A relationship was however evident among children from Non-Manual groups. Children from families with a Non-Manual head of household were more likely to have parental help in toothbrushing and the authors suggest that toothbrushing undertaken in these families was a more effective means of plaque removal and this was more important a factor than how many times a day toothbrushing was carried out. Other explanations are possible, such that for Manual groups deleterious dietary patterns are such that oral hygiene becomes secondary