A single-blind, cross-over study design was used to evaluate the effectiveness of four different manual toothbrushes and to determine whether patient toothbrush preference is directly related to plaque control in patients with fixed orthodontic appliances. The brushes evaluated were Orthodontic Oral-B, Oral-B Advantage 30, Colgate Precision and Aquafresh. Forty-six subjects, aged 11 to 27, undergoing fixed orthodontic treatment were screened and recruited with parental consent. Subjects were randomly allocated into four groups. All subjects had their teeth scaled and polished at week 0. Baseline recordings of PI and GI were done four weeks later and the first toothbrush was given. After using the toothbrush for a period of 2 weeks the PI and GI were again recorded and teeth were again scaled and polished. A period of four weeks elapsed before new baseline recordings were done and the sequence followed as described for the first toothbrush. This was done until all subjects had used all four toothbrushes. At the end of the clinical trial, each subject was asked which toothbrushes they preferred. PI and GI values were relatively low at baseline as well as after the use of the toothbrushes. General linear model procedure showed no statistical difference between the Mean Plaque Index (MPI) before and after use of each toothbrush as well as the Difference in Mean Plaque Index (DMPI). There was a slight difference in the Difference in Mean Gingival Index (DMGI) between the Colgate Precision and Aquafresh toothbrush. For all the other comparisons general linear model procedure showed no difference between the Mean Gingival Index before and after use of each brush. There was no correlation between the toothbrush preferred by the patient and oral cleanliness as measured by DMPI and DMGI.