Comparative effectiveness of triple-headed and conventional toothbrushes for plaque control and gingival health in children and adolescents with autism spectrum disorder: A randomized controlled trial.

BACKGROUND

Children and adolescents with autism spectrum disorder (ASD) are prone to poor oral hygiene due to motor and sensory challenges. This trial evaluated whether a triple-headed toothbrush (THT) improves gingival health and plaque control more effectively than a conventional toothbrush (CT).

METHODS

A multicenter, single-blind randomized controlled trial enrolled 102 children aged 7 through 18 years with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition level 1 or 2 ASD across 3 special schools in India, randomized 1:1 to THT or CT. All participants received standardized oral health education and caregiver-supervised twice-daily brushing for 3 months. Plaque and gingival index scores were recorded by a calibrated, blinded examiner at baseline and at 3 months.

RESULTS

At 3 months, THT use produced significantly greater reductions in plaque (Hodges-Lehmann estimator, -0.50; 95% CI, -0.63 to -0.31; P < .001; r = 0.60) and gingival (Hodges-Lehmann estimator, -0.25; 95% CI, -0.44 to -0.13; P < .001; r = 0.39) scores than CT, with pronounced improvements on the lingual surface. Both groups showed significant within-group reductions. THT acceptability improved significantly over the study period.

CONCLUSIONS

A THT produced superior plaque and gingival improvements compared with a CT in children and adolescents with ASD, with pronounced lingual surface benefits and increasing acceptability over time.

PRACTICAL IMPLICATIONS: For families supporting children with ASD in resource-limited settings, a THT offers a cost-effective, technique-forgiving alternative to CTs, improving oral hygiene outcomes when used with caregiver supervision. This clinical trial was registered at Clinical Trials Registry-India. The registration number is CTRI/2024/12/078552.