Maternal and Child Health Journal

, Volume 23, Issue 12, pp 1587–1594 | Cite as

The Impact of Adaptive Functioning and Oral Hygiene Practices on Observed Tooth-Brushing Performance Among Preschool Children with Special Health Care Needs

  • Ni Zhou
  • Hai Ming WongEmail author
  • Colman McGrath



To investigate the impact of adaptive functioning and oral hygiene practices on tooth-brushing performance among preschool children with special health care needs (SHCN).


A cross-sectional study was conducted in Special Child Care Centers. Children’s tooth-brushing performance was assessed by a standardized 13-step pro forma. Information regarding children’s socio-economic status, adaptive skills, and oral hygiene practices were collected. Bivariate analysis and ANCOVA were used to explore the potential factors which might be associated with children’s tooth-brushing performance.


The tooth-brushing assessment was provided to 379 children with SHCN. Approximately 3% of the recruited children performed the whole tooth-brushing procedure independently. The number of tooth-brushing steps practiced by those children was 4.47 ± 3.56. Children who had established tooth-brushing habit before age one practiced more tooth-brushing steps than children who brushed their teeth after age one (p = 0.029). When children’s age, gender, and socio-economic status were adjusted, children who had established regular tooth-brushing habit or children who had high levels of adaptive skills showed better tooth-brushing performance than their peers. Children who used gauze, cotton swab, or dental floss to clean their teeth practiced fewer key tooth-brushing steps than their peers who had never used additional cleaning approaches (p = 0.038).

Conclusions for Practice

Children’s tooth-brushing performance was associated with adaptive skills and oral hygiene practices. Tooth-brushing training should be provided to children with SHCN in early childhood. For children who had limitations in adaptive functioning, parental assistance or supervision is recommended to guarantee the efficacy and safety of daily tooth brushing.


Pediatric Tooth brushing Adaptive functioning Special needs Oral hygiene 



We would like to express our deepest gratitude to all the recruited children and their parents for their participation and cooperation. We gratefully acknowledge the staff in the Special Child Care Centers, Ms Cindy YEUNG and Kuen Wai Ma for their excellent assistance in administration of the study. The work described in this paper was fully supported by a grant from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. 17118518).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Paediatric Dentistry & Orthodontics, Faculty of DentistryThe University of Hong KongHong KongChina
  2. 2.Pediatric & Preventive DentistryThe Affiliated Stomatology Hospital of Kunming Medical UniversityKunmingChina
  3. 3.Paediatric Dentistry & Orthodontics, Faculty of DentistryThe University of Hong Kong, The Prince Philip Dental HospitalHong KongChina
  4. 4.Periodontology & Public Health, Faculty of DentistryThe University of Hong KongHong KongChina

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