Manual and Powered Toothbrushing Effectiveness on Autistic Children's Oral Hygiene Status

Evaluation of Effects of Verbal and Video-Based Instructions on the Improvement of Oral Hygiene Status in Children: A Randomised Clinical Trial

OBJECTIVES

To evaluate the effects of verbal and video-based oral hygiene instructions (OHIs) on the improvement of the oral hygiene status (OHS) in children of different age groups in the mixed dentition period.

METHODS

In total, 202 children aged 6-9 and 10-12 years (n = 101 each) were included. Before providing the OHIs, the baseline OHS was determined using the Simplified Oral Hygiene Index (OHI-S). From each age group, approximately half of the participants were randomly assigned to the verbal (n = 50 and n = 51 from the 6-9-year and 10-12-year age groups, respectively) or video-based (n = 51 and n = 50 from the 6-9-year and 10-12-year age groups, respectively) OHI groups. Children were recalled after 30 days and post-instruction OHI-S were recorded. Data were analysed using Shapiro-Wilk, Mann-Whitney U, and Wilcoxon signed-rank tests. The statistical significance level was set at 5%.

RESULTS

For both OHI methods, no significant difference was found between the age groups in terms of the OHI-S at both the pre- and post-instruction timepoints (verbal OHIs: p = 0.354, p = 0.860 and video-based OHIs: p = 0.174, p = 0.632, respectively). In both age groups, a significant difference was found between the baseline (pre-) and post-instruction OHI-S for both OHI methods (p < 0.001); the post-instruction OHS was found to be better than the pre-instruction OHS. In both age groups, video-based OHIs resulted in a significantly higher improvement in the OHS, compared with verbal OHIs (p = 0.004 and p < 0.001, respectively).

CONCLUSION

OHIs are effective in improving the OHS of children. In addition, video-based education is preferable to verbal instruction for improving the OHS of children.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT06449950.

Comparison of Oral Hygiene and Gingival Outcomes in Children With Special Care Needs Using Powered or Manual Toothbrushes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

AIM

This systematic review and meta-analysis (SRMA) compares oral hygiene and gingival outcomes in children with special care needs (CSCNs) using powered or manual toothbrushes.

MATERIAL AND METHODS

Two authors searched articles using PubMed and Cochrane library; the search was extended to other databases to include publications until July 2024. RCTs available in English were included. Oral hygiene and gingival outcomes in CSCNs, using powered or manual toothbrushes were: plaque index (PI), Quigley Hein plaque index (QHPI), gingival index (GI), and oral hygiene index simplified (OHI-S). ROB and publication bias was assessed using Cochrane tool and funnel plots, respectively. Meta-analyses were performed using forest plots. GRADE was used for the quality.

RESULTS

Twelve studies were included in SR and 11 studies in MA. In relation to GI and in the subgroup analysis of QHPI, powered toothbrushing was superior to manual toothbrushing with SMD -0.681 [95% CI (-0.911 to -0.451)] and SMD -0.85 [95% CI (-1.166 to -0.53)], respectively using REM. Comparisons with other indices exhibited no significant differences. The ROB and publication bias were moderate, quality of evidence was low to moderate GRADE.

CONCLUSION

Powered toothbrushes had favorable outcomes in a few but not all parameters. The overall quality of evidence is low.

PROSPERO REGISTRATION ID

CRD42024579260.

Effectiveness of two visual-pedagogical methods for toothbrushing skills in autistic children: A randomized clinical trial

AIM

This study aimed to compare the effectiveness of two visual pedagogy methods, video modeling and educational posters, on improving tooth-brushing autonomy in 10-12-year-old children with mild autism.

METHODS

Sixty-four autistic children were randomly assigned to either the video or poster groups using the Rand function in Excel. Toothbrushing skills were divided into five stages: preparation, buccal, occlusal, lingual surfaces, and the end. These five stages comprised a total of 20 steps, with each step scored from 1 (not done at all) to 5 (done independently). The final score was calculated by averaging the scores of the five stages. The FONES method of toothbrushing was used for training. Follow-up assessments were conducted after 1 and 3 months. The data were analyzed using SPSS V26, including t-tests, Mann-Whitney U tests, and repeated-measures ANOVA.

RESULTS

After 3 months, there were significant improvements in autonomy scores for both groups, with the video group showing greater benefits (4.37 ± 0.43) compared to the poster group (4.11 ± 0.49) (p = .03), with an effect size of η2 = .07.

CONCLUSION

Both video and poster methods were effective in improving tooth-brushing skills, but video modeling was associated with a higher total autonomy score.

Effectiveness of picture-based interventions of toothbrush training on improvement of oral hygiene in children with autism spectrum disorders: A systematic review and meta-analysis

BACKGROUND

Children with autism exhibit a higher risk of poor oral health due to difficulty in the performance of simple tasks such as toothbrushing.

AIM

This current systematic review aims to evaluate the effectiveness of Picture based intervention of toothbrush training on improvement of oral hygiene in children with autism spectrum disorders (ASD) MATERIALS AND METHODS: Prospero registered (CRD42023450156). PubMed, Cochrane, Scopus databases are searched from years January 1, 1980 to August 1, 2023 using broad search terms (brush) AND (autism).

RESULTS

The search queries have identified 853 titles, from three databases (PubMed, Scopus, Cochrane), after application of filters for exclusion of systematic reviews and meta-analysis, duplicate exclusion and removal of irrelevant titles led to the final inclusion of 24 articles for full text screening. From the 24 included studies, 10 studies (four RCTs and six non-randomized clinical studies) sustained the final rigorous PICO search. Quantitative pooling of data were performed for limited articles.

CONCLUSION

Low quality evidence suggest that picture-based intervention of toothbrush training has significant improvement (p ≤ .05) in improving toothbrushing habit as well as performance as indicated by the Plaque Index score (PI), Gingival index (GI) and Oral hygiene index score (OHI-S).