Video instruction to establish a panel of experts to compare tooth cleaning by 4 electric toothbrushes

Laboratory robots can reveal differences in the cleaning of artificial tooth surfaces by different electric toothbrushes. The primary aim of this study was to establish, through video instruction, a panel of experts in tooth cleaning with an oscillating rotating electric toothbrush in an attempt to mimic the highly reproducible laboratory robot. A secondary aim was to use the "expert" panel, in an attempt to distinguish between tooth cleaning efficacy of 4 head/model combinations of the oscillating rotating electric brush.

A 24-subject panel, after video training and home habituation for up to 12 weeks with the basic model of electric brush, participated in a single examiner blind, 4-cell, randomised, cross-over study balanced for residual effects. In each period, subjects suspended tooth cleaning for 4 days. Plaque was then scored by area before and after tooth brushing for 2 min in tandem with the instructional video with the allocated brush head/model combination.

Differences between subjects was significant, but overall plaque removal with all brushes was of the order of 85% with one subject achieving >97% plaque removal. There were significant differences between the brushes with the oscillating rotating brush with the faster head movement, in most analyses, significantly more effective than the slower oscillating rotating brush with 2 head combinations. The faster oscillating rotating brush was also significantly more effective than the most recently introduced oscillating rotating reciprocating model.

Previous studies have shown that single uses of watch-and-follow video instruction significantly improve toothcleaning with electric toothbrushes. The present study shows that extended training using these videos results in almost complete plaque removal even when prebrushing plaque levels have been enhanced by a 4-day period of no oral hygiene. Furthermore, the establishment of an "expert" panel can distinguish between brushes of different cleaning efficiencies. However, given the level of achievement of all panel members with all brushes, the absolute differences observed are of doubtful clinical significance for gingival health. Finally, the slightly-reduced plaque removal by the 3 directional head action brush can be explained by the inability within the present protocol to habituate the subjects in its use.