Clinical Oral Investigations

, Volume 22, Issue 6, pp 2219–2228 | Cite as

Randomised controlled trial on differential learning of toothbrushing in 6- to 9-year-old children

  • Sven-Olav Pabel
  • Franziska Freitag
  • Valentina Hrasky
  • Antonia Zapf
  • Annette Wiegand
Original Article



This study aimed to evaluate the effect of differential learning of toothbrushing compared to habitual toothbrushing and instruction/demonstration of toothbrushing on plaque reduction and gingival inflammation of primary school children.


Children (6–9 years) were subjected to a toothbrushing training consisting of 15 days (3 × 5 days, interval 2 days, 3 min/day) and randomly assigned to one of three groups (each n = 18): habitual toothbrushing/control, instruction/demonstration of toothbrushing, differential learning of toothbrushing. The differential learning approach comprised 15 different movement exercises (1/day), while instruction/demonstration of toothbrushing was based on repetitive practice of toothbrushing. Plaque (Turesky-modified Quigley-Hein plaque index (T-QHI)) and papilla bleeding (papilla bleeding index (PBI)) scores were assessed prior to the first toothbrushing (t0, baseline) and 21 (t1), 42 (t2) and 63 (t3) days after beginning of the study. Primary statistical analyses were performed with cumulative logit regression models with repeated measures. The global significance level was set to 5% two-sided.


At all time points, PBI and T-QHI were significantly reduced by differential learning compared to instruction/demonstration of toothbrushing and habitual toothbrushing. Compared to baseline, differential learning improved PBI and T-QHI significantly at all time points. In the other groups, no significant reduction of PBI compared to baseline was observed. T-QHI was significantly reduced by habitual toothbrushing only at t1 and by instruction/demonstration of toothbrushing at t1 and t2. Differential learning had an improved effect on posterior compared to anterior teeth.


Differential learning of toothbrushing improved plaque reduction and reduced gingival inflammation compared to habitual toothbrushing and instruction/demonstration of toothbrushing in 6- to 9-year-old children in mixed dentition.

Clinical relevance

Toothbrushing skills of children might be improved by differential learning.

Trial registration



Oral hygiene Child Learning Instruction Movement 



This study was funded by the institution of the authors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local ethics committee (No.13/1/16).

Informed consent

Informed consent was obtained from children and their parents or legal guardians.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sven-Olav Pabel
    • 1
  • Franziska Freitag
    • 1
  • Valentina Hrasky
    • 1
  • Antonia Zapf
    • 2
  • Annette Wiegand
    • 1
  1. 1.Department of Preventive Dentistry, Periodontology and CariologyUniversity Medical Center GöttingenGöttingenGermany
  2. 2.Department of Medical StatisticsUniversity Medical Center GöttingenGöttingenGermany

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