The purpose of this controlled investigation was to test the effectiveness of three dental health programmes designed to improve oral cleanliness and gingivitis in groups of 3 -4 year old nursery schoolchildren in areas of urban deprivation in Edinburgh. A total of 349 children completed the study. The children were divided into 4 groups; a control group that received no dental health education and three experimental groups. One of these groups received daily toothbrushing instruction at school, a second group also took part in the school based brushing but in addition their parents were given dental health education at home. Parents of a third group of children received the home based dental health education only.
Following baseline measurements, the dental health education programmes continued for about 5 and a half months when the children were re- examined. The programmes then ceased over the 6 week period of the summer vacation and the children were again examined on returning to school. A dental health education programme was deemed to have been successful only if there was no statistically significant and clinically important relapse in oral cleanliness and gingivitis at the third examination.
There was a relapse in the oral hygiene of the school brushing only group during the summer holiday but oral cleanliness and gingivitis had not relapsed in the two groups of children whose parents had received dental health education at home.
A cost benefit analysis (effort effectiveness) showed that of these two programmes, the programme that consisted of home based dental health education only cost the least for a unit improvement in oral cleanliness and gingivitis.
A questionnaire was used to record parents' attitudes towards toothbrushing practices at home. Children whose parents always helped them with toothbrushing had cleaner mouths and less gingivitis than children who always brushed their teeth by themselves.
It is concluded that dental health education, which included home visits, was more effective than daily supervised toothbrushing at school in improving and maintaining oral health in pre- school children and that parents should be encouraged to help young children with toothbrushing at home. Such an approach demands considerable resources and may only be suitable for groups of children with special needs.