The Impact of a 21day School Brushing Intervention on the Knowledge, Behaviour and Oral Health of School Children
Condition: Dental Plaque; Behavior; Behavior, Health
MeSH terms: Dental Plaque
Study type: Interventional

Summary: 
      In this study we aim to study the effectiveness of a specially designed 21 day Brush Day and
      Night programme for school children aged 6-9 which aims to establish the habit of twice a day
      toothbrushing for oral health.

      The 21 day programme is led primarily by teachers with support from a oral health care
      professional.

      Schools will be recruited in Indonesia and Nigeria to take part in the study. Half of the
      schools will run the 21 day programme with their children in school grades 1 to 3, half will
      act as a control.
    

Detailed description: 
      Background The World Health Organization reports that dental cavities affect 60-90% of
      children globally. FDI World Dental Federation and Unilever Oral Care have developed public
      health programmes to improve brushing habits over their 12-year partnership. The last of
      these (Phase III) named Brush Day & Night aimed to educate children in brushing twice daily
      with a fluoride toothpaste and gave useful information for a new project, Phase IV. The
      21-day Brush Day & Night programme is an intense education activity designed to establish the
      habit of brushing day and night with a fluoride toothpaste. The programme involves daily
      brushing instruction and includes free toothpaste and toothbrushes.

      Objective In Phase IV of the partnership, the aim is to evaluate the impact on the knowledge,
      behaviour and toothbrushing habits in schoolchildren aged 6-9 years old, after a 21-day
      school programme and compare with baseline and a control group. The enduring nature of the
      programme will be determined by the inclusion of 8 and 24-week time points.

      Methods The study is a two-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 6-9 years old, 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 (OHIs)
      and Decayed Missing and Filled Teeth (DMFT) 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 OHIs assessment are repeated after the 21 days programme is completed
      and then again at 8 weeks 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 to oral health and toothbrushing routine
      at each of the four times points (baseline, 21-day, 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.

      Results:

      The 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. This 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.

      Conclusions:

      The Investigators expect to collect all the data during 2019 and publish findings from the
      study by Q3 2020.
    

Intervention name(s): 21 day Brush Day and Night school programme
Intervention type(s): Behavioral
Intervention description(s): Children participating in the 21 day Brush Day and Night school programme are provided with toothpaste and a toothbrush each and enjoy brushing instruction, supervised brushing, and the singing of songs to facilitate learn the importance of brushing day and night, and stickers and calendars to track progress. A celebration is held at the end of the programme with certificates and rewards. The programme is supported by colourful and attractive materials with bespoke cartoon characters. Parents are provided with educational leaflets.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This study is a two-arm, parallel, stratified, cluster randomised trial. Clusters in this study are infant / junior schools in Indonesia and Nigeria. Ten schools in each country will be recruited. Schools will be matched into pairs by location (urban, semi-urban, rural) and then randomised to the 'intervention' and 'control' groups. using a randomisation table.
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Behavior; Toothbrushing; Toothpastes; Dental Caries; Education, Dental