Toothbrushing Education via a Smart Software Visualization System Christian Graetz,* Jule Bielfeldt,* Lars Wolff, † Claudia Springer,* Karim M. Fawzy El-Sayed,* Sonja Sa ¨lzer,* Sabah Badri-Ho ¨her, † and Christof E. Do ¨rfer* Background: The aim of this study is to evaluate the ef- ficiency of a recently developed smart digital toothbrush monitoring and training system (DTS) in terms of correct brushing motion and grip axis orientation in an at-home environment. Methods: Twenty-one participants (11 test individuals [DTSG] and 10 control individuals [COG]) received instruc- tions on the modified Bass technique (MBT) after their toothbrushing performance was monitored and they re- ceived professional tooth cleaning (T0). After 36 hours (T1), without mechanical oral hygiene measures, plaque and gingival indices were recorded, and the brushing technique was reviewed. After randomization, participants individually performed oral hygiene for 6 weeks (T2) with the provided oral hygiene kits. The DTSG group additionally used DTS. During the following 8 weeks (T3), participants used their original brushing devices without any additional interfer- ence. Investigators at each visit were masked regarding group identity. Data were statistically evaluated using Mann-Whitney U, Friedman, Wilcoxon, and paired tests and Pearson correlation. Results: At T0, 27.27% of DTSG participants used the MBT correctly (COG, 50%), increasing to 54.55% (COG, 60%) after professional instruction (T1) and further to 90.91% at T2 (COG, 60%) (P <0.001). Plaque scores were reduced in DTSG (P <0.05). At T3, 80% of the DTSG (COG, 40%) totally adopted the MBT (P <0.05). The plaque scores on buccal surfaces of the DTSG showed an addi- tional slight improvement between T2 and T3, in contrast to a decline on oral surfaces (P <0.001). At T2 and T3, the DTSG brushed >120 seconds (COG, 90% and 50%) (P <0.05). Conclusion: Apparently, the tested DTS effectively im- proves the brushing technique and leads to a prolonged learning effect, including improved oral hygiene. J Peri- odontol 2013;84:186-195. KEY WORDS Computers; dental plaque; dental prophylaxis; oral hygiene; problem-based learning. A correct application of the tooth- brushing technique is a major prerequisite for good oral hy- giene performance. Although there is a definite consensus concerning the need to use toothbrushes, opinions about the design of a perfect tooth- brush and its correct application are diverse. Inadequate toothbrushing ac- tions can result in gingivitis, gingival trauma, tooth decay, or eventually tooth loss. 1 Toothbrushing at least once a day is important to prevent tooth decay but also to maintain a toothbrushing habit and to promote appropriate brushing patterns. The primary goal of any brush- ing technique should be to allow the patient to reach all accessible tooth sur- faces. A secondary but equally impor- tant goal is enabling the patient to prevent trauma from brushing. The Bass brushing technique was shown to be superior in terms of cleaning tooth sites adjacent to the gingival tissue on lingual and facial surfaces. 2 The modi- fied Bass technique (MBT) seemed significantly effective in removing su- pragingival plaque, thereby improving the level of oral hygiene, 3 with little soft- tissue damage observed. 4 Several studies have previously tried to provide methods for evaluating brush- ing techniques in terms of brush motion action. 5-7 A particular study 8 recently at- tempted to present a visual image of brushing patterns in real time. In the cur- rent pilot study, we implement a digital toothbrush monitoring and training * Clinic of Conservative Dentistry and Periodontology, Christian Albrechts University, Kiel, Germany. † Institute of Communications Technology and Microelectronics, University of Applied Sciences, Kiel, Germany. doi: 10.1902/jop.2012.110675 Volume 84 • Number 2 186