Improving oral health and well-being in Vanuatu through the community promotion of toothbrushing with fluoride toothpaste and healthier food choices

Vanuatu’s 2017 National Oral Health Survey revealed that five- to seven-year-old children had a high prevalence of tooth decay (70%), bleeding gums (77%) and toothache (10%) in their primary teeth which had a negative impact on their physical, mental and social well-being. Forty percent of the children rarely or never brushed their teeth. In response to excessive sugar consumption and inadequate tooth brushing habits, WHO Vanuatu supported the Government to implement the “Healthy Tooth School” programme, known as the Gudfala Tut Skul Program (GTSP). The 20-week trial of this supervised tooth brushing programme in selected kindergartens and primary schools resulted in significantly reduced plaque scores and improved oral habits in students and their families. The success of the programme has seen it expand to 51 kindergartens and primary schools in three provinces, benefiting over 5000 children and an estimated 25 000 family members. GTSP aims to target rural areas to reach all five- to seven-year-old children in Vanuatu by 2023.

How did Vanuatu, with the support of the WHO Secretariat, achieve this?

Vanuatu took an important step towards improving the oral health of its citizens with the National Oral Health Survey, conducted using WHO methodology, and its first National Oral Health Policy (2019–2023). The survey provided information on the oral health status of the population, while the policy outlined strategies to reduce the burden of oral diseases with a focus on prevention through community participation and multisectoral collaboration.

In 2019, the Vanuatu Government designed and launched GTSP in collaboration with WHO and other local partners. This communitybased programme aimed to ensure equitable improvements in oral hygiene via school-based activities and community outreach. WHO Vanuatu coordinated with the WHO Regional Office and WHO headquarters to bring global evidence and technical and financial support to the programme.

GTSP is designed to improve the oral hygiene of children attending kindergarten and primary schools. With the support from WHO Vanuatu, GTSP offers toothbrushing kits, which include two toothbrushes, storage containers for the classroom and for home, and fluoride toothpaste produced locally by a women’s association. The toothpaste is made with coconut oil and calcium carbonate, has an appropriate fluoride concentration and is stored in reusable containers. Teachers are trained to dispense a small amount of toothpaste, supervise brushing and store the toothbrushes safely, and children’s daily brushing at school and at home is monitored.

The Gudfala Tut Skul Program takes “ advantage of the fact that young children are more open to learning and adapting new behaviours. By educating them on proper brushing and good nutrition, we can help ensure a healthier future for generations to come.” - Dr Jenny Stephens, Acting Director, Department of Public Health, Ministry of Health

The programme emphasizes the importance of brushing with fluoride toothpaste for two minutes, and encourages good nutrition and hydration habits. Given the increasing prevalence of NCDs in the Pacific, the programme was designed to also teach children to make healthier food choices, limiting their intake of free sugars such as sweets and biscuits, and encouraging them to drink more water and reduce their consumption of sugar sweetened beverages.

Healthy Tooth School is part of the “ concept of healthy promoting schools. It is an investment for the future to reduce the disease burden of people across the life course by introducing healthy behaviours at an early stage of life.” - Dr Eunyoung Ko, Country Liaison Officer for WHO Vanuatu

WHO provided technical support to collect data at baseline and after the pilot. The data showed an improvement in dental hygiene and oral hygiene habits. Due to its success GTSP is being integrated into the Government of Vanuatu’s Health Promoting Schools initiative, which includes a school health policy that includes oral health and teeth brushing. WHO funded a programme coordinator to scale up the project at the national level while supporting the Ministry of Health to successfully raise funds from other international donors. The project is expanding as awareness of it increases. To further increase its impact, the Government of Vanuatu’s Integrated Health Unit has incorporated eye, ear, nose and throat screenings.

Knowledge

WHO country stories: delivering for all

“This impact story was published as part of the WHO country stories: delivering for all report, which presents a snapshot of how WHO has delivered on its mission in countries and contributed to health outcomes across a wide range of issues during 2022-2023.”