Tooth brushing learning methods: time to change practice?

Leghrouz L, Khole M R, Splieth C H, Schmoekel J. Tooth Brushing Learning Methods: Differential or Conventional? - A Randomized Controlled Clinical Trial. Caries Res 2024; 58: 399-406.

A two-arm single-blinded randomised controlled clinical trial to investigate the effects of the differential learning method versus conventional tooth brushing instruction by assessing changes in plaque levels and gingivitis in children aged three to eight years.

Children aged three to eight years with poor oral hygiene at baseline, needing parental assistance with tooth brushing, and available to attend follow-up appointments were included in the study. Exclusion criteria included children with acute dental pain, those with serious systemic diseases requiring special attention during dental care, and those who refused to participate in the study. Participants were randomly assigned to the test and control groups by self-drawing an unlabelled envelope from a box. The sealed envelopes contained oral hygiene instructions with exercises to use the differential learning method for the test group and children in the control group received the usual tooth brushing instructions. Participants were asked to follow the instructions at home for 28 days.

The sample size was calculated according to previous similar oral hygiene studies, with a final sample size of 29 participants in each group to allow for dropouts of approximately 30%. Data was analysed using Microsoft Excel, with the significance threshold set at p < 0.05. Descriptive analysis included the calculation of means, standard deviation, absolute numbers, and percentages. Comparisons between the two groups were made using the independent samples t-test for quantitative variables and the chi-squared test for categorical variables.

Two calibrated and blinded examiners recorded the papillary bleeding index (PBI) and the Quigley-Hein Index for dental plaque (QHI) at baseline and at the first and second recall visits at four and twelve weeks respectively. Of the 58 children recruited for the study, 46 were included in the final analysis with 22 in the control group and 24 in the test group. At baseline, there were no significant differences between the groups with respect to plaque and gingival indices. At the first recall, a statistically significant difference in the PBI index was found in favour of the test group (test: 0.1 ± 0.2 v.

0.3 ± 0.2; p < 0.001) but the difference in relation to the QHI index was not statistically significant (test: 2.1 ± 0.9 v. control 2.6 ± 0.9; p = 0.07). At the second recall, statistically significant differences in both indices were found in favour of the test group (PBI test: 0.1 ± 0.2 v. PBI control: 0.5 ± 0.2; p < 0.001; QHI test: 2.1 ± 0.9 v. QHI control: 3.2 ± 1; p < 0.001).

The authors of the study concluded that simple instructions with the differential learning method for home tooth brushing can lead to significantly greater improvements in oral hygiene in children with poor oral hygiene when compared to traditional instructions, particularly in the medium term retention phase.