China - An oral health education and supervised tooth brushing programme in kindergartens

In order to improve the oral health of pre-school children particularly from the rural areas of China, a kindergarten based oral health programme was introduced in 1998. This presentation is based on the study by Rong WS, Bian JY, Wang WJ and Wang JD, published in 2003.

Background and Rationale
The second Chinese national oral health survey of 1995 showed that caries was a big problem in preschool children especially in the rural areas. Caries prevalence in the 5-year-olds was 77% and dmft 4.5. Nearly 95% of the dmft was decayed teeth. There is no caries prevention programmes for preschool children and their parent's oral health education knowledge was poor. In addition, most toothpastes available were not fluoridated. All these factors indicating the urgent need for caries prevention programmes targeting preschool children.

Project Outline
This study evaluates the effect of oral health education and tooth brushing programme carried out in kindergartens in a rural area for 2 years.

tooth brush instruction

Initially 731 3-year-old children participated from 10 kindergartens in Miyun County, Beijing. The kindergartens were randomly divided into test and control groups. The test children received oral health education sessions monthly and their parents every 6 months by trained teachers. The test group brushed their teeth under supervision twice daily with fluoridated toothpaste in the kindergarten during weekdays. No oral health education or supervised tooth brushing was conducted in the control kindergartens. A clinical examination of all children and questionnaire survey of their parents were conducted at baseline and after 2 years.

brushing twice a day

After 2 years 514 children remained in the programme.

  • The mean caries increment of the test (n=258) and control (n=256) groups were 2.5 and 3.6 dmfs respectively. The reduction of caries increment of 31% was statistically significant.
  • A significantly high percentage of test children (88%) reported brushing teeth twice a day than the control group (69%).
  • Parents of children from the test group had better oral health knowledge and attitudes than the parents of the control group.

This oral health prevention programme targeting preschool children in kindergartens in a rural area was effective and could be implemented in China.


Rong WS, Bian JY, Wang WJ and Wang JD. Effectiveness of an oral health education and caries prevention program in kindergartens in China. Community Dent Oral Epidemiol 2003; 31: 412-416.