to the internationally accepted Turesky modification of the Quigley and Hein Index (TQHI).

METHODS

Data from two studies with n = 64 and n = 67 participants, respectively, are reported here. Convergence of MPI with TQHI and concurrent and predictive validity with papillary bleeding index were assessed, as was treatment sensitivity to a treatment of proximal hygiene (study 1) or toothbrushing (study 2), respectively.

RESULTS

Convergent validity with TQHI is very good. Concurrent and predictive validity parameters of the MPI are similar to the TQHI. The treatment sensitivity of MPI exceeds TQHI by far. This results in a reduction by >70% of the sample size needed to discover significant treatment effects. As expected, the largest treatment sensitivity was observed for proximal MPI measures in study 1, whereas study 2 showed largest effects for cervical measures.

CONCLUSIONS

MPI appears to be a valid plaque-scoring system that assesses plaque at the gingival margin. It responds with high sensitivity to treatments aimed at plaque reduction at the gingival margin. Its treatment sensitivity and capacity to differentiate between proximal and cervical plaque make it a promising tool for periodontal research.

Comparison of Two Brushing Methods- Fone's vs Modified Bass Method in Visually Impaired Children Using the Audio Tactile Performance (ATP) Technique

BACKGROUND

To evaluate the effectiveness of two brushing techniques - Fone's method Vs Modified Bass method in visually impaired children using the Audio Tactile Performance (ATP) technique.

SETTINGS AND DESIGN

Eighty institutionalised visually impaired children, aged between 4-15 y were randomly selected.

MATERIALS AND METHODS

Baseline plaque scores were recorded using Silness and Loe plaque index. The subjects were then randomly divided into two groups of which, 40 were trained with Fone's method and and other 40 with Modified Bass method using the ATP technique. Plaque scores were evaluated again after two months. The effectiveness of oral hygiene maintenance in these children were analysed and evaluated statistically.

STATISTICAL ANALYSIS

Data was analysed using Wilcoxon signed rank test and paired t-test.

RESULTS

Both Fone's and Modified Bass method showed reduction in plaque which was statistically significant. There was an increase in the frequency of tooth brushing following training.

CONCLUSION

The Fone's method and the Modified Bass method of tooth brushing showed a significant improvement in the oral hygiene of visually impaired children when taught using an effective communication tool, the ATP technique.

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.