Improving oral hygiene skills by computer-based training: a randomized controlled comparison of the modified Bass and the Fones techniques

Abstract

Background: Gingivitis and other plaque-associated diseases have a high prevalence in western communities even though the majority of adults report daily oral hygiene. This indicates a lack of oral hygiene skills. Currently, there is no clear evidence as to which brushing technique would bring about the best oral hygiene skills. While the modified Bass technique is often recommended by dentists and in textbooks, the Fones technique is often recommended in patient brochures. Still, standardized comparisons of the effectiveness of teaching these techniques are lacking.

Methodology/principal findings: In a final sample of n = 56 students, this multidisciplinary, randomized, examiner-blinded, controlled study compared the effects of parallel and standardized interactive computer presentations teaching either the Fones or the modified Bass technique. A control group was taught the basics of tooth brushing alone. Oral hygiene skills (remaining plaque after thorough oral hygiene) and gingivitis were assessed at baseline and 6, 12, and 28 weeks after the intervention. We found a significant group×time interaction for gingivitis (F(4/102) = 3.267; p = 0.016; ε = 0.957; η(2) = 0.114) and a significant main effect of group for oral hygiene skills (F(2/51) = 7.088; p = 0.002; η(2) = 0.218). Fones was superior to Bass; Bass did not differ from the control group. Group differences were most prominent after 6 and 12 weeks.

Conclusions/significance: The present trial indicates an advantage of teaching the Fones as compared to the modified Bass technique with respect to oral hygiene skills and gingivitis. Future studies are needed to analyze whether the disadvantage of teaching the Bass technique observed here is restricted to the teaching method employed.

Trial registration: German Clinical Trials Register DRKS00003488.

Conflict of interest statement

Competing Interests: This study was sponsored by GABA International, Therwill, Switzerland. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1. Assessment of the Marginal Plaque Index (Deinzer et al., submitted).

The gingival margin is divided into four equal sections. For each section, the presence or absence of disclosed plaque is registered. Eight sections per tooth are registered: vestibular cervical (grey): two sections; vestibular approximal (black): two sections; oral cervical: two sections; oral approximal: two sections.

Figure 2. Papillary Bleeding index (PBI;A), oral hygiene skills measured by TQHI (B), MPI all sections (C), MPI approximal sections (D), and MPI cervical sections (E) over time.

Mean and standard error of the mean of percentage of sites with bleeding (PBI>0), mean score of the Turesky modification of the Quigley & Hein Index (TQHI) and of percentage of sections showing staining as assessed by the MPI are shown for all groups (control n = 19; Fones n = 19; Bass n = 18) at baseline, 6, 12, and 28 weeks after intervention. Pairwise ANCOVAs are coded as following: *,**p≤0.05, p≤0.01 Fones vs. control; #,##p≤0.05, p≤0.01 Fones vs. Bass; +,++p≤0.05, p≤0.01 Bass vs. control.