International Journal of Paediatric Dentistry 1997; 7: 283±285

Bright Smiles/Bright Futures Award

The Bright Smiles/Bright Futures Award, intro-

duced this year, is sponsored by the International

Association of Paediatric Dentistry with the support

of Colgate-Palmolive Company. The competition is

intended to assist recognition of innovative pre-

ventive oral health programmes worldwide and the

e�orts of dental professionals committed to im-

proving oral health through these programmes, that

reach thousands of children. Through the competi-

tion, the IAPD and Colgate hope to provide a forum

for new information and preventive approaches.

In 1997 there were 36 entries for the award from

around the world. Countries represented included

Slovenia, Australia, Spain, Kuwait, Austria, Argen-

tina, China, Denmark, France, Norway, Turkey,

the Arabian Gulf states, Poland, Yugoslavia,

Bulgaria and the United Kingdom. Poster presenta-

tions of 25 of the entries were given at the IAPD

Congress in Buenos Aires, Argentina. Those from

Slovenia, Australia, Spain, Kuwait and Austria

received special recognition.

The IAPD and Colgate intend that the competi-

tion should become an annual tradition. ``We all

learn from one another and through our combined

e�orts, we may yet realize our ultimate goal; seeing

a generation of children grow up with no dental

caries'' says organizer of the award, Stephen J Moss.

The winning entry for the 1997 award, from

Slovenia, is published below.

Slovenia: national oral health education programme

By Vito Vrbic, Mitja Bartenjev, Narcisa Kosir and

Marta Skapin*, Univerza V. Ljubljani, Medicinska

Fakulteta, Odsek Za Stomatologijo, and *Pedonto-

loska sekcija SZD, Ljubljana, Ljubljana, Slovenia

Introduction

The National Oral Health Education Programme

(NOHEP) is part of the National Dental Preventive

Programme, which has operated in Slovenia for the

past 15 years. In the same period, the prevalence of

caries in Slovenia has decreased markedly, particu-

larly in more recent years. Two national and path-

®nder surveys were conducted in Slovenia in 1987

and 1993 to assess caries prevalence, with assess-

ment forms provided by the World Health Organi-

zation. The results showed that caries prevalence

declined in all age groups except the oldest. Mean

DMFT declined from 5.2 to 3.9 in 6-year-olds, from

5.1 to 2.6 in 12-year-olds, from 10.2 to 5.6 in 15-

year-olds, and from 12.9 to 8.8 in 18-year-olds.

The proportion of children with caries-free primary

teeth increased from 13% to 30% in 6-year-olds and

from 6% to 31% in the permanent teeth of 12-year-

olds. The substantial decline in caries was attributed

to the consistent and widespread use of ¯uoride

dentifrices. distribution of ¯uoride tablets to chil-

dren and expectant mothers, topical application of

an amine ¯uoride gel in school children and an

extensive sealant application programme. NOHEP

reached about 80% of Slovenian school children

beginning in 1980, and, beginning in 1987, 43% of

all 12-year-olds eventually had sealants on the

occlusal, pit and ®ssure surfaces of their teeth.

The programme helped Slovenia achieve and

surpass by 1993 the W.H.O. dental health goals

for the year 2000.

Methods used in NOHEP

The National Oral Health Education Programme

is carried out by dentists who are employed by

Public Dental Health Service in school-based dental

clinics, dental health `prevention' rooms in schools

and at community health centres. The programme

produces posters, brochures and videotapes on

prevention and oral health that are distributed to

Slovenian schools. State health institutions prepare

30% of those materials, and 70% are prepared by

the participating dentists themselves.

At their schools, students keep their toothbrushes

in the prevention rooms, which also house wash-

basins adjusted to children's height, and mirrors,

which are used by the children to monitor their own

brushing technique under the supervision of a

dental hygienist (Fig. 1).

# 1997 BSPD and IAPD 283

Award Report

284 Bright Smiles/Bright Futures Award

Preschool and elementary school children in the

®rst grade receive a 1-hour lesson on oral health,

during which they are shown a videotape describing

dental plaque, its removal, and cleaning techniques.

Techniques also are demonstrated on large plaster

casts of teeth with an over-sized toothbrush. After-

wards, children are instructed to clean their own

teeth in front of the mirror with the hygienist

correcting any problems along the way. Older

children receive lessons on cariogenic food, tooth

eruption, orthodontic anomalies and other types of

more sophisticated information. Twice a month,

group preventive activities are organized in the

prevention rooms, including toothbrushing with

amine ¯uoride gel under the supervision of dental

hygienists. All preventive activities in Slovenia are

performed in cooperation with the University

Department of Paediatric Dentistry.

In 65% of all Slovenian elementary schools, oral

hygiene lessons take place during the regular school

day. A dentist or hygienist enters the classroom,

randomly picks out three students and takes them to

the school dental o�ce or prevention room, where

they are given coloured tablets for an estimation of

their plaque removal e�ciency. Their plaque re-

moval marks are added to their overall class

evaluation. Classes and schools also compete with

one another. Once a year, in the last month of

school in June, the classes with the best oral hygiene

records are awarded special prizes. Student repre-

sentatives and teachers from the award-winning

schools take an active part in the observations.

During Oral Health Days, students who write what

are judged to be the best essays or poetry on

particular dental themes also are invited to read

their work. Each year, a special jury selects the

winners. In 1996 the Society published a booklet of

poetry written by school children, based on the

theme: `See a dentist on time.'

In addition to their participation in checking the

status of children's oral hygiene, the classroom

teachers provide basic scienti®c information on

teeth, their structure, the tooth eruption timetable,

cariogenic foods and more. At the inception of the

programme, dental information in textbooks was

inadequate and unprofessional. As a result of

NOHEP, the Slovenian Republican School Centre

organized the writing of new up-to-date textbooks

with chapters on teeth and nutrition written by

paediatric dentists. Further, paediatric dentists from

all nine Slovenian regions conducted seminars for

teachers on the changes in educational material and

modern concepts of dental education and instruc-

tion. They also lectured on dental preventive

measures and in¯uenced teachers to participate

more actively in dental health education. Through

that initiative, collaboration between teachers and

school-based dentists improved dramtically.

Parents also have been an integral part of

NOHEP. Expectant mothers receive information

on dental health and the formation of caries at

special lectures. After World War II, expectant

mothers were given ¯uoride tablets. At dental clinics

for preschool children, parents are informed about

# 1997 BSPD and IAPD, International Journal of Paediatric Dentistry 7: 283±285

Fig. 1. Two Slovenian schoolgirls practise

their toothbrushing technique at a

`prevention room', one of many

established in schools in Slovenia to assist

in improving oral self-care and providing

oral health education. The rooms, sta�ed

by dental hygienists and dentists, are part

of the National Oral Health Education

Programme.

Award Report

their babies' nutritional needs, thumbsucking, the

use of paci®ers, when to start cleaning infants' teeth

and baby bottle tooth decay. In ®rst-grade class-

rooms, dentists make presentations to parents about

dental health and prevention.

The educational and preventive programmes in

Slovenia are composed of paediatric dentists and

school dentists in cooperation with Slovenian Den-

tal Association and Slovenian Oral Health Society.

The Slovenian Oral Health Society was estab-

lished in 1993 and soon after organized the ®rst Oral

Health Days, with the assistance of World Health

Organization representatives. The Society unites

other health-care professionals and educators who

are involved in maintaining and improving the

dental health status of the general population.

NOHEP has further increased its impact by

gaining publicity through the media. Radio media

conduct dental education programmes on the air

during the morning hours and children have access

to them via microphones. The radio programmes

are designed by pediatric dentists or school-based

dentists. The national television network has aired

special programmes or public service announce-

ments about NOHEP during prime time for several

decades. Leading experts on dental health also

lecture on radio or television about particular

research conducted under the umbrella of the

national preventive programme, and newspapers

and magazines regularly publish articles about

NOHEP in their health sections.

Changes in oral health since the introduction of NOHEP

The programme includes an annual evaluation of

oral health status among 20,000 Slovenian children,

establishing new benchmarks for caries status, oral

hygiene and orthodontic anomalies through this

technique. It is evident from the results of the

annual survey that caries is decreasing in Slovenian

preschoolers and school children. The percentage of

caries-free 6-year-olds has increased from 3% to

16% in the last 10 years, and the percentage of

caries-free 12-year-olds has increased from 7% to

30%. Children's ability to conduct proper oral

hygiene at home also has improved markedly.

Conclusion drawn from the programme

The preventive dental health and education pro-

gramme in Slovenia, NOHEP, has proved to be a

success in reducing caries prevalence among preschool

and school children and could be adopted easily by

other countries, particularly those that are emerging

from years of dental health neglect. It should be

noted that if a NOHEP-style programme is con-

templated, the following factors in Slovenia must also

be considered: dentistry for children is organized in

every community; all dentists and chairside assis-

tants observe a uniform professional doctrine; from

1945 to 1993 all Slovenian dentists were employed

by the state dental public health authority and private

practice was not allowed; all the elementary schools

in Slovenia are owned and operated by the State.

# 1997 BSPD and IAPD, International Journal of Paediatric Dentistry 7: 283±285

Bright Smiles/Bright Futures Award 285

Award Report