Background Many countries offer systematic group prevention programs in kindergarten and school in order to promote children’s oral health. Little is known, however, about the actual toothbrushing abilities of children when group prevention programs end. Methods In Germany, all children take advantage from a nationwide group prevention program (called “Gruppenprophylaxe”) lasting from kindergarten up to sixth grade (12 years of age). Standardized recommendations are given concerning brushing systematics and brushing movements. N = 174 children at the age of 12 were thus randomly selected from two German towns and were asked to perform toothbrushing to the best of their abilities in front of a mirror which also served as a camera. Brushing behavior was analyzed by video analysis. Results Children brushed their teeth for an average of 200 s ± 80.48 s (mean ± SD). Still, more than 55% missed at least one sextant when brushing inner surfaces, 16% missed them all. Only 7.5% of the children brushed both inner and outer surfaces by the intended movements (vertical movements on the inner surfaces and circular movements on the outer surfaces) for at least 90% of the respective brushing time. Instead, horizontal brushing was very common on the lateral surfaces. Conclusions The present analysis indicates that children have low efficiency to adopt the tooth-brushing recommendations given in prevention programs. This is surprising as great endeavors are made to help children internalize the recommendations. Future research is needed to better understand which factors impede adoption of toothbrushing recommendations in children and which efforts are necessary to improve their toothbrushing abilities. Electronic supplementary material The online version of this article (10.1186/s12903-019-0755-z) contains supplementary material, which is available to authorized users.

should include extended cardiac examination (including 4-chamber view, three vessel view and outflow tract views, including colour doppler). However, this should only be performed when possible without extending the standard examination time (30 minutes). All screening procedures were performed by sonographers, specially trained in 2 nd trimester ultrasound. All examinations were registered in a fetal medicine database (Astraia), and the proportion of women having a complete extended cardiac examination was monitored quarterly, and reviewed at regular meetings. In Q1 and Q2, 2009, all sonographers at the department completed a two day 'hands-on course' in extended cardiac screening. Results: The quarterly proportion of women having an extended cardiac screening is shown on the graph. The time for full implementation was 3 1 2 year. Conclusions: Implementation of 2 nd trimester extended cardiac screening is feasible without extending the examination time of 30 minutes for a complete 2 nd trimester examination. The proportion of accomplished extended cardiac screening only exceeded 98% after dedicated 'hands-on' training for all sonographers. Monitoring, supervision and early 'hands-on' training seem to be of importance in the implementation process.

Objectives: Nationwide prevention programs in Germany aim to promote oral health. The group prevention program starts in kindergarten and ends when the children are about 12 y old. While in a recent study, toothbrushing behavior of 12-y-old children was analyzed, the present study’s objective was to examine the children’s ability to achieve oral cleanliness and to analyze how toothbrushing behavior and compliance with the toothbrushing recommendations taught in the group prevention programs predict oral cleanliness. Methods: Twelve-year-old randomly selected children ( N = 174) were asked to brush their teeth to the best of their abilities, and simultaneously a video was recorded for behavioral analyses. Plaque levels were measured before and immediately after toothbrushing. In addition, dental status and gingival bleeding were assessed. Results: After brushing to the best of their abilities, there was plaque on 50% (±24.72%) of all measured sites at the gingival margin (Marginal Plaque Index). Regression analyses revealed approximately 22% of the variance of marginal plaque on the outer surfaces to be explained by the time brushed by circular movements (β = −0.41; P < 0.001) and the number of sextants brushed for at least 7.5 s (β = −0.171; P < 0.05). Circular movements explained most additional variance (Δ R2 = 0.113; P < 0.001). With respect to inner surfaces, none of the behavioral aspects explained any variance of oral cleanliness. Conclusion: Despite regular group prevention measures, 12-y-old children show limited skills to clean their teeth adequately. Furthermore, none of the recommended behaviors relates to oral cleanliness after toothbrushing at inner surfaces. As a consequence, it is necessary to explore further which behavioral sequences effectively improve oral cleanliness. Knowledge Transfer Statement: This study illustrates that children’s compliance to toothbrushing recommendations is not necessarily related to toothbrushing effectiveness. Clinicians should therefore assess the effectivity of recommendations individually and provide individual guidance for improvement.