The development of correct toothbrushing technique in preschool children.

This study examined the effects of an intensive training program on the toothbrushing skills of three preschool children, using both performance measures and outcome (plaque level) indicators. Toothbrushing was broken into 16 steps that involved actual manipulation of the brush in the mouth. Correct brushing included four criteria: (a) appropriate angle of bristles, (b) appropriate motion of brush, (c) appropriate tooth surface, and (d) minimum duration of brushing. Training included instructions, a three-phase modeling procedure, physical guidance, and reinforcement. Results of a multiple baseline design across subjects showed that the children completed an average of 8.6% of the steps prior to training, as compared with an average of 95.8% of the steps following training. Plaque levels decreased from an average of 58% during baseline to 24.6% after training. Follow-up measures revealed that 86.6% of the steps were maintained. The study demonstrated that the effectiveness of the procedures in teaching very young children a complex motor skill that is essential to their future health.