Single vs Triple-Headed Toothbrushes in Children With Special Needs: A Randomised Crossover Trial of Brushing Efficacy

Abstract

Introduction and aims Children with special needs (CSN) often struggle with effective toothbrushing, which is attributed to factors such as toothbrush type and visual-motor integration (VMI). This study aimed to compare the brushing efficacy of single-headed toothbrushes (SHT) vs triple-headed toothbrushes (THT) at varying VMI levels. Methods This single-blind, randomised controlled crossover study involved 46 CSN ranging in age from 6.1 to 12.0 years. Baseline plaque index (PI), gingival index (GI), and VMI levels were measured. Participants were assigned a toothbrush type using block randomisation and received oral hygiene instructions accordingly. After participants completed self-brushing, immediate post-brushing PI, brushing durations, and brushing performance were assessed. Following a 1-month washout period, the process was repeated using the alternate toothbrush type. A t-test statistical analysis of 2 × 2 crossover design was utilised. Results THT use resulted in significantly lower post-brushing PI and a greater percentage of plaque reduction ( P < .001). Within similar VMI levels, THT showed significantly better plaque removal than SHT in both normal ( P = .02) and impaired ( P = .009) VMI groups. However, there was no statistically significant difference between VMI levels. Additionally, THT required less brushing time (2.3 ± 0.9 vs 3.3 ± 0.9 minutes, P < .001) and provided superior cleaning on lingual surfaces across all tooth areas ( P < .001-.041), except for the first permanent molars. Conclusion THT demonstrated superior plaque removal and reduced brushing time in CSN, regardless of VMI level. It also enhanced cleaning of difficult-to-reach lingual/palatal surfaces, although its efficacy was comparable to SHT in the first permanent molar areas. Clinical relevance For CSN who brush independently, the use of THT may improve oral hygiene and reduce the burden on caregivers. Dental professionals should consider recommending THT for this cohort.