Video instruction to establish a panel of experts to compare tooth cleaning by 4 electric toothbrushes

Background and Aims: Laboratory robots can reveal differences in the cleani ng of artificial tooth surfaces by different electric toothbrushes. The pri mary aim of this study was to establish, through video instruction, a panel of experts in tooth cleaning with an oscillating rotating electric toothbr ush in an attempt to mimic the highly reproducible laboratory robot. A seco ndary aim was to use the "expert" panel, in an attempt to distinguish betwe en tooth cleaning efficacy of 4 head/model combinations of the oscillating rotating electric brush. Method: A 24-subject panel, after video training and home habituation for u p to 12 weeks with the basic model of electric brush, participated in a sin gle examiner blind, 4-cell, randomised, cross-over study balanced for resid ual effects. In each period, subjects suspended tooth cleaning for 4 days. Plaque was then scored by area before and after tooth brushing for 2 min in tandem with the instructional video with the allocated brush head/model co mbination. Results: Differences between subjects was significant, but overall plaque r emoval with all brushes was of the order of 85% with one subject achieving > 97% plaque removal. There were significant differences between the brushe s with the oscillating rotating brush with the faster head movement, in mos t analyses, significantly more effective than the slower oscillating rotati ng brush with 2 head combinations. The faster oscillating rotating brush wa s also significantly more effective than the most recently introduced oscil lating rotating reciprocating model. Conclusions: Previous studies have shown that single uses of watch-and-foll ow video instruction significantly improve toothcleaning with electric toot hbrushes. The present study shows that extended training using these videos results in almost complete plaque removal even when prebrushing plaque lev els have been enhanced by a 4-day period of no oral hygiene. Furthermore, t he establishment of an "expert" panel can distinguish between brushes of di fferent cleaning efficiencies. However, given the level of achievement of a ll panel members with all brushes, the absolute differences observed are of doubtful clinical significance for gingival health. Finally, the slightly- reduced plaque removal by the 3 directional head action brush can be explai ned by the inability within the present protocol to habituate the subjects in its use.