A customized toothbrush with an enhanced hand grip and a modified brush head can help cerebral palsy patients improve their oral health, a study found. Results of the three-week study,“Evaluation of the effectiveness of a custom-made toothbrush in maintaining oral hygiene and gingival health in cerebral palsy patients,” were published in the journal Special Care in Dentistry. Poor coordination and muscular limitations resulting from an injured central nervous system are common features of cerebral palsy that make everyday tasks harder. Oral health is important for communication, appearance, and performance. However, "it is the most unattended health need of special children," researchers said. These patients often face an array of dental disorders, ranging from simple cavities to more serious oral diseases. Difficulty in swallowing causes patients to drool, while a lack of well-coordinated movements renders them unable to perform efficient oral hygiene. "Furthermore, antiepileptic drugs, especially phenytoin sodium, used in these patients to treat commonly occurring seizure attacks, can cause gingival overgrowth," researchers said. In the study, researchers compared the efficacy of custom-made toothbrushes with conventional toothbrushes. The toothbrushes were customized with wax finger imprints on the handle (easier to grab and rotate) and a modified head (a soft reliner was added to facilitate oral muscle exercises). Thirty patients ages 6-18 were recruited from the Disability Centre, Wenlock Hospital (Mangalore) and Aruna Chethana Special School (Bangalore), India. The participants were divided into two groups. Group 1 (16 participants) used a regular toothbrush. Group 2 (14 participants) used the customized toothbrush and was asked to perform muscle exercises using the modified brush head. This last procedure was added to the protocol as an attempt to improve swallowing defects and drooling problems; however, its effects were not objectively assessed in the study, researchers stated. Participants were asked to perform the brushing routine twice a day for three weeks. All were instructed to do the routine with the assistance of their caregivers. The children's parents/caretakers were given a health education program that included the importance of regular oral hygiene and information regarding preventive home care measures. Plaque index (a measure of plaque removal efficiency) and modified gingival index (a measure of the level of gingival inflammation) were recorded at the beginning of the study and at the second appointment three weeks later. When comparing the plaque index before and after, group 2 (customized toothbrush) showed a clinically significant drop of 31.55%, compared to only 8.34% in group 1 (regular toothbrush). Modified gingival index showed a similar trend, with groups 1 and 2 showing a 14.51% and 30.23% drop, respectively. Although not objectively validated in the study, the authors observed that “patients who used customized toothbrushes could perform toothbrushing themselves without any external assistance.” "Considering the small sample size and short-term follow-up of the study, we recommend longer-term studies including more patients to confirm the merits of the customized toothbrushes in patients with mild to moderate [cerebral palsy]," researchers concluded.