Should five to eleven-year-olds use manual or electric toothbrushes to clean their teeth?

Design A cohort study design was used. 120 healthy children were randomly assigned to a manual group and an electric tooth brushing group. Plaque scores plus a post-brushing questionnaire examining executive function/motor skills using indices from the occupational and developmental sciences (e.g. shoelace tying), was completed by the parents .Sample selection 120 subjects were recruited from a single site, the Nationwide Children's Hospital in Columbus, Ohio. The entire research project was carried out in the dental department there.All children were fit and healthy and presented with:• No caries• No disability that would affect the task completion• No injury to the dominant hand• Adequate parental literacy to complete a questionnaire• Teeth present to score.All ages were evenly represented in the final sample.Data analysis Two hygienists and one dentist were calibrated and trained in the use of the OHI-S plaque scoring system. Reliability was determined using the Cohen's kappa. Teeth were disclosed and pre-brushing plaque scores were obtained. A set of brief brushing instructions were delivered orally to the patient. The children were given a brush and were asked to brush at a sink with no toothpaste or mirror. The minimum brushing time was 30 seconds but the children were unaware that they were being timed. Post- brushing plaque scores were measured.Results The response rate to the questionnaire was 100%. A chi-square test was carried out on the data. The results showed that if a child can exhibit the following skills/characteristics they were more likely to perform well in the brushing task• Never has poor handwriting• Always writes their address• Always ties their own shoes• Always cuts food into bite-sized pieces• Can cut out complex shapes.There was a positive correlation between pre-brushing scores and post-brushing scores .Conclusions Good handwriting and other motor/cognitive skills were linked to good tooth brushing and manual and electric toothbrushing were equally effective at removing plaque. If a child was able to play a musical instrument well, they were likely to have less plaque. The study also demonstrated that parents are good judges of their children's abilities and motor skills.