Toothbrushing behavior in children: a study of pressure and stroke frequency.

The pattern, the applied pressure, and the stroke frequency of toothbrushing during a specific test period were studied in 7and 11-year-old children by means of a strain gauge connected to a toothbrush and an oscillograph. The younger age group consisted of 19 children and the older of 24 children. The majority of the children of both age groups spontaneously used the horizontal scrub technique. The hand motions of the younger children varied from long to short strokes, whereas the majority of the older children applied the short stroke technique. The toothbrushing behavior of the younger children was irregular, that of the older children more regular. The ll-year-old children showed significantly higher accumulated pressure and stroke frequency values than the younger ones. The findings indicated an age-related factor between the development of motor skills and the ability to brush. The study of the toothbrushing behavior in children at different ages has grown during the last decades. Several studies"3havereportedtheuseofthe horizontal scrub technique to be the method of choice by young children, and also their inability to apply other toothbrushing methods. Meseher’ et al. decribed the difficulties 6and 8-year-old children had in performing suleular brushing and found that handfunction was age-related. The brushing performance of children under age seven was also observed to be briefer, more haphazard and erratic than those aged seven.’ Studies on the force and stroke frequency applied by children during toothbrushing are scarce. McClure 2 observed the pressure young children exerted on the gingiva when brushing their teeth, but this pressure was not recorded. Several investigations of toothbrushing forces in adults showed significant variations in magnitude, varying from 203 g to 1533.3 g depending on the hardness of the brush, the method and the design of the investigation, and whether the brush was manual or powered. 3.6.7.s Fraleigh et al. 7 measured the toothbrushing force in a group of children aged four to fifteen years and reported that they recorded a mean of 123.6 g when using a powered toothbrush. Oral hygiene instruction in younger age groups requires knowledge of their level of motor skill development. The purpose of this study was to compare toothbrushing patterns in terms of the pressure and stroke frequency in children either seven or eleven years of age. Methods and Materials Forty-seven children, 22 seven year olds tmean age 7.03) and 25 eleven year olds {mean age 11.64}, were recalled for routine prophylactic treatment in a School Dental Clinic and in the Department of Pedodontics, Faculty of Odontology in GSteborg. The children were of Swedish origin and came from a mixed socio-economic background. The children’s parents were informed that the toothbrushing pattern of the children would be investigated with a specially designed toothbrush connected to an oscillograph. In cooperation with the Departments of Physiology and Technology, University of GSteborg, a measuring bridge with strain gauges {micromeasurements 120 ohms} was coupled to the upper part of an instrument, to which a toothbrush-head was attached, for recording the pressure and stroke frequency during the test period. The measuring bridge was isolated from the saliva with silicone {Figure 1). An amplifier was directly connected to the oscillograph in order to reinforce the signals from the measuring bridge. The recording device was calibrated according to the manufacturer’s manual before the test was started (Mingograph 800¢). The toothbrush head was a Jordan Junior ® toothbrush, multitufted straight cut, with triple rows and medium nylon bristle. It had been specifically prepared for the measuring device and had 31 bristles PEDIATRIC DENTISTRY: Volume 4, Number 3 225 Figure 1. Standardized toothbrush, a. The rubber handle, b. The connection to the amplifier and the oscillograph, c. The measuring bridge with strain gauges isolated with silicone, d. The brass extension with a replaceable toothbrush head. with a height of 11 mm. The toothbrush head, attached by small screws, was changed for each child. The oral examination revealed complete dentitions in all the children. The children were given no formal toothbrushing instructions prior to the test. Each child was separately introduced to the toothbrush and the oscillograph and asked to demonstrate his/her routine toothbrushing technique. Before the start of the recording, the children, standing in front of a mirror, were instructed to brush the buccal side of the maxillary primary molars or the bicupsid and first permanent molar, depending on the development stage of the dentition. The toothbrushing method, use of right or left hand, and the side of the maxilla brushed were recorded. The horizontal scrub method was divided into short and long strokes by visual observation and later the distance between the amplitudes on the curves were measured. The brushing technique was recorded as irregular when it could not be defined. Calibration of interobserver reliability concerning the brushing technique was made by the two observers. There was a good reliability between the observers. The test period for each child lasted 16 seconds. The length of this period was chosen to correspond to the integrator of the oscillograph, recording the accumulated pressure (Figure 2). Three 7 year olds and one 11 year old were not inPressure gram