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 (ß = -0.41;P < 0.001) and the number of sextants brushed for at least 7.5 s (ß = -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.

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.

Comparison of experimental gingivitis with persistent gingivitis: differences in clinical parameters and cytokine concentrations.

BACKGROUND AND OBJECTIVE: Experimental gingivitis has been studied extensively as a well-controlled laboratory model of gingivitis. It is unclear, however, how experimental gingivitis compares with persistent plaque and gingivitis in more naturalistic settings. The present study compares both conditions in a randomized controlled design. MATERIAL AND METHODS: Twenty-six students suffering from plaque and gingivitis were randomly assigned to either a persistent gingivitis or an experimental gingivitis condition. Subjects with persistent gingivitis continued their habitual (i.e. insufficient) oral hygiene behaviour, resulting in persistence of plaque and gingivitis. Experimental gingivitis consisted of initial prophylaxis and subsequent total neglect of oral hygiene. Crevicular interleukin-1beta and interleukin-8 and clinical data were assessed weekly. RESULTS: After 4 wk, subjects with experimental gingivitis showed significantly more plaque accumulation (p = 0.005), higher interleukin-1beta (p = 0.037), and lower interleukin-8 (p = 0.043) concentrations than subjects with persistent gingivitis. Whereas in experimental gingivitis we observed considerable fluctuations in clinical and immunological parameters over the 4-wk period, persistent gingivitis was characterized by little fluctuation, indicating that we were monitoring an inflammatory steady state. CONCLUSION: The data indicate that conditions observed after 4 wk of experimental gingivitis are not comparable with persistent gingival inflammation in a naturalistic setting. Results are discussed with respect to current studies, indicating that chronic inflammation may reflect a stage of down-regulated pro-inflammatory response.