Toothbrushing Programme Research Articles

Effectiveness of the bucco-lingual technique within a school-based supervised toothbrushing program on preventing caries: a randomized controlled trial

BackgroundSupervised toothbrushing programs using fluoride dentifrice have reduced caries increment. However there is no information about the effectiveness of the professional cross-brushing technique within a community intervention. The aim was to assess if the bucco-lingual technique can increase the effectiveness of a school-based supervised toothbrushing program on preventing caries.MethodsA randomized double-blinded controlled community intervention trial to be analyzed at an individual level was conducted in a Brazilian low-income fluoridated area. Six preschools were randomly assigned to the test and control groups and 284 five-year-old children presenting at least one permanent molar with emerged/sound occlusal surface participated. In control group, oral health education and dental plaque dying followed by toothbrushing with fluoride dentifrice supervised directly by a dental assistant, was developed four times per year. At the remaining school days the children brushed their teeth under indirect supervising of the teachers. In test group, children also underwent a professional cross-brushing on surfaces of first permanent molar rendered by a specially trained dental assistant five times per year. Enamel and dentin caries were recorded on buccal, occlusal and lingual surfaces of permanent molars during 18-month follow-up. Exposure time of surfaces was calculated and incidence density ratio was estimated using Poisson regression model.ResultsDifference of 21.6 lesions per 1,000 children between control and test groups was observed. Among boys whose caries risk was higher compared to girls, incidence density was 50% lower in test group (p = 0.016).ConclusionModified program was effective among the boys. It is licit to project a relevant effect in a larger period suggesting in a broader population substantial reduction of dental care needs.Trial registrationISRCTN18548869.

Improving toothbrushing behaviour in an institution for the disabled in Lisbon, Portugal

This pilot study evaluates changes in toothbrushing capability among 135 disabled individuals enrolled in an institution for the disabled. Direct observation of toothbrushing behaviour of the disabled was used to recommend changes required in daily toothbrushing programme. The simplified Debris Index (DI-S) was used to compare plaque removal outcomes over a 3-month period. At baseline, of the 135 participants, 114 completed a routine toothbrushing procedure and 10 (8.8%) of them brushed all tooth surfaces. At the end of the study, 52 (48.6%) brushed all tooth surfaces. The mean difference between the initial and final DI-S was 0.62 (P < 0.01). Toothbrushing was not a common procedure at this institution. This study shows that it is possible to implement daily oral hygiene maintenance in disabled individuals. Furthermore, most participants will adopt more efficient toothbrushing behaviour when monitored daily.

Lack of Oral Care Policies in Toronto Daycares

Currently, there is a deficit of information on policies regarding oral hygiene practices in Toronto daycares. It is unknown if any tooth-brushing programs are in existence and if children are permitted to follow professional advice on oral hygiene. The main objectives of this investigation were to a) determine the prevalence of oral care policies in daycares and b) examine the availability of resources. Telephone interviews were conducted with daycare supervisors using a pretested questionnaire. Summary statistics and the chi-square test were used to analyze the results. Two hundred forty-nine questionnaires were completed (response rate of 99.6 percent), representing 38 percent of the total daycare population (650) in Toronto. Eighty-three percent did not have a policy on oral care and 11 percent would not cede to requests from parents or medical professionals to brush teeth. However, 50 daycares indicated that their centers used to have a tooth-brushing program, and most (79 percent) were open to establishing an oral care policy. Fifteen percent reported not having proper sinks for tooth brushing. Many daycares do not have a policy regarding oral hygiene. A policy that encourages and provides guidance on safe tooth-brushing procedures is needed and may improve the oral health of preschool children.

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.

Teacher-supervised toothbrushing with fluoride has little effect on dental caries prevention

Jackson RJ, Newman HN, Smart GJ, Stokes E, Hogan JI, Brown C, et al. The effects of a supervised toothbrushing programme on the caries increment of primary school children, initially aged 5-6 years. Caries Res 2005;39(2):108-15. 2b Does teacher-supervised toothbrushing with 1450 ppm fluoride toothpaste during the school term decrease caries incidence in primary-school children? Associations from the sugar industry Randomized controlled trial

The Effects of a Supervised Toothbrushing Programme on the Caries Increment of Primary School Children, Initially Aged 5–6 Years

Children in the London Boroughs of Kensington, Chelsea and Westminster have one of the highest levels of caries in England and Wales. In 1997/98, the mean dmft for 5-year-old children was 2.83 with only 45.9% of the children being caries free. The aim of this study was to determine whether teacher-supervised toothbrushing, once a day, at school, during term time, with commercial toothpaste containing 1,450 ppm fluoride, could reduce dental caries in primary school children when compared with children from the same community who did not receive this intervention. A total of 517 children (mean age 5.63 years) were recruited for the study. Class teachers were trained individually by the same dental hygienist in an appropriate toothbrushing technique for young children. Children in the intervention group brushed once a day at school. All examinations were by visual assessment only. All teeth present were assessed using the BASCD criteria. For children in the intervention group, the overall caries increment (2.60) was significantly less (10.9%; p < 0.001) than for children in the non-intervention group (2.92). Among different tooth surfaces, the difference in caries increment between the intervention group (0.78) and the non-intervention group (1.03) was greatest for the proximal surfaces (21.4%; p < 0.01). In conclusion, this study suggests that a programme of daily teacher-supervised toothbrushing with fluoride toothpaste can be effectively targeted into socially deprived communities and a significant reduction in dental caries can thereby be achieved especially among caries-susceptible children.

Targeted supervised toothbrushing reduces caries increment

Design Randomised Controlled TrialIntervention Supervised toothbrushing on schooldays with 1000 ppm fluoride toothpaste with toothpaste and brushes supplied for home use one class in each school was allocated to intervention and compared to a within-school control over a 2-year period. Dental examinations were performed by a single-blinded examiner at 6-monthly intervals.Outcome measure Visual examinations of caries at D1 level (all visible cavitated and non-cavitated lesions in enamel and dentine). Approximal and occlusal surfaces were also examined using Fibre-optic transillumination (FOTI).Results 86% of those examined at baseline completed study. At baseline children in both groups had similar levels of oral cleanliness; however, children from the more deprived areas had poorer levels of cleanliness. There was no significant difference between the groups in the caries increment in the deciduous teeth after 2 years. Dental immaturity had a significant effect on subsequent caries development. After 2 years there was a significantly less caries in the permanent molars in the intervention group, with 32% fewer D1 lesions (95% CI 4–60%) and 56% fewer D3 lesions (95% CI 13–101%).Conclusions A targeted supervised toothbrushing programme with support for home use resulted in a significant reduction in caries increment.

Supervised toothbrushing and oral health education program in Kuwait for children and young adults with Down syndrome.

The authors report on the effectiveness of a school-based, supervised toothbrushing program among a group of 112 children with Down syndrome in Kuwait. The study involved 45 boys and 67 girls, who ranged in age from 11-22 years (mean, 14.8 years). The participants had moderate mental retardation and attended one of two special needs schools. Plaque was scored according to the Silness and Löe plaque index and gingivitis according to the Löe and Silness gingival index. Supervised toothbrushing and dental health education sessions were conducted twice a week. The program was evaluated at the end of three months. The mean plaque score decreased from 1.93 to 0.95 (p < 0.001), and the mean gingival score from 2.00 to 0.83 (p < 0.001). This three-month supervised toothbrushing program was effective in reducing plaque and gingivitis scores, but the key to long-term success of the program is sustaining the children's motivation to make oral hygiene a part of their daily life.

A Randomised Controlled Trial of the Efficacy of Supervised Toothbrushing in High-Caries-Risk Children

Scottish children have one of the highest levels of caries experience in Europe. Only 33% of 5-year-old children in Dundee who developed caries in their first permanent molars by 7 brushed their teeth twice a day. High-caries-risk children should benefit if they brush more often with fluoridated toothpaste. The aim of this clinical trial was to determine the reduction in 2-year caries increment that can be achieved by daily supervised toothbrushing on school-days with a toothpaste containing 1,000 ppm fluoride (as sodium monofluorophosphate) and 0.13% calcium glycerophosphate, combined with recommended daily home use, compared to a control group involving no intervention other than 6-monthly clinical examinations. Five hundred and thirty-four children, mean age 5.3, in schools in deprived areas of Tayside were recruited. Each school had two parallel classes, one randomly selected to be the brushing class and the other, the control. Local mothers were trained as toothbrushing supervisors. Children brushed on school-days and received home supplies. A single examiner undertook 6-monthly examinations recording plaque, caries (D₁ level), and used FOTI to supplement the visual caries examination. For children in the brushing classes, the 2-year mean caries increment on first permanent molars was 0.81 at D₁ and 0.21 at D₃ compared to 1.19 and 0.48 for children in the control classes (significant reductions of 32% at D₁ and 56% at D₃). In conclusion, high-caries-risk children have been shown to have significantly less caries after participating in a supervised toothbrushing programme with a fluoridated toothpaste.

Dental health knowledge of Chinese kindergarten teachers

When developing dental health programmes for pre-school children involvement of kindergarten teachers must be considered as important. It becomes critical to assess the teachers' dental health knowledge and attitudes, because they will exert influence on the children and thus on the programme outcome. The purpose of the present study was to assess possible changes in the dental visit habits and the dental health knowledge of Chinese kindergarten teachers prior to their involvement in a kindergarten-based daily toothbrushing programme and after they had received dental health education from dental health professionals. Self-completed questionnaires were collected from two groups of kindergarten teachers of which one group received dental health education, whereas the other did not receive any information. The teachers were similar in age, education, experience and responsibilities. No difference in the dental visit pattern was found between the groups, but statistically significantly higher dental health knowledge was shown in the group who had received dental health education. The increase in the dental health knowledge was attributed to the influence from the dental health education programme. The results are considered important for the further development of dental health education in the Chinese kindergartens.

An institutional staff training and self-management program for developing multiple self-care skills in severely/profoundly retarded individuals.

Although considerable attention has been given to the development of institutional staff training and management programs, the generalized effects of such programs on staff and resident behavior have seldom been examined. This study evaluated a program for teaching institutional staff behavioral training and self-management skills during self-care teaching sessions with severely and profoundly retarded residents. Following baseline observations in three self-care situations (toothbrushing, haircombing, handwashing), four direct care staff were sequentially taught to use verbal instruction, physical guidance, and contingent reinforcement in the toothbrushing program. During maintenance, staff were simultaneously taught to record, graph, and evaluate resident and their own behavior in the toothbrushing sessions. Staff were taught use of the training and self-management skills through a sequence of written instructions, videotaped and live modeling, rehearsal, and videotaped feedback. Observer presence and experimenter supervision were gradually decreased during the maintenance condition. Results indicated that during training and maintenance staff: (a) learned to use the training skills appropriately and consistently in the example situation (toothbrushing); (b) applied the skills in the generalization situations (haircombing and handwashing); and thereafter (c) maintained consistent and appropriate use of the skills with infrequent supervision. In addition, important changes in retarded residents' independent self-care responding occurred as staff training skills developed. Results are discussed in terms of their implications for future research and continued development of effective staff training and management programs.

Caries prevalence in Norwegian recruits 5-7 years after discontinuation of supervised fluoride toothbrushing programmes.

The purpose of this study was to determine whether or not supervised fluoride toothbrushing programmes at school gave reduced caries prevalence among former participants 5–7 years after discontinuation. The 121 male military recruits of group A had brushed their teeth with an 0.5–1% sodium fluoride solution 3–5 times per year for at least 6 years, while the 64 subjects of group B had not. There were on average 3–4 fewer DMFS in group A than in group B. The results suggest some long-term benefit of limited practical importance, but alternative explanations for the observed difference cannot be precluded.