Brush Day & Night: a review of a landmark partnership for children's oral health

FDI World Dental Federation and Unilever: a 15-year partnership

In 2005, FDI World Dental Federation joined forces with Unilever in a landmark partnership to implement oral health education programmes across the globe. Since then, the FDI‐Unilever Brush Day & Night project has had a significant impact on children worldwide, specifically through innovative programmes in schools that promote oral health education and oral disease prevention. These programmes have mostly been implemented in resource-poor settings where levels of oral disease are disproportionately high, driven in part by poor access to information and health care services among children, their families, and teachers. Poor oral health can result in pain, school absences, and decreased well-being, exacerbating the challenges already faced by disadvantaged children. In such settings, school programmes offer an effective vehicle for improving children's oral health, reaching them at an age when habits are most likely to be formed and taking advantage of existing structures to deliver information and resources to those who may not access it elsewhere.
Brush Day & Night supports sustainable behaviour change

Brush Day & Night advocates twice-daily toothbrushing with a fluoride toothpaste as 1 of the most important habits for good oral health and overall health. For the past 15 years, the project has been teaching children how to brush their teeth and reinforcing the benefits of good oral hygiene. The project also encourages children to become community advocates and spread oral health messages to their families and friends, again demonstrating the potential of such initiatives in areas where access to care is limited.

Brush Day & Night is unique, innovative, and delivers a significant impact. Throughout their partnership, FDI and Unilever have:

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implemented sustainable oral health education and promotion programmes worldwide;
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positively impacted the oral health of target populations;
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engaged the dental community and general public in oral health education activities;
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trained and included dentists in public health programmes; and
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contributed to national and global oral health advocacy efforts by providing hard evidence and data.

For more than a decade, the partners have observed measurable, positive effects of the partnership on the lives of children worldwide.
Brush Day & Night Phase III results show promising improvements in oral health habits

Between 2014 and 2016, thanks to school programmes and World Oral Health Day (WOHD) activities in 22 countries, more than 4 million people received oral health education and prevention messages.

Throughout this 3‐year period, the Brush Day & Night Phase III expert advisors evaluated the effectiveness of the 21-day toothbrushing programme in Bangladesh, Chile, Greece, Indonesia, Morocco, Myanmar, Nigeria, the Philippines, Turkey, and Vietnam. The results of the evaluation revealed a 25% increase in the number of schoolchildren who brushed their teeth twice a day following the first 21-day intervention. Furthermore, this improvement was observed to be generally sustained over 6-12 months. The results showed that the programme was most effective in children between the ages of 7 and 9. The potential of the project was clear: By having a real, sustained effect on toothbrushing habits, Brush Day & Night can make a significant positive impact on the oral health and well-being of children.
Brush Day & Night Phase IV results reinforce positive impact on quality of life

Between 2017 and 2019, Brush Day & Night continued to implement oral health education programmes for children, running simultaneously in Indonesia and Nigeria. The programme evaluation now included clinical and well-being measures and adopted a strengthened methodology, with randomization of schools and control groups. The results of Phase IV, presented in this supplement and outlined here, build on those from Phase III, confirming the effectiveness of the programme, demonstrating how the improved behaviours and knowledge relate to improved health outcomes, and providing a solid evidence base on which to roll the programme out more broadly to the potential benefit of even more children worldwide.

In Nigeria, the evaluation showed that children who followed the school programme were 11 times more likely to have good oral hygiene after 21 days. In Indonesia, children in the intervention group had a 45% higher probability of seeing no worsening in their levels of decay. What's more, the evaluation highlighted the long-term effects of the programme: After 24 weeks, a 30% improvement in twice-daily toothbrushing behaviour persisted in children in Indonesia, and a 73% improvement was seen in the number of children using a fluoride toothpaste in Nigeria.

Importantly, the programme also looked at how improved oral health may benefit quality of life. Indeed, an essential goal of Brush Day & Night is to improve quality of life in addition to raising awareness about the importance of twice-daily toothbrushing and improving oral hygiene. Oral health, which is often a neglected health issue, can in fact have severe consequences on well-being1 and other important facets of daily life, such as school and work attendance.2 Although a longer-term study is required to fully evaluate Brush Day & Night's impact on quality of life, the project's ultimate aim is to reinforce the value of improving children's oral health to ensure they can fully enjoy life and learning.
What's next? A consolidated effort to roll out Brush Day & Night more broadly

FDI and Unilever are proud to be part of this unique public-private partnership that has been proven to benefit children's oral health on a global scale. Brush Day & Night's value in improving children's oral health is well understood; now is the time to ensure that these benefits can be enjoyed by as many children as possible. The next phase of the partnership aims to implement the programme as broadly as possible in close collaboration with FDI member national dental associations and local Unilever teams. Moving forward on this successful journey, all partnership stakeholders look forward to continuing to teach children to brush their teeth twice daily with a fluoride toothpaste and instil lifelong good oral hygiene habits. Brush Day & Night will continue to engage the dental profession to achieve the partnership's goals and actively include the general public and policy makers to improve oral health worldwide.
Funding

This article is published as part of a supplement sponsored by Unilever. Medical writing assistance, in the form of preparation and revision of the manuscript, as well as support of the conduct of the research, was supported financially by Unilever.
Conflict of interest

Mariano Sempietro is employed by Unilever Oral Care. He reports no other conflicts of interest regarding the work under consideration for publication or relevant financial activities outside the submitted work, and no patents or copyrights. Gerhard Seeberger reports no conflicts of interest regarding the work under consideration for publication, no relevant financial activities outside the submitted work, and no patents or copyrights.
References

1
M Glick, DM Williams, DK Kleinman, M Vujicic, RG Watt, RJ Weyant
A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health
Int Dent J, 66 (2016), pp. 322-324

View PDFView articleCrossRefView in ScopusGoogle Scholar2
SL Jackson, WF Vann Jr., JB Kotch
Impact of poor oral health on children's school attendance and performance
Am J Public Health, 101 (10) (2011), pp. 1900-1906

https://www.sciencedirect.com/science/ar...020653921000381

https://www.fdiworlddental.org/role-fdi-dental-ethics