Tooth brushing as routine behaviour

Regular tooth brushing is considered an excellent preventive measure for oral plaque control. Yet despite over one hundred years of effort by dental professionals, levels of tooth brushing remain distressingly low. Evidence from a variety of studies suggests that tooth brushing is commonly performed in a regularised, automatic (i.e., routine) manner. Here it is argued a routine can be considered a recurring sequence of behaviours produced in conjunction with a script (or group of behaviours hierarchically represented in memory), and controlled as a unit or ‘chunk’. A robust model of routine behaviour is presented, the Norman-Shallice-Cooper model, which is then applied to the example of tooth brushing behaviour, suggesting a variety of strategies for introducing tooth brushing into daily routines. Empirical studies are also reviewed which suggest that tooth brushing practices cluster in families. This clustering, together with the persistence of the practice throughout life, is consistent with the hypothesis that tooth brushing typically occurs within family-based traditions. Clinical and public health efforts in dentistry can therefore potentially be made more effective by taking into consideration how routines are created and then maintained within family or school environments.