Walsh M M, Heckman B H, Moreau-Diettinger R
Community Dent Oral Epidemiol. 1985 Jun;13(3):133-5. doi: 10.1111/j.1600-0528.1985.tb00427.x.
The present study examined the use of gingival bleeding as a reinforcement mechanism for interproximal home care with the toothpick. After initial assessments of plaque and gingival bleeding, 36 subjects were given a professional toothcleaning and instructed to maintain oral hygiene by toothbrushing alone for 3 months. After 3 months of brushing only, subjects were re-examined and given another professional toothcleaning. Having been matched for age and percentage of sites bleeding on probing, as determined at the initial examination, they were than randomly attached to one of three groups. One group, the control, continued to clean their teeth with only a toothbrush, while the other two groups used the toothbrush supplemented with the toothpick for interproximal subgingival cleaning. Both toothpick groups received identical instruction in toothpick technique, but one group was taught to use bleeding as an interpretive device for health. Three months later, clinical assessments indicated significantly less gingival bleeding for both toothpick groups as compared with the control (whose gingival health worsened). Although there was no significant difference between the final scores of the toothpick groups, only the group that used gingival bleeding as a sign of disease showed a significant improvement in gingival health (P less than 0.003), and also had a fivefold higher rate of return of self-report compliance cards. These results suggest that the use of gingival bleeding as a reinforcement mechanism should be considered as a strategy in oral home care instruction to promote compliance with recommended behavior.
本研究探讨了牙龈出血作为牙间隙家庭护理中使用牙签的强化机制的作用。在对菌斑和牙龈出血进行初步评估后，36名受试者接受了专业洗牙，并被指示仅通过刷牙保持口腔卫生3个月。仅刷牙3个月后，对受试者进行重新检查并再次进行专业洗牙。根据初次检查确定的年龄和探诊出血部位百分比进行匹配后，他们被随机分为三组。一组为对照组，继续仅用牙刷清洁牙齿，而另外两组使用补充了牙签的牙刷进行牙间隙龈下清洁。两个牙签组在牙签使用技巧方面接受了相同的指导，但其中一组被教导将出血作为健康状况的一种解读依据。三个月后，临床评估表明，与对照组（其牙龈健康状况恶化）相比，两个牙签组的牙龈出血明显减少。虽然牙签组的最终得分没有显著差异，但只有将牙龈出血作为疾病迹象的那组牙龈健康状况有显著改善（P小于0.003），并且自我报告依从卡的回收率高出五倍。这些结果表明，在口腔家庭护理指导中，应考虑将牙龈出血作为一种强化机制，以此促进对推荐行为的依从性。
