Inclusion criteria:  Ages between 6-9 years old. Participant must have at least 10 teeth free from dental caries on both buccal and lingual surfaces of the teeth. TMQHPI is at least 2. Cooperative participant (Positive according to Frankel's behavioral rating scale). Parents' consent. Participant with down syndrome must have been diagnosed by specialist.  Exclusion criteria:  Children undergoing orthodontic treatment. Allergic to any of the toothpaste ingredient used the study. Participant used any toothbrush other than the conventional brush before. Healthy children Participant with systemic diseases Excluding children with Down syndrome who suffer from chronic weakness such as epilepsy or taking medications continuously.