Association of toothbrushing behaviour with periodontal health status among Hong Kong adults: a video-based observational study

Abstract

Background and Aim: Toothbrushing is an indispensable self-care approach to maintaining good oral hygiene and periodontal health. However, a sufficient understanding of the relationship between toothbrushing behaviors and periodontal status is still lacking. This study investigated the association of actual brushing behaviors with periodontal status through video observations. Methods: This was a cross-sectional study on a convenience sample of 324 untreated dental hospital attendees. The subjects were required to perform habitual brushing while being video-filmed, followed by a full-mouth periodontal examination. Videos were analyzed using the software ELAN regarding the total brushing time, brushing duration in each area of the dentition and changes between areas. The modified Toothbrushing Systematics Index (mTSI) and coverage were introduced to describe the toothbrushing systematics after adjusting the number of teeth present. The correlation analyses of mTSI and coverage with periodontal parameters and diagnoses were performed. Results: Overall, only 84 (25.9%) of subjects brushed for 120s or longer (median: 88.32 s; interquartile range: 57.93-123.84 s), and 52 (16.0%) of them reached all 16 targeting areas. Brushing duration, mTSI and session coverage decreased with the extent of gingival inflammation defined by BOP% (threshold: 10% and 30%, P<0.001). Subjects with longer brushing duration, greater value of mTSI and session coverage exhibited increased odds ratio for periodontal health after adjustment for age, gender, smoking and systemic disease. Notably, brushing duration, mTSI and session coverage were negatively correlated with BOP%, mean values of PPD and CAL at the subject level (P<0.001), and coverage in the respective areas was significantly associated with mean values of PPD and BOP in the corresponding areas (P<0.001). Conclusions: The present study shows that systematic and adequate toothbrushing is favorably associated with periodontal health, independent of the individual demographics. Periodontal health education in the public community is of great importance for promoting oral health and general health/wellbeing.