School-based Toothbrushing Research Articles

Special education teachers' involvement and perceived barriers to delivering oral health education for students with disabilities-A cross-sectional study.

Dental caries is prevalent among children, including those with disabilities. Although the World Health Organization recommends school-based oral health promotion (OHP) programmes involving teachers, limited research has explored teachers' roles and perspectives. To assess special education teachers' involvement and difficulties regarding oral health education (OHE), attitudes towards OHP and barriers to oral healthcare access for students with disabilities (SWDs). This descriptive cross-sectional study, conducted in Al-Ahsa, Saudi Arabia, involved 264 special education teachers using a validated, self-administered questionnaire, and descriptive and analytical statistics were used for data analysis. Only 39% of teachers incorporated OHE into their teaching, and just 20.8% received training for OHE delivery. Teachers showed strong support for integrating OHE into the curriculum (84.1%) and a no-sugar policy (78%). There was, however, less support for school-based toothbrushing (39%). OHE barriers included insufficient resources (56.1%), limited knowledge (29.2%) and misconceptions about primary teeth removal (47.4%). The three most common barriers to oral healthcare access were extended waiting lists (75.0%), long waiting times (73.1%) and fear of dental equipment (67.4%). This study highlights the need for collaboration between healthcare professionals, educators and parents to enhance OHE and reinforce OHP for SWDs within special education and beyond.

Application of the integrated behavioral model to identify the predictors of toothbrushing practices among primary school children at Bahir Dar city, Ethiopia

Knowing the level of behavioral intention and tooth-brushing practices is crucial for the implementation of the intervention. However, such studies are too limited in Ethiopia. The current study employed a health behavior model to identify predictors that can serve to support primary school children's attitudes, intentions, knowledge, environmental constraints, and practices of tooth brushing. Thus, this study aimed to assess tooth brushing practices and their predictors among primary school children in Bahir Dar city, Ethiopia. An Institutional based cross-sectional study was conducted among primary school children in Bahir Dar city. A multi-stage sampling technique was used to select 610 participants. Data were collected using pre-tested interviewer-administered questionnaires. Questionnaires adapted from items' previous literature were used for integrated behavioral model constructs incorporated with elicitation study results. Data were entered into Epi data and then analyzed by Stata. Descriptive statistics were done. Confirmatory factor analysis was performed to check the convergent validity of the measurement. The Internal reliability of the items was also checked using composite reliability. Multivariable logistic regression was used to predict the role of independent variables in toothbrushing practices. Moreover, path analysis was performed to check the causal effect of integrated behavioral model constructs on toothbrushing practices. The goodness of fit of the final model was checked using the Hosmer and Lemeshow test of best fit with a large p value = 0.97 and Area under receiver operating characteristics curve = 0.98. The overall prevalence of the current practice of toothbrushing among the respondents was 45.4%. The prevalence of brushing frequency was 243 (89.01%), 27 (9.89%), and 3 (1.09%) brushed once a day, twice a day, and more than twice a day respectively. Female child's [AOR 3.23, 95% CI 1.48–7.02], mothers' education [AOR 4.6; 95% CI 1.22–17.44], past experience of toothbrushing [AOR 0.042; CI 0.018–0.101], knowledge about tooth brushing practices [AOR 1.3; 95% CI 1.09–1.60], behavioral intention [AOR 2.01; 95% CI 1.74–2.32], experiential attitude [AOR 1.09; 95% CI 1.01–1.17],instrumental attitude [AOR 1.02; 95% CI 1.01–1.03], and descriptive norm [AOR 1.07; 95% CI 1.01–1.14] were predictors of toothbrushing practices. The findings indicate that the practice of toothbrushing practices among primary school students was low. Sex, mother's education, knowledge, intention, experience, experiential attitude, instrumental attitude, and descriptive norm, have significant effects on toothbrushing practices; indicating that the integrated behavioral model showed adequate utility in predicting toothbrushing practices in the study area. School-based toothbrushing practices change interventions such as communication strategy.

A qualitative study of barriers and facilitators to the implementation of a pilot school-based, toothbrushing programme

BackgroundWhile supervised toothbrushing programmes have been established in many countries of the world, little is known about different perspectives on their implementation. The aim of the study was to explore stakeholders' barriers and facilitators to implementation of a school-based toothbrushing programme in Taiwan.MethodsFocus groups and interviews were used to explore the views of elementary school students, teachers, staff, and nurses in a piloted school-based toothbrushing programme. The topic guides were developed according to the Theoretical Domains Framework (TDF) to cover the behavioural factors systematically and comprehensively. Data were analysed with content analysis.ResultsOverall, 36 students, 29 teachers/staff, and five school nurses (N = 65) were included. The overarching theme was the importance of habit formation for both staff and children to ensure that toothbrushing as part of the programme was embedded into the school schedule and routine. While children did not necessarily appear to retain the dental knowledge which was taught in the programme, the provision of fluoride toothpaste and toothbrush for their use in schools allowing teachers and staff to choose the timing of the brushing and engaging classmates to supervise each other were found to be key factors.ConclusionsImplementing a school-based toothbrushing programme with the support of staff and active engagement of children can help children to develop a toothbrushing habit. Classmate-supervised toothbrushing may reduce the burden on teachers and staff to implement the programme.

Barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools: a systematic review

BackgroundUntreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools.MethodsFive electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and PsycINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings or primary schools were included in the review. The methodological quality of included studies was assessed by using Joanna Briggs Institute [JBI] and mixed methods appraisal tool [MMAT] critical appraisal tools and results were reported in accordance with PRISMA guidelines.ResultsA total of six studies met the eligibility criteria and were included in the review. Toothbrushing programs in early childhood settings and primary schools were mostly implemented under the supervision of staff and teachers. A positive attitude of the staff, the flexibility of toothbrushing sessions, involvement of community volunteers and parents were a few of the identified enablers. However, the timing of the communication of the program, inadequate transfer of information among staff, frequent staffing turnover, lack of parental support, and staff feeling overburdened while acting as pseudo parents were frequently reported as barriers.ConclusionThe results of this systematic review identify key enablers and barriers for toothbrushing programs in early childhood settings and primary schools which need to be considered for developing oral health promotion initiatives.

School Based Tooth Brushing and Annual Silver Diammine Fluoride Application as a Highest Priority Package for Achieving Universal Oral Health Care for Cambodian Children

Background: Achieving Universal Oral Health Care among Low-to Middle-Income settings is challenging and little literature exists around exploring what a “Highest Priority Package” of care might look like in the context of oral health. The Healthy Kids Cambodia (HKC) program differs from most conventional school dental services in that the initial package of care that is offered is daily toothbrushing with 1,500 ppm fluoride toothpaste (DTB) together with the topical application of Silver Diamine fluoride (SDF) for management of lesions in primary teeth.Aim: To examine tooth level outcomes for 8- to 10-year old children from two schools that performed DTB with application of SDF at differing time-points.Design: This was an observational cohort study that examined lesion progression among children in late mixed dentition at two schools. Data were collected using the dmft and pufa indices. Both schools received materials and training for DTB at baseline. School One received SDF at baseline while School Two received SDF after 9-months. Intraoral examinations were performed and the presentation of primary teeth with cavitated carious lesions were compared at baseline and 12 m. If a tooth was still caries-active or had become pulpally involved, this was considered to be an unacceptable outcome. Descriptive analysis was performed the chi-squared test was used to examine differences in the proportion of teeth with unacceptable outcomes by school membership.Results: Of the 521 children recruited, 470 (90.2%) were followed. Where there was a delay in SDF application (School 2) there was a three times greater chance of an unacceptable outcome. Ten percentage of primary teeth in School One and 33% of primary teeth in the School Two had unacceptable outcomes.Conclusion: The present study offers data on expected effect sizes that might inform future step-wedged clinical trials to validate an oral health Highest Priority Package of care for Cambodian children. The delivery of a package of care that includes both DTB and SDF can prevent adverse outcomes, such as dental infections, in primary teeth with carious lesions.

A 21-Day School-Based Toothbrushing Intervention in Children Aged 6 to 9 Years in Indonesia and Nigeria: Protocol for a Two-Arm Superiority Randomized Controlled Trial.

BackgroundThe World Health Organization reports that dental cavities affect 60% to 90% of children globally. FDI World Dental Federation and Unilever Oral Care have developed public health programs to improve brushing habits over their 12-year partnership. The last of these (phase III) named Brush Day & Night aimed to educate children on brushing twice daily with a fluoride toothpaste and gave useful information for a new project, phase IV. The 21-day Brush Day & Night program is an intense education activity designed to establish the habit of brushing day and night with a fluoride toothpaste. The program involves daily brushing instruction and includes free toothpaste and toothbrushes.ObjectiveThe main objective of the study is to evaluate the impact of a 21-day school program on children’s oral health. As a secondary objective, we aim to evaluate the impact on the knowledge, behavior, toothbrushing habits, and quality of life in school children aged 6 to 9 years after a 21-day school program and compare with baseline and a control group as measured by the self-reported questionnaires issued to children (in particular, the self-reported brushing frequency and positive responses on fluoridated toothpaste use). The enduring nature of the program will be determined by the inclusion of 8- and 24-week time points.MethodsThe study is a 2-arm superiority randomized controlled trial. Clusters in this study are infant and junior schools in Indonesia and Nigeria. The study aims to recruit 20 schools with children aged 6 to 9 years in each country. At baseline, children in both intervention and control schools will answer a questionnaire and have their clinical oral health assessed using the Simplified Oral Hygiene Index (OHI) and Decayed Missing and Filled Teeth index. Children in the intervention schools will then take part in a structured 21-day Brush Day & Night intervention. Children in the control schools will be provided with free toothpaste and toothbrushes but will not receive the 21-day intervention. The questionnaires and OHI assessments are repeated after the 21-day program is completed and again 8 weeks later and 24 weeks later for all participating children. Parents/carers/guardians of all children will sign the informed consent and complete questionnaires on their own experience and attitudes toward oral health and toothbrushing routine at each of the four times points (baseline, 21 days, 8 weeks, and 24 weeks). The study will be conducted by the national dental associations of Indonesia and Nigeria and was approved by the ethics committees of both countries.ResultsThe study is ongoing. Recruitment of schools started in Indonesia in February 2018 and in Nigeria in April 2018 for the first part of the study, which concluded in Indonesia in September 2018 and in Nigeria in November 2018. The second part of the study (the second half of the schools) started in November 2018 in Indonesia and December 2018 in Nigeria.ConclusionsWe expect to collect all the data during 2019 and publish findings from the study by March 2020.Trial RegistrationClinicalTrials.gov NCT04001296; https://tinyurl.com/selxraaInternational Registered Report Identifier (IRRID)DERR1-10.2196/14156

The impact of a school-based tooth-brushing program on dental caries: a cross-sectional study

BackgroundPromotion of oral health in children is recognized as one of the components of health-promoting schools (HPSs). However, few studies have addressed supportive school environments for children’s oral health. This study aimed to evaluate the status of dental caries in school children at HPSs, with the objective of examining the impact of a supportive school environment for oral health, considering the lifestyles of individual children and the socioeconomic characteristics of their communities.MethodsData of 2043 5th-grade students in 21 elementary schools in Ichikawa city between 2008 and 2013 were analyzed. Children’s oral health status was evaluated using the decayed, missing, and filled permanent teeth (DMFT) index. A self-reported lifestyle questionnaire, a survey of the school environment promoting tooth-brushing, and community socioeconomic characteristics derived from the National Census data were included in the analyses. Bivariate analyses were conducted to evaluate the children’s DMFT status, and zero-inflated negative binominal (ZINB) regression was used to assess the relationships between DMFT and other variables.ResultsPrevalence of dental caries in the permanent teeth of 5th-grade children (aged 10–11 years) was 33.3%, with a mean DMFT score (± SD) of 0.83 ± 1.50. According to multilevel ZINB regression analysis, children from schools with after-lunch tooth-brushing time showed a higher odds ratio (OR) for excess zero DMFT (OR = 1.47, 95% CI = 1.00–2.15, P = 0.049) as compared to those from schools without it. Neither bivariate analysis nor ZINB model analysis revealed any significant influence of children’s gender or use of a toothpaste with fluoride.ConclusionsThe school-based environment supportive of oral health was significantly associated with a zero DMFT status in children. School-based efforts considering the socioeconomic characteristics of the area warrant attention even with declining prevalence of dental caries.

School-Based Preventive Dental Program in Rural Communities of the Republic of Armenia.

Objectives: This paper describes a school-based preventive dental program implemented in 14 rural schools within nine villages of Armenia. As part of the program, school-based toothbrushing stations (called Brushadromes) were installed in the participating schools. The intervention included school-based supervised toothbrushing with fluoride toothpaste and oral hygiene education.Methods: The study evaluates the prevalence and levels of dental caries among rural schoolchildren in 2013 (before the implementation of the preventive program, referred to as a pre-intervention group) and 2017 (4 years after the start of the program, referred to as an intervention group) in two randomly selected villages where the program was implemented. A repeated cross-sectional study design was used. The prevalence of caries and the number of decayed, missing, and filled teeth in permanent dentition (DMFT) and primary dentition (dmft) were recorded among 6–7 and 10–11-year-old schoolchildren in 2013 (n = 166) and 2017 (n = 148). The pre-intervention and intervention groups include different children in the same age range, from the same villages, examined at different time points. In both instances, they represented over 95% of the 6–7 and 10–11-year-old student populations of the studied villages. Pearson Chi-square, Fisher's Exact test, independent t-test, and quasi-likelihood Poisson regression were utilized for data analysis.Results: Schoolchildren involved in the intervention had significantly less decay levels compared to same-age pre-intervention groups. For 10–11-year-old schoolchildren involved in the program, the mean number of permanent teeth with caries was lower by a factor of 0.689 (lower by 31.1%), p = 0.008, 95% CI, 0.523; 0.902, compared to the 10–11-year-old pre-intervention group, after controlling for age, sex, child's socio-economic vulnerability status, the village of residence, and the number of permanent teeth with fillings.Conclusions: The study indicates a significantly lower level of caries among schoolchildren in the studied two villages where the intervention was implemented. The described intervention is particularly suitable in rural settings where water fluoridation is not available and homes have limited availability of running water.

Oral Hygiene Practices and Factors Affecting Oral Health Service Utilization among Children (11-14 Years) of Government School of Nikol Ward of East Zone of Ahmedabad, Gujarat, India.

Context:Oral hygiene practices and factors affecting oral health service utilization among the children of 10–16 years of age play a vital role in achieving comprehensive dental care.Aims:This study was done to assess oral hygiene practices, creating oral hygiene awareness, and to analyze the overt hurdles in getting basic and timely dental care among children.Materials and Methods:It was a cross-sectional survey conducted among 200 schoolchildren aged 11–14 years using a pretested, semistructured questionnaire, and clinical examination was done to assess dental caries. Convenience sampling method was used, and the sample size for the study was equal to the total number of participants. The logistic regression analysis along with odds ratios with 95% confidence interval and P < 0.05 was also reported. Chi-square test was used for statistical analysis of dental caries prevalence.Results:Around 70% of the study participants had the habit of brushing their teeth once daily, whereas only 30% of them used to brush their teeth twice daily. The prevalence of dental caries shows an upward trend with increasing age from 11 to 14 years. Cost of dental treatment, transportation, and dental taboos followed by fear of dental treatment are the major constraints for the students in accessing dental treatment.Conclusion:School-based tooth brushing and oral health education programs should be regularly organized to promote healthy tooth brushing practices. The cost-effective and timely transportation services along with proper oral health education in alleviating fear of dental treatment and dental taboos should be provided to these children for enhancing the utilization of dental services.

Caries experience of children in primary schools with long-term tooth brushing programs: A pilot Australian study.

The aim of this study was to evaluate a primary school-based tooth brushing (TB) program conducted in a low socio-economic area of Queensland, Australia, to determine its effectiveness in reducing caries. Records kept at the central dental clinic of the district were used to analyse the caries experience (decayed, missing, filled teeth [dmft/DMFT]) and caries prevalence in children from two schools with long-term TB programs (TB) (N=1191) and three Non-TB schools (N=553). The schools were matched by socio-economic indices. Historical records showed that the baseline caries experience in all TB and Non-TB primary schools were similar at each primary school year. After a mean period of 5-9years of the TB program, the caries experience (mean decayed, missing, filled teeth, dmft/DMFT) and prevalence were lower for TB group than Non-TB group. In the primary dentition, the overall mean dmft (±standard deviation) of TB group (2.53±3.00) was significantly lower than the Non-TB group (3.06±3.30) (P<.001). Similarly, in the permanent dentition, the overall mean DMFT of TB group (0.47±1.05) was reduced significantly compared to the Non-TB group (1.15±1.72) (P<.001). The overall caries prevalence in the TB group was 68% compared to 78% in Non-TB (P<.001). Overall, the mean annual DMFT increments of children in the TB schools were also significantly less compared with children in the Non-TB schools (P<.001). A long-term primary school TB program significantly reduced caries experience and caries prevalence in an optimally fluoridated (1-ppm), very low socio-economic district.

EFFECTIVE CARIES PREVENTION IN A HEBRIDEAN ISLAND POPULATION.

The Isle of Islay has a remote-rural population. Two dentists have been responsible for the care of the majority of the school-age children for 15 years. The island affords a unique situation to measure caries prevalence in a relatively static population. This study measures the changes in the dental caries experience of five and 12-year olds exposed to a preventive-based approach to improving dental health, which included a school-based tooth-brushing programme (four to 12-year-olds). Data from practice-based records were collected for children aged five and 12 in the years 1999-2003 and 2012-2014. Indices including percentage of children with no obvious caries, decayed, missing or filled teeth (dmft/DMFT) and care indexes were calculated, translated into graphs and compared to Scotland's National Dental Inspection Programme (NDIP) data. 478 children were included in the study. The mean number in each year group for five-year-olds was 28 (SD ± 5.65) and for 12-year-olds was 31.75 (SD ± 8.30). The percentage of children caries-free increased from 39% to 85% (five-year-olds) and 31% to 97% (12-year-olds). DMFT decreased from 3.04 to 0.30 (five-year-olds) and 3.74 to 0.03 (12-year-olds). Figures for care index and percentage of first permanent molars fissure sealed were higher than national data averages. Caries prevalence decreased in children in Islay aged five and 12 years over the period 1999-2014. There was no control group but the differences described above can be associated with the introduction of a preventive approach, however they cannot be assumed to be causative.

일부 초등학교 교사의 학생 칫솔질 실천에 대한 의견조사

Objectives : The purpose of this study was to examine the relationship between the preparation of toothbrushing and the opinion of teachers in the practice of toothbrushing of elementary school students to provide information on the implementation of school-based toothbrushing programs. Methods : The subjects were 85 elementary school teachers. The statistical package SPSS 18.0 was used to obtain descriptive statistics and <TEX>${\chi}^2$</TEX>-test. Results : Oral health education program and toothbrushing preparation proved to be the most important priority in this study. The barriers to school-based toothbrushing guideance were limit of education time and shortage of space. School-based toothbrushing was related to oral health education program in the meanwhile school without school-based toothbrushing program needed the toothbrushing facilities. About 87.5% of the schools had not equipped with toothbrushing facilities. If the facilities were given, 82.5% of the school would implement the program. Conclusions : The elementary school is the place where the lifelong oral health program is given to the students, so it is very important to promote the school-based toothbtushing nationwide in the future.

The Bila Muuji Oral Health Promotion Partnership

In western NSW in 2006, a group of Aboriginal Community Controlled Health Organisations identified oral health as a priority need in their regions, considering the lack of regular dental services, poor access to oral health information, and high dental disease rates. A regional oral health promotion program was developed and implemented under the guidance of a regional coordinator who supports local staff in oral health promotion activities such as school-based toothbrushing and the provision of oral health information to targeted groups (e.g. young mothers and carers) and staff of chronic disease programs. The program's strength in its planning and continuity is due to many factors, one of the main being the active involvement of local Aboriginal Community Controlled Health Organisation staff in its genesis, planning and implementation. Combined with strong management support, local partnerships and regional coordination, the program continues to provide collaborative approaches to community-based oral health promotion programs.

Caries preventive efficacy of silver diammine fluoride (SDF) and ART sealants in a school-based daily fluoride toothbrushing program in the Philippines

BackgroundOcclusal surfaces of erupting and newly erupted permanent molars are particularly susceptible to caries.The objective of the study was to assess and compare the effect of a single application of 38% SDF with ART sealants and no treatment in preventing dentinal (D3) caries lesions on occlusal surfaces of permanent first molars of school children who participated in a daily school-based toothbrushing program with fluoride toothpaste.MethodsThe prospective community clinical trial in the Philippines was conducted over a period of 18 months and included 704 six- to eight-year-old school children in eight public elementary schools with a daily school-based fluoride toothpaste brushing program. Children were randomly assigned for SDF application or ART sealant treatment. Children from two of the eight schools did not receive SDF or ART sealant treatment and served as controls. SDF or ART sealant treatment was applied on sound occlusal surfaces of permanent first molars. Surfaces that were originally defined as sound at baseline but which changed to dentinal (D3) caries lesions were defined as surfaces with new caries (caries increment). Non-compliance to the daily toothbrushing program in three schools offered the opportunity to analyze the caries preventive effect of SDF and sealants separately in fluoride toothpaste brushing and in non-toothbrushing children.ResultsIn the brushing group, caries increment in the SDF treatment group was comparable with the non-treatment group but caries increment in the sealant group was lower than in the non-treatment group with a statistically significant lower hazard ratio of 0.12 (0.02-0.61). In the non-brushing group, caries increment in the SDF treatment group and the sealant group was lower than the non-treatment group but the hazard ratio was only statistically significant for the sealant group (HR 0.33; 0.20-0.54). Caries increment was lower in toothbrushing children than in non-toothbrushing children. Hazard ratios reached statistical significance for the non-treated children (HR 0.43; 0.21-0.87) and the sealant-treated children (HR 0.15; 0.03-0.072).ConclusionsA one-time application of 38% SDF on the occlusal surfaces of permanent first molars of six- to eight-year-old children is not an effective method to prevent dentinal (D3) caries lesions. ART sealants significantly reduced the onset of caries over a period of 18 months.Trial registration numberGerman Clinical Trial Register DRKS00003427

Gingivitis and plaque scores of 8‐ to 11‐year‐old Burmese children following participation in a 2‐year school‐based toothbrushing programme

The present study assessed whether gingivitis and plaque scores of 8- to 11-year-old school children who participated in a SBTB programme for 2 years were lower than those of children who did not participate in the programme. The present study was performed using an examiner-blind, parallel group design and was performed in Burma (Myanmar) in 2006. Three of the five schools where daily SBTB programmes took place after lunch and which were performed under teacher supervision were randomly selected; three non-participating schools (non-SBTB) from the same area were assigned as controls. Twenty-five children per school were examined for gingivitis (bleeding on marginal probing) and plaque (Quigley & Hein). In total, 150 8- to 11-year-old children participated, with 75 children in either group. The test group (SBTB) exhibited an overall mean bleeding score of 0.76. For the control group (non-SBTB), this score was 0.83. With respect to the overall mean plaque scores, the test group exhibited a score of 2.93, whereas the control group exhibited a score of 2.91. No statistically significant differences between the test and the control group were observed. The present study did not reveal a statistically significant effect of daily SBTB programmes in 8- to 11-year-old school children with respect to gingivitis and plaque scores.

LOGISTIC PREPARATION TO ENABLE THE BRIGHTER SMILES AFRICA PROGRAM TO BE ESABLISHED IN UGANDA.

Background The implementation of a successful international health program comes with a constellation of unique obstacles that require a collaborative approach and careful project design. Over the summer of 2006, a Canadian school-based tooth-brushing and oral health education program, “Brighter Smiles,” was delivered to 600 primary school children in four rural Ugandan communities in Africa. The international program resulted from collaboration between the University of British Columbia (UBC), Vancouver, BC, and Makerere University (MU), Kampala, Uganda, and was implemented in 2006 by medical and dental students from both institutions. Methods Initiation of the Brighter Smiles Program in Uganda was requested by MU faculty members and the third-year dental class. Once collaboration was confirmed, planning began. Initial sessions with the UBC medical students were done in the aboriginal communities to enforce the basic program philosophy and teaching. Fundraising and grant competitions were conducted. An initial contact team composed of two medical students was sent to present the basic program at a local conference and then with faculty on board to begin the adaptation of the program to suit Uganda9s children9s community and write culturally appropriate ethics and protocols. The project then moved into all four communities under the leadership of the Ugandan dental students, who obtained preliminary consents for the project and baseline dental surveys of the children. The main UBC team then arrived for the implementation of the bulk of the project (teaching dental health, brushing techniques, and supply distribution) and while supporting the Ugandan students in this phase of the project saw their collaboration come to life. Results The 2006 pilot year of the program was embraced by target communities and is successfully under way. Six hundred children received baseline dental examinations and enrolled in the oral health tooth-brushing program. In the coming year, the program will be reinforced in Uganda by another cohort of UBC students. Key relationships were established to act as a substrate for future public health initiatives between UBC and MU. Conclusion The implementation of the “Brighter Smiles Program” in Uganda demonstrates the importance of solid preparation in advance and how the potential success of a true collaboration between international universities and local communities depends on this logistic preparation.

Evaluation of a stannous fluoride dentifrice for use in dental public health programs I. Basic findings

In a 3-year school-based toothbrushing project, use of the stannous fluoride dentifrice either at home alone or once a day in school as well as at home produced about a sixth to a fifth reduction in dental caries increment. Children who brushed in school as well as at home with the stannous fluoride dentifrice derived no additional benefits for caries control compared with benefits gained by children who brushed their teeth only at home with the same dentifrice.