Characteristics of effective toothbrushing: results of the 6th German Oral Health Study (DMS • 6)

The objective was to better understand why toothbrushing often fails to achieve the desired state of plaque-free dentition, by systematically analyzing toothbrushing behavior in four age groups (12-year-olds, 20-year-olds, 35- to 44-year-olds, 65- to 74-year-olds).

Analyzable video recordings of toothbrushing, as well as plaque scores assessed immediately after brushing, were available from 1,941 participants of the 6th German Oral Health Study (DMS • 6). All videos were analyzed in terms of tooth contact time (TCT), use of interdental cleaning aids, and type of toothbrush (electric/manual). A more detailed analysis of oral hygiene behavior was conducted in two extreme groups comprising the 10% of adults who showed the lowest (n = 35) vs the highest (n = 33) plaque sores after manual brushing.

Only younger seniors (65- to 74-year-olds) showed a mean TCT below 2 minutes. Interdental cleaning was practiced by 25% of the participants, while 44% used electric toothbrushes. The extreme-group comparison revealed significant differences across all observed behavioral aspects, except for correct dental floss use, which no participant was able to master. The use of interdental cleaning aids was associated with a more elaborate toothbrushing behavior.

These findings highlight the critical role of toothbrushing behavior in achieving oral cleanliness. The extent of plaque removal is associated with various aspects of toothbrushing behavior. (Quintessence Int 2026;57(Suppl):S98-S104; doi: 10.3290/j.qi.b6955521).