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Background There is no consensus regarding when children are ready to brush independently. Aim To examine the effects of chronological age and motor development on toothbrushing effectiveness in 5‐ to 7‐year‐old children. Design In this cross‐sectional study, the change in Oral Hygiene Index (OHI) score and the improvement in OHI category (eg, poor to fair) were used to measure toothbrushing effectiveness. Motor development was assessed using the Beery‐Buktenica Developmental Test of Visual Motor Integration, and a parental questionnaire was used to determine the child's ability to perform certain daily tasks. Results Children aged ≥6 years were significantly more likely to show improvement in OHI category (OR = 2.4, p = .032) than 5‐year‐old children. Parental report of their child's ability to write/print addresses (OR = 3.7, p = .009), tie shoelaces (OR = 2.9, p = .008), and cut/file nails (OR = 3.2, p = .036) was significantly more likely to show improvement in OHI category. A model using chronological age, visual motor age, ability to write/print addresses, tie shoelaces, cut/file nails, and toothbrushing duration achieved 61.8% sensitivity and 80.4% specificity in predicting a child's ability to achieve improvement in OHI category. Conclusions Children entering elementary school (≥6 years old) brushed their teeth more effectively than preschool children. A multifactorial model provided an acceptable predictor of the child's ability to brush effectively.

The caries prevalence among Singapore children remains high, with almost 50% affected by the age of 6 years. Among oral hygiene homecare, toothpastes with a minimum fluoride concentration of 1000 ppm or greater have been shown to be more effective at preventing caries. Previous concerns with dental fluorosis have led to the marketing of non-fluoride and low-fluoride toothpastes specifically for children. In the local context, many parents start their children on these products due to ingestion concerns and recommendations of the product, rather than on sound advice from a healthcare professional. The latest recommendation is to use a smear size of 1000 ppm or greater fluoride toothpaste in children under 3 years of age with high caries risk. For children aged 3 years and older, a pea size of 1000 ppm or greater fluoride toothpaste should be used. As medical physicians are typically the first healthcare encounter for many children, they are well positioned to provide recommendations on the concentration and amount of fluoride toothpaste to be used in young children.