Impact of sustained attention and working memory on toothbrushing efficacy in typically developing children: A cross-sectional study

**Introduction:**Toothbrushing is the most basic and fundamental means of plaque control. Ideally parent-supervised twice-daily brushing has proved to be highly effective in preventing dental caries in children below 8 years of age. However, efficacy of unsupervised toothbrushing in older children depends on factors such as toothbrushing duration, frequency, technique, manual dexterity and cognitive skills, etc. Higher level of cognitive functions known as executive functions are required for effective toothbrushing. These include sustained attention and working memory. Studies have reported poor oral hygiene and higher prevalence of dental caries in children with neurodevelopmental disorders due to impairment of cognitive skills. Therefore, present study will aim to assess the influence of sustained attention and working memory on toothbrushing efficacy in 9-12 year old typically developing children.

**Aim:**To assess the influence of sustained attention and working memory on toothbrushing efficacy in 9-12 year old typically developing children.

**Materials & Methodology:**60 typically developing children in age group of 9-12 years will be included. Informed consent will be obtained from parents. Oral health status of children will be recorded using DMFT index. Plaque disclosing agent will be applied and Turesky modification of Quigley-Hein Plaque Index (TQHPI) will be recorded (P1). The children will be asked to brush their teeth with standard toothbrush and toothpaste. After brushing, TMQHI will be recorded again (P2). The mean plaque score difference will be used to determine the efficacy of toothbrushing. The sustained attention will be evaluated using the d2 test and working memory using the Corsi Block Tapping test. 1.     d2 test- This is a paper and pen-based letter cancellation test, consisting of 14 trials. Each trial consists of a row with 47 “p” and “d” characters adjacent to one another. The target symbol is a “d” with two dashes. The task is to cancel out as many target symbols as possible, moving from left to right, with a time limit of 20 seconds per trial. Attention performance will be obtained by subtracting errors from correctly crossed out relevant items. Higher scores will indicate higher sustained attention. 2.     Corsi block tapping test- This is a digital test that begins with a sequence of 2 blocks. Once the sequence has been shown on the screen the participant needs to click on the blocks in exact same order as shown. If done correctly, then next higher number of block sequence is displayed. The Corsi block span displayed at the end is the final score. Higher the Corsi block span, better will be the working memory. Evaluation Parameters- DMFT score, Difference in plaque score before and after toothbrushing, d2 test score, Corsi block tapping test score.