Daily supervised toothbrushing in kindergartens: second and third years of "Smiles" oral health promotion program among preschool children.

Objectives: To describe the second and third years of "Smiles", with the objective of demonstrating feasible, practical, and realistic aspects of enhancement of daily tooth brushing skills and integration of a supportive environment of daily-supervised tooth brushing in kindergartens.

Methods and materials: Thirty-six out of 180 kindergartens (20%) across Israel, which participated at the first year of the program, took part at the second and third years of the program. Eighteen kindergartens served as study group with a supervised tooth-brushing routine, and 18 kindergartens served as controls without supervised tooth-brushing routine. Tooth-brushing skills recorded by Simmons index at base line among 3-year-old children, after one year and finally after two years among 5-year-old children. ECC (early childhood caries) evaluated by deft index among 5-year-old childrenat the end of the program. Statistical analysis included Chi-square test, Mann-Whitney test, and aGeneral Linear Model.

Results: One thousand and twenty eight (1,028) preschool children (503 of them in the daily toothbrushing kindergartens), their parents, and their educational staff took part in the program. The average number of brushing days per week at the daily-supervised tooth brushing kindergartens met the desired threshold of 3 days a week. The average daily percentage of preschool children brushing their teeth exceeded 80%. High levels of program cooperation and satisfaction (>80%) were recorded. Children in tooth brushing kindergartens demonstrated statistically significant three fold higher levels of tooth brushing skills improvement as compared to children in control kindergartens (33% as compared to 11%, p<0.001 respectively). Being in the Jewish sector and participation in daily tooth brushing program revealed as predictors of low dft scores among 5 year old children (OR=0.320, OR=0.552, p<0.001 respectively).

Conclusion: The successful performance and positive atmosphere of "Smiles" in all its levels; the organization, the staff, the parents, and the children, made this endeavor an example of a large-scale demonstration program with practical and realistic enhancement of daily tooth brushing skills and integration of daily-supervised tooth brushing among preschool children in kindergartens. Following the introduction of "Smiles" program results to the Ministry of Health in 2017, this service has turn to a fait accompli as part of the dental health services for pupils in Israel in 2018.