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...

“Tan's Dent-Card Qr Model Website Based” as an Effort to Improve Teeth Brushing Behavior and Dental Hygiene Status Primary School Children

Background: Children aged 10-12 years have a very high rate of tooth decay at 57.6% with a mean (DMF-T) of 4.8. This is caused by one of the influencing factors, namely the low level of behavior in maintaining dental hygiene, as evidenced by the results of the 2019 Semarang City health data, that 86.7% of elementary school children do not have good tooth brushing behavior. The achievement of the new joint tooth brushing program is 47.8%, so innovation is needed in changing tooth brushing behavior, namely through the "Tan's Dent-Card QR Website Based Model" which is expected to improve tooth brushing behavior and the dental hygiene status of elementary school children. Research purposes:Producing a "Website Based Tan's Dent-Card QR Model" that is effective and feasible to implement to improve tooth brushing behavior and the dental hygiene status of elementary school children. Method : The method used in this research is Research and Development (R&D) with 5 research stages, namely needs identification, design and build, expert validation, feasibility test 1, and feasibility test 2. This research uses a pre-experimental design with a one- group pre-post- test. The sampling technique was purposive sampling consisting of 30 elementary school children aged 10-12 years who were given intervention for 14 days. Results: The validity results of the "Tan's Dent-Card QR Website-Based Model" show a value of p=0.000, which means this model is suitable for use to improve the behavior and dental hygiene status of elementary school children. “Tan's Dent-Card QR Website-Based Model” was also effective in enhancing tooth brushing behavior and dental hygiene status (p=0.000). In feasibility test 2, the result was p=0.000, which means the model is suitable for independent use by elementary school children aged 10-12 years. Conclusion: "Tan's Dent- Card QR Website-Based Model" is effective and ideal for use as an effort to improve tooth brushing behavior and the dental hygiene status of elementary school children.

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.

A Cluster Randomised Controlled Trial of a Targeted Distributed Toothpaste and Toothbrushing Programme

Plain Language SummaryThe study wanted to explore if giving toothbrushes and toothpaste, regularly, to families with children at high risk for developing tooth decay could reduce the number of referrals for tooth extractions under general anaesthetic. The study randomly assigned families to receiving either the toothbrush/toothpaste intervention or standard care (a control group). Families were invited to take part if they had a child aged 3–10, who had previously had tooth extractions under general anaesthetic, when attending hospitals in the North West of England. The study looked at whether any child within the family was then referred for a tooth extraction under general anaesthesia during the next 2 years, after consent. A total of 961 families took part, 482 families received the intervention and 479 families acted as the control. Analysis showed no difference between the groups in the number referred for a tooth extraction under general anaesthetic. In the group that received the intervention, 9% of children were referred, while in the group that received standard care, 7% of children were referred. While the study did not show the intervention reduced the number of children referred for a dental general anaesthetics, it did show focussing on families with children who had previously undergone tooth extraction in hospital, to attempt to reduce numbers referred in the future, is the correct approach. The study’s findings provide valuable insights for policymakers, local authorities, and commissioners. It can help them understand the occurrence of repeat DGAs within families and the ongoing need for interventions to address this issue.

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.

Development, implementation and evaluation of a dental hygienist supported daily toothbrushing programme in Irish pre-schools: A single-case experimental design.

Many pre-school children in Ireland experience dental caries in their primary dentition. The rate of dental caries varies, impacted by the levels of fluoride in the water and socio-economic status (18%-55%). This article reports on a novel initiative in which dental hygienists (DHs) supported pre-school teachers (PST) to implement a toothbrushing programme for children attending pre-schools in Ireland. It was hypothesised that such an initiative would create an environment in pre-schools that would improve the oral hygiene skills and habits of children and increase the oral health knowledge of parents and PST. A storybook (Brushing our teeth with Brush Bunny), a toothbrushing song and information leaflets were developed. DHs were provided with specific online training for the programme. The resources, including toothbrushes and toothpastes, were delivered to the pre-schools and training was provided by the DHs to the PST to prepare for and implement daily toothbrushing sessions. The standards for the toothbrushing programme followed the ChildSmile© programme. Before and after questionnaires gathered quantitative and qualitative data from the parents and PST. The toothbrushing programme was implemented by PST for 3 months. Sixteen DHs and PST from 19 classes in 17 schools successfully delivered the programme to 331 children, and 227 parents completed both pre- and post-questionnaires. Poor baseline knowledge in relation to the 'spit don't rinse' message increased from 29% to 48%. However, there was no improvement in awareness of the benefits of fluoride in toothpaste. Awareness of the best brushing routines in relation to frequency and length was good at baseline and remained so after the programme. Most parents (90%) felt the programme had impacted positively on their child's toothbrushing routine. This experimental study suggests that the logistics of implementing a daily toothbrushing routine to improve the oral hygiene skills and habits of pre-school children are possible in Irish pre-school settings when PST are supported by DHs. Parents' oral health knowledge may be improved, and it may impact positively on the children's daily toothbrushing routine. A larger study is required to confirm these findings.

Enabling educator oral health literacy: An impetus for oral health promotion in early childhood development.

This study reports on the process evaluation of an oral health promotion intervention for educators (principals and teachers) at early childhood development (ECD) centres within a low-socioeconomic community in South Africa. This approach was based on the premise that oral health literacy plays a significant role in shaping personal health and serves as an impetus to influence change in others. Using a cross-sectional, descriptive study design, 91 educators participated in the oral health intervention as part of their 1-year ECD training programme. The pre-test questionnaire measured perceived dental status, oral health-related knowledge, attitudes and practices and impact of oral health problems on oral health-related quality of life (OHRQoL). The post-test questionnaire evaluated the usefulness of the oral health workshop to participants, intentions for personal change as well as for the inclusion of oral health in their ECD centre programme. Participants reported: having their natural teeth (80%), being happy with their mouth (56.2%), having oral problems (34%), inadequate oral hygiene practices (43%), dental visits when symptomatic (74%), a compromised OHRQoL and inadequate knowledge of oral problems experienced. Oral health promotion activities at ECD centres were limited, with only 34% reporting on toothbrushing programmes. Following the intervention, participants reported positively on aspects such as, the value of the workshop for themselves and their ECD centres, intentions for personal change to hygiene practices (56%), dietary practices (76%) and dental visits (63%). The incorporation of oral health education in their ECD centres was mentioned by most educators. Daily toothbrushing was noted by up to 40% while some highlighted their engagement with parents. Building oral health literacy among educators has the potential for personal change and serves as an impetus to introduce oral health promotion programmes at ECD centres. The findings may be used to advocate for oral health partnerships with established community-based structures to increase access to oral care in ECD centres in underserved communities.

A national survey of supervised toothbrushing programmes in England.

Introduction Supervised toothbrushing programmes (STPs) are a cost-effective public health intervention, reducing tooth decay and health inequalities in children. However, the uptake of STPs in England is unknown. This study aimed to establish the current provision of STPs across England and summarise the barriers and facilitators to their implementation.Methods An online survey was sent to dental public health consultants, local authority (LA) oral health leads, and public health practitioners across England. Quantitative data were analysed using descriptive statistics. Barriers and facilitators were analysed using the Consolidated Framework for Implementation Research.Results Information was received for 141 LAs across England. Approximately half implemented an STP (n = 68/141). Most STPs were commissioned by LAs (n = 44/68) and adopted a targeted approach (n = 54/68). Barriers to implementation were: 1) acquiring funding; 2) poor communication and engagement between LAs, oral health providers and settings; 3) oral health not a priority; 4) logistically challenging to implement; and 5) lack of capacity. Facilitators were: 1) an integrated and mandated public health approach; 2) collaboration and ongoing support between LAs, oral health providers, and settings; 3) clarity of guidance; 4) flexible approach to delivery; 5) adequate available resources; and 6) ownership and empowerment of setting staff.Conclusion The current provision of STPs is varied, and although there are challenges to their implementation, there are also areas of good practice where these challenges have been overcome.

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.

Child oral health and preventive dental service access among children with intellectual disabilities, autism and other educational additional support needs: A population-based record linkage cohort study.

Inequalities in child oral health are a global challenge and the intersection of socioeconomic factors with educational additional support needs (ASN), including children with intellectual disabilities or autism, have thus far received limited attention in relatively small clinical studies. We aimed to address this evidence gap by investigating oral health and access to preventive dental services among children with ASN compared to the general child population. Cohort study linking data from six Scotland-wide health and education databases compared: dental caries experience and tooth extraction via general anaesthetic; receipt of school-based dental inspection; access to primary care and hospital dental services; and access to the Childsmile national oral health improvement programme between children with a range of ASN (intellectual disabilities, autism, social and other) and their peers for the school years 2016/17-2018/19 (n=166 781). Children with any ASN had higher rates of caries experience than those with no ASN, however, after adjustment for socioeconomic deprivation, sex, year, and school type only those with a social or other ASN remained at increased risk. Rates of tooth extraction under general anaesthesia in hospital were higher among children with intellectual disabilities (aRR=1.67;95% CI=[1.16-2.37]). School-based dental inspection access improved for children with intellectual disability and/or autism from 2016/17 onwards, although higher rates of child refusal on the day were observed in these groups (no ASN refusal: 5.4%; intellectual disability: 35.8%; autism: 40.3%). Children with any ASN were less likely to attend primary dental-care regularly, and in those who attended, children with intellectual disability or autism were less likely than their peers to receive prevention (fluoride varnish, oral-hygiene instruction, or dietary advice). Childsmile nursery-supervised toothbrushing programme access among children with any ASN was similar to children with no ASN and children with intellectual disability (aRR=1.27;95% CI=[1.12-1.45]) or autism (aRR=1.32;95% CI=[1.19-1.45]) were more likely to receive support from Childsmile dental health support worker. We have identified inequalities in oral health and dental care for children with different ASN in Scotland with both a greater burden of disease among some groups and higher complexity of care; compounded by reduced and variable access to preventive dental services. Further efforts are needed to develop and improve preventive care pathways for children with ASN and integrate oral health to wider healthcare systems for these children to mitigate against oral health inequalities.

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.

The environmental impact of community caries prevention - part 2: toothbrushing programmes

Introduction Community-level caries prevention programmes includes supervised toothbrushing in schools and the provision of toothbrushes and toothpaste. The environmental impact of these interventions is an important factor to consider when commissioning these services.Materials and methods A comparative life cycle assessment (LCA) was conducted to quantify the environmental impact of a five-year-old child receiving one of two toothbrushing programmes over a one-year period; supervised toothbrushing in school, or the provision of toothbrushes and toothpaste.Results Supervised toothbrushing had a lower environmental impact than provision of toothbrushes and toothpaste in all 16 impact categories measured. The water use needed for children to brush their teeth was the greatest contributing factor to the provision of toothbrushes and toothpaste, accounting for an average of 48.65% of the impact results.Discussion All community-level caries prevention programmes have an associated environmental cost. LCA is one way to quantify the environmental impact of healthcare services and can be used along with cost and clinical effectives data to inform public healthcare policy. Organisations responsible for these programmes could use the results of this study to consider ways to reduce the environmental impact of their services.

An Evaluation of a Supervised School Tooth Brushing Program on Plaque and Gingival Scores of a Group of Rural Nigerian Primary School Children

Aim: The study assessed the Plaque and Gingival scores of rural Nigerian school children before and after supervised school brushing program.
 Methods: This was an interventional study of 96 children aged 6 to 12 years in selected rural primary schools in Enugu, Nigeria. Data on sex, age, type of school, Plaque score and Gingival score were collected. Data was analyzed using SPSS version 20 and student's t- test was used to compare means. P<0.05 was considered significant.
 Results: There were 45(46.9%) male and 51(53.1%) female participants and their mean age was 8.45±1.83years. Forty nine(51.0%) children attended private school while 47(49.0%) attended public school. Only 10(10.4%) had good Plaque score while 8(8.3%) had healthy gingiva. Before intervention, 83(86.5%) children used tooth brush as cleansing tool, 7(7.3%) children brushed twice a day while after the intervention, 96(100.0%) children used toothbrush and 39(40.6%) children brushed twice a day. Also, before intervention, there was significant association between Plaque scores (p=0.012), Gingival scores (p<0.001) and type of school attended. The mean plaque score for the school children before and after intervention was 2.17±0.57, and 1.28±0.49 respectively and the change was statistically significant (p=0.01). The mean gingival score before and after intervention was 1.23±0.67 and 0.31±0.49 respectively and the change was also statistically significant (p<0.001).
 Conclusion: Children who attended private schools had better Plaque and Gingival scores than those who attended public schools. Supervised school tooth brushing program improved the plaque and gingival scores of rural primary school children in the study population.
 Authors
 S P Ozoemena 1, N K Onyejaka 2, E F Ani 1, O F Eboh 3, E O Odo 4

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.

Prioritising child health and maternity evidence-based interventions or service models: a stakeholder-driven process

AimA UK programme, led by the National Institute for Health Research (NIHR) (https://www.nihr.ac.uk) and coordinated by Applied Research Collaborations (ARC), (https://www.nihr.ac.uk/explore-nihr/support/collaborating-in-applied-health-research.htm) aimed to identify and select evidence-based, implementation-ready service innovations for evaluation. The programme focused on seven areas of health provision. We report on a prioritisation process designed to identify and assess innovations in one of these areas: child and maternal health (CH&M).MethodsWe developed a three-stage, online, stakeholder driven process to 1) identify, 2) assess and prioritise and 3) select evidence-based interventions or service models, using crowdsourcing to identify projects and the APEASE criteria to assess and select projects. A brief evidence review was conducted for all initial suggestions to identify those with the largest evidence-base to take forward for ranking by stakeholders. Stakeholder workshops considered and ranked these suggestions using the APEASE criteria. We then conducted in-depth evidence reviews for the highest ranked suggestions. The Project Management Group and Advisory Board used these reviews and the APEASE criteria to select the final projects.ResultsWe received 32 initial suggestions from a range of clinicians, practitioners and researchers. Fourteen of the most evidence-based suggestions were considered and ranked at four themed stakeholder workshops. Nine suggestions were ranked for further in-depth evidence review and a final four projects were selected for implementation evaluation using the APEASE criteria. These were: 1. Maternal Mental Health Services Multidisciplinary Teams 2. Early years tooth brushing programme 3. Trauma-focused CBT for young people in care and 4. Independent Domestic Violence Advisors in maternity settings. Feedback from participants suggested that having public representatives participating in all stakeholder meetings, rather than being consulted separately, focused discussions clearly on patient benefit rather than research aims.ConclusionsThe stakeholder-driven process achieved its aim of identifying, prioritising and assessing and selecting, evidence-based projects for wider implementation and evaluation. The concurrent process could be adapted by other researchers or policy makers.

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.

A tailored tooth brushing program to control plaque accumulation and gingivitis among orphan children: A randomized trial

Objectives: Poor oral hygiene among children is major cause of gingivitis, caries, and especially orphans constitute socially disadvantaged group. The objective of the study was to assess the efficacy of a tailored tooth brushing program to improve supragingival plaque control and gingival health among 13–17-year-old orphan children in Chennai city over a period of 21 days. Materials and Methods: A double-blind parallel, controlled clinical trial was conducted among 60 orphan children (28 males and 32 females) with mean age of 15.24 years. Dental plaque was assessed using the Turesky modification of Quigley-Hein index; gingival inflammation was assessed using gingival index at initial visit and after 14 and 21 days. Subjects were randomly allocated into one of two groups (study – audiovisual and individual demonstration of brushing technique with reinforcement at 14 days follow-up/control – only individual demonstration) and instructed to brush twice daily using modified bass technique with the toothbrush and paste provided throughout the trial. Results: The children who had audiovisual, individual demonstrations of brushing technique exhibited significantly superior total oral plaque control and significant reduction in the gingival inflammation at the end of 21 days trial (P < 0.05). The study group participants reported improved compliance and motivation to practice modified bass technique because of the reinforcement. Conclusion: The children who had both audiovisual and individual demonstration exhibited superior total plaque control and gingival health compared to control group and continued to demonstrate modified bass technique without any reinforcement at the end of 21 days trial.

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.

Revitalizing School Dental Health Effort through ?Model 222? as a Strategy to Achieve Caries-Free Indonesia 2030

The tooth brushing program together is a self-preservation effort for elementary school children. The tooth brushing program that has been implemented in schools has not been able to change the tooth brushing behaviour of elementary school students, indicated by the value of OHI-S = 1.3; DMF-T = 1.09, def-t = 1.78, indicating the condition is below the national target 2010. Improvements in the behavioural aspects need to be done to improve the dental health status of elementary school students. One of the changes in behaviour influenced by information. Information will be stored as much as 20% if delivered through visuals, 50% if delivered through audio-visual media and 70% if implemented in real practice. to generate alternative changes in tooth brushing behaviour through brushing teeth audio-visual in elementary school students and analyse their effectiveness. Research and Development (R&D) with stages: information gathering, design, expert validation and revision as well as testing (using the Quasi-Experimental Control Group Pre-test and Post-test Design method). The test sample was divided into two, the 222 (intervention), and brushing teeth 21 days (control) group. The results of expert validity showed that the 222 was feasible as an effort to form the teeth brushing behaviour of elementary school children (p = 0.020). Model 222 was more effective in increasing teacher knowledge, attitudes and skills than brushing teeth 21 days (control) p = (0,002). The 222 was more effective in increasing the knowledge, attitudes and skills of dokter kecil (elementary school student child doctor) than brushing teeth 21 days (control) p-value 0.05 but the mean value in the intervention group was bigger. The 222 was more effective in increasing knowledge, attitudes, skills, and reducing debris scores in elementary school students compared to the 21 days program (control) p = 0.000. from the results of the research, it can be concluded that the model 222” effectively shaped the teeth brushing behaviour of teachers, elementary school student child doctor and the skills of brushing teeth and dental hygiene of students at school.