Supervised Toothbrushing Programme Research Articles

Toothbrushing programme in Saudi Arabia ‘TOPS’: a study protocol for a cluster randomised controlled trial in kindergartens, Riyadh

IntroductionDental caries among children is a major global health problem and is a particular public health challenge in Saudi Arabia. Dental caries cause pain, infection and negatively impact quality of...

Modeling the cost-effectiveness of school-based supervised toothbrushing program in reducing the dental caries burden in India.

Supervised toothbrushing (STB) significantly reduces the incidence and progression of dental caries. School years present a favorable age for introducing such healthy habits for a lifetime. To estimate the cost-effectiveness of implementing a STB program in India in preventing dental caries incidence. An operational framework of a national STB program was devised. A mathematical model was then developed to evaluate this program's clinical effectiveness and economic impact in the Indian scenario. This study considered a hypothetical cohort of the Indian population aged from 6 to 75 years. Two groups were compared: no intervention and STB in government schools. The health outcomes assessed were a number of tooth caries incidences averted and quality-adjusted life years gained. The STB program in the government schools of India would prevent at least one tooth from developing caries in an individual's lifetime. Considering the current treatment-seeking behavior, the STB program saves INR 153 (US$ 1.95) per carious tooth incidence averted and INR 22 202 (US$ 283) per QALY gained. In India, the school-based STB program is expected to be a cost-effective strategy for reducing the dental caries burden and its associated treatment costs.

Environmental impact of the supervised toothbrushing programme amongst children in Scotland

ObjectivesTo understand the environmental impact of providing a nationwide supervised toothbrushing programme (Childsmile) for 5-year-old children in Scotland. MethodsA life cycle assessment was conducted to assess the annual environmental effects of the supervised toothbrushing programme in early years childcare, as well as each dental procedure (dental restoration under local anaesthesia (LA), single tooth extraction under LA, and multiple teeth extraction under general anaesthesia) spanning from 2001/02 to 2009/10. The expected savings in annual carbon dioxide equivalent (CO2e) emissions for all combined dental treatments in subsequent years were calculated compared to those in 2001/02. ResultsAn overall decrease in CO2e emissions was evident in the Childsmile programme and across all dental procedures. The estimated reduction in emissions across all procedures varied from 102.5 tonnes in 2002/03 to 461.1 tonnes in 2009/10 when compared to 2001/02. Within three years, the expected emissions savings from all combined dental procedures surpassed the emissions generated by implementing the Childsmile programme. ConclusionsOver time, there was a significant reduction in annual CO2e emissions for all combined dental treatments in children. In the eighth year of the Childsmile, emissions savings were more than 4.5 times greater than the emissions generated during its implementation. Clinical significanceThe study highlights the importance of educating public by individual dentists about the environmental impact of caries prevention programmes and paediatric dental treatments as this may influence patient choice. It also encourages commissioners of community dental programmes to support the implementation of supervised toothbrushing programmes in early years childcare.

Impact of virtual supervised tooth brushing on caries experience and quality of life among primary school children: study protocol for a randomized controlled trial

BackgroundDental caries is one of the most common diseases affecting children world widely as well as in the Kingdom of Saudi Arabia. Supervised tooth brushing programs are implemented throughout the world to provide young children’s developing teeth with additional fluoride as a form of dental caries prevention. While school-based supervised tooth brushing programs have been proven to improve young children’s oral health, virtual supervised teeth brushing programs have not been assessed. The purpose of this protocol is to assess the impact of virtual supervised tooth brushing on caries experience and quality of life among primary school students in Riyadh, Saudi Arabia.MethodsThis is a cluster randomized controlled trial comparing a virtual supervised tooth brushing program against no intervention applied. A total of 1192 (596 in each group) 8–9-year-old children in Riyadh primary schools, Saudi Arabia, will be recruited for the trial. Schools (cluster) will be randomly selected and allocated to either group. Clinical assessment for caries experience will be conducted in six points (baseline, + 3 months, + 6 months, + 12 months, + 24 months, + 36 months) by dental hygienists using the World Health Organization criteria. Data on sociodemographic behavioral factors and children’s quality of life will be collected with every clinical assessment through a structured questionnaire. The primary outcome is the change in caries experience (the number of teeth with untreated dental caries, filled and missing teeth) in both primary and permanent teeth over 36 months.DiscussionVirtual education as well as some health consultation through the pandemic period had enabled an effective IT infrastructure in Saudi Arabia. Virtual supervised tooth brushing is a proposed initiative. It is also an opportunity for targeting a large portion of the population with a high level of disease as a quarter of the Saudi population is younger than 15 years. This project should provide high level evidence on the effectiveness of virtual supervised tooth brushing. The findings should potentially inform policies related to the continuation/implementation of school-based programs in Saudi Arabia.Trial registrationClinicalTrials.gov, ID: NCT05217316. Registered on 19 January 2022.

Dental health of preschool children after two-years of a supervised tooth brushing program in Southern Israel

BackgroundSupervised tooth brushing is an important part of leading national oral health improvement programs in different countries.With the cessation of water fluoridation in 2014, a new program was immediately required to provide community-based caries prevention, especially amongst young children.The aim of this study was to determine whether a supervised tooth brushing program (STBP) in kindergartens could reduce dental caries amongst preschool children, when compared with children from the same community who did not participate in the program. The study was performed 2 years after the start of the program.MethodsTwo Jewish and two Arab local authorities (one participating and one control) were randomly chosen. In each local authority, 4 kindergartens (children aged 5) were randomly chosen, giving a total of 16 kindergartens. Children in the intervention group brushed once daily at kindergartens, with fluoridated toothpaste, for two school- years. All the children were examined using the WHO Oral Health Survey Methods Ed.4.ResultsTwo hundred eighty-three five-year-old children were examined, 157 of them Jewish (86 participants in STBP, 71 non-participants) and 126 Arab (59 vs 67 respectively). Among Jewish children, the fraction of untreated decayed teeth was 61% in the participant group and 65% for non-participants, and amongst the Arab children 69% vs. 90% respectively. The fraction of treated decayed teeth for the participant group was 37% compared to 29% for the non-participants among Jewish children, whilst for the Bedouin group it was 23% vs. 8% respectively.ConclusionsAfter 2 years, supervised tooth brushing with fluoride toothpaste shows a favorable effect. This study suggests that dental health of children participating in STBP was better than the control group. Fewer carious teeth and more treated carious lesions were recorded in this group. This program can be applied to low SES communities nationwide.Guidelines for fluoride concentration in toothpaste for children should be re-considered based on high caries levels.

Investing to prevent: Description of an innovative approach to commissioning a supervised toothbrushing programme across multiple local authorities in England.

The NHS Long Term Plan prioritises NHS action to reduce health inequalities and give children a good start in life. A Sustainability and Transformation Partnership (STP) is a collaborative working arrangement between local authorities and the NHS covering a defined population and geography. Within the STP in Devon, England, all three local authorities had separate supervised toothbrushing programmes; all were precariously funded. Devon has limited access to routine NHS dentistry and children in deprived areas have high rates of general anaesthetics for dental extractions. Consolidating the supervised toothbrushing programmes presented an opportunity to address oral health inequalities across Devon STP. 1. Reduce oral health inequalities for children in deprived areas. 2. Reduce treatment need for children who have limited access to routine NHS dentistry. 3. Invest in prevention. A proposal, supported by local authorities in Devon STP, was developed for a targeted supervised toothbrushing programme at early years sites across the most deprived 50% of areas in Devon. Return on investment was estimated using a national resource. Methods are described for identifying eligible sites and defining procurement lots. The NHS dental services commissioner agreed to support this proposal using an innovative approach to commissioning. Three lots, totalling 525 sites, were awarded to two providers. Mobilisation over summer 2019 led to implementation from September 2019. Partnership working and innovative commissioning can enable NHS England to invest in prevention at scale where options to increase dental access are limited. Implementation across a large geographical area creates challenges but facilitates equitable programme delivery.

The formation of tooth brushing automaticity of 7-8 year-old children using appreciative inquiry (Ai) approach

Objective: To measure the effectiveness of the appreciative inquiry (AI) approach for the formation of tooth brushing automaticity of children in school for 2 months.Material and Methods: Randomized-Community Trial with a school-based supervised tooth brushing program for two months. Automaticity was measured with self-report behavior automaticity index (SRBAI) and intraoral examination was done with patient hygiene performance modified index (PHP-M)at the baseline, after 1 month and after 2 months. Results: automaticity proportion was significantly higher in the AI group (63.8%) compared to conventional group (22.1%) (P = 0.000; OR= 11.9, 95% CI = 4.794-29.497). Conclusion: appreciative inquiry was more effective than conventional health education approach for tooth brushing behavior change.

Practical realization of the caries prevention program among school children in Bobruisk, Belarus

Целью исследования была оценка медицинской эффективности программы контролируемой чистки зубов младшими школьниками в профилактике кариеса в отдаленные сроки. Материалы и методы. В 2012 г. 250 детей первых классов нескольких школ г. Бобруйска были охвачены двухлетней программой контролируемой чистки зубов ежедневно в школьные дни под наблюдением и с помощью учителей. Детям бесплатно были предоставлены зубные щетки и пасты с активным противокариозным компонентом Mineralin Kids® без фтора. Стоматологические осмотры детей проводили в первые 2 года и через 3 года после завершения программы. Определяли интенсивность кариеса постоянных зубов с помощью индекса КПУ и его компонентов. Результаты. Средний КПУ постоянных зубов у 12-летних детей, принявших участие в 2-летней программе контролируемой чистки зубов, равнялся 1,72, что на 14% меньше, чем в аналогичной возрастной группе сравнения. Заключение. Контролируемая гигиена полости рта у первоклассников в рамках государственной программы профилактики стоматологических заболеваний является эффективным методом в отдаленные сроки наблюдений.

Two-year supervised tooth brushing program evaluation in preschools in Southern Israel

Abstract Background Dental care for children was included into National Health Insurance Law in 2010 and eligibility age went up gradually to 18 in 2019, providing universal dental care. As a part of dental care reform, community based preventive School Dental Services were extended to preschool children. School dental service (SDS), funded entirely by the State, was extended to younger ages providing supervised tooth brushing module. The national supervised teeth brushing program (STBP) was first implemented in 2015-2016 amongst 3-4 year old children attending 600 nurseries in Israel. Due to the program’s success, it was gradually extended to more nurseries in low socio economic regions across the country, reaching 2200 settings in 2019. The objective of this study was to assess dental health among preschool children participating in the program during the last two years, comparing to those who did not. Methods Participant and non-participant kindergartens were randomly selected in Jewish and Bedouin Arab towns in the Southern district matched according to SES level. DMFT index measuring mean number of decayed, missing and filled teeth was recorded among preschool 5 years-old children. Results 283 children were examined, 157of them Jewish (86 participants in STBP, 71 non-participants) and 126 Bedouins (59 vs 67 respectively). Mean untreated carious teeth (d) was 1.15 vs 1.8 for Jews and 3.22 vs 3.9 for Bedouins. Percent of treated teeth within total caries experience index (f/dmf) was higher in tooth brushing group: 37% vs. 29% for Jews and 23% vs. 8% for Bedouins. Key messages Supervised tooth brushing shows favorable effect. Less carious teeth and more treated caries were recorded in STBP group.

Childsmile after 10 years part 2: programme development, implementation and evaluation

Childsmile is the national child oral health improvement programme for Scotland. It was developed as pilot studies from 2006/7, building on an established national supervised toothbrushing programme in nursery schools. By 2011, an integrated programme was in place in all NHS Boards across the country. The importance of a multi-agency, common risk factor approach is acknowledged and the programme continues to evolve through learning from the embedded process evaluation. The development and implementation of Childsmile has been associated with major improvements in child oral health. However, clear health inequalities remain and the future focus of the programme will aim to reduce further the social gradient of child oral health in Scotland. CPD/Clinical Relevance: This paper describes the development, implementation and evaluation of Childsmile, utilizing the theories and approaches outlined in Part 1.

Caries-preventive efficacy of a supervised school toothbrushing programme in Northland, New Zealand.

Toothbrushing with fluoride toothpaste reduces the incidence of dental caries. To evaluate a supervised school toothbrushing programme to reduce dental caries experience in children. Quasi-experimental study. All children had routine dental examinations at baseline using the ICDAS to record dental caries, along with bitewing radiographs. Half of the children were involved in a supervised toothbrushing programme. Examinations were repeated at the end of the school year. Northland, New Zealand. 335 10-13-year-old New Zealand children with high caries experience. Half of the children participated in the supervised toothbrushing session each school day; the other half had no intervention. Caries increment, determined by comparing the baseline and follow-up status of each tooth surface. At baseline, there were 335 children, of whom 240 (71.6%) were followed up. The ICDAS net caries increment for those in the toothbrushing group was a mean of 11.7 surfaces improved; the control group had a mean of 8.6 surfaces which had deteriorated. Caries incidence for those in the toothbrushing group was 7.3%; that for the control group was 71.5%. Multivariate analysis showed that membership of the brushing group was the only statistically significant predictor of a lower net caries increment. A supervised school toothbrushing programme can reduce caries increment in a population experiencing high levels of dental disease.

A Comparison of Three Child OHRQoL Measures.

Comparing oral health-related quality of life (OHRQoL) measures can facilitate selecting the most appropriate one for a particular research question/setting. Three child OHRQoL measures Child Perceptions Questionnaire (CPQ11–14), the Child Oral Health Impact Profile (COHIP) and the Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) were used with 335 10- to 13-year-old participants in a supervised tooth-brushing programme in New Zealand. The use of global questions enabled their validity to be examined. Assessments were conducted at baseline and after 12 months. All three measures had acceptable internal consistency reliability. There were moderate, positive correlations among their scores, and all showed differences in the impact of dental caries on OHRQoL, with children with the highest caries experience having the highest scale scores. Effect sizes were used to assess meaningful change. The CPQ11–14 and the CARIES-QC showed meaningful change. The COHIP-SF score showed no meaningful change. Among children reporting improved OHRQoL, baseline and follow-up scores differed significantly for the CPQ11–14 and CARIES-QC measures, although not for the COHIP-SF. The three scales were broadly similar in their conceptual basis, reliability and validity, but responsiveness of the COHIP-SF was questionable, and the need to compute two different scores for the CARIES-QC meant that its administrative burden was considerably greater than for the other two measures. Replication and use of alternative approaches to measuring meaningful change are suggested.

Assessment of Oral health status of people attending Gulf Week Festival in Al- Qassim governorate, Cross-sectional survey

Objective: To assess the oral health challenges of people attending Gulf Week Festival in Al-Qassim governorate, Kingdom of Saudi Arabia (KSA).Methods : This study was conducted at Qassim, KSA .Oral examination of the participants was conducted March 2017. The sample size was 550 participants (278 female and 272 male).from deferent age groups were assessed for the prevalence of dental caries , oral hygiene, fluorosis and malocclusion and their compliance or adherence for fluoride topical application.Results: The Caries Prevalence in The Study population was 73.4% (n=508), improper oral hygiene 38.1%(n=548), Non-compliance to Fluoride Application 34.8%(n=543), Fluorosis 8.9%(n=540), Malocclusion 14.2%(n=541).Conclusion. It was concluded that: - Dental caries was high in the population attending the Gulf week festival in Qassim region. -Calculus accumulation is more prevalent in male than in female. - slight plaque accumulation was more in female under 13 years - Oral health education program and effective supervised tooth brushing program is mandatory to control plaque and calculus accumulation.

Sustainability of Supervised Toothbrushing in Israeli Nurseries - Teachers' Perspective.

The national supervised toothbrushing programme was implemented in 2015-2016 among 3- to 4-year-old children attending 600 nurseries in Israel. The objectives of this study were to assess factors associated with sustainability of programme implementation, based on nursery teachers' attitudes towards the programme, beliefs in its success and willingness to continue it in in the future. A phone survey was conducted among nursery teachers participating in the programme. Study objectives were assessed using a 19-item structured questionnaire. A linear regression model was built to identify factors which contributed to the positive attitude of the teachers towards programme sustainability. Some 300 teachers were interviewed over the telephone. The programme was implemented daily or several times a week in 66% of the nurseries. Around 70% of teachers reported willingness to continue the programme in the future. Teachers' confidence in programme success (r = 0.73), acknowledgment of their role in teaching children to brush their teeth (r = 0.53), tendency to like teaching toothbrushing (r = 0.59) were positively associated with their willingness to continue the programme. Teachers who anticipated more problems were less willing to implement the programme in the future (r = -0.34). Statistically significant differences in frequency of programme implementation were found according to teachers' attitudes towards the programme. A strong relationship (adjusted r2 = 0.71) was found between the teacher's positive perception of programme sustainability and the attribute variables. The degree of interest in continuing a programme and the belief in their ability to operate it attributed most to teachers' positive perception of programme sustainability. A high percentage of teachers expressed a positive attitude towards the programme. Factors contributing to the positive attitude of teachers towards programme sustainability were identified. The survey's results may help in the implementation of similar programmes and contribute to their future success.

School-Based Oral Health Promotion: A ThoroughReview

Objectives Schools are considered as important platforms for oral health promotion worldwide. Oral diseases are preventable and any focus on schoolchildren can minimize suffering, reduce inequity, and create productive years of healthy adulthood later on. Hence, we need to explore oral health promotion methods conducted within the school systems in different countries. This is especially required for developing countries with limited resources.Methods The PubMed database was searched for English peer-reviewed articles published from January 2000 to June 2017 with available abstracts, specifically focusing on primary school children aged between 7 and 12 years. “Oral health”, “health promotion” and “school” were used as keywords in our search strategy. Relevant papers were selected and reviewed by two independent readers using predefined exclusion criteria, firstly on the basis of abstracts, secondly by assessing full-text papers.Results From a total of 257 articles, 22 were eligible for analysis. Of all oral health related activities implemented in schools, oral health education was mentioned in most studies (n=15) followed by supervised tooth brushing program in schools with fluoride toothpaste (n=5), administration of fluoride (varnish/gel) (n=3), provision of nutritious food (n=3), multimedia game or campaign (n=3), and tooth examination with screening (n=3).Conclusion Improvement of children’s oral health related to school-based oral health programs is the result of a combination of several interventions. The governments and other policy makers should consider implementing some appropriate health promotion schemes in schools, which take local needs and resources into account

Effect of a School-Based Supervised Tooth Brushing Program In Mexico City: A Cluster Randomized Intervention.

To assess the three-month efficacy of supervised tooth brushing in reducing dental plaque, gingival inflammation, and bleeding on probing in schoolchildren participating in SaludARTE. This was a pragmatic cluster randomized intervention, with two parallel branches. Four randomly selected schools participating in SaludARTE (n=200) and one control school, which did not participate in the program (CG) (n=50), were assessed. Clusters were not randomly allocated to intervention. The main outcomes were as follows: mean percentage gingival units with no inflammation, dental surfaces with no dental plaque, and gingival margins with no bleeding. The independent variable was supervised tooth brushing at school once a day after a meal. Guardians and children responded to a questionnaire on sociodemographic and oral hygiene practices, and children were examined dentally. Mean percentage differences were compared (baseline and follow-up). A total of 75% of guardians from the intervention group (IG) and 77% from the CG answered the questionnaire. Of these, 89.3% were women, with a mean age of 36.9±8.5 years. No differences in sociodemographic variables were observed between groups, and 151 children from the IG and 35 from the CG were examined at baseline and follow-up. Mean percentage differences for plaque-free surfaces (8.8±28.5%) and healthy gingival units (23.3%±23.2%) were significantly higher in the IG. The school-supervised tooth brushing program is effective in improving oral hygiene and had a greater impact on plaque and gingivitis than on gingival bleeding. It is necessary to reinforce the oral health education component of the program.

Effect of using an intra-oral camera as a reinforcement tool for plaque control in a supervised toothbrushing program: An interventional study

Introduction: Supervised toothbrushing program at schools have indicated limited improvement in oral hygiene among children. Aim: The aim of this study is to evaluate whether the use of an intra-oral camera as a reinforcement tool in a supervised tooth brushing program at school can improve plaque control. Materials and Methods: A double-blind, parallel, two arm interventional study was conducted among 120 school children from 2 schools, aged 12-year in Pune. The study group received an intervention of supervised toothbrushing and reinforcement sessions for 30 days using intra-oral camera. The control group received only supervised toothbrushing. Evaluation for plaque control was performed at the end of 30 days, 3 months, 6 months, and 12 months. Analysis of co-variance was used to find the intergroup difference at different time intervals. Analysis of variance was used to find the intragroup differences of the plaque scores. Post hoc Bonferroni test was used to find the pairwise changes in plaque scores between different time intervals. Results: In the study group, the mean plaque score was reduced to a significant extent from baseline to 30 days and 3 months (P < 0.05) and then the plaque score remained stable until the end of 12 months. While in the control group, the plaque score increased compared to baseline. There was a statistically significant difference between the mean plaque scores of study and control group at each time interval (P < 0.05). Conclusion: Intra-oral camera can be effectively used as a reinforcement tool in supervised toothbrushing program at school for achieving higher plaque reduction.

National supervised toothbrushing programme in Scotland, 1986–2009: trends over time, reduction in inequality, and cost analysis

BackgroundDental decay is one of the most common diseases of childhood. In the 1990s Scottish children had among the worst rates of dental decay in the UK and Europe. We aimed to assess the association between the roll-out of nursery toothbrushing within the national Childsmile programme and a reduction in dental decay in 5-year-old children and to assess cost savings. MethodsThe intervention was supervised toothbrushing in nurseries measured as the percentage of nurseries participating in all Scottish health boards. The endpoint was mean d3 mft (number of teeth decayed into the dentine, missing, or filled) in 99 071 children aged 5 years, covering 7–25% of the population, who participated in multiple cross-sectional dental epidemiology surveys in 1987–2009 (conducted every 2 years in every health board). Estimated costs of the nursery toothbrushing programme in 2011 were requested from all health boards. Unit costs of filled, extracted, and decayed teeth were calculated. The total costs associated with actual and anticipated dental treatments were estimated for 1999–2009. These costs were based on the unit costs and on data from the dental epidemiology surveys and then extrapolated to the population level. Savings were calculated for the subsequent years in comparison with the reference 2001 dental treatment costs. FindingsMean d3mft in years −2 to 0 (relative to that in toothbrushing start-up year 0) was 3·06, reducing to 2·07 in years 10 to 12 (mean difference −0·99, 95% CI −1·08 to −0·90; p<0·0001). This improvement was greater for children in the most deprived areas (−1·71, −1·93 to −1·49; p<0·0001) than for children in the most affluent areas (−0·43, −0·60 to −0·25; p<0·0001). The uptake of toothbrushing correlated with the decline in d3mft (correlation −0·64, p=0·011). The estimated cost of the nursery toothbrushing programme in Scotland was £1 762 621 per year. The estimated savings ranged from £1 217 255 in 2003 (13·9% of costs in 2001) to £4 731 097 in 2009 (54·0%). InterpretationAn improvement and reduction in inequalities in the dental health of 5-year-old children was detected and was associated with the uptake of nursery toothbrushing. The costs associated with the actual and anticipated dental treatments for 5-year-old children decreased over time. In the eighth year of the toothbrushing programme the savings were more than two and a half times the costs of the programme implementation. FundingChildsmile is funded by the Scottish Government. Dental epidemiology surveys data collections were funded by the National Health Service.

National supervised toothbrushing programme in Scotland 1986-2009: trends over time, reduction in inequality and cost analysis

Background Dental decay is one of the most common diseases of childhood. We aimed to assess the association between the roll-out of the nursery toothbrushing component of the national Childsmile programme and a reduction in dental decay in five-year-old children and to examine cost savings. Methods The intervention was supervised toothbrushing in nurseries measured as the percentage of nurseries participating in health boards. The endpoint was mean d3mft (number of teeth decayed into the dentine, missing, or filled) in 99 071 five-year-old children, covering …

Custo-efetividade da escovação dental supervisionada convencional e modificada na prevenção da cárie em molares permanentes de crianças de 5 anos de idade

The cost-effectiveness of a modified supervised toothbrushing program was compared to a conventional program. A total of 284 five-year-old children presenting at least one permanent molar with emerged/sound occlusal surface participated. In the control group, oral health education and dental plaque dying followed by toothbrushing with fluoride dentifrice was carried outfour times per year. With the test group, children also underwent professional cross-brushing on surfaces of first permanent molar rendered by a dental assistant five times per year. Enamel/dentin caries were recorded on buccal, occlusal and lingual surfaces of permanent molars for a period of 18 months. The incidence density (ID) ratio was estimated using Poisson's regression model. The ID was 50% lower among boys in the test group (p = 0.016). The cost of the modified program was US$ 1.79 per capita. The marginal cost-effectiveness ratio among boys was US$ 6.30 per avoided carie. The modified supervised toothbrushing program was shown to be cost-effective in the case of boys.