Association of children’s toothbrushing and fine motor skills: a cross-sectional study

MAFLA, Ana Cristina; BENAVIDES, Ramiro José; MEYER, Pierre; GIRAUDEAU, Nicolas; SCHWENDICKE, Falk

doi:10.1590/1807-3107bor-2022.vol36.0103

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Original Research, Pediatric Dentistry • Braz. oral. res. 36 • 2022 • https://doi.org/10.1590/1807-3107bor-2022.vol36.0103 copy

Association of children’s toothbrushing and fine motor skills: a cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Fine motor skills (FMS) allow for the control and coordination of the distal musculature of hands and fingers, a skill required to brush teeth. The objective of this study was to investigate the association between FMS and toothbrushing efficacy. This cross-sectional study included 42 low-income Latino children aged 5 to 9 years from Pasto, Colombia. Toothbrushing efficacy was determined by the children’s dental plaque Quigley-Hein Index (QH-I) mean-score difference from before and after toothbrushing. FMS were evaluated using the 5–15R parent evaluation, the spiral drawing Archimedes test, and a neurodevelopmental assessment of movements and prehension patterns during toothbrushing. A descriptive analysis was performed to assess the characteristics of FMS and children’s toothbrushing, and a generalized linear model was used to determine associations between these skills and toothbrushing efficacy. Eighty-six percent of the children had at least one difficulty with FMS, and in 7%, they interfered with daily activities. Fourteen percent presented a moderate pattern in the Archimedes test, and 43% had inefficient prehension patterns. Toothbrushing reduced the QH-I by a mean of 1.45 (SD = 0.78–2.12) (p < 0.001). Toothbrushing efficacy was only significantly associated with age (mean-difference = -0.315, 95%CI: -0.481 to -0.148, p < 0.001). FMS and toothbrushing efficacy were not significantly associated. Other components of fine motor control should be analyzed to understand the kinetics of toothbrushing.

Child; Motor Skills; Toothbrushing; Neurodevelopmental Disorders; Hand Strength

Child’s use of his or her hands	Does not apply		Applies sometimes/to some extent		Applies definitely
Child’s use of his or her hands	n	%	n	%	n	%
Does not like to draw, has difficulty drawing figures that represent something	30	71	4	10	8	19
Difficulty handling, assembling, and manipulating small objects	37	88	3	7	2	5
Difficulty pouring water into a glass without spilling it	34	81	6	14	2	5
Often spills food onto clothes or table when eating	20	48	17	40	5	12
Difficulty using a knife and a fork	21	50	14	33	7	17
Difficulty buttoning or tying shoelaces	23	55	15	35	4	10
Difficulty using a pen (e.g., presses too hard, hand is shaking)	35	84	6	14	1	2
Has not developed a clear hand preference, i.e., is neither clearly right-handed nor left-handed	34	81	4	9	4	10
Writing is slow and laborious	20	48	14	33	8	19
Immature pencil-grip, holds the pen in an unusual manner	33	78	7	17	2	5

Movement/prehension	Items	n	%
Screwing the toothpaste top	Child can screw the toothpaste top (normal)	29	69
Screwing the toothpaste top	Child never/seldom performs this movement	13	31
Immature prehension pattern: Underlying intrinsic hand strength, finger isolation and hand separation have not yet developed	Not present (normal)	31	73
	Yes, immature prehension pattern	11	27
Type of immature prehension pattern when handling the toothbrush	No immature prehension pattern (normal)	31	73
	Palmar supinate	2	5
	Radial/digital	3	7
	Static tripod	2	5
	Dynamic tripod	4	10
Inefficient prehension pattern: Holding the toothbrush in a way that does not allow the usage of the finger muscles to move quickly with control	Not present (normal)	24	57
	Yes, inefficient prehension pattern	18	43
Type of inefficient prehension pattern when handling the toothbrush	No inefficient prehension pattern (normal)	24	57
	Thump wrap	6	15
	Thumb tuck	-	-
	Interdigital brace	1	2
	Supinate grasp	3	7
	Index (five finger) grasp	8	19
Palm-to-finger translation can be performed	Child can perform this translation (normal)	31	74
Palm-to-finger translation can be performed	Child never/seldom performs this translation	11	26
Simple rotation: Ability to roll a small object between the thumb and fingertips	Child can perform a simple rotation with the hand (normal)	39	93
	Child never/seldom performs this movement	3	7
Complex rotation: Ability to rotate objects with the fingertips	Child can perform complex rotation with the hand (normal)	16	38
	Child never/seldom performs this movement	26	62

Movement	Items	n	%
Movements from hands	Child only uses the hand to perform movements for toothbrushing (without the forearms and arms)	40	95
Movements from hands	Child never/seldom performs this movement	2	5
Movements from hands and forearms	Child uses the hand and forearms to perform movements for toothbrushing	39	93
Movements from hands and forearms	Child never/seldom performs this movement	3	7
Movements from hands, forearms and arms	Child uses the hand, forearms, and arms to perform movements for toothbrushing	23	55
Movements from hands, forearms and arms	Child never/seldom performs this movement	19	45
Lateral movements	Child uses the lateral movements to perform toothbrushing	41	98
Lateral movements	Child never/seldom performs this movement	1	2
Contralateral movements	Child uses the contralateral movements to perform toothbrushing	40	95
Contralateral movements	Child never/seldom performs this movement	2	5
Up-down movements	Child uses the up-down movements to perform toothbrushing	7	17
Up-down movements	Child never/seldom performs this movement	35	83
Back-forward movements	Child uses back-forward movements to perform toothbrushing	41	98
Back-forward movements	Child never/seldom performs this movement	1	2
Spiral movements	Child uses spiral movements to perform toothbrushing	2	5
Spiral movements	Child never/seldom performs this movement	40	95

Dental plaque scores	Regular toothbrushing						p-value^a
	Baseline		Final		Difference
	mean	SD	mean	SD	mean	SD
QH-I Overall	2.78	1.86–3.70	1.33	0.55–2.11	1.45	0.78–2.12	< 0.001
Upper incisors/horizontal (back-forward, spiral)	2.42	1.11–3.73	0.84	-0.14–1.82	1.58	0.6–2.56	< 0.001
Upper right/lateral (back-forward, spiral)	2.80	1.29–4.31	1.12	–0.18–2.42	1.68	0.51–2.85	< 0.001
Upper left/contralateral (back-forward, spiral)	2.78	1.24–4.32	0.98	-0.08–2.04	1.75	0.37–3.13	< 0.001
Lower incisors/vertical (up-down)	3.08	1.92–4.24	1.64	0.42–2.86	1.43	0.49–2.37	< 0.001
Lower right/lateral (back-forward)	2.60	1.87–3.33	1.65	0.72–2.58	0.95	0.3–1.60	< 0.001
Lower left/contralateral (back-forward)	2.70	2.04–3.36	1.92	1.01–2.83	0.76	0.08–1.44	< 0.001

Child’s use of his or her hands	Correlation Coefficient^a	p-value
Does not like to draw, has difficulty drawing figures that represent something	0.064	0.688
Difficulty handling, assembling, and manipulating small objects	0.063	0.693
Difficulty pouring water into a glass without spilling it	0.156	0.325
Often spills food onto clothes or table when eating	0.296	0.057
Difficulty using a knife and a fork	0.351	0.023
Difficulty buttoning or tying shoelaces	0.288	0.065
Difficulty using a pen (e.g., presses too hard, hand is shaking)	0.006	0.968
Has not developed a clear hand preference, i.e., is neither clearly right-handed nor left-handed	-0.114	0.473
Writing is slow and laborious	0.040	0.800
Immature pencil grip, holds the pen in an unusual manner	0.070	0.659

Parameter	Mean difference in dental plaque score (B coefficient)
	Unadjusted	p-value	Adjusted	p-value
	[95%CI]	p-value	[95%CI]	p-value
(Intercept)			3.569	< 0.001
(Intercept)			[2.150-4.987]	< 0.001
Boys	-0.456	0.017	-0.253	0.153
(ref. girls)	[-0.833 - -0.080]	0.017	[-0.601-0.094]	0.153
Screwing the toothpaste top	-0.135	0.536	0.189	0.369
(ref. never/seldom)	[-0.565-0.294]	0.536	[-0.224-0.602]	0.369
Palm-to-finger translation^a	-0.018	0.938	0.304	0.195
(ref. never/seldom)	[-0.472–0.436]	0.938	[-0.156-0.765]	0.195
Movements from hands^a	-0.840	0.068	-1.012	0.060
(ref. never/seldom)	[-1.742–0.061]	0.068	[-2.066-0.041]	0.060
Lateral movements^a	-0.236	0.723	0.961	0.208
(ref. never/seldom)	[-1.543–1.071]	0.723	[-0.535-2.457]	0.208
Up-down movements^a	-0.089	0.745	-0.235	0.290
(ref. never/seldom)	[-0.623–0.446]	0.745	[-0.670-0.200]	0.290
Age (continuous)	-0.240	0.001	-0.315	< 0.001
Age (continuous)	[-0.396 - -0.094]	0.001	[-0.481 - -0.148]	< 0.001
(Scale)			0.263
(Scale)			[0.172-0.404]

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[1] Corresponding Author: Ana Cristina Mafla E-mail: ana.mafla@campusucc.edu.co