Video vs. Model-Based Oral Hygiene Instruction in Gingivitis Patients

Comparison of Video-Based Versus Model-Based Oral Hygiene Instruction on Clinical Outcomes and the Predictive Role of Self-Efficacy in Gingivitis Patients: A Single-Blind Randomized Clinical Trial

This randomized, single-blind clinical trial aims to evaluate the short-term effectiveness of two different oral hygiene instruction (OHI) methods-video-assisted instruction versus traditional 3D model demonstration-on periodontal clinical parameters in patients diagnosed with gingivitis. A critical secondary objective of this study is to investigate the predictive role of patients' baseline Oral Hygiene-Related Self-Efficacy (OHSE) on the extent of clinical healing, and to assess changes in patient-reported subjective gingival health using a Visual Analogue Scale (VAS). A total of 80 patients undergoing standard Phase 1 periodontal therapy (scaling and root planing) are randomly assigned in a 1:1 ratio to either the video instruction group or the model instruction group. Periodontal clinical indices, including Plaque Index (PI), Gingival Index (GI), Probing Depth (PD), and Bleeding on Probing (BOP), alongside patient-reported outcomes, are recorded at baseline and at a one-month follow-up by a blinded examiner. The primary hypothesis is that video-based instruction is non-inferior to conventional model-based instruction in improving clinical parameters. Furthermore, the study hypothesizes that a patient's baseline self-efficacy level-independent of the educational method received-significantly predicts the reduction in periodontal inflammation and bleeding scores.

Study Overview

• Status: Completed
• Conditions: Gingivitis; Gingivitis and Periodontal Diseases
• Intervention / Treatment: Behavioral: Video-Based Oral Hygiene Instruction; Behavioral: Model-Based Oral Hygiene Instruction

Detailed Description

Background and Rationale Gingivitis is a reversible inflammatory condition of the gingival tissues caused by the accumulation of dental plaque. The gold standard for its prevention and treatment is professional mechanical plaque removal (Phase 1 periodontal therapy) combined with effective, daily supragingival plaque control by the patient. However, maintaining long-term patient compliance and motivation remains a significant clinical challenge. Traditionally, oral hygiene instruction (OHI) involves verbal guidance and practical demonstration of brushing and interdental cleaning techniques on 3D dental models. With the integration of digital health technologies, video-based educational tools have emerged as a viable alternative. Video instructions offer standardized content and optimize the clinician's chair-time, which is highly valuable in busy clinical settings. While clinical indices objectively measure disease severity, contemporary periodontal care increasingly recognizes the crucial role of psychological and behavioral factors in treatment success. Oral hygiene-related self-efficacy (OHSE)-a patient's belief in their ability to maintain oral care habits even under taxing situations-is a key cognitive determinant of behavior change. Therefore, evaluating clinical outcomes in conjunction with OHSE and Patient-Reported Outcome Measures (PROMs) provides a more comprehensive understanding of periodontal healing dynamics. Study Objectives The primary objective of this study is to compare the short-term clinical efficacy of video-based versus model-based OHI delivered as an adjunct to Phase 1 periodontal treatment in patients with gingivitis. The secondary objective is to evaluate whether patients' baseline OHSE scores predict the amount of clinical improvement (reductions in Plaque Index and Bleeding on Probing) and to assess changes in self-reported gingival symptoms using a Visual Analogue Scale (VAS). Methodology and Study Design This study is designed as a prospective, randomized, single-blind, parallel-group clinical trial conducted at Ankara University Faculty of Dentistry. The trial enrolls 80 eligible patients diagnosed with plaque-induced gingivitis, characterized by a whole-mouth average Gingival Index (GI) > 2.0 and no probing depths > 4 mm. Patients with a history of systemic diseases affecting periodontal tissues, current smokers, and those who received antibiotic therapy within the last 3 months are excluded. Clinical and Behavioral Assessments Prior to any intervention (Baseline - T0), a blinded examiner assesses the periodontal health of the participants using the Plaque Index (PI), Gingival Index (GI), Probing Depth (PD), and Bleeding on Probing (BOP) at six sites per tooth. Following the clinical examination, patients complete a validated Oral Hygiene-Related Self-Efficacy (OHSE) questionnaire, which evaluates their confidence in performing toothbrushing, interdental cleaning, and regular dental visits under various psychological barriers. Additionally, patients rate their subjective gingival symptoms (e.g., bleeding, swelling, bad breath) using a 10-point VAS. Intervention Following baseline assessments, all patients receive standard Phase 1 periodontal treatment, consisting of full-mouth supragingival and subgingival scaling and polishing using ultrasonic instruments and hand curettes. Immediately after the mechanical therapy, patients are randomly allocated to one of two groups (1:1 ratio): Video Group: Patients receive a digital link to a standardized instructional video demonstrating proper toothbrushing and interdental cleaning techniques. Model Group: Patients receive one-on-one practical oral hygiene instruction demonstrated by a clinician on a 3D dental model. Follow-up and Statistical Analysis Patients are recalled at 1 month (T1) post-intervention. The same blinded examiner repeats all clinical measurements (PI, GI, PD, BOP) and patients re-evaluate their subjective gingival symptoms (VAS). Statistical analyses will be performed to assess within-group and between-group variations. The comparison of clinical improvement amounts (Δ T0 - T1) between the Video and Model groups will be conducted using Independent Samples t-tests and Analysis of Covariance (ANCOVA), adjusting for baseline clinical values and initial OHSE scores. Correlation analyses will be employed to examine the predictive relationship between baseline OHSE subsets (particularly interdental cleaning self-efficacy) and objective reductions in periodontal inflammation.

• Study Type: Interventional
• Enrollment (Actual): 80
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ankara, Turkey (Türkiye)
    • Ankara University Faculty of Dentistry

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Patients officially diagnosed with plaque-induced gingivitis. Patients having an average whole-mouth Gingival Index (GI) score strictly above 2.0 at baseline.

Patients aged between 18 and 65 years. Patients who have provided written informed consent to participate in the study.

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Exclusion Criteria:

Individuals with an average whole-mouth Gingival Index (GI) score of 2.0 or below.

Individuals presenting with periodontal pockets deeper than 4 mm in any single area of the mouth.

Individuals who possess fixed prosthetic restorations on any tooth. Individuals who have received any form of professional periodontal treatment within the last 6 months.

Individuals who currently smoke or use similar tobacco products. Individuals who have used systemic antibiotics for any medical or dental reason within the last 3 months.

Individuals who are physically or cognitively unable to perform adequate daily oral hygiene practices.

Individuals who have lost 5 or more natural teeth (excluding third molars/wisdom teeth).

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Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Video-Based Instruction; Following standard Phase 1 periodontal treatment (full-mouth supragingival and subgingival scaling and polishing), patients assigned to this arm receive their oral hygiene instruction via a digital video platform.	Behavioral: Video-Based Oral Hygiene Instruction; Patients are provided with a digital link to a standardized, audio-visual instructional video. The video comprehensively demonstrates proper toothbrushing and interdental cleaning techniques. Patients are instructed to watch the video and use it as a reference to reinforce their daily oral home care routine.
Active Comparator: Model-based Instruction; Following standard Phase 1 periodontal treatment (full-mouth supragingival and subgingival scaling and polishing), patients assigned to this arm receive conventional oral hygiene instruction demonstrated directly by a clinician.	Behavioral: Model-Based Oral Hygiene Instruction; A clinician provides a one-on-one, hands-on practical demonstration of proper toothbrushing and interdental cleaning techniques. This instruction is delivered interactively using a 3-dimensional physical dental model to guide and educate the patient on their daily oral home care routine.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Plaque Index (PI)	The Plaque Index evaluates the level of dental plaque accumulation. Measurements are taken by a blinded examiner at six sites per tooth (mesio-facial, mid-facial, disto-facial, mesio-oral, mid-oral, and disto-oral). The whole-mouth average score is calculated for each patient. A decrease in the score represents an improvement in oral hygiene and plaque control.	Baseline (T0) and 1-Month Follow-up (T1)
Change in Gingival Index (GI)	The Gingival Index assesses the severity of gingival inflammation. Measurements are recorded by a blinded examiner at six sites per tooth. The whole-mouth average score is calculated. A decrease in the score indicates a reduction in gingival inflammation and clinical improvement.	Baseline (T0) and 1-Month Follow-up (T1)
Change in Bleeding on Probing (BOP) Percentage	Bleeding on Probing assesses the presence or absence of gingival bleeding stimulated by a periodontal probe. It is evaluated at six sites per tooth. The outcome is calculated as the percentage of bleeding sites relative to the total number of sites evaluated. A decrease in the percentage indicates reduced inflammation and clinical healing.	Baseline (T0) and 1-Month Follow-up (T1)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Patient-Reported Subjective Gingival Health (VAS)	Patients evaluate their subjective perception of their own gingival health and symptoms (such as bleeding, swelling, or bad breath) using a 10-point Visual Analogue Scale (VAS). The scores range from 1 to 10, where 1 indicates "very poor" and 10 indicates "excellent". An increase in the score represents an improvement in the patient's subjective perception of their gingival health.	Baseline (T0) and 1-Month Follow-up (T1)
Baseline Oral Hygiene-Related Self-Efficacy (OHSE) Score	The validated OHSE questionnaire evaluates a patient's internal confidence in performing oral hygiene tasks (toothbrushing, interdental cleaning, and attending dental visits) under taxing situations. It consists of 19 items rated on a 4-point Likert scale (1 = "completely confident not to", 4 = "completely confident"). The total score ranges from 19 to 76. Higher scores indicate greater psychological resilience and self-efficacy. This is measured prior to intervention to serve as an independent predictive variable for clinical healing.	Baseline (T0)

Collaborators and Investigators

• Sponsor: Ankara University

Publications and helpful links

General Publications

• Woelber JP, Bienas H, Fabry G, Silbernagel W, Giesler M, Tennert C, Stampf S, Ratka-Kruger P, Hellwig E. Oral hygiene-related self-efficacy as a predictor of oral hygiene behaviour: a prospective cohort study. J Clin Periodontol. 2015 Feb;42(2):142-9. doi: 10.1111/jcpe.12348. Epub 2015 Jan 21.
• Syrjala AM, Kneckt MC, Knuuttila ML. Dental self-efficacy as a determinant to oral health behaviour, oral hygiene and HbA1c level among diabetic patients. J Clin Periodontol. 1999 Sep;26(9):616-21. doi: 10.1034/j.1600-051x.1999.260909.x.

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2024
• Primary Completion (Actual): August 30, 2024
• Study Completion (Actual): February 1, 2025

Study Registration Dates

• First Submitted: July 10, 2026
• First Submitted That Met QC Criteria: July 10, 2026
• First Posted (Actual): July 15, 2026

Study Record Updates

• Last Update Posted (Actual): July 15, 2026
• Last Update Submitted That Met QC Criteria: July 10, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Gingivitis; oral hyigene instructions; oral health realted self efficiacy
• Additional Relevant MeSH Terms: Mouth Diseases; Stomatognathic Diseases; Infections; Gingival Diseases; Periodontal Diseases; Gingivitis
• Other Study ID Numbers: 2024-08

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: All collected de-identified individual participant data (IPD) that underlie the results reported in the final published article will be shared. This includes demographic data, clinical periodontal indices (PI, GI, PD, BOP), and patient-reported outcome measures (OHSE and VAS scores).
• IPD Sharing Time Frame: Data will be available beginning 6 months and ending 36 months following the publication of the article.
• IPD Sharing Access Criteria: Data will be shared with researchers who provide a methodologically sound proposal for the purpose of achieving the specific aims outlined in their approved proposal. Requests should be directed to the corresponding author via email.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No