Dental Tribune Europe

Researchers compare user friendliness of toothbrushing techniques

By Dental Tribune International
June 18, 2012

GIESSEN, Germany: Most people consider it important to brush their teeth regularly. However, the majority are unaware that good oral health care depends not only on frequent cleaning but also on the correct brushing technique. In a recent study, German researchers compared two common techniques to determine which is the easiest to learn and use over a long period.

The research team at Justus Liebig University Giessen aimed to compare the respective effects of three interactive computer presentations teaching the modified Bass technique, the Fones’ method and the basics of oral hygiene alone.

The Fones’ method, introduced by Alfred C. Fones and often recommended in patient brochures, is the most commonly used method. With the toothbrush held at right angles to the tooth surfaces, the brush is moved in large, sweeping circles over the occluded teeth. With the jaws parted, the palatal and lingual surfaces of the teeth are brushed in smaller circles. The occlusal surfaces of the teeth are brushed in an antero-posterior direction.

The Bass technique, introduced by Dr Charles C. Bass and often recommended by dentists and in textbooks, concentrates on cleaning the areas that lie below and just adjacent to the gingival margin. The brush head is placed at an angle of 45° to the posterior teeth, with the bristle tips contacting the gingival margin. The bristles are lightly pressed without bending them, so that they reach the gingival sulcus underneath the gingival margin. The toothbrush is then vibrated with short back-and-forth motions. The brush is held in a vertical position for the anterior teeth.

The study involved 67 students at the university who had at least 20 of their own teeth, of which ten or more teeth exhibited plaque or bleeding. They were students in disciplines other than dentistry, non-smokers and users of manual tooth-brushes.

One group underwent training in the Fones’ method and the second in the Bass technique. The control group received training in toothbrushing basics only. The students attended only one training session, but were able to navigate around and review the PowerPoint presentation (which included text, oral explanations and images) as many times as desired.

After the training, the students received a booklet on the major aspects of the presentations. Additionally, they were given the same brand of toothbrush, toothpaste and dental floss to use at home.

The participants were examined after 6, 12 and 28 weeks. According to the researchers, significant group differences were observed for the papillary bleeding index (PBI) after 28 weeks. The marginal plaque index (MPI) revealed significant group differences for all sections together and for cervical sections alone after 6, 12 and 28 weeks. For approximal sections, significant group differences were observed after 6 and 12 weeks.

“At no time did Bass differ significantly from control. Fones differed significantly from control with respect to PBI after 28 weeks and with respect to skills after 6 and 12 weeks,” the researchers said. “Significant differences between Bass and Fones were observed with respect to gingival health after 12 weeks and with respect to skills after 6, 12, and 28 weeks. From these analyses, training of Fones turned out to be superior to training of basics of toothbrushing alone (control) and training of Bass.”

During the study, five participants dropped out of both the Fones group and the control group, and 11 out of the Bass group. These participants generally reported not having applied the techniques consistently owing to time pressure, idleness or examination stress. Three students from the Bass group reported unpleasant effects on the gingiva as their main reason for non-compliance.

The researchers concluded that “the result is surprising with respect to the low effectiveness of teaching the modified Bass technique and that it seemed as if teaching the Bass technique is of no advantage over teaching the basics of toothbrushing alone. In contrast, teaching the Fones’ technique brought about a clear advantage in terms of gingivitis and hygiene skills.”

The researchers assumed that one reason for this outcome was that Fones is the best-known brushing technique in Germany, where the study was conducted, and therefore easier to remember after only one training session.

The researchers recommended further research with participants in different age groups and varying levels and types of education, in addition to other factors.

The study, “Improving oral hygiene skills by computer-based training: A randomized controlled comparison of the modified Bass and the Fones’ techniques”, was published online in the May issue of PLoS ONE journal.

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