Patient Attitudes and Practices Towards Oral Home Care

Patient compliance with overall oral hygiene recommendations has been shown to be fairly low. Only 60.5% of children ages 3-15 report brushing their teeth (or having their teeth brushed) twice daily⁶² and only 51% of adults reported brushing twice daily.⁶³ Furthermore, 23% of Americans have gone two or more days without brushing their teeth in the past year and 37% of adults ages 18 to 24 have gone that long without brushing.⁶³ Even when individuals do brush, they may not be following the recommended time or methods. It has been reported that the average individual performs 45-70 seconds of toothbrushing daily, far below the ADA’s recommended two minutes twice daily.¹⁶Additionally, while the most recommended method of toothbrushing by dental healthcare professionals is the Modified Bass technique,⁶⁴ patients often employ other techniques, notably the scrub brush technique, and distribute the brushing unevenly throughout the mouth, which may lead to decreased efficiency of biofilm removal during toothbrushing.⁶⁵

Interdental cleaning is also not universally employed by individuals. Despite evidence to suggest that daily flossing reduces bacteremias associated with dental biofilm and inflammation,⁶⁶ patient compliance with regular and sustained daily use of dental floss for interdental cleaning has been estimated to be as low as 2%.¹⁷ But reporting of flossing prevalence varies considerably; a 2014 national public opinion poll, the 2014 Delta Dental Oral Health and Well-Being Survey reported that 41% of Americans floss at least once daily, and 20% never floss.⁶³ And amongst individuals with risk factors for periodontitis, female gender, higher income, and non-smoking status were associated with an increase in daily flossing.⁶⁷Additionally, individuals report they dislike flossing. In a survey from the AAP, more than 35% of respondents stated they would rather perform an unpleasant task, like filing their tax return or cleaning their toilet, than floss.¹⁸ Methods of aiding planning and developing self-efficacy have been used to increase flossing behaviors in individuals with moderate success,⁶⁸ but floss usage remains lower than recommended.