Association Between Quantitative Brushing Efficacy and Dental Caries Severity in Schoolchildren

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Abstract
Background: Although toothbrushing is widely recognized as a cornerstone of caries prevention, oral hygiene has traditionally been assessed using self-reported frequency or categorical plaque indices. Evidence regarding the relationship between objectively quantified brushing efficacy and cumulative caries severity remains limited. This study evaluated the association between a quantitative brushing efficacy index and dental caries severity among schoolchildren. Methods: A cross-sectional analytical study was conducted among 200 schoolchildren examined during a community dental campaign in 2025. Caries was assessed using Decayed, Missing, and Filled Teeth indices following Word Health Organization criteria. Severe caries was defined as Decayed, Missing, and Filled Teeth ≥ 5. Oral hygiene was measured using a brushing efficacy index, expressed as the percentage of biofilm removed after supervised brushing. Associations were evaluated using chi-square tests and logistic regression models adjusted for age and sex. Results: Caries prevalence was 95.5%, with a mean Decayed, Missing, and Filled Teeth of 4.99 ± 2.96. Severe caries was observed in 49% of participants. No statistically significant differences were found across tertiles of brushing efficacy (χ2 (2) = 2.18; p = 0.336). In regression analysis, each 10% increase in brushing efficacy was not significantly associated with severe caries (adjusted OR = 0.92; 95% CI: 0.81–1.03; p = 0.154). Conclusions: Dental caries prevalence was high in this population, and nearly half of the participants presented severe caries. Quantitative brushing efficacy was not significantly associated with severe dental caries after adjustment for age and sex.

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