Electronic Toothbrush Research Articles

Interventions and evaluation to improve oral health in patients with stroke: a scoping review

Objectives: This scoping review aimed to identify and analyze intervention strategies and assessment methods for oral hygiene management (OHM) and oral function management (OFM) in patients with stroke admitted to general wards, with the goal of providing directions for future research. Methods: We conducted a comprehensive literature search on studies published over the past 10 years across databases, including Cochrane, Embase, Medline, PubMed, and ProQuest. A total of 18 studies met the inclusion and exclusion criteria. Results: In the OHM studies (N=7), oral hygiene care was primarily provided by nurses, dental assistants, and nursing care aides. Oral hygiene was assessed using plaque and gingival bleeding indices with products such as electronic toothbrushes and mouth rinses. In the OFM studies (N=11), care was provided by speech-language pathologists, occupational therapists, and dental hygienists. Assessment tools included the Functional Oral Intake Scale, the PenetrationAspiration Scale, and Video Fluoroscopic Swallowing Studies. Conclusions: Improving the oral health of patients with stroke requires both hygiene and functional management. Therefore, it is necessary to develop a method that provides specialized oral care tailored to the hospitalization environment and the specific conditions of patients with stroke.

Sono-Catalytic Tooth Whitening and Oral Health Enhancement with Oxygen Vacancies-Enriched Mesoporous TiO2 Nanospheres: A Nondestructive Approach for Daily Tooth Care.

Tooth discoloration and the breeding of oral microorganisms pose threats to both one's aesthetic appearance and oral health. Clinical whitening agents based on H2O2 with high concentrations are effective in tooth whitening and bacterial elimination but may also cause enamel demineralization, gingival irritation, or cytotoxicity, necessitating professional supervision. Herein, leveraging sono-catalysis effects, a nondestructive and convenient tooth whitening strategy was developed, utilizing oxygen vacancies (OVs)-enriched mesoporous TiO2 nanospheres. The introduction of OVs leads to TiO2 bandgap narrowing, boosting the generation of reactive oxygen species (ROS) by TiO2 under ultrasound treatment. Additionally, through the chemocatalysis effect, the ROS yield can be further augmented by employing OVs-enriched TiO2 in conjunction with an extremely low concentration of H2O2 (1%) during ultrasound treatment. Hence, under ultrasound treatment simulating daily tooth brushing using an electronic toothbrush, the combination of OVs-enriched TiO2 and 1% H2O2 proves to be effective in whitening teeth stained by tea, coffee, and mix juice. Furthermore, the combination of OVs-enriched TiO2 and 1% H2O2 demonstrates potent bacterial-killing and biofilm-eradicating effects under ultrasound treatment within an extremely short duration (5 min). Additionally, given the mesoporous structure, curcumin, serving as an anti-inflammatory agent, can be efficiently loaded into OVs-enriched TiO2 and then controllably released through ultrasound treatment. The curcumin-loaded TiO2 facilitates the transition of macrophages to the anti-inflammatory M2 phenotype, potentially alleviating oral inflammation induced by bacterial infection without showing any biotoxicity. The OVs-enriched TiO2 based sono-catalysis tooth whitening procedure provides the convenience of whitening teeth during daily brushing without requiring professional supervision.

Dentists who can auscultate: Microphone-based toothbrushing quality monitoring system for electronic toothbrush

Tooth brushing is a widely recognized and effective method for daily oral care. However, the lack of real-time feedback for monitoring the brushing process can hinder individuals in maintaining their oral hygiene. Currently, only high-end electric toothbrushes offer evaluation functions based on built-in sensors, making them unaffordable for the majority of people. In this paper, we propose a novel and cost-effective wearable acoustic-based system (both hardware and software) for monitoring the quality of daily tooth brushing. Our system combines a throat-microphone and a Bluetooth earphone to capture brushing noises, which are unique acoustical signals generated from the air and the human body during tooth brushing, respectively. By leveraging the distinctive characteristics of brushing sounds in these two different conductive media, we introduce an intelligent detection algorithm based on Single-Input Multiple-Output (SIMO) modeling and frequency response functions (FRFs) to detect the corresponding brushing area. Through experimentation, we have found that the divergence of FRFs provides more stable features compared to general statistical features used in previous studies. After comparing various machine learning algorithms, we have selected XGBoost as the final detection model. Additionally, we utilize the Symmetric Nearest Neighbor (SNN) filter in the post-processing stage to further reduce the jitter noise in continuous detection. The final system achieves an average precision of 98.46% when tested on tooth brushing data collected from different volunteers. To enhance user experience, we have developed an Android App with a user-friendly interface that incorporates the detection system. With a total wearable hardware cost of less than 10 dollars, our system shows great potential for integration into future smart wearable devices.

Whitening Toothpastes Effect on Enamel Surface Morphology, Chemical Profile and Color: An In Vitro Study

To assess the effect of different whitening toothpastes on enamel surface morphology, chemical profile and their whitening efficiency. Sixty teeth were divided into 5 groups (12 teeth/group); Gp I: brushed with no toothpaste. Gp II: brushed with Pearl-based toothpaste. Gp III: brushed with Charcoal-based toothpaste. Gp IV: brushed with Alumina-based toothpaste. Gp V: brushed with salt and lemon-based toothpaste. Each tooth was brushed with a bean sized toothpaste wetted with distilled water twice daily by using standard electronic toothbrush for four weeks. Enamel surface morphology, chemical profile and color of each tooth were investigated. Chemical profile results and color measurements were analyzed statistically. Gp I revealed normal enamel surface morphology and chemical profile. Gp II and Gp III demonstrated surface morphology close to Gp I with insignificant reduction in mineral content. Gp IV showed obvious shallowing of perikymata ridges, exposure of fish-scale appearance, with pits and depressions, alongside to the significant reduction in mineral content. Gp V presented the most enamel surface alteration with widening of prism sheath and depressions all over the surface, besides the highest significant reduction in mineral content. Gp V, followed by Gp IV, demonstrated the highest color and whiteness changes, followed by Gp III, then Gp II, while the lowest value was in Gp I. Salt & lemon-based toothpaste, followed by Alumina-based, exerted the most considerable changes in the morphology and chemical profile of the enamel surface, beside to the higher whitening effects on teeth than the others.

Comparison of Oral Hygiene Practices between Dental, Medical and Allied Health Sciences Undergraduate Students of Lahore

Aim: To determine how dental education affects the oral hygiene practices in Pakistan. Study design: Descriptive cross-sectional study. Place: FMH College of Medicine and Dentistry, Lahore, Pakistan. Duration: One month. Methodology: A self-administered questionnaire was circulated amongst BDS, MBBS, and AHS students of FMH College of Medicine and Dentistry, Lahore, Pakistan. The responses were analyzed using SPSS version 20.0. Results: Dental students were superior to MBBS and AHS students in brushing frequency, electric toothbrush and water flosser use. Manual toothbrushes are more commonly used than electric toothbrushes in all three groups. More MBBS students believed that electric toothbrushes were better. Flossing proved unpopular. Toothpicks were the preferred interdental aid. Few students use water flossers. Mouthwashes are only used when needed. Most respondents were nonsmokers, but more BDS students smoked. Conclusion: Conclusion: Dental education in Pakistan impacts oral hygiene habits since dental students reported to have superior oral hygiene habits. More MBBS students believed electronic toothbrushes are superior to manual ones, indicating that BDS and AHS students require knowledge of electric toothbrushes. Keywords: Allied Health Sciences, Dental education; Dental students; Medical students; Oral hygiene practices.

Uses and applications of the manual versus electronic toothbrush: A literature review

Abstract Aim: The aim of this study was to describe the scientific literature on the use and applications of manual and electronic toothbrushes. Materials and Methods: An electronic search without date restriction was carried out in the PubMed and Scopus databases. The articles were selected, and their characteristics, objectives, and methods were analyzed using the following keywords: “manual toothbrush,” “electronic toothbrush,” “interdental brush,” “dental plaque,” “gingivitis,” “periodontitis” and “mechanical cleaning.” Ten relevant studies investigating the uses and applications of manual versus electronic toothbrushes were selected for this review. Results: The studies determined the efficacy of electronic and manual toothbrushes for the reduction of gingivitis and plaque, detailing the characteristics of the populations. Some studies evaluated the effectiveness of the two classes of brushes using different dental plaque indexes. One study determined plaque removal by comparing an interactive versus manual toothbrush, and two studies evaluated the effectiveness of the brushes in plaque reduction in a pediatric population. Based on the research articles, it was evident that some studies found no significant difference in biofilm removal in the use of electronic toothbrushes versus manual toothbrushes. Conclusion: In summary, it is not possible to give a conclusion because there is a discrepancy between the authors, and further studies are needed to corroborate and contrast the usefulness of manual and electronic toothbrushes.

Physical, Optical, and Mechanical Properties of Ceramic Materials after Coffee Immersion and Evaluation of Cleaning Impact with Different Oral Hygiene Tools

This study aimed to evaluate the effect of three oral hygiene tools, a regular toothbrush, an electronic toothbrush, and mouthwash, on the color stability of three different computer-aided design (CAD) and computer-aided manufactured (CAM) ceramic blocks. Feldspathic ceramic (Vita Triluxe Forte), hybrid resin ceramic (Vita Enamic), and lithium disilicate glass-ceramic (IPS e.max CAD) were used in this study. A CAD/CAM system and 81 (27 of each material) samples of ceramic blocks were used. All samples were immersed in black coffee for 15 days, and the coffee was changed twice per day. Using a spectrophotometer probe, samples on a grey background were scanned, and physical properties like surface hardness and depth were measured using interferometry and a 3D non-contact surface metrology. After 30 days of application of oral hygiene tools, instruments were used to measure various physical, mechanical, and optical properties. Vita Triluxe had the highest average color variation values (ΔE00) after 15 and 30 days of immersion in coffee in both regular and electronic toothbrushes. Moreover, IPS e.max CAD had the least ΔE00 values with no significant differences among the groups. The surface roughness (Ra) of the Vita Enamic ceramic increased when using a regular toothbrush, and the surface height (Rz) for the Vita Enamic ceramic increased when an electronic toothbrush was used. IPS e.max CAD had the greatest modules of elasticity forces, and Vita Triluxe Forte had the lowest when used with a regular toothbrush. The ΔE00 values of the tested materials were minimally increased or decreased after 30 days of cleaning, and all were clinically acceptable. Ra and Rz were the highest for Vita Enamic in comparison to the other groups. The highest percentage in IPS e.max CAD was associated with a type 1 fracture, whereas type 3 was predominantly observed with Vita Enamic, and type 2 in the Vita Triluxe group without significant differences.

Study protocol for a randomised controlled trial of a care partner assisted intervention to improve oral health of individuals with mild dementia

IntroductionIndividuals with mild dementia are at high risk of poor oral health outcomes. To address this issue, we describe an intervention to teach care partners skills to guide individuals with...

TELEDENTISTRY:THE FUTURE'S WAY TO SMILE.

Technology dictates modern life. From our electronic toothbrushes in the morning to communication devices, binary codes drive us ahead. Teledentistry, however, still grows slow with its nascent evolution. The eld of medicine has inarguably taken huge strides with its technical advancements.The recent situation of pandemic has cemented the need for development of newer methods of diagnosis and treatment planning.Gone are the days where the patient needs to be physically examined for the prognosis of an anomaly.Digital growth has opened several avenues in every eld of medicine,with digital dentistry taking clinical strides along the way. Telecommunication in dentistry is not as synonymous as it has been the general eld of medicine.Teledentistry, though introduced in the last decades has found it's true use in these dire times, paving a way for the future.Here ,we enumerate upon the history, the recent advancements and the need of telecommunication in dentistry or teledentistry,along with pitching some of our ideas as dental practitioners to advance upon the eld.

A profilometric and scanning electron microscopic analysis of tooth surface abrasion caused by rotary/oscillatory, linear motion, sonic, and ultrasonic toothbrushes: An in vitro study.

Background:Adequate plaque control facilitates good gingival and periodontal health, prevents tooth decay, and preserves oral health. Toothbrushing is the primary method of removing plaque and can be classified into powered and manual toothbrushes.Aim:The primary objective was to compare the abrasiveness and surface roughness caused by four different power-driven toothbrushes with a different mode of action, on tooth surfaces in vitro.Materials and Methods:An in vitro experiment was conducted on eighty freshly extracted tooth specimens which were equally divided into four groups. Each group was brushed with the specifically assigned electric toothbrush to that group, but keeping parameters such as force applied during brushing, storage of tooth before and after brushing, and toothbrushing time same. A total of the 2-month study was done on each tooth specimen. Tooth surface roughness was recorded before and after the toothbrushing experiment to check the difference between surface roughness readings. Scanning electron microscopic (SEM) analysis was done afterward to analyse the surface topography of each group specimens.Statistical Analysis Used:Paired t-test used for intergroup analysis and intragroup analysis was done using Kruskal–Wallis test.Results:After comparing the baseline and final readings of each group, it has been found that the mean difference between values is highly significant in Group 1 (rotary/oscillatory). The mean rank of Group 1 was least in all four groups, which showed the highest tooth surface abrasion in that group. SEM analysis also revealed that Group 1 tooth specimens had deeper scratches/lines comparatively to other groups.Conclusion:Rotary/oscillatory toothbrush caused the highest tooth surface abrasion when compared with other electronic toothbrushes.

Respective Effects of Oral Hygiene Instructions and Periodontal Nonsurgical Treatment (Debridement) on Clinical Parameters and Patient-Reported Outcome Measures with Respect to Smoking.

Background: Oral hygiene instructions (OHI) and periodontal nonsurgical treatment (PNST) play pivotal roles in the management of periodontitis. The study aims to discern their respective effects on periodontal clinical parameters and patient-reported outcome measures (PROMs). Methods: Ninety-one patients were included, 34 non-smokers (NS), 25 former smokers (FS) and 32 current smoker (CS). Clinical parameters such as probing depth (PD) and bleeding on probing (BOP) were collected, and the periodontal inflamed tissue area (PISA) was calculated. Clinical parameters and PROMs were recorded before and after receiving OHI, with electronic tooth brush and interdental brushes, as well as 3 months after debridement. Results: Smokers presented a significantly higher proportion of severe periodontitis (64.7%) with generalized extension (76.5%) and with a rapid rate of progression (97.1%) compared to NS and FS. OHI led to a significant decrease of PD, BOP, and PISA (p < 0.0001) only in NS and FS. Debridement reduced PD and the percentage of PD >6 mm in all groups (p < 0.0001). OHI induced significant improvement of oral hygiene, frequency of interdental cleaning, and PROMs (p < 0.0001). Further debridement induced significant additional improvement PROMs in FS and NS (p < 0.0001). Conclusion: OHI and debridement improved periodontal clinical parameters and PROMs in both NS and FS. Former smokers had comparable outcomes to non-smokers, suggesting that smoking cessation should be encouraged.

A Scalable System for Passively Monitoring Oral Health Behaviors Using Electronic Toothbrushes in the Home Setting: Development and Feasibility Study.

BackgroundDental disease (including dental caries and periodontal disease) is largely preventable and closely linked to inadequate oral health behaviors. Digital health technologies have great potential for unobtrusively monitoring brushing behaviors in home settings and promoting optimal oral self-care routines at scale.ObjectiveThe aim of this study is to leverage the ubiquity of electronic toothbrushes and smartphones with the development of a Remote Oral Behaviors Assessment System (ROBAS) and evaluate its feasibility for passively tracking brushing behaviors in real-world settings.MethodsWe developed ROBAS by linking inertial sensors contained within consumer electronic toothbrushes to a scalable software platform comprised of a smartphone app linked to a cloud platform. First, the criterion validity of ROBAS for accurately capturing brushing details was established in a laboratory setting. Next, real-world performance and usability were evaluated in a stratified community sample of 32 participants who used ROBAS daily for 1 month and maintained a diary of their brushing episodes. Semistructured interviews at baseline and exit captured the user experience. We used regression models and Bland-Altman analyses to assess the criterion validity, functionality, accuracy, and consistency of ROBAS.ResultsUsing a stopwatch as the criterion reference, ROBAS showed a mean absolute percent error (MAPE) of 1.8%, an estimated bias of 0.64 seconds that was not statistically distinguishable from zero (95% CI –0.93 to 2.22 seconds, SE 0.79), and a connection failure rate of 6.7% (95% CI 0.8%-22.1%, SE 4.6%). In real-world testing, ROBAS showed close agreement with the daily diary recordings of brushing episodes; estimated average discrepancies between the diary and ROBAS were 0.13 sessions per day (95% CI 0.01-0.26, SE 0.06), 8.0 seconds per brushing session (95% CI 1.4-14.7, SE 3.3), and 30 seconds of brushing per day (95% CI 9.3-50.1, SE 10.0). Retrospective self-reports produced substantially higher estimates of brushing frequency and duration compared to ROBAS measurements. Participants reported ROBAS was easy to use and expressed an interest in receiving ROBAS-delivered feedback on their brushing behaviors. Most participants were bothered by the use of an additional study phone, and some reported connectivity-related issues.ConclusionsROBAS has a high criterion validity for measuring oral health behaviors. It can accurately and reliably monitor brushing patterns in home settings for extended periods. Unobtrusive data collection through ROBAS sets the stage for automated coaching and optimization of oral self-care practices at the individual and population level.

CARE PARTNER-ASSISTED PILOT ORAL HEALTH INTERVENTION FOR PERSONS WITH COGNITIVE IMPAIRMENT

This study pilot tested effectiveness of a care partner-assisted intervention on improving oral health among community-dwelling older adults with cognitive impairment. Twenty five participants (15 with mild cognitive impairment [MCI] and 10 with mild dementia) and their care partners were enrolled. Eighteen participants were randomly assigned to the treatment and 7 to the control group. The treatment group received educational materials, an electronic toothbrush, coaching on communication and goal setting, and individualized instruction on oral hygiene technique. The control group received educational materials and an electronic toothbrush. There were 3-data collection points: baseline, the end of the 3-month intervention, and 3-month after the intervention. The intervention improved participants’ oral hygiene (based on clinical measure of plaque index and gingival bleeding) for both groups; with more improvement in the treatment group. Improvement was greater for MCI than for mild dementia participants. This intervention showed promising results for a larger trial.

Effects of salivary pH on coating durability of two different aesthetic archwire coatings under a simulated intraoral environment

ObjectivesThis study compared the effects of normal salivary pH, and acidic pH found in patients with poor oral hygiene, on the durability of aesthetic archwire coated with epoxy resin and polytetrafluoroethylene (PTFE). MethodsThe posterior parts of the archwires were sectioned into 20 mm segments (N = 102) and divided among six groups. Four groups were treated with different pH levels and two served as controls. The specimens were immersed in individual test tubes containing 10 ml of artificial saliva adjusted to a pH of 6.75 or 3.5. The tubes were sealed and stored in a 37 °C water bath for 28 days. After 28 days, the specimens were ligated to brackets embedded in an acrylic block and subjected to mechanical stress using an electronic toothbrush for 210 s. The specimens were photographed, and images were measured for coating loss using AutoCAD® software. Surface morphology was observed using a scanning electron microscope (SEM). ResultsSignificant coating loss (p < 0.001) was found in the epoxy resin groups, regardless of pH value, but not in the PTFE groups. The acidic pH caused epoxy resin layer coating loss by twice as much as normal pH. SEM revealed existing manufacturing defects on the as-received epoxy resin coating, whereas the retrieved epoxy resin demonstrated rupture, roughness, and coating loss in multiple locations. SignificanceEpoxy resin coatings demonstrate poor durability in acidic environments. This condition is worsened by the existing manufacturing defects found on as-received archwires. Hence, archwires coated with epoxy resin are not recommended in patients with poor oral hygiene.

An invention of multifunction washing ball

Ultrasonic clean is a very fashionable trend in cleaning appliance and tools in domestic and international markets, from washing machine, electronic toothbrush to household, ultrasonic cleaning machine (for jewelry, watch, glasses, etc.) Every ultrasonic related thing is very popular and the price is raised immediately. For example, the washing machines under the same brand, the one with ultrasonic will be USD 180 more expensive than the other one as the price could up to 8 times of difference for the ultrasonic function of the electronic toothbrushes of the same brand. Multifunction washing ball is the pioneer creation of the world, which is advanced and can be applied for many purposes. It can replace various cleaning household appliances in modern family with the remarkable cleaning effect. Ultrasonic current powerfully get rid of the hidden dirt among the clothes fiber. It will definitely be popular with the collocation of the trend. In the environmental protection, it reduces washing powder usage, minimum power consumption, save the water, cherish the resource on earth.

Effectiveness of electric toothbrush as vibration method on orthodontic tooth movement: a split-mouth study.

Objective: To investigate the effects of application of vibratory stimuli, using an electric toothbrush, on the rate of orthodontic tooth movement during maxillary canine retraction. Methods: A split-mouth study was conducted in 28 subjects (mean age = 20.8 years; ranging from 18 to 24 years) whose bilateral maxillary first premolars were extracted with subsequent canine retraction. On the Vibration side, light force (100 g) was applied to the canine for 90 days, in combination with vibratory stimuli provided by an electric toothbrush; only orthodontic force was applied to the canine on the non-vibration side. Amount of canine movement was measured monthly. Related to electronic toothbrush usage, a diary was provided to each patient for recording discomfort during experimental period, having 100-mm visual analogue scale (VAS). The paired t-test was used to assess the differences in amount of tooth movement between canines of the vibration and non-vibration sides. Results: The amount of tooth movement was similar for canines on the vibration side and on the non-vibration side (mean 0.81 ± 0.10 mm and 0.82 ± 0.11 mm, respectively, p> 0.05). Plaque accumulation was minimal in any subject throughout the study. No subject reported discomfort as a result of using the electric toothbrush. Conclusions: This study demonstrates that application of vibratory stimuli using an electric toothbrush, in combination with light orthodontic force, do not accelerate orthodontic tooth movement.

Connected toothbrushes: Bridging the gap to personalized oral health

To describe the health-related metrics available from a connected toothbrush and potential insights into individualized toothbrushing behavior and performance.A total of 1,926 patients used a new connected electronic toothbrush within a 4-month period. Data were collected from the brush using a smartphone application including frequency of use, duration and surface coverage of each brushing session across 16 zones covering occlusal, buccal and lingual surfaces.The population was comprised of 73% males, and 11% were left handed. Overall, there was no statistical difference between gender or handedness and mean duration (124 seconds) or mean proportional zonal duration (70%) of a brushing session. Both duration and zonal duration improved with usage of brush up to 60 days.The use of connected toothbrushes in patients' home care routines can improve overall brushing duration and zonal duration and offers the opportunity to understand authentic brushing habits on both an individual and population level. As such these data are of interest to practicing clinicians, clinical trialists and public health dentists. Such brushes are in their infancy and further developments will enhance these insights into whole mouth care and the link to oral and general health.

Role of Touch Perception and Audio Aids as Patient Education and Motivation Tools in Adjunct to the Use of Manual and Electronic Toothbrushes in Visually Impaired Individuals: A Cross over Study

Role of Touch Perception and Audio Aids as Patient Education and Motivation Tools in Adjunct to the Use of Manual and Electronic Toothbrushes in Visually Impaired Individuals: A Cross over Study

An Analysis of Improving Parameters by Using an Ionic Electronic Toothbrush

An Analysis of Improving Parameters by Using an Ionic Electronic Toothbrush

Development of a Health Risk Communication Tool to address Oral Health Issues of Schoolchildren of Balotra Block, Rajasthan

Aim: Oral health is one of the leading preventable problems around the globe. India is the second largest populous country, with the majority of the population living in rural areas. Rural population still uses traditional methods to maintain oral hygiene as opposed to urban population which has progressed to electronic toothbrushes. The aim of the present study was to identify the predisposing risk factors for oral health issues among early adolescents and develop a health risk communication tool that will aid in addressing the problem of oral hygiene in school-going children. Materials and methods: A cross-sectional study that included 920 school-going children of class 6 to 9th was conducted in the region of Balotra, Rajasthan, India. Single-stage cluster sampling technique was used in the study to select and collect data from children from 23 (15 government and 8 private) schools that were randomly selected. Analysis was done using Statistical Package for the Social Sciences (SPSS) version 15.0. Results: Overall, the prevalence of caries and dental fluorosis was found to be 47% and 61% respectively. The oral health problem of dental caries was seen to be less prevalent in girls (39.7%). Dental caries were found to be more in government schools (58.7%) and in rural areas (59.6%) as compared with urban areas (52.1%). It was also observed that prevalence of dental caries was more in permanent dentition (44%) as compared with primary dentition (14%). Factors found to be associated with caries were private schools, age of the children, and irregular brushing habits. Conclusion: Based on the prevalence of caries and fluorosis and other findings of the study, it can be concluded that children lack knowledge and awareness about oral hygiene. There is a need to enhance the oral health knowledge level of schoolgoing children. Implementation of a school health program would help change the status quo, and positively influence oral health and well-being of children.