Brushing as a complex automatic motor sequence: student generated evidence

Introduction: Since 2004 BDent1 students have been involved in learning about the concept of brushing as a complex automatic motor sequence. At one station in an OSCE about oral hygiene, students have worked in pairs to map the brushing sequence and characteristics at 16 sites around the mouth. Objective: To quantify three features of brushing sequences that show automation or complexity with and without blinding. Method: This year, students self-selected into groups of either 3 or 2, with 1 person in each group electing to manually brush the teeth (if a motorised brush was not used at home). Two (blind) observers mapped the brushing sequence or characteristics in a cross over design for consecutive brushings. In written instructions, the single observer was requested to mark where the brusher started for the same consecutive observations. All brushers were blind to the features to be described. The groups of students could not chat with each other on the OSCE circuit, and morning and afternoon sessions involved different sets of students. Observation sheets were collected and entered into a spread sheet with backwards and forwards movements between sextants or jaws being analysed at data entry. Results were fed back in a follow-up lecture. Results: For blind observers these were not significantly different from those not blind. 100% of brushers started at the same sextant and surface on repeated brushings; 95% moved backwards and forwards between the left, right or front of the mouth; 74% moved backwards and forwards between the upper and lower dental arches. 100% demonstrated one or both of these last two behaviours. Conclusion: These observations provide support for the concept of brushing as a complex automatic motor sequence.