Behind every smile is teeth

"Only brush the want to keep..."

Behind every smile is teeth.

Measuring oral care activity.
Noldus Consultant: Jason Rogers, PhD
Case study write up: Abbe Macbeth, PhD and Jason Rogers, PhD

We all know what is advisable for proper dental health…but who follows these instructions to the letter, every day? The ADA recommends that anyone with teeth brush at least twice a day for at least two minutes each time. To encourage this healthy habit, companies have developed phone/tablet apps, and even YouTube videos to help you count to 120 (such as 2-Minute Timed Tooth Brushing for Kids).

Of course, brushing isn’t the only part…the ADA also recommends regular, daily flossing between all teeth to prevent cavities and gingivitis.

We all know this. But do we follow these simple guidelines?

In order to better market oral care products, it helps to know the actual oral care routine, carried out in the home by average adults, day in and day out.

We could ask people these questions via survey, but we are then likely to fall prey to acquiescence bias, where respondents want to please the survey takers, and say “Yes!” There is also a great deal of social pressure to respond as if you are the ideal tooth brusher/flosser.

Additionally, it is very difficult for consumers to respond accurately about something that becomes an unconscious habit, as tooth brushing is.

How accurately could you answer these questions:

  • Which did you pick up first this morning: your tooth brush, or tooth paste?
  • How did you apply your tooth paste to the brush?
  • Which teeth did you brush first: top or bottom?
  • How long did you brush each set of teeth? How long was your total brushing time?
  • Do you repeat brushing over any teeth?
  • Do you brush or floss first? Are you consistent in this pattern?
  • Do you brush in the morning, or evening?

Without being able to accurately gather answers to these and similar questions, researchers cannot fully capture the details of this very important daily habit. This means that the best way to understand oral care is to actually study oral care behavior in the home! Behavioral Observations hold a wealth of information relevant to product development, governmental organizations, and even dentists.


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What are the oral care routines of individuals in their own homes?

The Noldus method

In this client case, Noldus Consulting aimed to reveal true brushing and flossing activities of adults in their daily routines. As experts in the understanding of human behavior, Noldus Consulting adds value by assessing natural behaviors in a home environment, with no interference from a moderator. Specific activities that comprise individual routines and habits can easily be assessed and analyzed for new insights.

With our Unobtrusive Observation methods, we recorded adult participants as they engaged in oral care activity in the morning and at night, during the week and on the weekend.

By assessing only those behaviors relevant to oral care, and breaking down observed behaviors into their component parts, Noldus Consultants were able to accurately focus analysis in order to provide insights into the clients’ specific questions.

The Noldus method allows us to:

  • Assess natural behaviors in a natural environment
  • Gather data with no interference from the researcher
  • Quantify specific behaviors by coding/marking only those of interest
  • Objectively assess desired behaviors
  • Detect patterns and provide novel insights into routines and habits

In any project carried out by Noldus Consulting, our coding consists of a set of behaviors that are important to each specific project. It can be challenging to get to the most relevant behaviors – with too many, there is an overload of data, while not enough can cause you to miss the most pertinent behaviors. Our behavioral scientists are skilled in working with our clients to get the coding scheme just right, to optimally contribute to insight generation.

Question 1: Do people actually brush for two minutes?


The average time spent brushing was around 90 seconds. What about differences between traditional vs electric toothbrush users? Electric toothbrush users did brush longer, but both fell short of the two minute recommended time. About half of the daily brushing time was done in the morning, with ~10% less brushing at night. This means that morning brushing is crucial and nighttime brushing is sometimes missed. Despite this, brushing time was equal on weekdays and weekends, which means routines are conserved throughout the entire week, which is good!

What does this mean?

Either respondents cannot mentally calculate two minutes while performing a task like tooth brushing, or they perceive their teeth to be clean well before the recommended time is complete.

Question 2: How much flossing is done, and when is it done?

Adults do not floss their teeth nearly as much as is recommended.

Not much of a surprise there, right? But what further insights can we find, that could positively affect adults’ flossing behavior? Flossing is not a daily activity, as it occurred in only a quarter of the observed oral care routines. When adults do floss, they typically do so after brushing and at night. Interestingly, those who did floss before brushing spent more time doing so than those who did it after.

Unlike tooth brushing, which remains consistent across weekdays and weekends, number of episodes of flossing and duration spent flossing is decreased on the weekend.

What does this mean?

Flossing is generally seen as a need-based activity, providing a deeper clean that is not deemed needed every day. Additionally, lack of routine on the weekend (sleeping in, or running around) could prevent adults from flossing on those days.

  • Pre-brush flossing serves as a pre-treatment to brushing.
  • Post-brush flossing serves to clean up areas missed while brushing.


  • Insight and recommendations

Make a game-style app for adults
Apps like the Oral B/Disney Magic Timer are great for kids. They will also help adults to obtain better compliance to the recommended time guidelines.

Create a toothbrush that adds gentle reminders regarding time
But, given the higher levels of traditio-nal toothbrush usage than electric usage, there is a real challenge to improve nighttime brushing.

Sell an integrated set (brush and floss)
So that when the floss is empty it serves as a reminder to change the toothbrush.

Launch a campaign aimed at increasing pre-brush flossing
The ADA recommends flossing, then brushing, but that is not what most people actually do. Reposition floss as a pre-treatment to brushing in order to improve usage.


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