Sir, we congratulate Davies and Bridgman (Br Dent J 2011; 210: 59–61) for expressing so clearly that the traditional model of (oral) health education for children lacks evidence. Knowledge alone does not lead to significant behaviour change in adults, adolescents or children. However, this outdated and simplistic model of health education is still the basis for many oral health promotion activities worldwide, including many of those undertaken by national professional organisations, non-governmental organisations and the dental industry. We could not agree more with their conclusion, that 'education alone is a great way to increase health inequalities'.
It is encouraging to learn that in the UK there is a steady realisation of the need to go beyond the concept of just educating children to keep their teeth healthy. The move to more effective and evidence-based approaches such as skills-based learning using a settings-approach, as well as the effective use of fluoride through supervised tooth brushing with a 1,450 ppm-fluoride toothpaste in nursery classes, child centres and other venues, as is the case for the Manchester initiative, is a timely development that needs widespread public support.
While the Manchester initiative works within a well-developed (oral) health care system, the situation on a global level, and particularly in low- and middle-income countries, is very different. Almost all dental decay remains untreated and creates a largely ignored public health problem affecting children in particular.1,2 Weak health systems offering unaffordable or no oral care at all for the masses require a dramatic change in professional thinking and political priorities. The WHO and the world's leading oral health organisations recommend jointly that 'exposure to appropriate fluoride, in particular through fluoride toothpaste, will improve quality of life and enhance the achievement of the Millennium Development Goals by reducing the high dental disease burden of entire populations, especially children'.3
In an unprecedented move, the World Bank, the WHO and the United Nations have chosen an innovative school health programme in the Philippines, the 'Fit for School Programme' as best-practice model for innovation in global health.4 This horizontal programme consists of simple, evidence-based high impact interventions that integrate daily supervised tooth brushing with an adult-strength fluoride toothpaste with other health interventions such as daily supervised hand washing with soap to prevent gastrointestinal and respiratory diseases. The programme is the national school health flagship programme of the Ministry of Education and currently covers over 1.5 million children in elementary schools and day-care centres.
While the Manchester initiative is to be highly commended, it might be considered to integrate more general health promoting habits as regular habits within the school setting. Many interventions in school health have good evidence for improving health and education performance,5 such as hand washing with soap,6,7 physical activity to tackle obesity,8 or tobacco use prevention.9 For many years the dental profession has been advocating the integration of oral health within general health. The improvement of child health through evidence-based health promotion in a school health programme is an ideal opportunity to make this a reality. More information on the FIT for School programme can be found at: http://www.fitforschool.ph/
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Holmgren, C., Monse, B., van Palenstein, H. et al. Learning lessons. Br Dent J 210, 292–293 (2011). https://doi.org/10.1038/sj.bdj.2011.248
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DOI: https://doi.org/10.1038/sj.bdj.2011.248