Background
Methods
Study design and participant recruitment
Outcome measurement
Coding | Degree | Toothbrush wear (Conforti et al.,2003 [14]) | Distribution of bite marks |
---|---|---|---|
0 | No | No visible signs of wear | Absence of bite marks |
1 | Light | Inner tufts are intact; outer tufts begin to splay | Presence of blurred marks |
2 | Medium | Inner tufts begin to splay; outer tufts splayed beyond the base of the toothbrush | Localized distinct marks |
3 | Heavy | Inner and outer tufts are splayed | Generalized distinct marks |
4 | Extreme | All the tufts are splayed whereby no distinction can be made | Distinct marks distributed on the entire surface; the contour of the toothbrush head is significantly distorted |
Statistical analysis
Results
Participant characteristics
Characteristics | N (%) |
---|---|
Age (yr) ± SD | 3.64 ± 0.78 |
Male | 187 (67.5) |
Diagnosis | |
Autism | 86 (31.0) |
Developmental delay | 71 (25.6) |
Down syndrome (DS), Cerebral Palsy (CP), or epilepsy | 32 (11.6) |
Multiple diagnoses | 88 (31.8) |
Conceptual skills | |
Average or high | 38 (13.7) |
Limited | 171 (61.7) |
Low | 68 (24.5) |
Practical skills | |
Average or high | 24 (8.7) |
Limited | 142 (51.3) |
Low | 111 (40.1) |
Social skills | |
Average or high | 43 (15.5) |
Limited | 175 (63.2) |
Low | 59 (21.3) |
Parents’ educational attainment | |
9 years or below | 37 (13.4) |
10–13 years | 78 (28.2) |
14 years or above | 162 (58.5) |
Household monthly income (HKD) | |
20,000 or below | 109 (39.4) |
Above 20,000 | 168 (60.6) |
Toothbrushing is a difficult task | 171 (61.7) |
Types of toothbrush | |
Manual | 258 (93.1) |
Electric | 12 (4.3) |
Both manual and electric | 7 (2.5) |
Toothbrushing frequency | |
Never/occasionally | 44 (15.9) |
Once daily | 89 (32.1) |
Twice daily or more | 144 (52.0) |
Toothbrushing duration | |
Less than 1 min | 76 (27.4) |
1–2 min | 142 (51.3) |
2–3 min | 47 (17.0) |
Over 3 min | 12 (4.3) |
Characteristics of children who used multiple toothbrushes in a 3-month period
No. of toothbrushes used in 3 months | No. of children (%) |
---|---|
1 | 252 (91.0) |
2 | 16 (5.8) |
3 | 3 (1.1) |
4 | 3 (1.1) |
5 | 2 (0.7) |
6 | 1 (0.4) |
Children used at least two toothbrushes in 3 months | |||
---|---|---|---|
OR (95% CI) | p-value | Multiple comparisons | |
Gender | |||
Male | 5.10 (1.33, 19.51) | 0.017 | |
Femalea | |||
Diagnosis | 0.032 | (3), (4) > (2) | |
Autism (1) | 0.32 (0.10, 1.05) | 0.060 | (1)=(2) |
Developmental delay (2) | 0.09 (0.01, 0.72) | 0.024 | (1)=(4) |
DS, CP, or epilepsy (3) | 1.32 (0.32, 5.43) | 0.703 | (1)=(3) |
Multiple diagnoses (4)a | |||
Social skills | 0.024 | (3) > (2) | |
Average or high (1) | 0.15 (0.02, 1.38) | 0.093 | (1)= (2) |
Limited (2) | 0.25 (0.09, 0.74) | 0.012 | (1)= (3) |
Low (3)a | |||
Excessive toothbrush wear | |||
Yes | 10.49 (3.21, 34.26) | < 0.001 | |
No a |
Overview of the collected toothbrushes
Associations between toothbrush deterioration and participant characteristics
Presence of heavy to extreme wear | Presence of distinct bite marks | |||
---|---|---|---|---|
OR (95% CI) | p-value | OR (95% CI) | p-value | |
Social skills | 0.027 | |||
Low | 2.89 (1.32, 6.29) | 0.008 | ||
Limited | 2.69 (1.11, 6.53) | 0.028 | ||
Average or high a | ||||
Toothbrushing is a difficult task | 0.013 | |||
Yes | 1.96 (1.15, 3.32) | |||
No a | ||||
Toothbrushing frequency | 0.021 | |||
Twice daily or more | 2.80 (1.31, 5.98) | 0.008 | ||
Once daily | 1.78 (0.81, 3.88) | 0.150 | ||
Never/occasionally a | ||||
Parents’ education | 0.040 | |||
14 years or above | 0.53 (0.26, 1.11) | 0.532 | ||
10–13 years | 0.35 (0.15, 0.79) | 0.012 | ||
9 years or below a |
Parents’ comments about the toothbrushes used by children with special care needs
Items | Brief comments/suggestions |
---|---|
Bristles | • “The bristles are too long” • “The bristles are too thin” • “The bristles are too hard/stiff” • “The bristles are too soft, and the toothbrush cannot remove the debris efficiently” • “The bristles are too rough, and my child complains that toothbrushing causes pain” • “The bristles should be softer. The pressure of toothbrushing should not cause bleeding gums” • “The bristles should cover all the surfaces of the toothbrush head” • “Multi-dimensional bristles” • “Optimal bristle diameter” • “The procedure of toothbrushing might be simplified if there the bristles are distributed on the lateral sides of a toothbrush head” |
Handle | • “The toothbrush handle is difficult for my child to hold” • “The angle of toothbrush handles should be adjusted, so that the back teeth could be reached easily” |
Toothbrush head | • “Various sizes of the toothbrush head should be provided” • “The size of a toothbrush head should be adjusted properly, so that the back teeth could be brushed more efficiently. • “There should be a soft rubber pad on the toothbrush head. If children bite the toothbrushes, less damage will be caused to their teeth, and they can feel more comfortable” |
Additional function | • “It is better if the toothbrush can make toothbrushing fun for kids (help my child love teeth brushing)” • “We need a toothbrush which can simplify the toothbrushing steps (brush more areas with a single stroke)” • “…show the toothbrushing steps or provide instructions to children by using verbal or visual hints” • “Toothbrushing instruction is needed” |
Others | • “My child bites the toothbrushes, and the toothbrushes are distorted very soon” • “When I help my child to brush the buccal surfaces of the front teeth, my child does not know how to cooperate. I wish there is a toothbrush which is specialized in brushing the front teeth” • “The design of toothbrushes should make it more convenient for parents to help children brush their teeth” • “The individually-modified toothbrushes should be less expensive” |