Impact of video instructions and additional hands-on instructions on the dental flossing performance - an observational study

Abstract

Objectives: This study aimed to evaluate the effectiveness of an instruction-video, with and without additional hands-on instruction, in teaching young adults proper flossing performance.

Materials and methods: This randomised intervention and observational study included 94 participants, 24 (23; 25) years, receiving an instruction-video with (group 1) or without additional hands-on instruction (group 2). The flossing performance was assessed by videotaping before instruction (T1), after instruction and one week of practice (T2), as well as after two weeks of practice (T3). Parameters of interest were number of interdental spaces reached, adaptation to mesial and distal surfaces, flossing technique, systematic approach and handling combined with self-assessment of flossing skills and time spent, assessed by questionnaires.

Results: Additional hands-on instruction did not lead to a significant improvement in any parameter compared to video-instruction alone. At T1, the participants reached many interdental spaces, but only two managed to floss their entire dentition correctly. After video instruction (T2), the participants reached more interdental spaces (p = 0.039) using a systematic approach and improved adaptation, technique and handling (p < 0.001 each). Parameters improved again at T3, resulting in 42 participants flossing their entire dentition correctly. After instruction participants found flossing less difficult, although they estimated it took more time.

Conclusion: Video-instruction significantly improved flossing performance, whereas hands-on instruction had no additional benefit. This indicates that video-instruction could be an effective and timesaving tool to improve flossing performance.

Clinical relevance: The results emphasize the importance of appropriate teaching-methods in dental prophylaxis and highlight the potential of video-instructions to improve interdental cleaning skills significantly.

Keywords: Dental flossing; Flossing technique; Instruction technique; Preventive dentistry; Video instructions; Video-observation.

Fig. 1

Flow chart of the study procedure

Fig. 2

Analogue scale scores at T1, T2 and T3. Significant changes compared to the previous appointment are marked in bold

Fig. 3

Reached interdental spaces at T1, T2 and T3 for all areas of the dentition as well as for the anterior/canine teeth, premolars and molars separately. Participants who had already reached all interdental spaces at T1 were excluded (included participants: n = 43). Significant changes compared to the previous appointment are highlighted in bold

Fig. 4

Correlation between systematic scores and reached interdental spaces (unfilled circles T1; black circles T3)

Fig. 5

Percentage of different techniques across all participants and interspaces at T1 to T3

Fig. 6

Boxplots of self-assessment of the ability to reach all interdental spaces by gender at T3. The self-assessment is based on an analogue scale from 0: cannot reach interdental spaces, to 10: can reach every interdental space