The most important finding in this follow-up study is not just that children brush better, but that they retain improvement.
The graph below shows time on tooth surface. The orange area also shows how the problem areas retained improvement.
Before playing the game, children neglect large areas of the mouth.
Right after training, they had brush everywhere.
A year later, although overall time diminishes, every area is brushed.
There are no more neglected areas – except for the lingual surface of the lower incisors. Since then, our brushing instruction has been changed to address this deficiency.
In a second study, children played for two weeks and then the game was taken away for a full year.
The map below shows the brush pattern of children when they returned after one year without playing.
Did they forget everything?
They retain improvement.
Brush Up caused measurable improvement, but not by training the talents of an elite few. This chart demonstrates that, as children spend more time playing the game, sufficiency scores increase uniformly. The 7 day scores show the uniform distribution most clearly. By 14 days, while there are still some kids that did not improve much, most kids improved tremendously (shown by the high percentage of red values).
To measure the aggregate benefit of Brush Up, researchers calculated a "sufficiency" metric. The chart below shows sufficiency calculations for each test group. The sufficiency is further broken down by value, indicated by a range of colors from violet (less than 10% sufficient) to red (100% sufficient). Colors closer to red indicate learning by the brusher.
A blinded expert hygienist scored each brush performance with an error count for each of nine metrics:
Patience: Subject completes each brushing surface.
Moderation: Subject avoids excessive force
Brush Position: Subject holds brush at 45 degree angle near gumline
Variation: Subject performs distinct sulcus and sweep strokes
Sweeps: Subject sweeps from gumline to apex
Restraint: Subject performs small horizontal sulcus stroke
Tooth Group Awareness: Subject focuses on each surface
Surfaces: Subject attends to all classes of tooth surfaces
Orderly Progression: Subject brushes teeth in sequence
The chart below shows how those metrics improve over time.
The children then played the game at home every night with early prototype hardware. They were given no instruction by parents or researchers.
The second map shows the brush pattern of children when they returned after two weeks. Again, they played without the game or any other guidance. There is stark improvement in their performance.
Consider the maps below of children brushing in the lab without help from parent, scientist, timer or music. They weren't playing a game during this test. Each map shows toothbrush time. Bands indicate time on each tooth surface (inside, outside and biting). It takes 7.5 seconds to fill all three bands.
The first map shows how children brushed before playing the game. Despite life-long training by loving parents and professionals, these children do very poorly. They brush only surfaces that are easy to see and convenient to reach.
Did they learn anything?
They brush better in two weeks.
For over a year, these trials tracked brushing by a group of thirty four diverse children, ages 5 and 6.
Health professionals want effective weapons to fight the plague of plaque. Brush Up is such a weapon.
The National Institute of Health supported trials of Brush Up through the National Institute of Dental and Craniofacial Research with institutional review by the Morehouse School of Medicine. The results of our trial are in this whitepaper now awaiting peer review at the journal of the American Academy of Pediatric Dentistry.