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PubMed2003

Self-reported oral hygiene practices among adults in Denmark.

OBJECTIVES: To assess the present level of oral hygiene practices in the Danish adult population aged 16 or above, in particular to analyse how self-care practices in terms of oral hygiene habits and cleaning of dentures are affected by socio-economic factors, dental status, actual dental visiting habits, and the experience of oral health care during school years. BASIC RESEARCH DESIGN AND PARTICIPANTS: A cross-sectional study of 5802 persons, randomly sampled amongst the Danish population aged 16 years or above. Data were collected by means of personal interviews and self-administered questionnaires. The response rate was 66%. RESULTS: Toothbrushing twice-a-day was reported by 68% of the dentates while 32% brushed their teeth once-a-day or less frequent. Daily use of toothpicks was reported by 28% while daily use of dental floss was reported by 11%. Oral hygiene habits were more frequent amongst women. Toothbrushing twice-a-day was related to regular dental visits, dental care during school years, and a high level of education. Daily use of toothpicks was more common among females and older persons. Regular dental visits, having 20 or more teeth in situ, and regular dental service through school years were predictors for daily use of toothpicks. Amongst denture wearers, one-third cleaned their dentures twice-a-day. Frequency of denture cleaning was significantly associated with gender, age, number of teeth left, and educational level. CONCLUSION: Intensive population-directed strategies for oral health education should be considered in order to further improve the oral hygiene practices of the entire population.

Adolescent↗
PubMed2004

Familial and cultural perceptions and beliefs of oral hygiene and dietary practices among ethnically and socio-economicall diverse groups.

UNLABELLED: OBJECTIVE; The aim of this international study was to develop a valid and reliable psychometric measure to examine the extent to which parents' attitudes about engaging in twice-daily tooth brushing and controlling sugar snacking predict these respective behaviours in their children. A supplementary objective was to assess whether ethnic group, culture, level of deprivation or children's caries experience impact upon the relationships between oral health related behaviours, attitudes to these respective behaviours and to dental caries. CLINICAL SETTING: Nurseries, health centres and dental clinics in 17 countries. PARTICIPANTS: 2822 children aged 3 to 4 years and their parents. MAIN OUTCOME MEASURES: Dental examination of children and questionnaire to parents. RESULTS: Factor analysis identified 8 coherent attitudes towards toothbrushing, sugar snacking and childhood caries. Attitudes were significantly different in families from deprived and non-deprived backgrounds and in families of children with and without caries. Parents perception of their ability to control their children's toothbrushing and sugar snacking habits were the most significant predictor of whether or not favourable habits were reported. Some differences were found by site and ethnic group. CONCLUSIONS: This study supports the hypothesis that parental attitudes significantly impact on the establishment of habits favourable to oral health. An appreciation of the impact of cultural and ethnic diversity is important in understanding how parental attitudes to oral health vary. Further research should examine in a prospective intervention whether enhancing parenting skills is an effective route to preventing childhood caries.

Adult↗
PubMed2004

International comparisons of health inequalities in childhood dental caries.

OBJECTIVE: To undertake formative studies investigating how the experience of dental caries in young children living in diverse settings relates to familial and cultural perceptions and beliefs, oral health-related behaviour and oral microflora. PARTICIPANTS: The scientific consortium came from 27 sites in 17 countries, each site followed a common protocol. Each aimed to recruit 100 families with children aged 3 or 4 years, half from deprived backgrounds, and within deprived and non-deprived groups, half to be "caries-free" and half to have at least 3 decayed teeth. OUTCOME MEASURES: Parents completed a questionnaire, developed using psychological models, on their beliefs, attitudes and behaviours related to their child's oral health. 10% of children had plaque sampled. RESULTS: 2,822 children and families were recruited. In multivariate analyses, reported toothbrushing behaviours that doubled the odds of being caries-free were a combination of brushing before age 1, brushing twice a day and adult involvement in brushing. Analyses combining beliefs, attitudes and behaviours found that parents' perceived ability to implement regular toothbrushing into their child's daily routine was the most important predictor of whether children had caries and this factor persisted in children from disadvantaged communities. 90% of children with lactobacillus had caries. CONCLUSIONS: Parental beliefs and attitudes play a key role in moderating oral health related behaviour in young children and in determining whether they develop caries. Further research is indicated to determine whether supporting the development of parenting skills would reduce dental caries in children from disadvantaged communities independent of ethnic origin.

Adult↗
PubMedDate not supplied

Practice patterns of board-certified pediatric dentists: frequency and method of cleaning children's teeth.

PURPOSE: The purpose of this study was to assess the periodicity of the recall examination and frequency and most often used technique for cleaning children's teeth. The resulting data were compared to current scientific evidence and recommendations to determine the appropriateness of practices by board-certified pediatric dentists. METHODS: A 28-item questionnaire was mailed to the 1,034 members of the College of Diplomates of the American Board of Pediatric Dentistry residing in the United States. This report describes data pertaining to recall appointment periodicity, frequency and method of cleaning children's teeth, use of auxiliaries in prophylaxis, and instruction in oral hygiene. RESULTS: Six hundred twenty-nine surveys were returned, tabulated, and analyzed. Only 1% of dentists did not have an active recall program, 95% used a 6-month recall interval, and the remaining 5% had an interval ranging from 3 to 18 months. Hygienists were employed in 62% of pediatric dentistry practices. Pumice/rubber cup prophylaxis was employed routinely at recall by 67% of respondents; 24% reported the use of toothbrush and dental floss for cleaning; the other 9% reported no routine method for prophylaxis. The average fee for a pumice/rubber cup prophylaxis was dollar 42.55, and dollar 40.31 for a toothbrush prophylaxis. One hundred percent of pediatric dentists reported providing oral hygiene instruction for their patients. The instruction was directed to both parent and child in 97% of practices, child only in 2% of practices, and the parent only in 1% of practices. CONCLUSIONS: Recall intervals were not based on specific criteria related to individual patient needs. The majority of pediatric dentists employed the pumice/rubber cup prophylaxis method for cleaning children's teeth.

Appointments and Schedules↗
PubMed2002

Interactive simulation of the teeth cleaning process using volumetric prototypes.

In this paper, an interactive simulation system for teeth cleaning is presented. This simulation system offers assistance for optimizing design and manufacturing of new toothbrushes. Data acquisition and pre-processing techniques for the model generation are shown and the mathematical method for modelling of the elastic behaviour of the toothbrushes parts is explained. Afterwards, a new approach to collision detection based on simple volumetric prototypes is described, user interaction is discussed and results of the project are shown.

Computer Simulation↗
PubMed2003

[Evaluation of caries prevention programmes in preschool children].

The aim of the two-year study was to compare the efficacy of two caries prevention approaches in preschool children basing on oral hygiene and dentition. In addition, parents were polled in order to evaluate their attitude towards prophylaxis and treatment of caries and to obtain their opinion on the programme. The first year of the study focused on 4 and 6-year-old children in whom two preventive approaches were applied, i.e. daily toothbrushing under supervision of trained (1) teacher or (2) parents. Since the results of the second approach were unsatisfactory, approach No. 1 was adopted during the second year of study in 3, 4, 5, and 6-year-old children. All children were supplied with a low-fluoride toothpaste and the toothbrush was replaced every three months. Approach No. 1 significantly reduced Pl.I by 89% in 4-year-old children, decreased caries progression in primary and permanent dentition, and reduced the number of filled teeth. A more prominent effect of oral hygiene vs. diet on caries progression in primary teeth was documented. Efficacy of approach No. 2 did not meet expectations.

Child↗
PubMed2004

Survey of dental prophylaxes rendered by pediatric dentists in New England.

BACKGROUND: The objective of this anonymous postal survey was to assess the provision of dental prophylaxis by pediatric dentists in New England. METHODS: The questionnaire survey was sent by first class mail in September, 2001 to all 217 American Academy of Pediatric Dentistry (AAPD) members in active private practice in the six New England States of Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont. A self-addressed, stamped envelope was provided to facilitate the returned response. RESULTS: The survey had a response rate of 70%. Most practitioners (93%) routinely recommended dental prophylaxis for their recall patients. The proportion of practitioners who considered the following indications for recommending dental prophylaxis was: plaque, stain, and/or calculus removal - 99%; caries prevention - 75%; prior to topical fluoride application - 82%; prior to sealant application - 58%; and for behavioral modification - 68%. Almost two thirds of the practitioners (62%) defined dental prophylaxis as referring to both rubber cup pumice prophylaxis as well as to toothbrush prophylaxis. However, only one in four practitioners (26%) had modified her/his clinical practice to substitute toothbrush prophylaxis in lieu of rubber cup pumice prophylaxis. CONCLUSION: Pediatric dentists in New England routinely provide dental prophylaxis to their recall patients.

Behavior Therapy↗
PubMed2003

Home oral hygiene revisited. Options and evidence.

In regard to the limited literature on the subject, and the contradictions observed, we can not conclude that the types of manual brushes produce clinically important effects on the patients' gingival health, or that these effects can be detected consistently. However, the best results have been obtained with new brush designs, and future studies are necessary to clarify the existing contradictions. There is a clear need of long-term studies which comparatively evaluate the ability to reduce gingivitis and plaque with the newly designed brushes. On the other hand, there is evidence that supports the use of powered toothbrushes in the general population, especially those of the oscillating-rotating and counter-rotational type, as they have shown their ability to reduce gingival bleeding or inflammation, and dental plaque with greater efficacy than manual brushes. There is a clear need of long-term trials on the efficacy of powered brushes in orthodontic patients. With the existing studies we can conclude that there is limited evidence that orthodontic patients using a powered toothbrush show a slight, but significant, reduction of bleeding, compared with users of manual brushes. No conclusion can be made concerning the type of brush to be used. The techniques of interproximal oral hygiene, fundamentally the use of dental floss and interproximal brushes, appear to add additional benefits, in terms of plaque reduction, when they are associated with conventional manual brushes. Further long-term studies are necessary to confirm their efficacy in the reduction of gingival bleeding or inflammation. The choice of the type of technique must be made in relation to the characteristics of the patient: dental floss could be indicated in individuals with closed interdental spaces, and inter-proximal brushes in periodontal patients, or in those with open embrasures.

Dental Devices, Home Care↗
PubMed2005

Primary tooth fluorosis in 5-year-old schoolchildren in Ireland.

AIM: This was to determine the prevalence of primary tooth fluorosis in the dentitions of 5-year-old schoolchildren. A subsidiary aim was to investigate whether an association existed between the presence of primary tooth fluorosis, fluoridation status, infant feeding practices or the oral hygiene practices of the child. STUDY DESIGN: A cross-sectional and stratified by fluoridation status study. METHODS: Fluorosis was recorded using a modification of the Tooth Surface Index of Fluorosis (TSIF). Demographic data, information on infant feeding practices and oral hygiene practices were collected via a parental questionnaire. STATISTICS: Stepwise logistic regression analysis. RESULTS: Fluorosis prevalence in the fluoridated group (n=208) was 32%; 29.3% (n=61) had a modified TSIF score of 1; 2.4% (n=5) had a modified TSIF score of 2; and 1% (n=1) had a modified TSIF score of 5. In the non-fluoridated group (n=86) one child had a modified TSIF score of 1. Primary tooth prevalence of fluorosis in the entire sample (n=294) was 23%. Factors that were associated with primary tooth fluorosis were: fluoridation status (p= 0.0003, 95% CI = 5-281) and the age at which toothbrushing with toothpaste commenced (p = 0.016, 95% C.I. 1.1 - 3.8). No association with infant feeding practices was identified. CONCLUSION: The overall prevalence of primary tooth fluorosis was 23%. Lifetime residence in a fluoridated area and commencement of toothbrushing with toothpaste between 12 and 18 months of age were associated with primary tooth fluorosis. No association with infant feeding practices was identified.

Bottle Feeding↗
PubMed2004

Oral hygiene habits and oral health awareness among urban Saudi Arabians.

PURPOSE: To analyze prevailing oral hygiene practices and oral health awareness among urban Saudi Arabians in relation to age, gender and educational level. MATERIALS AND METHODS: Structured interviews with 1155 regular patients at two centers providing dental care for university and military staff and their families, respectively, in the city of Makkah. Consecutive patients were stratified by gender and age, into 6 categories from 10 to 60 years, with 50 male or female subjects in each group at each center. Oral hygiene habits and attitudes to oral health were correlated with age, gender and educational levels, using ANOVA. RESULTS: For the majority (> 88%) oral hygiene routines were introduced very late, after the age of 7 yr. Habits were strongly correlated to the level of education (p < 0.001); subjects with less education favored the miswak. Among the better educated, toothbrushing started earlier (p < 0.001). Regular miswak use was more frequent in older age groups (p < 0.001). Females used a toothbrush more often than males (p < 0.001), and miswak use by women was less frequent than by men (p < 0.001). Despite the availability of free dental care at the public health centers, 89% of the participants at the military center sought only emergency care, in contrast to 54% at the university center. CONCLUSIONS: Among urban Saudi Arabians, oral hygiene routines are introduced relatively late in life and knowledge and awareness of oral health is very low. There are pronounced variations in oral hygiene habits, related mainly to age and educational levels. Such factors should be taken into account when planning oral health strategies.

Adolescent↗
PubMedDate not supplied

Assessing the tooth-restoration interface wear resistance of two cementation techniques: effect of a surface sealant.

This study compared (1) the tooth-restoration interface width of conventional and "resin coating" cementation techniques, (2) the toothbrushing wear resistance of the two interfaces and (3) this study evaluated the influence of a restoration surface sealing on toothbrush wear resistance on both cementation technique interfaces. Mid-coronal buccal surfaces of 40 bovine teeth were ground to obtain a flat enamel surface. For each specimen, a 3 mm x 4 mm x 3 mm dimension rectangular cavity was prepared. The teeth were divided into four groups. Two groups (RC) received a "resin coating" (ED Primer + Tetric Flow) prior to cementation. The remaining two groups (NC) served as non-coated groups. All teeth were restored with composite inlays (Z250) fabricated by the indirect method and were cemented with dual cure resin cement (Panavia F). After finishing the margins, one group from each of the cementation techniques (RC+S and NC+S) had the tooth-restoration interface protected with a restoration surface sealant (Biscover). The specimens were subjected to 100,000 brushing abrasion cycles. The tooth-restoration width was obtained using a Hommel Tester T 1000-basic profilometer and Turbo Datawin NT 1.34 Software (microm). The interface wear (vertical loss/microm and area/microm2) was calculated with Image Tool 3.0 Software. Data were analyzed with Student t-test, one-way analysis of variance and Tukey test (alpha=0.05). Mean interface width for the NC group was 67 microm and 72 microm for the RC group. The student t-test showed no significant differences between groups (p=0.53). ANOVA showed significant differences (p<0.01) in vertical loss among groups (NC: 49.30 microm; NC+S: 7.90 microm; RC: 27.15 microm; RC+S: 4.74 microm). Also, ANOVA showed significant differences (p<0.01) in worn areas among groups (NC: 2,008 microm2; NC+S: 128 microm2; RC: 1,580 microm2 and RC+S: 88 microm2). No differences were found in tooth-restoration interface width and worn area between conventional and "resin coating" techniques. "Resin coating" interface presented reduced vertical loss. Restoration surface sealing provided reduced wear in tooth-restoration interface for both techniques.

Acrylates↗
PubMed2005

[Evaluation of clinical effects of amine fluoride/stannous fluoride containing toothpaste and mouthrinse].

The aim of the study was to evaluate the effects of amine fluoride (AmF)/stannous fluoride (SnF2) containing toothpaste and mouthrinse on gingival health of young adults. Altogether 42 persons participated in the study (mean age: 28.3 +/- 7.2) and were evaluated for Plaque Index (PI) (Silness and Löe, 1963) and Gingival Index (GI) (Löe and Silness, 1964). The probands were randomly divided into two groups, both of them used AmF/SnF2 containing toothpaste twice a day for three minutes toothbrushing. One group (combined group) after toothbrushing rinsed with mouthrinse containing AmF/AnF2 combination. After four weeks the participants were re-examined. At the end of the study statistically significant decrease was found in dental plaque (PI) and gingival index (GI) values. Values of PI and GI in the group using only toothpaste were as follows (mean +/- S.D.): PI values-baseline: 1.03 +/- 0.20; final: 0.60 +/- 0.13; p<0.001; GI values-baseline: 0.87 +/- 0.22; final: 0.505 +/- 0.22; p<0.01. The values of PI and GI in the combined group were as follows: PI values-baseline: 1.10 +/- 0.20; final: 0.52 +/- 0.10; p<0.001; GI values- baseline: 1.05 +/- 0.27; final: 0.50 +/- 0.17; p< +/- 0.001. The reduction of PI and GI values was significant in all groups but it was higher in the combined (toothpaste + mouthrinse) group than in the one using toothpaste only. It is concluded that regular use of AmF/AnF2 toothpaste has a beneficial effect for reduction of plaque accumulation but its effect can be enhanced with additional use of Am/SnF2 containing mouthrinse.

Adult↗
PubMed2006

Penetration of fluids into periodontal pockets using a powered toothbrush/irrigator device.

UNLABELLED: This study was a single-blind, randomized, controlled clinical trial. The researchers evaluated a powered brush/irrigating device (HydraBrush Oral Health System; OHS) for its safety and ability to deliver a solution to the bottom of 5-6 mm pockets, compared to rinsing alone with a solution following brushing with a powered toothbrush (Sonicare Elite 7800; SE). An evaluation technique to measure the quantity and quality of solution able to enter the pocket was also introduced in this project. METHODS: Subjects were randomized in one of two-groups: brush plus simultaneous irrigation (OHS) versus brush plus rinsing (SE). Subjects used their devices at home for two weeks. At the measurement visit, subjects used the OHS to irrigate and brush simultaneously for 1 minute (30 seconds per each side of the mouth) with a 0.01% erythrosine disclosing solution in 10 oz of distilled water. Control subjects brushed for 2 minutes with a SE followed by a 1 minute rinse with an identical disclosing solution. A blinded evaluator collected six samples of approximately of 1 microL of sucular fluid from six 5-6 mm evaluation sites. This was accomplished by inserting a microcapillary tip with a 20 microL micropipette in the sulcus. Two-group repeated measures ANOVA was used to examine differences in two measures of the disclosing solution between OHS and SE subjects; the spectrometer reading of the disclosing solutions, and by visual inspection of the samples (positive/negative) to determine the presence or absence of solution in the samples. Subjects' diaries were collected. Bleeding and discomfort during the evaluation period was reported. RESULTS: Visually, OHS had a significantly greater proportion of solution taken from the base of 5-6 mm sites than the SE (p=0.0001). However, there was no statistical difference between the two groups (p=.1359) in the spectrophotometer readings. CONCLUSION: The experimental device is more efficient in delivering a solution to the base of 5-6 mm pockets than rinsing following use of a control powered toothbrush. Both devices have demonstrated they are safe and well accepted by patients. The technique developed provides a useful method for quantitative and qualitative studies of solutions from the base of periodontal pockets.

Adult↗
PubMed2001

The relation between toothpaste usage and fluorosis: a cause for concern?

Fluoride-containing toothpaste is by far the most widespread source of fluoride in the world and after fluoridated water the most cost-effective at reducing dental caries. Of the seven current issues in the development of fluoride-containing toothpaste described by Holt & Murray (1997), five are either directly or indirectly related to the risk of developing fluorosis, a phenomenon which is on the increase in the industrialised world. The purpose of this study was to evaluate fluoride-containing toothpaste available to the South African public regarding the issues described by Holt & Murray (1997) and to relate the results to the possible development of fluorosis. The amount of fluoride ingested from toothpaste was calculated using the total fluoride concentration present in toothpaste, quantity of toothpaste used per brushing, mean percentage of toothpaste ingested and the 90th percentile of body weight. Results indicate that the "threshold" level of fluoride intake of 0.05 to 0.07 mg F/kg body weight/day beyond which dental fluorosis might occur (Burt, 1992), is exceeded when a ribbon of toothpaste was placed on a child's toothbrush at ages 2-3 years. 'Threshold' levels were ingested when placing a ribbon of toothpaste on the brush at ages 4 and 5 for all toothpaste as well as for a children's formulation containing 1000 microg F/g. Of all pastes studied, 41.9% of the packaging has information for the prevention of swallowing of paste and/or the supervision of children by adults when brushing. The dental profession, manufacturers of toothpaste and government all have a role to play in the prevention of fluorosis in the toothbrushing population of South Africa.

Adult↗
PubMed2006

Usage of the product of the Italian company "President" for the treatment of inflammatory diseases of periodontium.

Unsatisfactory hygienic condition of mouth cavity is one of the main reasons of periodontitis and gingivitis. The purpose of the investigation was the evaluation of effectiveness of the product of Italian company "President" for curing inflammatory diseases of the periodontal tissues. 42 patients aged from 18 to 65 were under observation. With the general and local anti-inflammatory treatment they were prescribed the following tooth-pastes: President Active, President Exclusive, and President Sensitive; rinses: President Profi, President sensitive plus, gel for gums--President Sensitive Plus. We used unique toothbrushes: President Gold, President z3, President Silver Care. The patients of the second group used desired toothpastes, eliminators and toothbrushes. The patients studied before and after the treatment was defined by the hygienic indices: HI, OHI, GI, PI. Microbiological investigations have shown high sensitivity of "President" product to Candida type fungi. Treatment results have shown that the data of clinical indices in both groups came nearly up to the norm, but in the first group its significance turned to be lower then in the second group. According to the results of the investigation we can sum up that the product of Italian company "President" secures essential improvement of hygienic state of mouth cavity, has antimicrobial and anti-inflammatory effect and its using is effective for curing and prophylaxis of periodontal tissues inflammatory disease.

Adolescent↗
PubMed1991

The effectiveness of differing dental health education programmes in improving the oral health of adults with mental handicaps attending Birmingham adult training centres.

There are few published data available relating to dental health in adults with handicaps, or to the effectiveness of dental health education in this group. The present study involved 382 people attending four different adult training centres in Birmingham, UK. Following baseline examinations all participants were given oral hygiene instruction and a scale and polish. Each of the centres was then randomly allocated to one of the four treatment regimens. No specific treatment was provided for the control group; daily supervised toothbrushing was carried out by the participants in the other three groups, with the addition of a three-monthly scale and polish and reinforcement of oral hygiene instruction in group 3 and one-monthly input in group 4. The participants were re-examined after three months and then at six-monthly intervals until 24 months after the baseline examination. The results showed that those people left to their own devices to carry out toothbrushing at home following instruction were not achieving an acceptable standard. Those who were reminded, encouraged and motivated by the adult training centre staff were obviously capable of better standards of oral care. The input of an experienced dental hygienist on a regular basis improved the periodontal condition considerably. Although there were significant differences between the groups throughout the study, particularly in the presence of calculus, the differences between the one-monthly and three-monthly hygienist input were not clinically very apparent after two years, and therefore a one-monthly input would be difficult to justify on a cost benefit basis.

Adult↗
PubMedDate not supplied

The role of instruction and a brushing device on the oral hygiene of blind children.

A brushing device using the tactile ability of blind children was compared to the use of a toothbrush. The experimental group consisted of 18 blind children, 7-14 years old; controls consisted of two groups of sighted classmates of the blind children. All children studied together in an integrated school and were match-paired. The brushing device was made from a valcran strip worn on a fingertip and used for cleaning the tooth surfaces. The experiment was conducted for 36 weeks with alternating periods of reinforcement and non-reinforcement. General oral hygiene improved after instruction and declined after non-reinforcement periods. The performance of the blind children improved with the cleaning device. The device was also helpful in developing a sense of "tooth cleanliness" and could be used as a pre-learning aid to prepare the blind children to efficiently use a toothbrush. Instruction followed by individual supervision and reinforcement will encourage all children to improve their oral hygiene level.

Adolescent↗
PubMed1991

Deprivation and dental health. The benefits of a child dental health campaign in relation to deprivation as estimated by the uptake of free meals at school.

The objectives of the present study were to evaluate the overall effect of the 1989 Lothian dental health education campaign on 8-year-old school children's dental health knowledge and behaviour and to examine the relationship between free meals and the children's benefit from the campaign. Altogether 874 children were randomly selected and included in the study. Sugar-free meals and drinks were provided in all primary schools throughout the campaign week. Dental officers held 30-minute information sessions with each class and encouraged teachers to continue dental health activities. Dental knowledge and behaviour were evaluated by interviews immediately before and after the campaign. The results showed a significant increase in knowledge about diet and dental health and a significantly higher proportion of children claimed to choose non-cariogenic foods and drinks as a result of the campaign. Toothbrushing frequency also increased significantly. Ninety-eight per cent of the children enjoyed the campaign and 66 per cent discussed it with their family. Each school was classified according to the proportion of children receiving free school meals, and this showed a statistically significant negative correlation with the proportion of children who chose non-cariogenic meals and drinks before the campaign but not afterwards. Toothbrushing frequency showed a significant negative correlation with free meals both before and after the campaign. A positive correlation was found between free meals and the proportion of children who claimed to have received new information during the campaign and ate healthier food because of it.(ABSTRACT TRUNCATED AT 250 WORDS)

Beverages↗

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