Validation of a Tooth-brushing Visual Pedagogy for Mentally Challenged Children

Abstract

Objectives: To validate a tooth-brushing visual pedagogy (TBVP) for tooth-brushing training among mentally challenged children. Methods: The TBVP demonstrated 13 tooth-brushing steps, which had previously applied to children with autism. Face and content validity were assessed by a panel of dentists (n=4), preschool teachers (n=8), and parents (n=8). A total of 157 mentally challenged children were recruited from the Special Child Care Centers. After oral hygiene examination and tooth-brushing assessment, a comprehensive tooth-brushing training was performed using the TBVP. Construct validity was assessed by correlating dental plaque scores with achieved tooth-brushing steps. Concurrent validity was evaluated by assessing the association between the changes in tooth-brushing steps and oral health status after 6 months. Internal reliability was assessed using Cronbach’s alpha. Ethical approval was obtained (IRB HKU: UW 16-012). Results: Among the 20 members in the panel, 90% agreed that the TBVP would be efficient in tooth-brushing training. The TBVP tooth-brushing training was successfully provided to 156 mentally challenged children, and 150 children participated in the oral health assessment at 6-month interval. The recruited children were aged 3.68 ± 0.76 y; 67.9 % were males. The mean number of tooth-brushing steps achieved was 6.53 ± 3.10, and the mean plaque score was 1.93 ± 1.08 at baseline; the former increased to 8.07 ± 3.32, and the latter decreased to 0.82 ± 0.43 after TBVP training. Construct validity was supported by a statistically significant negative correlation between plaque scores and tooth-brushing steps (r = -0.39, p < 0.001). Concurrent validity was supported by a statistically significant positive correlation between the reduction of plaque index and the increment of tooth-brushing steps (r = 0.214, p = 0.009). The internal reliability of tooth-brushing steps accomplished by children was 0.82. Conclusions: The 6-month follow-up suggests that the TBVP is a validate instrument for tooth-brushing training among mentally challenged preschool children.