Division for Cariology, Department of Operative Dentistry and Periodontology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Conservative and Preventive Dentistry, Dental Clinic of the Justus-Liebig-University Giessen, Giessen, Germany.
PLoS One. 2018 Apr 30;13(4):e0196497. doi: 10.1371/journal.pone.0196497. eCollection 2018.
Systematics is considered important for effective toothbrushing. A theoretical concept of systematics in toothbrushing and a validated index to quantify it using observational data is suggested. The index consists of three components: completeness (all areas of the dentition reached), isochronicity (all areas brushed equally long) and consistency (avoiding frequent alternations between areas). Toothbrushing should take a sufficient length of time; therefore, this parameter is part of the index value calculation. Quantitative data from video observations were used including the number of changes between areas, number of areas reached, absolute brushing time and brushing time per area. These data were fed into two algorithms that converted the behaviour into two index values (each with values between 0 and 1) and were summed as the Toothbrushing Systematics Index (TSI) value; 0 indicates completely unsystematic and 2 indicates perfectly systematic brushing. The index was developed using theoretical data. The data matrices revealed the highest values when all areas are reached and brushed equally long. Few changes occurred between the areas when the brushing duration was ≥90 s; the lowest values occurred under opposite conditions. Clinical applicability was tested with data from re-analysed videos from an earlier intervention study aiming to establish a pre-defined toothbrushing sequence. Subjects who fully adopted this sequence had a baseline TSI of 1.30±0.26, which increased to 1.74±0.09 after the intervention (p≤0.001). When the participants who only partially adopted the sequence were included, the respective values were 1.25±0.27 and 1.69±0.14 (p≤0.001). The suggested new TS-index can cover a variety of clinically meaningful variations of systematic brushing, validly quantifies the changes in toothbrushing systematics and has discriminative power.
系统方法被认为对有效刷牙很重要。本文提出了一种刷牙系统方法的理论概念，并提出了一个使用观察数据来量化该方法的验证指数。该指数由三个部分组成：完整性（刷到所有牙齿区域）、等时性（所有区域刷牙时间相等）和一致性（避免频繁在区域之间切换）。刷牙应该持续足够的时间，因此这个参数是指数值计算的一部分。使用视频观察获得的定量数据，包括区域之间的变化次数、到达的区域数量、绝对刷牙时间和每个区域的刷牙时间。这些数据被输入到两个算法中，将行为转换为两个指数值（每个值在 0 到 1 之间），并将它们相加得到刷牙系统学指数（TSI）值；0 表示完全无系统，2 表示完全系统。该指数是基于理论数据开发的。当所有区域都被触及并且刷牙时间相等时，数据矩阵显示出最高值。当刷牙时间≥90 秒时，区域之间的变化很少，此时出现最低值。为了测试临床适用性，对之前旨在建立预定义刷牙顺序的干预研究中重新分析的视频数据进行了分析。完全采用该顺序的受试者基线 TSI 为 1.30±0.26，干预后增加至 1.74±0.09（p≤0.001）。当包括仅部分采用该顺序的参与者时，相应值分别为 1.25±0.27 和 1.69±0.14（p≤0.001）。建议的新 TS 指数可以涵盖系统刷牙的各种临床有意义的变化，有效量化了刷牙系统方法的变化，并具有鉴别力。
