The aim of the study was to compare the effectiveness in plaque removal of a three-headed toothbrush with a conventional toothbrush in pre-school children. Twenty-nine children (aged 4 - 5 years) participated in this study. Fourteen children (group A) used a three-headed toothbrush, and 15 children (group B) used a conventional toothbrush for 3 months. At the initial visit, the children brushed their teeth with their regular toothbrush, and at the final visit with the type of toothbrush they had used for the past 3 months. Plaque was recorded at 48 surfaces (molars: vestibular, oral, occlusal; front teeth: vestibular, oral). Plaque reduction was assessed on anterior and posterior areas of the dentition, and on the different tooth surfaces in sextants (I = 55/54; II = 53/63; III = 64/65; IV = 74/75; V = 73/83; VI = 84/85). Statistical evaluation was performed using Wilcoxon signed rank and Mann-Whitney tests. In group A, the median number of surfaces with plaque was reduced significantly after 3 months (p 0.05). At final examination the number of surfaces with plaque in both groups differed significantly (p 0.05). Significant decreases in plaque scores were recorded at maxillary and mandibular posterior and mandibular anterior teeth in group A (p 0.05). The comparison of changes in plaque scores of both groups showed significant differences (p 0.05) on the occlusal surfaces of molars, except in sextant IV. Significant differences between the groups were also noted on all surfaces of the left side and on the occlusal surfaces of the right side of the mouth (p 0.05). This study indicates that the three-headed toothbrush could be an alternative to the conventional toothbrush. Keywords: pre-school children, oral hygiene, toothbrush