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Little is reported on parental supervision, an essential aspect of routine effective toothbrushing in this age group. The aim of this study was to evaluate pre-schoolers\u2019 toothbrushing behaviour including parental involvement and its association with their oral health.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This was a cross-sectional study. A total of 92 preschool children (4\u20136\u00a0years) were invited to participate with their parents\/guardians. Nine parameters of toothbrushing behaviour were assessed from parental responses (questionnaire) and observation of child and parents\/guardians (video recording). Oral examination included recording plaque, gingival and dental caries indices. BORIS software was used to assess toothbrushing parameters and Smart PLS was used to perform association with a second-generation multivariate analysis to create models with and without confounding factors.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Girls were slightly more (53%) than boys (47%). Children aged 4\u00a0years were slightly more in number (38%), followed by 6-year-olds and 5-year-olds. Nearly, 90% parents had tertiary education and 46% had more than 2 children. Differences were recorded in the reported and observed behaviour. Thirty-five percent parents\/guardians reported using pea-size toothpaste amount but only 28% were observed. Forty percent reported to brush for 30\u00a0s\u20131\u00a0min, however 51% were observed to brush for 1\u20132\u00a0min. Half the children were observed to use fluoridated toothpaste (F\u2009&lt;\u20091000\u00a0ppm) under parental supervision (11%). The mean (SD) plaque score reduction after toothbrushing was 10.80 (2.46), mean pre-brushing plaque score was 90.3 (10.2), mean gingival index was 0.89 (0.65) and mean dental caries status (ICDAS<jats:sub>(1\u20136)<\/jats:sub>) was 18.87 (12.39). Toothbrushing behaviour in terms of toothbrushing technique, duration, pattern and frequency, toothbrush type and grip type, toothpaste type and amount, post-brushing mouth rinsing and parental involvement contributed significantly to plaque score change (86%), dental caries status (73%), gingival index (66%) and pre-brushing plaque score (31%). The significant confounding variables had a small influence on oral health of preschool children.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Preschool children\u2019s toothbrushing behaviour was inadequate while their oral health was poor, with a significant association between the two parameters.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12903-021-01643-8","type":"journal-article","created":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T12:11:34Z","timestamp":1622635894000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Pre-schoolers\u2019 tooth brushing behaviour and association with their oral health: a cross sectional study"],"prefix":"10.1186","volume":"21","author":[{"given":"Iqra Muhammad","family":"Khan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shani Ann","family":"Mani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer Geraldine","family":"Doss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Danaee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia Yi Li","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,2]]},"reference":[{"issue":"3","key":"1643_CR1","doi-asserted-by":"publisher","first-page":"154","DOI":"10.17796\/1053-4625-44.3.4","volume":"44","author":"P Subramaniam","year":"2020","unstructured":"Subramaniam P, Surendran R. 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