The present descriptive, cross-sectional and non-disguised observational study was conducted to observe and perform a computerised analysis of the everyday toothbrushing and, for the first time, flossing habits of adolescents, who have recently reached the age of legal majority. At this age, the legally anchored prevention programme ends, and no further systematic toothbrushing assistance is provided. Therefore, 101 inhabitants of Giessen aged between 18-19 years were included. After the plaque index was assessed according to Silness and Loe, the participants were filmed while performing their habitual toothbrushing and flossing in the dental clinic in Giessen (Germany). All the participants were aware of the filming. Subsequently, they completed questionnaires to provide their socio-demographic data and some psychological data. The video analysis was performed with the observation software INTERACT 9. Different toothbrushing parameters, as described in literature from the seventies, were assessed, such as brushing duration, brushing movements, starting location, the frequency of alternations between areas of the mouth and flossing technique. This study showed that the participants brushing duration corresponded to the international recommendations; however, only a few of the participants exhibited a systematic brushing technique. The motion sequences during toothbrushing were characterised by frequent changes between the anterior and posterior areas. The brushing movements of most of the participants were characterised by elements that were taught as a part of oral hygiene education in kindergarten and primary school. Many participants did not reach all the areas, especially the oral surfaces of the posterior teeth. An interesting finding is that similar toothbrushing motion sequences performed by adolescents were observed in the late seventies. These sequences included the preferred brushing of vestibular surfaces, the neglect of brushing the oral surfaces and the tendency towards frequent alternations from the anterior vestibular to the posterior vestibular areas, and vice versa. Flossing was performed by almost half of the participants, whereas a discrepancy between the self-reported and actual flossing was recognised. Five of them reached all the interproximal spaces; only two performed a correct flossing technique, and just one flossed correctly and completely. In conclusion, there was a general deficiency in flossing abilities. For the first time, the new method used in the present work allowed the visualisation of brushing patterns, which led to a characterisation of three different toothbrushing types: systematic, sequential and unstructured movement patterns. It is conceivable that these patterns represent different predictors for the success of oral hygiene instructions. The present results show a discrepancy between the efforts of prevention strategies regarding oral hygiene education and the actual, observed oral hygiene habits in young adults. Strategies for imparting oral hygiene techniques, especially within individual prophylaxis, should be reconsidered. The complexity of this task requires an interdisciplinary approach. The present method for analysing toothbrushing behaviour offers the possibility of differentially and objectively observing and evaluating motion sequences over a number of sessions. This possibility offers the opportunity to answer multi-layered questions concerning, for example, the persistence of movement patterns and their relevance for instruction strategies, to investigate the age- and development-associated learnability of brushing techniques for children, the motor aspects of oral hygiene of older people or oral hygiene training for people with cognitive or motor handicaps.
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