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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.

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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.

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OBJECTIVES: Video observation studies of habitual oral hygiene from the 1970s revealed a striking neglect of brushing oral surfaces and unsystematic brushing patterns with frequent movements between areas. These findings were not systematically followed up; furthermore, nothing is known about whether subjects are able to floss sufficiently. Therefore, the aim of this video study was to analyse the performance of habitual toothbrushing and flossing. METHODS: A random sample of 101 18-year-olds was included. Toothbrush and floss were provided; habitual brushing/flossing was videotaped in a standardised setting and analysed with the video coding software INTERACT. Parameters of interest were toothbrushing duration, type of brushing strokes, brushing patterns, flossed interproximal spaces and flossing technique. RESULTS: The mean brushing duration was 156.0 ± 71.1 s; duration differed only slightly between the upper and lower jaw as well as between the right, left and anterior areas. However, oral surfaces were brushed distinctly shorter than vestibular surfaces (27.1 ± 27.8 s versus 72.1 ± 31.8 s; p ≤ 0.001). Participants brushed different areas of the mouth with different types of strokes, predominantly with horizontal and circular strokes. Brushing movements frequently alternated between areas (45.1 ± 22.4) not randomly but accumulated within a jaw with a tendency to move from the right to the left. Half of the participants flossed, but only one performed sufficiently. CONCLUSIONS: There was a significant neglect of brushing oral surfaces and insufficient use of floss. Brushing patterns were similar to those observed in the 1970s. CLINICAL RELEVANCE: Understanding habitual oral hygiene behaviour is essential for improving oral hygiene instruction strategies.

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Our study investigated the effect of a selective intensive prevention (SIP) programme on dental health of pupils in comparison to a control group. While no differences were observed in respect to dental health of first graders, the DMF-T values of fourth and 6 graders participating in SIP were significantly lower. Concerning the psychometric variables only few differences were found. The fourth and 6 graders in the test group reported less dental fear than the pupils in the control group.

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