Self-reported Tooth Brushing Research Articles

Does the Self-Reported Behavioural Automaticity Index provide a valid measure of toothbrushing behaviour in adults?

Studies to promote regular toothbrushing usually rely on self-reports of toothbrushing frequency (SRF). However, toothbrushing frequency measures may be open to responder bias since twice-daily toothbrushing is a commonly accepted social norm. The validity of SRF measures is unclear, meaning that their use as outcomes in interventional work may be flawed. The study's aim was to compare two different self-reported toothbrushing measures: SRF and the Self-Reported Behavioural Automaticity Index (SRBAI); with measurement of observed toothbrushing frequency tracked over 6 weeks. A secondary aim was to explore the interaction effect of various moderators (age, ethnicity, socioeconomic status (SES), sex, self-efficacy, participant personality and routine preference) upon the correlation between SRBAI and observed toothbrushing frequency. One hundred and sixty-four adults were recruited via a number of different community groups and workplaces outside the dental setting. After consent, participants completed a questionnaire which collected demographic and participant characteristics measures (age, ethnicity, SES, sex, self-efficacy, participant personality and routine preference) and self-reported toothbrushing habits. Participants then attached a 'Brushlink' device to their toothbrush for 6 weeks to track their observed toothbrushing frequency. Using the Pearson correlation coefficient, a moderately strong positive linear association (r = 0.65) between SRBAI and observed toothbrushing frequency was found. By comparison, the correlation between SRF and observed toothbrushing frequency was weak (r = 0.39). There was a weak positive association between self-reported behaviour frequency and SRBAI score (r = 0.35). Using multivariable linear regression, no statistically significant interactional effect was demonstrated for any moderator variable upon the correlation coefficient of SRBAI and observed toothbrushing frequency. The SRBAI provided a stronger association with observed toothbrushing frequency than the SRF measure. A moderately strong relationship between SRBAI and observed toothbrushing frequency was found, compared to a weak positive relationship between self-reported behaviour frequency and SRBAI score. This suggests that the SRBAI score could be a suitable proxy to measure observed toothbrushing behaviour and preferable to SRF in interventional work.

A Scoping Review of the Relation Between Toothbrushing and Diabetes Knowledge, Glycemic Control, and Oral Health Outcomes in People With Type 2 Diabetes.

Given the bidirectional relationship between type 2 diabetes and periodontal disease, this study sought to compile the available data regarding the relationship between home oral hygiene, specifically toothbrushing, and glycemic control and oral health in people with type 2 diabetes. A systematic scoping review was conducted using a combination of controlled vocabulary and keyword terms for type 2 diabetes and home oral care in PubMed and CINHAL. Publications from the past 20 years were considered for inclusion. Study data were summarized. A total of 11 studies met our inclusion criteria. In all survey research identified, self-report of more frequent toothbrushing in people with type 2 diabetes was always found to be associated with self-report of better glycemic control and was often associated with better clinician-conducted measures oral health. In the interventional studies identified, health coaching about oral health was associated with improvements in glycemic control, and health coaching compared with health education was found to be associated with enhanced improvement in glycemic control and self-reported toothbrushing behavior. The available data suggest that improved engagement in toothbrushing behavior may be associated with improved oral health and better glycemic control in people with type 2 diabetes. Whether improvement in glycemic control is a direct result of change to the oral environment, succeeding with one behavior change stimulating engagement in other health behavior changes, a combination of the two, or something else cannot be determined from this review. Additional studies are needed to further explore the potential for oral health coaching to improve the well-being of people with type 2 diabetes.

Does Providing Story Books to Children Lead to an Improvement in Oral Hygiene in School Children: A Quasi-Experimental Study

Objective: To assess the effect of giving tooth brushing storybooks along with verbal oral hygiene (OHI) instructions on plaque levels to schoolchildren. Methodology: This quasi-experimental study was conducted in a private school in Islamabad from October to November 2022. Children in Class V were selected as the Experimental Group I (Storybooks + OHI), while Class IV children were placed in the Control Group II (OHI alone). There were 20 students in each group. Plaque levels were compared at the baseline (before intervention) and after seven days. Tooth brushing practices were recorded at the baseline. Quantitative variables, such as age and mean plaque score were reported as mean and standard deviation. Categorical variables such as gender and tooth brushing frequency were described as frequencies and percentages. Results: The mean age of the children was 9.6 + 1.08 years. A total of 16 (40%) boys and 24 (60%) girls were included in the study. Children in Group II had significantly better self-reported tooth brushing practices with 16 (80%) children brushing twice a day, as compared to 10 (50%) children from Group I (p = 0.041). There was no difference in the reduction in plaque scores between group I (0.14 + 0.21) and group II (0.08 + 0.21; p = 0.382). Conclusion: Giving story books to children is not an effective intervention to improve the oral hygiene status of children, as compared to oral hygiene instructions alone.

Set up and assessment of progression criteria for internal pilots: the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial example

BackgroundDental caries is common in young people and has wide-ranging ramifications for health and quality of life. Text messaging interventions show promise as a means to promote oral health behaviour change among young people. This paper reports the internal pilot of the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial, which is evaluating an intervention comprising an oral health classroom lesson and text messages about toothbrushing, on caries in young people. Pilot trial objectives were to evaluate the feasibility and appropriateness of recruitment and data collection methods, the randomisation strategy, and intervention delivery against progression criteria for the main trial.MethodsThis is an internal pilot trial embedded within an assessor-blinded, two-arm, cluster randomised controlled trial. Participants were pupils aged 11–13 years (in year 7/S1 or year 8/S2) in secondary schools in England, Scotland, and Wales with above average pupil eligibility for free school meals. Following completion of pupil baseline questionnaires and dental assessments, year groups within schools were randomised to the intervention or control arm. Approximately 12 weeks later, participants completed a follow-up questionnaire, which included questions about sources of oral health advice to assess intervention contamination between year groups. At the end of the pilot phase, trial conduct was reviewed against pre-specified progression criteria.ResultsTen schools were recruited for the pilot, with 20 year groups and 1073 pupils randomised (average of 54 pupils per year group). Data collection methods and intervention delivery were considered feasible, the response rate to the follow-up questionnaire was over 80%, there was an indication of a positive effect on self-reported toothbrushing, and interest was obtained from 80% of the schools required for the main trial. Despite partial intervention contamination between year groups, within-school randomisation at the level of the year-group was considered appropriate for the main trial, and the sample size was revised to account for partial contamination. Facilitators and barriers to recruitment and data collection were identified and strategies refined for the main trial.ConclusionsProgression to the main trial of BRIGHT, with some design refinements, was concluded. The internal pilot was an efficient way to determine trial feasibility and optimise trial processes.Trial registrationISRCTN registry, ISRCTN12139369, registered 10/05/2017

HABIT: Health visitors delivering Advice in Britain on Infant Toothbrushing – an early-phase feasibility study of a complex oral health intervention

ObjectivesTo conduct an early-phase feasibility study of an oral health intervention, Health visitors delivering Advice on Britain on Infant Toothbrushing (HABIT), delivered by Health Visitors to parents of children aged...

Toothbrushing, Blood Glucose and HbA1c: Findings from a Random Survey in Chinese Population.

Both diabetes and periodontal disease are prevalent in China. Poor oral hygiene practice is the major cause of periodontal disease. An association between oral hygiene practice and blood glucose level was reported in individuals with diabetes, but not in the general population. We examined the association in a population-based random survey recruiting 2,105 adults without previously diagnosed diabetes in Chongqing city, China. Plasma glucose and hemoglobin A1c (HbA1c) were measured, and a 2-hour oral glucose tolerance test was conducted for each respondent. Self-reported toothbrushing frequency was used as a proxy for oral hygiene practice. In a linear model controlling for potential confounders (demographic characteristics, socio-economic status, lifestyle risk factors, BMI, dental visit frequency, etc.), urban residents who barely brushed their teeth had an increase of 0.50 (95% CI: 0.10–0.90) mmol/L in fasting plasma glucose, and an increase of 0.26% (0.04–0.47%) in HbA1c, relative to those brushing ≥twice daily; for rural residents, the effects were 0.26 (0.05–0.48) mmol/L in fasting plasma glucose and 0.20% (0.09–0.31%) in HbA1c. Individuals with better oral practice tended to have lower level of blood glucose and HbA1c. Establishing good oral health behavioral habits may be conducive to diabetes prevention and control in the general population.

Regular Tooth Brushing is Associated with a Decreased Risk of Metabolic Syndrome According to a Medical Check-Up Database.

Associations have been reported between periodontal disease and increased cardiovascular disease risk, as well as between healthy self-reported tooth brushing behavior and reduced cardiovascular disease risk. We examined the association between self-reported tooth brushing behavior and the risk of metabolic syndrome (MetS) using a large medical check-up database. A total of 12,548 medical checkup records from a medical screening center in a city in southwest Japan were assessed. Subjects were aged 30 to 59 years. As lifestyle is associated with both tooth brushing and MetS, many lifestyle variables were considered as potential confounders. Logistic regression model were employed with a list of 127 lifestyle variables. Twenty variables associated with both tooth brushing and MetS were selected for both males and females. Furthermore, final confounding variables were selected by principal component analysis to avoid collinearity problems. The association of tooth brushing and MetS was evaluated for males and females separately by calculating adjusted odds ratios (ORs) with selected confounders plus age. The association between daily tooth brushing frequency and MetS risk for both genders was significant after adjusting for confounders, with the risk of MetS decreasing with increased frequency of daily tooth brushing (adjusted OR = 0.57 (95%Cl:0.48-0.81), 0.50 (95%Cl:0.35-0.71), 0.42 (95%Cl: 0.29-0.61) for males and adjusted OR = 0.65 (95%Cl:0.48-0.87), 0.44 (95%Cl:0.32-0.62) for females). Therefore, oral hygiene, including the frequency of tooth brushing as a significant component, may be an important factor in preventing MetS.

Reliability of self-reported toothbrushing frequency as an indicator for the assessment of oral hygiene in epidemiological research on caries in adolescents: a cross-sectional study.

BackgroundIn the present state of knowledge regarding the etiology of dental caries, it is unacceptable for studies addressing factors associated with this outcome to disregard oral hygiene. Simple, valid methods are needed for the assessment of oral hygiene in adolescents to allow this condition to be properly investigated in epidemiological studies on caries and assist in the establishment of health promotion measures. The aim of the present study was to test the hypothesis that the self-reported toothbrushing frequency can be used as a proxy measure for clinical oral hygiene indices in epidemiological studies on dental caries in adolescents.MethodsA cross-sectional study was conducted with a representative sample (n = 589) of 12-year-old school children in a medium-sized city in southern Brazil. A detailed questionnaire addressing socio-demographic and economic characteristics was sent to primary caregivers. Adolescents answered a brief self-administered questionnaire on behavioral characteristics, including toothbrushing frequency and sugar intake. Samples of stimulated saliva were collected from the adolescents and evaluated for levels of mutans streptococci and lactobacilli using Dentacult kits I and II, respectively. Examiners who had undergone a training and calibration exercise (kappa > 0.81) performed the clinical examination of the adolescents. Caries experience was assessed using the decayed, missing and filled teeth index. Oral hygiene was determined using the Simplified Oral Hygiene Index and the Visible Plaque Index.ResultsWhen the oral hygiene variables were used alone in the multiple models, significant associations with dental caries were found. When Simplified Oral Hygiene Index and/or Plaque Index were used together with toothbrushing frequency in the same model, only the latter was significantly associated with dental caries. A significant association was also found between self-reported toothbrushing frequency and the clinical indices.ConclusionBased on the present findings, self-reported toothbrushing frequency can be used as a proxy measure for clinical oral hygiene indices, which facilitates data collection in epidemiological studies addressing dental caries in adolescents.

Keep on brushing: a longitudinal study of motivational text messaging in young adults aged 18-24 years receiving Work and Income Support.

Using text messaging, underpinned by the Health Belief Model, this study aimed to improve tooth brushing frequencies among unemployed young adults aged 18-24 years. Set within Work and Income's Linwood Community Link office (one Christchurch branch of the New Zealand Government's employment and beneficiary services), unemployed young adults aged 18-24 years with access to a mobile phone were recruited using either a purpose-built computer kiosk or Work and Income's Facebook site. Participants completed a baseline survey and then received and responded to a series of motivational text messages over 10 weeks. Self-reported tooth brushing frequency was the primary outcome variable. Important socio-demographic (age, gender, ethnicity, employment status) and method-specific (level of attrition, distribution of successful text messages deliveries, active withdrawal) variables were also collected. Longitudinal analyses of these responses employed generalized estimating equation (GEE) models. Four hundred and three registered for the trial, of whom 171 (42%) were eligible. Self-reported tooth brushing twice or more per day increased from 51% at baseline to 70% at week 3, 74% at week 6, and 73% at week 9 - an increase significant in crude (P<0.001) and adjusted (P<0.001) GEE analyses. No important differences were noted between age, gender, or ethnic groups, although attrition was relatively high with only 26% participating by week 9. However, no evidence of differential attrition was observed. Invention through motivational text messaging improved the measured oral health self-care behavior in a hard-to-reach group carrying a disproportionately heavy oral health burden. This intervention warrants further investigation.

Sociodemographic, Clinical, and Laboratory Parameters Related with Presence of Regular Toothbrushing in Hemodialysis Patients

Introduction: Regular toothbrushing (TB) has been shown to be related with better oral health. Studies have shown that various sociodemographic and clinical factors were related with regular TB in general population with normal renal function. However, no study had analyzed the factors related with regular TB in hemodialysis (HD) patients. Methods: The laboratory parameters, depressive symptoms, health-related quality of life, sleep quality, and cognitive function were measured for all patients. Self-reported TB frequency was determined from all patients. Results: The frequency of patients TB were as follows: More than once a day (n = 20), once a day (n = 39), 2–5 times a week (n = 7), at most once a week (n = 16), at most once at 15 days (n = 21), at most once a month (n = 24), and never brushers (n = 8). Patients were dichotomized mainly into two groups: Group 1 was composed of 59 patients with regular TB (sum of patients with TB more than once a day and once a day) and Group 2 was composed of other 76 patients with irregular TB. In most of the domains of short form 36 (SF-36), cognitive function was higher, whereas depressive symptoms were lower in Group 1 patients when compared with Group 2 patients. Backward logistic regression analysis demonstrated that lower depression scores, lower high-sensitive C-reactive protein levels, higher cognitive function, and being middle school graduate or higher were independently related with regular TB. Conclusion: Regular TB is relatively low in HD patients. Preventive measures should be taken to improve regular TB in HD patients.

Changes in toothbrushing frequency in relation to changes in oral health‐related knowledge and attitudes among children – a longitudinal study

The aim of this study was to determine the associations between changes in self-reported toothbrushing frequency and the knowledge and attitudes related to oral health. The study population consisted of all fifth and sixth graders who started the 2001-2002 school year in Pori (n = 1,691); of these, 1,362 were monitored throughout the 3.4-yr study. Data were gathered by questionnaires before, in the middle, and after the follow-up, which was divided into two periods. Associations between changes in toothbrushing frequency, sum score of knowledge items, and sum scores of items in attitudinal factors were studied. The attitudinal factor structure was determined by principal component analyses. The associations were evaluated using mean values and general linear models for repeated measures. Toothbrushing frequency and knowledge and attitudes related to oral health improved among the same children during the study, with the changes usually taking place in the same time-period. In different time-periods, different children's toothbrushing and oral health-related knowledge and attitudes improved. Based on our results, changes in knowledge, attitudes, and behavior are related, but children are ready for change at different times. Therefore, oral health promotion should be designed to be a continuous process rather than a short-term intervention.

Parental cognitions in explanatory models of young children’s oral health-related behaviour and dental decay outcomes: A systematic review

The following sysstematic review presents evidence from four theoretically-based cross-sectional studies which investigate the role of parental cognitions in understanding young children’s oral health-related behaviours and outcomes. Findings indicate that the attitudes and beliefs of parents or caregivers of young children have significant predictive power in explaining self-reported tooth brushing, intentions to control sugar snacking and clinical decay outcome. In particular, measures of parents’ self-efficacy or perceived control beliefs appear particularly important in explaining variance in behavioural and dental decay outcomes. Researchers and clinicians involved in developing explanatory models of oral health and intervention approaches with young children should give greater consideration to the role of parental cognitions. This will improve our knowledge about how to change oral health preventative practices to improve oral health in this population.

Survey study of powered toothbrush with guiding device for oral hygiene improvement

Purpose: This study was performed to evaluate the effect of powered toothbrush with a wireless remote display on the subjective and objective oral hygiene improvement. Methods: One hundred and fifteen subjects in healthy or mild gingivitis status between the ages of 20 and 90 were re- cruited and reviewed for study inclusion criteria. At first visit, 115 pre-screened subjects filled in the questionnaire form which consisted of demographic factors, behavioral factors (smoking, alcohol consumption), toothbrushing habits (brushing time and frequency), self-reported oral health status, and self-satisfaction. Baseline clinical indices (Plaque index, Gingival index) were also recorded by a periodontist. Subjects were instructed how to use powered toothbrush with a wireless re- mote display, and were provided with it. Thirty days after first visit, 90 subjects returned for the second assessment by self-reported questionnaire form and professional clinical checkup. Statistical analysis was performed using paired t-test for the difference between baseline and second visit data. The relationship among variables was examined with chi-square test and Fisher's exact test. Results: Significant differences were not found on self-reported satisfaction related with sex, smoking, alcohol consumption (P<0.05). Self-reported tooth brushing habit was improved in the aspect of brushing time and frequency. Significant differ- ences were found on the self-reported oral health status, self-satisfaction, and clinical indices between the baseline and sec- ond visit data (P<0.01). Clinical indices were significantly reduced after using powered toothbrush with a wireless remote display (P<0.01). No adverse reactions were reported during the study period. Conclusions: Powered toothbrush with a wireless remote display successfully promoted oral hygiene from the subjective and objective viewpoint after 30 days of home usage. (J Korean Acad Periodontol 2009;39:407-412)

Oral health‐related behaviors predictive of failures in caries control among 11–12‐yr‐old Finnish schoolchildren

The aim of this study was to determine whether the baseline oral health-related behaviors of the participants of the intervention group of a randomized clinical trial conducted in Pori, Finland, were predictive of failures in controlling caries. Three definitions of failure were considered, namely if the children developed one or more, three or more, or five or more new caries lesions, as evidenced by the change in number of decayed, missing or filled surfaces (Delta DMFS) during the follow-up period of 3.4 yr. Children (n = 497) aged 11-12 yr, with at least one active initial caries lesion at baseline, were studied. The data were based on clinical examinations in 2001 and 2005 and on a questionnaire on oral health-related behaviors that was administered in 2001. Associations between baseline behaviors and the measures of failure in caries control were evaluated using logistic regression analyses. Self-reported tooth brushing with fluoride toothpaste at least twice a day reduced the risk of failure. Children who, at baseline, reported eating candy at least once a day were more likely to experience failure at the levels of three or more and five or more new lesions.

Introducing a clinical-behavioural scoring system for children's oral hygiene

Developing and testing a clinical-behavioural scoring system for assessing children's oral hygiene. One clinical variable (the presence of dental plaque, measured using Silness and Loe's index) and one behavioural variable (self-reported tooth brushing frequency) were combined into secondary data analysis of research databases for 3-6-year-olds and 6-13-year-olds in a Mexican community. The combined scoring is an ordinal scale that depicts suitable, moderate and inadequate hygiene. Blinded dental examiners also collected dmft/DMFT data in standardised conditions. Data was analysed with Spearman's rho, Kruskall-Wallis, non-parametric tests for trends and Pearson's chi2 tests. 1303 children aged 3-6 years old and 1644 children aged 6-13 years old participated in the study. Clear relationships existed between the combined scoring system and dmft (p < 0.01) and between the scoring system and DMFT (p < 0.01), suggesting that the combined clinical-behavioural scoring system is a reasonably accurate measurement of the relationship between caries experience and oral hygiene in children in the given setting. The combined clinical-behavioural scoring system is a simple, easy-to-use tool that incorporates clinical and behavioural data commonly found in dental systems. Whether the clinical-behavioural scoring system can be generalised remains to be established.

Cynical hostility as a determinant of toothbrushing frequency and oral hygiene

Our aim was to investigate whether cynical hostility, self-reported toothbrushing frequency and objectively assessed levels of oral hygiene were associated. The present study sample consisted of 4156 30-64-year-old dentate Finns. The questionnaire and the home interview included information about socioeconomic and sociodemographic factors and behavioural variables, such as toothbrushing frequency, dental attendance, smoking and cynical hostility. The level of oral hygiene was assessed during a clinical oral examination. The chi(2) test and ordinal logistic regression analyses were used. After controlling for sociodemographic and socioeconomic factors, smoking habits and reported dental attendance, the subjects belonging to the lowest cynical hostility level were found to brush their teeth significantly more often and to have better oral hygiene compared with those belonging the highest cynical hostility level. Toothbrushing frequency was adjusted when oral hygiene was used as the outcome variable. The association of cynical hostility with toothbrushing frequency and the oral hygiene seems to be partly dependent on the level of education. Cynical hostility is a psychosocial risk marker for the frequency and quality of toothbrushing and it could be a connecting trait between general health behaviour and oral health behaviour.

Toothbrushing Patterns Over Time in At?Risk Metropolitan African?American 5th?8th Graders

A large study of risky pre-teen behavior provided an opportunity to examine self-reported toothbrushing frequency for stability over time and adequacy. 1115 metropolitan African-American children at risk for violence and drug use self-reported toothbrushing frequency in at least one of five measurement points from 5th to 8th grade as part of a larger study. Longitudinal data were available for 815 students. 81% reported mainly twice daily, 8% reported mainly once daily, 10% changed over time, and 1% were consistently less than once daily. Overall, the children reported once or twice daily toothbrushing frequency, stable between 5th and 8th grades. A minority of children showed low or inconsistent frequencies and these results may indicate an opportunity for intervention to improve habits.

Sense of Coherence as a Determinant of Toothbrushing Frequency and Level of Oral Hygiene

Antonovsky's salutogenic theory seeks to find general health-promoting factors in individuals as distinct from characteristics that function as risks for specific diseases. A central construct of the theory is sense of coherence (SOC). Individuals with a strong SOC have the ability to define events as less stressful (because of comprehensibility); to mobilize resources to deal with encountered stressors (manageability); and to possess the motivation, desire, and commitment to cope (meaningfulness). Our aim is to investigate whether SOC, self-reported toothbrushing frequency, and objectively assessed levels of oral hygiene are related. The sample of the present study consisted of 4,131 30- to 64-year-old dentate Finns belonging to a large nationally representative sample. The questionnaire and home interview included information about socioeconomic and demographic factors, behavioral variables, such as oral health behaviors (toothbrushing frequency), and a 12-item SOC scale, used here as a unidimensional measure categorized into quintiles. The level of oral hygiene was measured during clinical oral examination. Chi-square test, ordinal, and ordinary logistic regression analyses were used. Subjects belonging to the strongest SOC quintile were found to be significantly more often two, or more, times a day brushers compared to those with less strong SOC. After controlling for toothbrushing frequency, sociodemographic and socioeconomic factors, smoking habits, and number of teeth, both strong and moderate levels of SOCs were also found to be related to a good level of oral hygiene compared with moderate and poor levels of oral hygiene. Furthermore, subjects within the weakest SOC quintile were found to have significantly more often than others poor levels of oral hygiene. Our results suggest that a weak sense of coherence increases both the probability of having a poor level of oral hygiene and a frequency of toothbrushing of less than once a day. This and the theory concerning the development of SOC suggest that sense of coherence may be taken as a determinant of both the frequency and the quality of toothbrushing.