Use of gingival bleeding for reinforcement of oral home care behavior

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Abstract
The use of gingival bleeding as a reinforcement mechanism for interproximal home care with the toothpick was studied. After initial assessments of plaque and gingival bleeding, 36 subjects were given a professional toothcleaning and instructed to maintain oral hygiene by toothbrushing alone for 3 mo. After 3 mo. of brushing only, subjects were re-examined and given another professional toothcleaning. Having been matched for age and percentage of sites bleeding on probing, as determined at the initial examination, they were than randomly attached to 1 of 3 groups. One group, the control, continued to clean their teeth with only a toothbrush, while the other 2 groups used the toothbrush supplemented with the toothpick for interproximal subgingival cleaning. Both toothpick groups received identical instruction in toothpick technique, but 1 group was taught to use bleeding as an interpretive device for health. Three months later, clinical assessments indicated significantly less gingival bleeding for both toothpick groups as compared with the control (whose gingival health worsened). Although there was no significant difference between the final scores of the toothpick groups, only the group that used gingival bleeding as a sign of disease showed a significant improvement in gingival health (P < 0.003), and also had a 5-fold higher rate of return of self-report compliance cards. The use of gingival bleeding as a reinforcement mechanism should be considered as a strategy in oral home car instruction to promote compliance with recommended behavior.