Improving Oral Hygiene Skills by Computer-Based
Training: A Randomized Controlled Comparison of the
Modified Bass and the Fones Techniques
Daniela Harnacke1, Simona Mitter1, Marc Lehner1, Jörn Munzert2, Renate Deinzer1*
1 Institute of Medical Psychology, University of Giessen, Giessen, Germany, 2 Institute of Sports Sciences, University of Giessen, Giessen, Germany
Abstract
Background: Gingivitis and other plaque-associated diseases have a high prevalence in western communities even though
the majority of adults report daily oral hygiene. This indicates a lack of oral hygiene skills. Currently, there is no clear
evidence as to which brushing technique would bring about the best oral hygiene skills. While the modified Bass technique
is often recommended by dentists and in textbooks, the Fones technique is often recommended in patient brochures. Still,
standardized comparisons of the effectiveness of teaching these techniques are lacking.
Methodology/Principal Findings: In a final sample of n = 56 students, this multidisciplinary, randomized, examiner-blinded,
controlled study compared the effects of parallel and standardized interactive computer presentations teaching either the
Fones or the modified Bass technique. A control group was taught the basics of tooth brushing alone. Oral hygiene skills
(remaining plaque after thorough oral hygiene) and gingivitis were assessed at baseline and 6, 12, and 28 weeks after the
intervention. We found a significant group6time interaction for gingivitis (F(4/102) = 3.267; p = 0.016; e= 0.957; g2 = 0.114)
and a significant main effect of group for oral hygiene skills (F(2/51) = 7.088; p = 0.002; g2 = 0.218). Fones was superior to
Bass; Bass did not differ from the control group. Group differences were most prominent after 6 and 12 weeks.
Conclusions/Significance: The present trial indicates an advantage of teaching the Fones as compared to the modified Bass
technique with respect to oral hygiene skills and gingivitis. Future studies are needed to analyze whether the disadvantage
of teaching the Bass technique observed here is restricted to the teaching method employed.
Trial Registration: German Clinical Trials Register DRKS00003488
Citation: Harnacke D, Mitter S, Lehner M, Munzert J, Deinzer R (2012) Improving Oral Hygiene Skills by Computer-Based Training: A Randomized Controlled
Comparison of the Modified Bass and the Fones Techniques. PLoS ONE 7(5): e37072. doi:10.1371/journal.pone.0037072
Editor: Songtao Shi, University of Southern California, United States of America
Received January 20, 2012; Accepted April 10, 2012; Published May 21, 2012
Copyright:  2012 Harnacke et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The authors appreciate sponsoring of this study by GABA International Therwill, Switzerland. The funders had no role in study design, data collection
and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: This study was sponsored by GABA International, Therwill, Switzerland. This does not alter the authors’ adherence to all the PLoS ONE
policies on sharing data and materials.
* E-mail: renate.deinzer@psycho.med.uni-giessen.de
Introduction Today, there is little evidence as to which brushing technique
would bring about the best results for oral hygiene at home, e.g.
Though daily plaque removal is considered to be important for [9,10]. The few studies directly comparing brushing techniques
oral health [1,2], representative studies indicate this goal is not suffer from methodological shortcomings like lack of control
achieved by most patients. Approximately 90% of German adults groups [11], non-blinded examiners [12,13] or confounders and
suffer from gingivitis and 30%–70% from periodontitis [3]. Other missing standardization [14]. We thus decided to compare the
countries report similar figures [4]. Contemporaneously, 70% of effects of computer-based training. A major advantage of
German patients report brushing their teeth twice a day [5] computer-based training is its high degree of standardization, its
indicating that most patients do not sufficiently remove all plaque repeatability, and its transparency. This is what has been called for
deposits. Recent studies by our group support the notion that skill in research into oral hygiene techniques for a long time, e.g. [15].
deficits may play an important role here. When we asked a We compared training in the modified Bass technique and the
representative German sample whether they knew any brushing Fones technique. The Fones technique seems to be the one best
technique, more than 30% responded negatively [6]. Students known to German adults [6] and is also considered a standard
were found to brush their teeth rather unsystematically in a video technique, e.g. [16]. The modified Bass technique, on the other
observation study [7] and to remove no more than 60% of hand, is often recommended as being particularly efficient in
marginal plaque deposits when asked to brush to the best of their removing plaque at the gingival margin and thereby in preventing
abilities [8]. Current data thus suggest deficits in oral hygiene skills periodontal lesions, e.g. [16,17].
which might be overcome by teaching brushing techniques. According to arguments proposed, for example, by Renz et al.
[18], we integrated psychological knowledge into the design of the
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Comparison of Modified Bass vs. Fones Techniques
interventions and extended their appeal by also including an Independent Variable
expert in motor control and movement learning. Participants were randomly assigned to a PowerPoint-based
Teaching brushing techniques is a complex and time-consum- training of either Fones technique, modified Bass technique, or
ing procedure. From the perspective of movement sciences, skill basics of tooth brushing alone (control); groups were stratified with
training makes many repetitions of the same movements necessary respect to oral hygiene skills at baseline (for assessment see below)
in order to incorporate them into the motor program. This high and gender. Tickets for randomization were put in identical,
number of repetitions is seen to be a prerequisite for automation of opaque boxes and were drawn by a person not involved in the
skills [19]. In face-to-face training it is difficult to motivate both the study.
trainer and the trainee to repeat the same movement again and To reduce participant expectations (and confounders associated
again and to practice the movements in very small steps, which with them), participants were not informed about the three
would be desirable from a movement sciences perspective. This conditions or the hypotheses to be tested. Furthermore, they were
issue has been widely discussed as part versus whole practice [20]. not told the common name of the technique taught, to prevent
Computer-based training might help to overcome this disadvan- them obtaining further information via the Internet. All partici-
tage and some others as well. While having only the computer as a pants received the same brand of toothbrush (Elmex InterX,
training device, the trainee may choose his or her own learning GABA, Germany), toothpaste (Elmex, GABA, Germany), and
tempo to practice the movements. Furthermore, the trainee does dental floss (Elmex waxed and unwaxed, GABA, Germany) for
not feel observed when performing the movements in front of a oral hygiene at home and were asked not to use additional aids like
computer. Thus, adverse effects of the social interaction, like mouth rinsing solution, etc.
feelings of embarrassment, can be diminished, thereby allowing Participants can navigate the PowerPoint based training back
the trainee to fully concentrate on the training and not on the and forth and repeat every part as often as they want to. The
consequences of the social interaction. presentations comprise written text, oral explanations, pictures,
We hypothesized that both computer-based training of the and videos. For skill acquisition, multimodal training devices have
modified Bass technique and the Fones technique would improve proven to be remarkably efficient [21]. As brushing is demon-
oral hygiene skills and gingival health as compared to controls. strated in videos and photographs, separate presentations for left
Furthermore, we aimed to investigate whether there would be a handers and right handers are provided (pictures in left handers’
difference in the effectiveness of computer-based training of Bass presentations are mirror images of the original pictures taken of
vs. Fones. To find out how long training effects persist without any right handers). A mirror is provided to allow for exercising with
further intervention, we assessed skills and gingival health 6, 12, visual control of what is seen in the presentation. Participants are
and 28 weeks after training. asked at several points to exercise immediately what they see (see
Presentations S1). At the end of the presentation, participants are
Materials and Methods asked to apply the technique from now on whenever brushing
their teeth. When they have finished the training, participants
The protocol for this trial and supporting Consort checklist are receive a brochure to be able look up major aspects of their
available as supporting information; see Checklist S1 and Protocol presentations at home.
S1.
The content of the three training programs is provided in detail
as supporting information (see Presentations S1). Every training
Participants program starts with twelve slides explaining the structure of the
N = 67 students at the University of Giessen provided informed presentation and some basics of tooth brushing (called 161 of
written consent and fulfilled the following inclusion and exclusion tooth brushing), namely sites to be cleaned, devices that can reach
criteria: at least 20 of their own teeth, 10 or more teeth showing them, systematics of tooth brushing and their advantages, and
plaque or bleeding, no study of dentistry, no smoking, no electrical brushing pressure. In the control condition, the training ends after
tooth brushing, no dental treatment affecting gingival health or these slides. In the Fones and Bass conditions, the training is
oral hygiene throughout the study (participant flow is shown as continued with a further 25 slides. Presentations for the modified
supporting information in CONSORT Flow Diagram S1). Bass technique and the Fones technique are parallel in all major
Participants were promised a monetary compensation (J 50) in aspects (i.e., number of slides (25) and videos (7), design of slides,
order to cover for the investments of time and travel costs. They persons demonstrating the technique, time of repetitions, words to
were also promised a small gift of oral hygiene products as encourage participants to try the technique) beside the technique
appreciation for their help in the study. Participants were recruited shown.
with the help of postings on the campus and announcements in
local magazines. In these postings and announcements some Dependent Variables
information (getting a professional tooth cleaning; examination Dependent variables were assessed by calibrated examiners
points; monetary compensation and gift of oral hygiene products) blind to the condition of the participants.
and inclusion criteria were already given (number of teeth, no As an indicator of gingivitis, the papillary bleeding index (PBI)
smoking and to be a student). Students who responded to the by Saxer & Mühlemann [22], modified by Rateitschak [23], was
postings and announcements received additional information and assessed at all sites. To assess oral hygiene skills, participants were
were asked about inclusion criteria (except of plaque and asked to clean their teeth as thoroughly as possible. They were
bleeding). Participants who met the inclusion criteria were invited provided with several devices like a tooth brush, tooth paste, and
to a first appointment. The study took place in laboratories of the dental floss and were allowed to use their own devices. Afterwards,
Institute of Medical Psychology, University of Giessen, Germany. remaining plaque was disclosed by Mira-2-Ton H-solution (Hager
The study protocol was conducted according to the principles of & Werken, GMBH & Co, Duisburg, Germany) and staining was
the Declaration of Helsinki and approved by the local Ethics assessed by the Turesky [24] modification of the plaque index
Committee of the medical department of the University of Giessen (TQHI) of Quigley & Hein [25] and the marginal plaque index
(91/09). All participants provided informed written consent. (MPI; Deinzer et al., submitted) which assesses the presences or
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Comparison of Modified Bass vs. Fones Techniques
Statistical analyses were run with SPSS 17.0 (SPSS Inc.). All
parameters were tested for normal distribution by the Kolmo-
gorov-Smirnov Test and were found not to deviate from the
normal distribution assumption (all p.0.05). To examine baseline
differences, ANOVAs and Chi2 Tests were run as indicated by the
variable characteristics. Respective baseline values were included
as covariates in all analyses. To analyse overall intervention effects,
two factorial (group6time) analyses of covariance (ANCOVA)
were run and corrected for non-sphericity by applying Green-
house-Geisser’s e. In the case of significant results of overall
Figure 1. Assessment of the Marginal Plaque Index (Deinzer et analyses, one-factorial ANCOVAs and pairwise comparisons were
al., submitted). The gingival margin is divided into four equal computed to assess how long group differences persist without
sections. For each section, the presence or absence of disclosed plaque
further intervention and which groups differed. Partial g2 is
is registered. Eight sections per tooth are registered: vestibular cervical
(grey): two sections; vestibular approximal (black): two sections; oral reported as measure of effect size.
cervical: two sections; oral approximal: two sections.
doi:10.1371/journal.pone.0037072.g001 Results
Table 1 provides baseline characteristics of participants. Groups
absence of staining at the gingival margin and provides good
did not differ statistically significant in any of the variables (all
validity coefficients (see Figure 1).
p.0.262).
Design and procedure
Overall intervention effects
This was a randomized, stratified (skills and gender), examiner-
Overall ANCOVAs revealed a significant group6time interac-
blinded, controlled study conducted in Germany. At baseline,
tion (F(4/102) = 3.267; p = 0.016; e= 0.957; g2 = 0.114) for
participants were examined for eligibility (see above) and provided
gingivitis (Figure 2) and a significant main effect of group for oral
written informed consent. The dependent variables were first
hygiene skills measured with the MPI (F(2/51) = 7.088; p = 0.002;
assessed. Afterwards, all participants were shown how to use dental
g2 = 0.218). No significant effect was observed for hygiene skills
floss by means of a video (provided by GABA international) and
measured with the TQHI (F(2/51) = 2.204; p = 0.121; g2 = 0.080)
were checked and corrected by a dentist (S.M.) and asked to floss
(see Figure 2). Separate analyses for approximal and cervical
all teeth daily from now on. The next appointment comprised a
sections of the gingival margin, as assessed by the MPI, revealed
professional tooth cleaning (removal of plaque and supragingival
significant main effects of group for both approximal (F(2/
calculus and polishing) and random allocated to one of the
51) = 4.435; p = 0.017; g2 = 0.148) and cervical sections (F(2/
interventions, which were launched by a person not further
51) = 7.776; p = 0.001; g2 = 0.234).
involved in the study. To maintain examiner blindness, partici-
pants were asked not to communicate the content of the
presentation to anyone, especially not to their examiner and not Effects after 6, 12, and 28 weeks
to ask the examiner any questions regarding the presentation. Table 2 presents results of univariate ANCOVAs for each point
Compliance with this instruction was excellent. Dependent in time. In these analyses, significant group differences were
variables were assessed 6, 12, and 28 weeks after this visit. At observed for the PBI after 28 weeks. The MPI revealed significant
the end of the study, after they had received their monetary group differences for all sections together and for cervical sections
compensation, participants were asked to answer a short alone after 6, 12, and 28 weeks. For approximal sections,
questionnaire where they should describe the technique they significant group differences were observed after 6 and 12 weeks.
learned, the degree of their adherence (‘‘I applied the technique Results of pairwise group comparisons are given in Figure 2. At no
consistently/inconsistently’’) and reasons why they did or did not time did Bass differ significantly from control. Fones differed
adhere. significantly from control with respect to PBI after 28 weeks and
with respect to skills after 6 and 12 weeks. Significant differences
Statistical Analyses between Bass and Fones were observed with respect to gingival
health after 12 weeks and with respect to skills after 6, 12, and 28
The unit of analysis is the person. Analyses respectively refer to
percentage of sites showing gingivitis (positive bleeding response)
measured by PBI (papillary bleeding index), percentage of sites Table 1. Group differences at baseline.
showing staining as assessed by the MPI, and mean score of the
TQHI. The mean TQHI is computed irrespective of the ordinal
scaling of this measure to provide better international compara- Groups
bility (in most international publications the mean TQHI is Variables Control (n = 19) Fones (n = 19) Bass (n = 18)
reported). Furthermore, this measure correlates well with other Age* 23.53 (2.39) 23.21 (1.75) 22.94 (2.16)
interval scaled plaque measures [26,27] Because of the more Gender (male/female) 3m, 16f 4m, 15f 5m, 13f
detailed assessment of plaque deposits at the gingival margin, the
PBI, bleeding sites* 19.73% (9.58) 22.04% (8.80) 24.80% (9.62)
MPI was taken as the primary and the TQHI as the secondary
dependent variable to test for treatment effects on oral hygiene MPI, sections with 68.53% (14.18) 71.30% (13.70) 68.62% (12.78)
staining*
skills. Significance was considered with p#0.05 and tentative
TQHI, mean score* 2.57 (0.56) 2.52 (0.43) 2.50 (0.50)
significance with p#0.10. Group size was determined to allow for
the detection of large effect sizes (f$0.40) with an a-error TQHI: Turesky modification of the Quigley&Hein Index; MPI: Marginal plaque
probability of 5% and a test-power of 80%. Index; PBI: Papillary bleeding index;
*mean (standard deviation).
doi:10.1371/journal.pone.0037072.t001
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Comparison of Modified Bass vs. Fones Techniques
Figure 2. Papillary Bleeding index (PBI;A), oral hygiene skills measured by TQHI (B), MPI all sections (C), MPI approximal sections
(D), and MPI cervical sections (E) over time. Mean and standard error of the mean of percentage of sites with bleeding (PBI.0), mean score of
the Turesky modification of the Quigley & Hein Index (TQHI) and of percentage of sections showing staining as assessed by the MPI are shown for all
groups (control n = 19; Fones n = 19; Bass n = 18) at baseline, 6, 12, and 28 weeks after intervention. Pairwise ANCOVAs are coded as following:
*,**p#0.05, p#0.01 Fones vs. control; #,##p#0.05, p#0.01 Fones vs. Bass; +,++p#0.05, p#0.01 Bass vs. control.
doi:10.1371/journal.pone.0037072.g002
weeks. From these analyses, training of Fones turned out to be Discussion
superior to training of basics of tooth brushing alone (control) and
training of Bass. This study aimed to compare the respective effects of three
interactive computer presentations teaching the modified Bass or
Self-reported adherence the Fones technique or the basics of oral hygiene alone.
Our hypothesis is confirmed only in part. Only the computer-
Both in the control and in the Fones group, five participants
based training of Fones turned out to be effective as compared to a
reported not having applied the technique consistently, while
control group but not the computer-based training of the modified
within the Bass group eleven persons reported non-adherence. In
Bass technique. Aiming to show whether computer-based training
all groups, the reasons reported most often as main reason for non-
of Fones and Bass would differ in their effectiveness, we found
adherence are related to the subjective expenses of the technique
superior results for the training of the Fones technique. Regarding
(e.g., time pressure, examination stress, idleness; control 5, Fones
the duration of effects, training of Fones turned out to be superior
5, Bass 8). Three persons of the Bass group reported unpleasant
to training of the modified Bass technique throughout the
feelings (‘‘unfriendly to the gingiva’’) as the main reason for non-
experiment. Considering skills, maximum differences between
adherence.
Fones and control groups were observed after 6 weeks, while
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Comparison of Modified Bass vs. Fones Techniques
Table 2. Results of ANCOVAs comparing groups at each teaching Fones might have been a repetition and reminder to our
point in time. participants, while teaching Bass might have meant to them a
completely new way of brushing their teeth. However, while this
may explain superiority of the Fones technique in our study, it
F-Statistics g2 P does not explain the lack of effects of Bass against the control.
Perhaps this technique is more difficult to integrate into everyday
Gingivitis (% sites with bleeding) life. This has been indicated by Arai & Kinoshita [13] and indeed
Papillary bleeding index in the present study more participants in the Bass than in the other
6 weeks F(2/52) = 0.539 0.020 0.587 groups reported non-adherence. In the present study, the
12 weeks F(2/52) = 2.829 0.098 0.068 respective technique was taught only once and the participants
were not checked by another person. Instead, participants
28 weeks F(2/52) = 3.582 0.121 0.035*
themselves checked in the mirror provided beneath the computer
Oral hygiene skills
whether they were performing the technique as shown in the
TQHI (mean score) computer presentation. Perhaps for a technique as difficult as the
6 weeks F(2/52) = 3.124 0.107 0.052# Bass technique, checking by a dentist would be necessary.
12 weeks F(2/52) = 1.801 0.065 0.175# Furthermore, even though participants were provided with a
28 weeks F(2/52) = 1.763 0.064 0.182# brochure to be able to call to mind the most important features of
the technique at home, this might have been too little effort to
MPI (% staining) - all sections
teach a completely new technique. Future studies should find out
6 weeks F(2/52) = 7.323 0.220 0.002* whether teaching the Bass technique would bring about advan-
12 weeks F(2/52) = 4.808 0.156 0.012* tages if more than one session were applied, if a dentist checked
28 weeks F(2/52) = 3.991 0.133 0.024* what they had learned and if patients were encouraged on a more
- approximal sections regular basis to adopt this technique.
The suggested re-encouragement might have been useful in the
6 weeks F(2/52) = 7.016 0.213 0.002*
Fones group, too. After an initial improvement of hygiene skills, no
12 weeks F(2/52) = 3.172 0.109 0.050*
further improvement is seen throughout the rest of the study.
28 weeks F(2/52) = 2.058 0.073 0.138 Future studies are needed to further elucidate this finding and to
- cervical sections determine which interventions would be effective in further
6 weeks F(2/52) = 5.736 0.181 0.006* enhancing hygiene skills.
12 weeks F(2/52) = 5.313 0.170 0.008* One limitation of our study is that the Fones technique seems to
be better known in adults. It therefore remains open whether
28 weeks F(2/52) = 5.043 0.162 0.010*
teaching Bass would have brought about better results if this
TQHI: Turesky modification of the Quigley&Hein Index; MPI: Marginal plaque technique had also been already known. Still, for dental practice it
Index; is important to realize that teaching Fones seems to fall on
*significant differences;
# prepared ground, while teaching Bass for most patients meansan ANCOVA including all points in time reveals no significant result (see Text),
comparisons for each point in time are thereby presented for exploratory entering virgin soil and may thus require much more investment at
reasons, only. the beginning. One should realize, however, that computer-based
doi:10.1371/journal.pone.0037072.t002 training as provided in this study took about 45 minutes, which is
already quite an investment, at least for the patient, and exceeds
regarding gingival health differences, reached a maximum after 28 by far what is commonly provided in dental practice for oral
weeks. hygiene skills training in face-to-face settings. Another limitation is
Our result is surprising with respect to the low effectiveness of our study population, which was restricted to students, thereby
teaching the modified Bass technique. Even though participants in challenging the external validity of our study. Additionally, much
the Bass group received an add-on compared to what the control more women than men volunteered for this study which can only
group had been taught, their results were in no way superior. partially attributed to an uneven distribution of men and women
Thus, it seems as if teaching the Bass technique is of no advantage (1:2) within students of our university. Future studies should
over teaching the basics of tooth brushing alone. Instead, these include more men, participants of different ages, education, and
groups return to baseline values of bleeding at the end of the study. familiarity with a computer to demonstrate whether positive effects
In contrast, teaching the Fones technique brought about a clear of the Fones training can be observed in these groups, too. With
advantage in terms of gingivitis and hygiene skills. This result is respect to the lack of effectiveness of the Bass technique, there is no
remarkable and warrants closer inspection. reason to expect that other populations would show more
Our findings are in line with those of Arai & Kinoshita [13], advantageous results. Instead, the group we analyzed is expected
who compared remaining plaque after brushing with the Bass and to show at least average if not above average cognitive and motor
the Fones techniques and found the Fones technique to be learning capacities, attributes promoting rather than hindering
superior. It is interesting that their participants were dental learning of a complicated motor skill [20]. A further limitation of
students and dental staff, persons who should know all techniques our study lies in the way of teaching itself. Our computer
pretty well. Some other studies are less conclusive, as they lack presentation provides detailed instructions, which allows for
control groups and standardized instructions. Furthermore, several repetitions and for adoption at the individual learning
gingivitis as an indicator of habitual oral hygiene is not assessed rate in that the participant is able to navigate at his or her own
in these studies nor are oral hygiene skills as a premise of successful tempo. Indeed, it has been shown that self-monitored practice
hygiene [11,12,28,29]. schedules may enhance skill acquisition [30,31]. Furthermore,
There are several possibilities as to why Fones turns out to be especially when learning a new skill, a high degree of detail is
superior in the present study. First and most importantly, the desirable and it is difficult to provide this detail in a face-to-face
Fones technique is the one best known in Germany [6]. Thus, interaction. We thus decided on a computer presentation.
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Comparison of Modified Bass vs. Fones Techniques
However, in doing so we waived the effect of a direct patient- (motivation techniques etc.), and the different efforts one should
physician interaction, which might have helped to improve make when teaching a well-known technique like Fones and a less
compliance, e.g. [32]. Similarly we waived any further measures known technique like Bass.
to improve oral hygiene compliance, like teaching advantages of
sufficient oral hygiene or working out implementation intentions, Supporting Information
as suggested by e.g. Gollwitzer [33], or self-regulation and
motivational interviewing, as recently demonstrated by Godard Checklist S1 CONSORT Checklist.
et al. [34]. We also did not employ measures to re-motivate (DOC)
participants, like oral hygiene feedback or repeated teaching CONSORT Flow Diagram S1 CONSORT Flow of Partic-
sessions. Employing all of these measures might have improved ipants.
our study results and led to better results with respect to skills and
(DOC)
gingivitis. Such an improvement would be mandatory as even in
the best (i.e. Fones) group participants never reached better values Presentations S1 Content of the slides in the PowerPoint
than a mean of 50% of marginal sections cleaned. Even though based trainings for oral hygiene.
this is a considerable improvement on baseline, and even though (DOC)
gingivitis rates remain pretty low in this group, there is still plenty
Protocol S1 Study Protocol.
of room for further improvement.
(DOC)
Irrespective of these limitations, the study provides some
important insights. First of all, we demonstrated that a computer
presentation teaching the Fones technique brought about signif- Acknowledgments
icant improvements in skills and gingivitis in a population of We gratefully acknowledge the valuable help of Prof. C. Ganss, DDS,
students. Secondly, we found teaching the modified Bass technique Dental Clinic, Justus-Liebig-University Giessen, Germany, in planning the
in a parallel manner to be of no advantage over teaching oral experiment and setting up the independent variable, and the assistance of
hygiene basics alone. Thus, the results of the present randomized, S. Jahns in data sampling.
controlled trial do not encourage teaching the modified Bass
technique, at least via a computer presentation. Future studies are Author Contributions
needed to analyze whether this disadvantage of Bass is restricted to
Conceived and designed the experiments: RD. Performed the experiments:
the teaching method employed here. Furthermore, our results RD SM DH ML. Analyzed the data: RD DH. Contributed reagents/
raise several other questions to be answered in future studies, like materials/analysis tools: RD. Wrote the paper: RD DH JM ML SM.
the effects of the same teaching methods in different populations, Designed computer presentations: RD JM SM ML.
the effects of additional measures to improve oral hygiene
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