Objectives: To describe the second and third years of “Smiles,” with the objective of demonstrating feasible, practical, and realistic aspects of enhancement of daily toothbrushing skills and integration of a supportive environment of daily supervised toothbrushing in kindergartens. Method and materials: In total, 36 out of 180 kindergartens (20%) across Israel that participated in the first year of the program, took part in the second and third years of the program. Eighteen kindergartens served as the study group with a supervised toothbrushing routine, and 18 kindergartens served as controls without a supervised toothbrushing routine. Toothbrushing skills were recorded using the Simmons Index at baseline among 3-year-old children, after 1 year, and finally after 2 years among 5-year-old children. Early childhood caries was evaluated by decayed, missing, and filled tooth (dmft) Index among 5-year-old children at the end of the program. Statistical analysis included the chi-square test, Mann–Whitney test, and a generalized linear model.
Results: 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 toothbrushing 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 toothbrushing kindergartens demonstrated statistically significant three-fold higher levels of toothbrushing skills improvement as compared to children in control kindergartens (33% compared to 11%, respectively; P .001). Being in the Jewish sector and participation in the daily toothbrushing program were revealed as predictors of low dft scores among 5-year-old children (odds ratio [OR] = 0.320, OR = 0.552, respectively; P .001).
Conclusion: The successful performance and positive atmosphere of “Smiles” at 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 toothbrushing skills and integration of daily supervised toothbrushing among preschool children in kindergartens. Following the introduction of the “Smiles” program results to the Ministry of Health in 2017, this service became part of the dental health service for pupils in Israel in 2018.