Toothbrush Design and Developmental Characteristics Influencing Plaque Removal in 7-Year-Old Children: A Randomized Crossover Trial.

BACKGROUND: Evidence comparing toothbrush designs and the influence of children's developmental abilities on brushing performance is limited. AIM: To compare the plaque-removal efficacy of three toothbrush types in 7-year-old children and to assess whether developmental characteristics affect brushing performance. DESIGN: This single-blind, randomized, three-period crossover clinical trial included 60 typically developing 7-year-old children. Participants used a conventional manual, triple-headed manual, and rechargeable powered toothbrush in randomized order with washout periods. Plaque was assessed using the modified Quigley-Hein Plaque Index and the Approximal Plaque Index. Developmental characteristics were evaluated using the parent-reported Five-to-Fifteen questionnaire. RESULTS: Mean plaque reduction differed significantly among toothbrush types. Powered (1.833 ± 0.705) and triple-headed manual toothbrushes (1.802 ± 0.678) achieved greater plaque reduction than the conventional manual toothbrush (1.310 ± 0.563; both p < 0.001), with no difference between powered and triple-headed brushes (p = 0.963). Approximal plaque removal was highest with the powered toothbrush, reaching 75% complete removal on posterior vestibular surfaces (p ≤ 0.016). Children with gross motor difficulties showed lower reduction with the powered toothbrush than children without such difficulties (p = 0.048). CONCLUSION: Powered and triple-headed toothbrushes are more effective than conventional manual brushes in 7-year-old children, with equivalent efficacy. Exploratory analyses suggest gross motor skills may influence powered toothbrush performance, warranting confirmation in adequately powered studies. TRIAL REGISTRATION: The study was registered retrospectively with the Australian New Zealand Clinical Trials Registry (ANZCTR; ACTRN12626000023358).