RECENT INVESTIGATIONS have demonstrated that there is a strong positive correlation between poor oral hygiene and periodontal disease (1-9). An awareness of this relationship has stimulated dentists to place greater emphasis on teaching patients the importance of good oral hygiene and the best methods for obtaining it. It has also stimulated additional study of the role of oral debris in dental disease. The current emphasis on patient education and on research in oral hygiene has underlined the need for a simple and accurate method for measuring the oral hygiene of dental patients. The simplified oral hygiene index (OHI-S) developed by Greene and Vermillion for measuring oral hygiene (10) has proved a reliable instrument for large epidemiologic studies. The need, however, for a simpler and more sensitive measurement device both for research and for use by the dental practitioner has stimulated the development of the patient hygiene performance (PHP) method (11, 12). This paper reports the results of an investiga

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Doctor Podshadley andMiss Schweikle have to conclude: "Sorry folks, but your single annual lecture and demonstration of toothbrushing for children in the third and fourth grades is not effective in changing their performance, regardless of their choice of two technics. "Good oral hygiene for a long period has been considered an important factor in the prevention of periodontal disease and the activity of dental caries. Although various methods have been utilized t o obtain good oral hygiene, the most widely accepted approach is the proper use of the toothbrush. In order t o remove oral debris the American Dental Association and other groups have recommended that people be taught to brush their teeth the way they grow-down on the upper teeth and up on the lower teeth.'-4 More recently, it has been recommended that people be taught t o use a disclosing tablet and to brush their teeth in a random manner until they are Although it has been established that the use of a disclosing dye is an important factor in improving oral hygiene,' no evidence is available t o support the choice of either of the methods of brushing listed as the better approach in the removal of oral debris. This paper will report the results of an investigation which was designed to determine any change in the performance of oral hygiene by groups of 8-10-year-old children when they are taught to brush "as teeth grow," and the ''random" method of brushing. Since a single lecture and demonstration frequently constitutes the technic used to motivate elementary school children t o improve their oral hygiene, this method was utilized for the investigation now t o be reported. ProcedureApproximately 150 students in the third and fourth grades of Yates Elementary School were divided into three groups. One group was taught to brush "as tceth grow," and another the "random" brushing. A third group of children served as the controls.The Patient Hygiene Performance (PHP) method* was used to evaluate each student's performance in oral hygiene. In this method, a 5.0 percent solution of erythrosin dye is used to stain the oral debris a dark pink color. The amount of debris then is assesscd on six selected teeth, and an average score is calculated for each participant. A PHP score can range from a minimum of 0.0 t o a maximum of 5.0 which indicates the presence of extensive debris. Using portable equipment, an initial PHP score was determined for each participant. The educational program then was presented to the two experimental groups. PHP scores again were determined for all participants at two weeks and at four months after this presentation. All examinations were performed in the morning and the time for examinations not announced to the children in advanced of the examination.All PHP scores were determined by the same examiner, and precautions were taken to ensure a completely unbiased calculation. The arrangements for examinations and the

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The enthusiasm of the writers of this report may stimulate comparable projects at other schools of dentistry

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