Barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools: a systematic review

Abstract

Background Untreated 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. Methods Five 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. Results A 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. Conclusion The 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.

Compliance Level of PAUD Students in Brushing with the Interactive Calendar Guide

“…| 83 morning and evening. Children who grow up in a healthy family environment with supportive parents, where each family member's role is present and harmonious, have better brushing habits than children who grow up in a less favorable family environment (Chandio et al, 2022;Soldani et al, 2018). Children at home can also obtain external motivation to brush their teeth in the morning and evening through parental support (Arora et al, 2021).…”

A mixed methods evaluation of the effectiveness of an oral health training program for disability care workers in Burkina Faso

“…There are multiple potential reasons for why all centres had not implemented brushing. Based on literature about barriers and enablers of sustainable school-based toothbrushing, organisational, staff-, parent- and child-level factors come into play [ 37 ]. Most relevant to the context of this study might be a lack of time to introduce toothbrushing as a regular daily activity with children, a lack of staff to supervise brushing (also mentioned in training feedback forms) and a lack of staff buy-in to start taking care of the oral health of their dependents [ 38 – 40 ].…”

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

“…The timing of the completion of the programme just before the COVID pandemic in March 2020 halted any follow‐up on this element. It is likely that the already existing concerns of PST and parents in relation to cross contamination between the children would have been heightened during this period 21 …”