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

Abstract

Background:

Autistic children want a lot of help cleaning their teeth and they have a higher risk of periodontal disorder and less caries than the general public. The study's purpose is to see how helpful manual and powered toothbrushing are for autistic kids aged 6–12 years.

Materials and Methods:

A total of 40 autistic children aged 6–12 years were chosen at random from Mangalore city schools. The simplified oral hygiene index was used to determine the baseline oral health (OHI-S). Children were split into two classes during an oral review. Children in Group 1 received a manual toothbrush, and those in Group 2 received a powered toothbrush. Many of the children were given Colgate fluoride-free toothpaste. Under the guidance of care professionals, children were taught to brush for 3 min. They were taught to count from 1 to 20 when brushing each buccal and lingual section. The index was rechecked at the conclusion of the 1^st month (30^th day) and the next month (3^rd month) (90^th day). On the 60^th day, the recently learned techniques were reinforced (end of the 2^nd month).

Result:

In Group 1, a statistically significant reduction in mean OHI-S scores was observed in baseline versus 30 days and baseline versus 90 days, while in Group 2, a statistically highly significant reduction in baseline versus 30 days, baseline versus 90 days, and 30 days versus 90 days was observed.

Conclusion:

Furthermore, in autism children, powered teeth brushing shows potential. Long-term follow-up and greater sample size are, however, needed.

INTRODUCTION

Autism's origins can be traced back to 1911 when Eugen Bleuler invented the word “autism,” which implies “life in one's own skin.” In 1943, Leo Kanner released an article named “Autistic Disorders of Affective Communication,” which detailed 11 case reports of children (eight males and three females) who had presented to his clinics.[1]

Autism tends to have little relation to ethnicity, socioeconomic class, or parental education degree.[2]

A manual toothbrush is made up of a bristle-filled head and a handle. Because of (1) the lack of objective tools to assess cleaning (plaque removal), (2) the many sizes and types of toothbrushes used, and (3) the lack of systematic toothbrushing techniques included in the tests, many of the early evidence evaluating the effectiveness of different toothbrush styles is inconsistent.[3]

Powered toothbrushes were first published in Harper's Weekly in February 1886,[4] but were not widely used in the United States until the 1960s, when Broxadent was introduced. With the launch of the Interplak product in the 1980s, the group of driven toothbrushes was revitalized. The spinning head of this “second generation” driven toothbrush was powered by long-life/rechargeable batteries. In reported trials, increased effectiveness was reliably shown as opposed to manual toothbrushes.[5,6,7] Since then, a “third” generation of sonic-powered toothbrushes has been created and shown to remove more plaque than manual toothbrushes, especially in long-term studies. The revolving, oscillating style with a short, circular molar-crown-size brush head, and three oscillating brushes with either vibrating or rotational sonic motions are now the most popular head designs.[8,9,10] When the engine is turned on, the head moves in three simple patterns: reciprocating, arcuate, and elliptical (a mixture of reciprocating and arcuate motions). In terms of plaque clearance and gingivitis effectiveness, these toothbrushes consistently outperform manual toothbrushes.[11]

Patients' motivation to enhance their oral health continues to be a major factor in their buying of activated toothbrushes.[12]

Oral health status in children with autism in developed nations is poorly recorded.[13]

Bäckman and Pilebro first used visual pedagogy in dentistry in 1999 to increase the cooperative rate of children with autism spectrum disorder (ASD) for dental care.[14] It has been used to enhance oral health in children by a collection of colored images explaining teeth brushing.[15] Video modeling (VM) is an important tool for teaching children with ASD different skills such as social, communication, and self-help. Hence, the present study compares manual and powered toothbrushes in oral hygiene maintenance among autistic kids.

MATERIALS AND METHODS

Data came from the following sources

Forty autism children aged 6–12-years old were chosen at random from the schools based on the inclusion and exclusion requirements mentioned below.

Criteria for inclusion

• Children aged 6–12 years who have been diagnosed with autism

• Permanent first molars and central incisors that have completely erupted

• Having a fair-to-poor oral hygiene regimen

• Children who can tightly grasp a tooth with one palm

• Others those are able to obey straightforward commands and fine motor gestures

• Children who do not brush their teeth with an operated toothbrush.

Criteria for exclusion

• Antiepileptic medications such as phenytoin, sodium valproate, phenobarbitone, ethosuximide, methosuximide, or steroids

• Children who refuse to cooperate

• Those suffering from cerebral palsy or other psychiatric illnesses

• Children who have a systemic disorder of some kind

• By which no parental permission would be sought.

Design of the study

Before the report, permission from the special school administrators was sought, as well as written informed consent from the parents of the participants.

Collection of information

Children became involved. The simplistic oral hygiene index (OHI-S) 75 was used to determine the baseline oral health. When participants became uncooperative during the examination, an alternative solution was utilized to promote cooperation through the application of simple behavior modification strategies (tell-show-do technique and short and clear verbal commands). The index was rechecked at the conclusion of the 1^st month (30^th day) and the next month (3^rd month) (90^th day).

Children were split into two classes during an oral review.

Group 1: manual toothbrush (20) Group 2: powered toothbrush (20).

Children in Group 1 received a manual toothbrush, whereas those in Group 2 received a powered toothbrush (Colgate 360° sonic control toothbrush, which generates high-energy sonic oscillations of 20,000 every minute). The children were shown how to use a circular fone. Under the guidance of care professionals, children were taught to brush for 3 min. On the 60^th day, the recently learned techniques were reinforced (end of the 2^nd month).

RESULTS

Table 1 and Graph 3 show the intragroup comparison of mean OHI-S at different intervals. At 30 days and 90 days, a statistically significant reduction in the mean OHI-S scores was obtained in both the groups (P = 0.00*) with a greater reduction in Group 2.

Table 1.

Comparison of the mean values of simplistic oral hygiene index at baseline, 30 days and 90 days between the groups

	Mean	SD	P
Baseline
Group 1	1.54	0.52	0.62
Group 2	1.46	0.47
30 days
Group 1	1.27	0.48	0.00*
Group 2	0.77	0.32
90 days
Group 1	1.15	0.49	0.00*
Group 2	0.43	0.47

*Significant. SD: Standard deviation

Table 2 shows the intergroup comparison of mean OHI-S scores at different time intervals. In Group 1, a slight reduction in the mean OHI-S score was observed from baseline to 30 days and 90 days with a statistically significant difference (P = 0.00*). While in Group 2, a marked decline in the mean OHI-S score was observed throughout the study with a statistically significant difference (P = 0.00*).

Table 2.

Comparison of the mean values of simplistic oral hygiene index at baseline, 30 days and 90 days within the groups

	n	Mean	SD	P
Group 1
Baseline	20	1.54	0.52	0.00*
30 days	20	1.27	0.48
90 days	20	1.15	0.49
Group 2
Baseline	20	1.46	0.47	0.00*
30 days	20	0.77	0.32
90 days	20	0.43	0.47

*Significant. SD: Standard deviation

Table 2a shows a statistically significant reduction in the mean OHI-S scores in baseline versus 30 days and baseline versus 90 days in Group 1, while in Group 2, there is statistically highly significant reduction in baseline versus 30 days, baseline versus 90 days, and 30 days versus 90 days.

Table 2a.

Post hoc-bonferroni

	Baseline versus 30 days		Baseline versus 90 days		30 days versus 90 days
	Mean difference	P	Mean difference	P	Mean difference	P
Group 1	0.27	0.002*	0.38	0.002*	0.11	0.36
Group 2	0.69	0.000*	1.02	0.000*	0.33	0.000*

*Significant

DISCUSSION

Usually, autism manifests itself in a variety of ways. The difficulties encountered by autistic children, as with any other special health care needs infant, are instilling in them the courage and skills necessary to gain autonomy.

People with ASDs will benefit from applied behavior analysis (ABA) in a variety of contexts, including health and dental treatment since it improves resistance to medical procedures.[16] The aim of this research was to see how efficient brushing using a manual and operated toothbrush was for autistic children who were institutionalized and under the guidance of professional caregivers. When opposed to manual toothbrushes, powered toothbrushes have the ability to increase oral health by reducing plaque, as shown in our study after 30 days.[17] The brushing approach used in this research was Fone's process. In addition, it is for small children and those who lack the muscle development needed for more advanced techniques. This is in line with the findings of Vajawat and Deepika research.[18]

According to Pine,[19] bad oral hygiene is an issue. Weak oral hygiene in autistic children is attributable to a variety of factors, including oral discomfort, a propensity for food pouching, a lack of physical dexterity, and difficulties in training these children, resulting in a high prevalence of caries and periodontal diseases due to limited access to treatment and difficulty in maintaining daily oral hygiene.

The simplicity at which driven toothbrushes can be used with less effort can be due to the noticeable increase in oral health in Group 2. Furthermore, the amount of oscillations in driven toothbrushes is predetermined, while the number of strokes in manual toothbrushes is reliant on the patient's dexterity, which is consistent with Vajawat and Deepika.[18] According to Hoover and Singer,[20] the controlled toothbrush has also been shown to play an important role in improving patient compliance and encouragement.

In Group 1, a statistically substantial decrease in the mean OHI-S score was observed in baseline versus 30 days and baseline versus 90 days, whereas in Group 2, a statistically extremely significant decrease in baseline versus 30 days, baseline versus 90 days, and 30 days versus 90 days was observed. When the mean OHI-S in Group 1 was just slightly reduced, it was significantly reduced in Group 2. Furthermore, the driven toothbrush's gingival massage seems to play an important role in enhancing gingival health. According to McCracken et al.,[21] controlled toothbrushes provide a statistically meaningful decrease in clinical parameters as opposed to manual toothbrushes. A few reports disagree, claiming that controlled toothbrushes are no better than manual toothbrushes at enhancing gingival well-being.

The results of this research support the usage of an operated toothbrush and video simulation to enhance oral health in autistic children with limited physical dexterity.

CONCLUSION

Powered toothbrushes have a “novelty impact” that tends to improve enforcement since they demand less effort from the user due to their automatic operation. For children with autism, VM is a commonly used tooth to improve coordination and success in classrooms and at home. The results of this research suggest that it may be used to successfully teach teeth brushing to autistic children. The results of this study revealed that children not only learned to clean but also did so successfully, as shown by a substantial decrease in the mean OHI-S ratings. As a result of the research, we can infer that driven teeth brushing can benefit autistic children.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.