Abstract
OBJECTIVES: To evaluate the effectiveness of powered versus manual toothbrushes in plaque removal among children with and without Attention Deficit Hyperactivity Disorder (ADHD). MATERIALS AND METHODS: Fifty-two children aged 8–10 years (26 with ADHD, 26 controls) were randomly assigned to powered or manual toothbrush groups. All received standardized instruction. Plaque and gingival health were assessed using the Turesky-modified Quigley-Hein Plaque Index (TQHPI), Approximal Plaque Index (API), and Löe-Silness Gingival Index (GI), recorded before and after supervised brushing, and at 1- and 3-month follow-ups. Children brushed at home twice daily. Mann–Whitney, Wilcoxon, and Friedman tests were used (p ≤ 0.05). RESULTS: Mean age was 8.8 ± 0.7 years. Supervised single brushing significantly reduced TQHPI and API in all subgroups (p < 0.05), with no differences by brush type or ADHD status (p ≥ 0.05). In the Control-powered group, API improved over time (p = 0.02), suggesting a familiarization effect during home use. No such trend was observed in the manual or ADHD subgroups. At 3 months, GI scores were higher in ADHD-powered than ADHD-manual users (p = 0.01). CONCLUSIONS: Both brush types were similarly effective for immediate plaque removal in children with and without ADHD. During home use, powered brushes improved approximal outcomes in healthy children but not in those with ADHD, who showed poorer gingival outcomes. CLINICAL RELEVANCE: In 8–10-year-old children, powered and manual toothbrushes demonstrated comparable plaque and gingival outcomes under standardized instruction. Familiarization may improve approximal plaque removal in healthy children using powered brushes. In children with ADHD, manual brushes yielded more favorable gingival scores, suggesting that effective use of powered brushes may require additional support. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05935254) registered retrospectively on 7 July 2023. URL https://clinicaltrials.gov/study/NCT05935254. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12903-026-07881-y.