Germany - An Oral health programme for children attending kindergartens in two Counties in Northern Hesse


Since 1994 – 2009, decline of dental caries experience in Germany among children’s deciduous teeth is 36.8% which is significantly less than the 72.7% seen in the permanent teeth , highlighting the need for caries prevention programmes targeting the pre-school children.

The aim of this intervention programme was to carry out and evaluate the effect of an intensified preventive programme in kindergartens in Northern Hesse (2006- 2008).


In the Counties of Marburg-Biedenkopf and Waldeck-Frankenberg, North Hesse, dental practices routinely adopt specific kindergartens. Once a year, the dentists and their teams visit the kindergartens to which they have been allocated, help the children to clean their teeth and educate them on a healthy diet. The children also have the opportunity to visit the dental practices, and parents’ evenings are held.


Project Outline

In addition to above mentioned basic preventive care, children included in the oral health programme received intensive daily dental hygiene provided by special personnel (called tooth brushing fairies) in the kindergartens. Children brushed their teeth with toothpaste containing 500 ppm fluoride.

  • Two thousand two hundred twenty eight 2- to 4-year-old children attending kindergartens in two counties in northern Hesse were randomly allocated to two groups (test (1096 children) and control (1048 children) groups).
  • Medical and dental professionals were trained to provide tooth brushing instructions and supervise the children daily at the kindergartens. They were known as the “tooth fairies”.
  • Daily, the fairies supervised the test group children brushing their teeth in the kindergartens with 500 ppm fluoride toothpaste.
  • Regular meetings were held every two months during the first year with the fairies in order to solve problems they may have faced while implementing the programme at the kindergartens.
  • During the second year, quarterly meetings were held.
  • Children in the control group received additional tooth brushing instructions three to four times a year, which were also carried out by the tooth fairies.
  • In addition, all the families of test and control group children received free tooth brushes and toothpastes during the programme.
  • Caries experience was recorded using WHO criteria. The basic survey was performed from October 2006 to April 2007, with the final examinations between March and July 2009.


  • The caries increment of the test group (dmfs=1.55) was 24 % lower than the increment of the control group (dmfs=2.02).
  • Based on dmft values, the corresponding figures were 0.79 for the test group and 1for the control group.
  • High increment values (dmfs >7) were observed in the control group twice as often as in the test group.


The results show t hat an intensified preventive programme in kindergartens, based on supervised daily tooth brushing, has a positive effect on the dental health of preschool children.


By Stjernswärd J, and Pieper K.



Pieper K, Winter J, Krutisch M, Völkner-Stetefeld P, Jablonski-Momeni A. Prevention in kindergartens with 500 ppm fluoride toothpaste—a randomized clinical trial. Clin Oral Invest. 2015;Sep