Abstract
BackgroundBiting objects was a parafunctional oral habit among children with special care needs. Chewing or biting toothbrushes could expedite the process of toothbrush wear. However, few studies evaluated the deterioration levels of toothbrushes used by children with special needs. This study aimed to assess the deterioration level of toothbrushes used by children with special care needs, and collect parents’ feedbacks to improve the design of children’s toothbrushes.MethodsThe cross-sectional study recruited 277 children who had special care needs. Children’s toothbrushing behaviors, background information, and parents’ comments on toothbrushes were obtained. Toothbrush deterioration was assessed by bristle wear and bite mark scores. Higher scores indicated severe deterioration.ResultsThree hundred twenty-one toothbrushes were collected. Children who used 2 to 6 toothbrushes in a 3-month period showed higher toothbrush deterioration scores than children who used a single toothbrush. Over 40% children’s toothbrushes presented excessive wear. Excessive wear was associated with social skills and parents’ education background. Distinct bite marks tended to exist on toothbrushes which had been used by children who showed challenging behaviors during toothbrushing (OR = 1.96, 95%CI1.15–3.32, p < 0.05). Approximately 27% parents reported that children’s toothbrushes should be modified. Parents recommended that the size of toothbrush heads, the angle of handles, and the texture/length/distribution/diameter of bristles should be adjusted. Besides, ideal toothbrushes should be able to provide verbal or visual instructions to children, motivate children to brush teeth, simplify toothbrushing procedure, and protect children who had toothbrush-biting habits.ConclusionsExcessive wear and distinct bite marks can be found on toothbrushes that had been used by children with special care needs. Toothbrush deterioration was associated with children’s social skills, toothbrushing behaviors, and parents’ educational attainment. The commercially available toothbrushes should be modified to meet the additional needs of young children.
Highlights
Biting objects was a parafunctional oral habit among children with special care needs
Few studies investigated the distribution of bite marks on toothbrushes that had been used by children with special care needs
A quarter of them were diagnosed with developmental delays, 86 (31.0%) were on autism, and the remaining had epilepsy, cerebral palsy, Down syndrome, or multiple developmental disorders. 60.6% children came from high-income families, 58.5% parents received at least 14 years’ education, and 61.7% parents reported that toothbrushing was a difficult task for their children
Summary
Biting objects was a parafunctional oral habit among children with special care needs. Few studies evaluated the deterioration levels of toothbrushes used by children with special needs. This study aimed to assess the deterioration level of toothbrushes used by children with special care needs, and collect parents’ feedbacks to improve the design of children’s toothbrushes. Various factors can contribute to the traumatic toothbrushing, including, brushing force, brushing technique, type of toothbrushes, component of toothpaste, texture or shapes of toothbrush bristles, and the time of use [4–7]. Toothbrushes were selected properly and appropriate brushing technique was used, the morphological features of toothbrushes could change with time. Since the tufts of worn brushes could compromise their abilities to remove food debris and dental plaque, the splaying of toothbrush bristles could be considered as an indicator for toothbrush replacement [9]
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