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.

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.

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.

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.

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.

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

BACKGROUND: Gingivitis and other plaque-associated diseases have a high prevalence in western communities even though the majority of adults report daily oral hygiene. This indicates a lack of oral hygiene skills. Currently, there is no clear evidence as to which brushing technique would bring about the best oral hygiene skills. While the modified Bass technique is often recommended by dentists and in textbooks, the Fones technique is often recommended in patient brochures. Still, standardized comparisons of the effectiveness of teaching these techniques are lacking. METHODOLOGY/PRINCIPAL FINDINGS: In a final sample of n = 56 students, this multidisciplinary, randomized, examiner-blinded, controlled study compared the effects of parallel and standardized interactive computer presentations teaching either the Fones or the modified Bass technique. A control group was taught the basics of tooth brushing alone. Oral hygiene skills (remaining plaque after thorough oral hygiene) and gingivitis were assessed at baseline and 6, 12, and 28 weeks after the intervention. We found a significant group×time interaction for gingivitis (F(4/102) = 3.267; p = 0.016; ε = 0.957; η(2) = 0.114) and a significant main effect of group for oral hygiene skills (F(2/51) = 7.088; p = 0.002; η(2) = 0.218). Fones was superior to Bass; Bass did not differ from the control group. Group differences were most prominent after 6 and 12 weeks. CONCLUSIONS/SIGNIFICANCE: The present trial indicates an advantage of teaching the Fones as compared to the modified Bass technique with respect to oral hygiene skills and gingivitis. Future studies are needed to analyze whether the disadvantage of teaching the Bass technique observed here is restricted to the teaching method employed. TRIAL REGISTRATION: German Clinical Trials Register DRKS00003488.

Oral and written instruction of oral hygiene: a randomized trial.

BACKGROUND: This randomized, evaluator-masked, controlled study evaluates the effectiveness of oral in contrast to written instruction of oral hygiene. METHODS: Eighty-three students without clinical signs of periodontitis were randomly assigned to either a control group or one of three experimental conditions: 1) written instruction, 2) standardized oral instruction, or 3) individualized oral instruction. Plaque and bleeding indices were assessed to analyze intervention effects on oral health and oral hygiene skills. Measurements took place at baseline and 4 weeks after intervention. RESULTS: Groups differed significantly with respect to gingival bleeding and were tentatively significant with respect to oral hygiene skills. Participants who had received oral individualized instructions showed the best results. CONCLUSION: A gradient of effectiveness of the instruction methods was observed with most favorable results for the individualized instruction.