Department of Electrical and Computer Engineering, University of California, Los Angeles, California, United States of America.
Department of Biostatistics, University of California, Los Angeles, California, United States of America.
PLoS One. 2022 May 19;17(5):e0263638. doi: 10.1371/journal.pone.0263638. eCollection 2022.
Dental caries and periodontal disease are very common chronic diseases closely linked to inadequate removal of dental plaque. Powered toothbrushes are viewed as more effective at removing plaque; however, the conflicting evidence and considerable unexplained heterogeneity in their clinical outcomes does not corroborate the relative merits of powered tooth brushing. To explain the heterogeneity of brushing patterns with powered toothbrushes, we conducted a observational study of tooth brushing practices of 12 participants in their naturalistic setting. Integrated brush sensors and a digital data collection platform allowed unobtrusive and accurate capture of habitual brushing patterns. Annotated brushing data from 10 sessions per participant was chosen for scrutiny of brushing patterns. Analysis of brushing patterns from the total 120 sessions revealed substantial between- and within-participant variability in brushing patterns and efficiency. Most participants (91.67%) brushed for less than the generally prescribed two minutes; individual participants were also inconsistent in brushing duration across sessions. The time devoted to brushing different dental regions was also quite unequal. Participants generally brushed their buccal tooth surfaces more than twice as long as the occlusal (2.18 times longer (95% CI 1.42, 3.35; p < 0.001)) and lingual surfaces (2.22 times longer (95% CI 1.62, 3.10; p < 0.001); the lingual surfaces of the maxillary molars were often neglected (p < 0.001). Participants also varied in the epochs of excessive brushing pressure and the regions to which they were applied. In general, the occlusal surfaces were more likely to be brushed with excessive pressure (95% CI 0.10, 0.98; p = 0.015). Our study reveals that users of powered toothbrushes vary substantially in their use of the toothbrushes and diverge from recommended brushing practices. The inconsistent brushing patterns, between and within individuals, can affect effective plaque removal. Our findings underscore the limited uptake of generic oral self-care recommendations and emphasize the need for personalized brushing recommendations that derive from the objective sensor data provided by powered toothbrushes.
龋齿和牙周病是非常常见的慢性疾病，与牙菌斑清除不充分密切相关。电动牙刷被认为在清除牙菌斑方面更有效；然而，其临床效果的证据相互矛盾，且存在大量无法解释的异质性，这并不支持电动刷牙相对优势的说法。为了解释使用电动牙刷时刷牙模式的异质性，我们在自然环境中对 12 名参与者的刷牙习惯进行了观察性研究。集成式牙刷传感器和数字化数据采集平台可实现对习惯性刷牙模式的非侵入式和准确捕捉。选择了每位参与者的 10 次刷牙数据进行刷牙模式的详细分析。对总共 120 次刷牙的刷牙模式分析显示，刷牙模式和效率存在很大的个体内和个体间差异。大多数参与者（91.67%）的刷牙时间少于一般规定的两分钟；个别参与者在不同的刷牙过程中也存在刷牙持续时间不一致的情况。用于清洁不同牙齿区域的时间也很不相等。参与者通常会将颊侧牙齿表面刷得比咬合面（长 2.18 倍（95%CI 1.42，3.35；p < 0.001）和舌侧表面（长 2.22 倍（95%CI 1.62，3.10；p < 0.001））长得多；上颌磨牙的舌侧表面经常被忽略（p < 0.001）。参与者在过度刷牙压力的时间段和应用区域上也存在差异。一般来说，咬合面更有可能承受过度的刷牙压力（95%CI 0.10，0.98；p = 0.015）。我们的研究表明，电动牙刷的使用者在使用牙刷方面存在很大差异，并且偏离了推荐的刷牙习惯。个体之间和个体内部不一致的刷牙模式会影响有效清除牙菌斑。我们的研究结果强调了通用口腔自我保健建议接受度有限，并强调需要根据电动牙刷提供的客观传感器数据制定个性化的刷牙建议。
