Apr 06, 2020, By: Krista Winarsky, Marcella Ogenchuk
Take away messages:
- Tooth decay is preventable, however, dental surgery accounts for one-third of pediatric surgeries in Canada.
- The Canadian Tooth Fairy group has partnered with kindergarten teachers to establish a daily toothbrush program.
- A student-led initiative, the Canadian Tooth Fairy group has significantly increased the overall health of at-risk children in one Saskatoon school, and can easily be adapted to other jurisdictions.
The tooth fairy is an early childhood fantasy figure as popular as Santa Claus. Among cultures influenced by Western folklore, children place their baby teeth that have fallen out under their pillow and receive money in exchange.
Oral health in early childhood
Positive early childhood oral health practices set precedents for lifetime overall health and well-being. Oral health affects general health and quality of life (Rowan-Legg, 2013). There is increasing evidence of a direct link between oral and systemic disease (Kane, 2017).
Developmental processes of communication, socialization, and self-esteem are also affected by oral health (Locker & Matear, 2000). Furthermore, tooth extraction may affect the alignment of the permanent teeth and increase the risk of future dental problems.
Oral pain has major effects on children, including lost sleep, poor growth, behavioural problems, and poor learning (Schroth, Harrison, & Moffat, 2009).
Unfortunately, dental surgery accounts for one-third of pediatric day surgeries in Canada, performed to treat early childhood dental caries among pre-school children (CIHI, 2013). Rates were almost four times as high for children in the least affluent regions, three times as high for children in rural versus urban neighbourhoods, and nine times as high for predominantly Indigenous populations. For thousands of these children, dental decay is treated under general anesthesia (CIHI, 2013). Tooth decay is preventable with good oral hygiene practices.
The CTF group
In 2013, pediatric nursing students (graduates of the class of 2015) from the University of Saskatchewan College of Nursing demonstrated that significant positive impacts can be made within local communities. Nursing students (not yet licensed registered nurses) recognized a crucial oral health need at our clinical placement: inner-city elementary schools. Very quickly, we became co-founders of the first Canada Tooth Fairy (CTF) group (modeled after the American Tooth Fairy group created in 2006), formally established in January 2014.
During our clinical placement, we learned that families and individuals of lower socio-economic status, those without dental insurance, and Indigenous children experience markedly worse oral health outcomes compared to the general Canadian population (CDA, 2017). A strong social safety net provided by the services of a group like CTF can help reduce these health risks (CDA, 2017); furthermore, it can serve as an upstream approach by teaching youth the importance of oral health.
Toothbrush program highlights
The aim of the group was to make a direct impact on the oral health habits and well-being of children along with the Saskatoon inner-city school community.
Since spring 2014, the CTF group has been partnering with local kindergarten teachers to establish a daily toothbrush program. As students, we created teaching materials that are now used to support school-aged children in the toothbrush program. A key feature of the toothbrush program was helping young students take charge of their own oral health.
The toothbrush program started at the beginning of our clinical rotation in 2013. The CTF group was formally established in 2014, and although the group did not continue formally, its work continued through successive pediatric nursing students until 2017.
… dental surgery accounts for one-third of pediatric day surgeries in Canada …
Implementation of the toothbrush program
From 2013 to 2014, as the CTF group co-founders, we provided teaching sessions to students from kindergarten to grade 8. Older grades were recipients of an oral health presentation, then were given oral hygiene products to use at home (toothbrush, floss, and toothpaste). Intermittent maintenance and oral hygiene teaching were provided as needed.
Kindergarten students received an initial teaching session and were then introduced to the toothbrush program, in which they brushed their teeth at school daily. The tooth brushing program was maintained intermittently by nursing follow-up with the teachers.
Also, in spring 2015, nursing students mentored junior nursing students in their clinical pediatric rotation regarding the CTF group program. Additionally, from 2016 to fall 2017, Winarsky, as a registered nurse, continued to mentor third- and fourth-year pediatric nursing students by making presentations on the CTF group opportunity under the aegis of the College of Nursing faculty.
Mentorship included instruction regarding the disparity between high and low socio-economic families and oral health, the prevalence of tooth decay, as well as sharing of established oral health resources, and the CTF group practice. Interest and excitement among nursing students were consistently apparent regarding the changes that could be made in this population.
From 2013 to 2017, the CTF group provided approximately 15 oral health teaching sessions outside of school hours. In several of the sessions, recently graduated nurses mentored nursing students. Verbal debriefing followed each teaching session, in which we reflected on what we did well and what we could improve (SRNA, 2018).
Together with the College of Nursing faculty we created a CTF group video clip. The video explains the oral health disparities present in inner-city Saskatoon schools, and the aim and impact of the CTF group. In the video, Funk states, “I think joining the Tooth Fairy group is a really great way to enjoy being with other nursing students and developing skills that you can take with you into your career.” Currie explains, “I learned a lot of basic things that you would think might be common sense to a nurse but are often forgotten.”
The toothbrushing program started initially in one kindergarten class. Currently, 75 kindergarten children in one inner city school brush their teeth daily as a result of the ongoing nursing student support. In addition, these students are sent home with a package containing a toothbrush and toothpaste for the summer months.
The CTF group of nursing students and professionals is beneficial to the public by increasing the overall health and well-being of children at risk (Funk, Currie, & Winarsky, 2015).
Based on our experiences, consistent written documentation and reflection after each teaching session would have been helpful in further measuring the CTF group’s efficacy. Furthermore, we learned about several barriers affecting nursing students’ ability to participate in the CTF Group on a full-time basis (specifically, lack of time focused on oral health awareness, and need for a meaningful incentive).
Therefore, to strengthen CTF group student recruitment and promote the program, we recommend creating additional health promotional videos; consistently informing medicine, nursing, and dentistry students about the program; and offering meaningful incentives to these disciplines. We feel that increased recruitment will improve the oral health literacy of elementary students and increase overall positive health outcomes.
… currently, 75 kindergarten children in one inner city school brush their teeth daily as a result of the ongoing nursing student support
Tooth decay continues to be the number one chronic disease in children (CDA, 2017). Although the national CTF group has dissolved, continuing with the CTF group as part of ongoing clinical practice fills an important gap in pediatric caries prevention.
Future plans for the CTF group include continued mentorship and teaching by faculty and oral health care professionals to nursing students about oral health hygiene. Older students in the inner-city schools that are familiar with the CTF group and who have previously been instructed about its philosophy will mentor younger students using the teach-back method. When mentors still have the information fresh in their mind, they are more likely to present important skills and knowledge to children in a way that will support their integration into their daily routine. Other disciplines, such as dentistry and medicine, will continue to be encouraged to join.
The CTF group benefits the public because it increases the overall health and well-being of children at risk through the continued support of self-regulated health skills, and by nursing students and professionals involved in the practice (Funk, Currie, & Winarsky, 2015).
Canadian Dental Association (CDA). (2017). Vulnerable Canadians and the need for targeted oral health programs.
Canadian Institute for Health Information (CIHI). (2013). Treatment of preventable dental cavities in preschoolers: A focus on day surgery under general anesthesia.
Funk, T., Currie, M., & Winarsky, K. (2015). Canada Tooth Fairy Group.
Kane, S. F. (2017). The effects of oral health on systemic health. General Dentistry, 65(6), 31–34.
Locker, D., & Matear, D. (2001). Oral disorders, systemic health, well-being and the quality of life: A summary of recent research evidence. Community Dental Health Services Research Unit, University of Toronto.
Rowan-Legg, A. (2013, 2018). Oral health care for children: A call for action. Paediatric Child Health, 18(1), 37–43.
Saskatchewan Registered Nurses Association (SRNA). (2018). Continuing competence program.
Schroth, R. J., Harrison, R. L., & Moffat, M. E. (2009). Oral health of Indigenous children and the influence of early childhood caries on childhood health and well-being. Pediatric Clinics of North America, 56(6), 1481–1499.doi:10.1016/j.pcl.2009.09.010
Krista Winarsky enjoys working as a Registered Nurse with maternal Services at the new (2019) Jim Pattison’s Children’s Hospital in Saskatoon SK.
Prof. Marcella Ogenchuk is an Associate Professor with the College of Nursing at the University of Saskatchewan. She has extensive experience in Pediatric Nursing and is presently teaching courses and completing research related to children and youth.