Sugarless Green:
 
An education study - modelling oral hygiene through garden-based activities

Each year, about 60,000 school days are missed because children need to have tooth extractions (Public Health England, 2019). In London boroughs alone, the NHS spends approximately £7M for acute dental care for children, including these emergency extractions (British Dental Association, 2019). This has led to the British Dental Association (BDA) declaring the prevalence of tooth decay in young children as a crisis and calling for more political action geared to prevention (BDA, 2019). Tooth decay is not an isolated physical health issue; it also affects mental wellbeing. In the UK, 12% of children have nightmares about their teeth and 18% are stressed about the general appearance of their teeth and smiles (Oral Health Foundation 2020). Covid-19 has exacerbated these issues due to heightened restrictions, causing a back log of dental appointments and increased anxieties for families visiting dentists (Westgarth, 2020). 

What is this project about?

'Sugarless Green' is an educational study which aims to support health and wellbeing in young children by reinforcing correct oral hygiene techniques, and by educating pupils on healthier food choices, as alternatives to sugar. This project is conducted with the RSU Growhampton programme and university student volunteers to work with local primary school pupils to do a series of activities. The project seeks to engage primary school pupils in Key Stage 2 (ages 7-11), across 1 or 2 primary schools (depending on participation rates) in the Alton Estate (total approximately 120 pupils), in the London borough of Wandsworth. The BDA has noted that Wandsworth is among the top 5 boroughs which has seen worsening incidences of child tooth decay since 2015 (BDA, 2019), particularly due to the socioeconomic inequalities in the area.

The university students are trained to run a one-hour programme on oral care for primary school pupils from KS2 (ages 7-11). This unique programme hosts a series of activities which focus on demonstrating oral hygiene while using garden vegetables as props. Some examples include brushing the soil off a carrot top to bottom, and flossing debris out of potato-carved teeth. The sessions educate children about the importance of the vegetables in their diets while explaining how difficult it can be to remove sugar from their teeth, showing for example, the challenge of brushing sticky syrup off oranges.

In compliance with Covid-19 government guidance and subsequent university and school closures, adaptations have been ongoing to make this research project safe and accessible for all participants. To minimise health and safety risks our university student pre-packed resources and conducted the activities in primary school classrooms. All adult participants completed Covid tests prior to their campus visit and school visits and used safety gear (masks, hand sanitiser) for the duration of the activities.

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Participant Feedback:

Student volunteers were impressed that participating in university research projects can have such rewarding benefits. Volunteers were recruited across the School of Education, Business, Education, Sociology and Psychology, all at different stages of their undergraduate completion. Students were extremely positive about their experience on the project highlighting that working with other university peers across different academic programmes made them stronger as a team, as some of them had more knowledge about sustainability initiatives and others had more refined education skills for working with young children which they found enrichened their Roehampton experience.

The students shared what they learnt through the Sugarless Green project and working with primary school pupils. One student commented “shockingly 1 in about every 3 pupils in the class had teeth extracted and these were permanent teeth, not just baby ones … I thought about myself as a child and this was not the case at all ". Another student facilitator said that red flags were raised when children told them him that “their first visit to the dentist was them needing to have a painful tooth removed". Other indirect rewards included university volunteers using their participation in the project as inspiration for their course assignments while others commented on the gains from stepping outside of their comfort zone and developing their teamwork skills.

When questioned about how the primary pupils responded to the Sugarless Green activities one student commented that “at this age pupils learn about brushing their teeth through the school curriculum but in a theoretical way, only through books, so the children knew the words ‘cavities’ and ‘dental care’ but …” he went on to explain, “… this project made us bring the practice of brushing their teeth to at a level they could relate to, so using the carrots to show harder brushing does not mean better brushing was eye-opening for the children, and allowing them to struggle with sticky syrup on oranges was a great way to explain how after eating sugar this kind of sticky gunk is left on your teeth and if uncleaned causes the cavities.” 

The Primary school teachers recruited for the project expressed their pupils were quite excited to engage in all the activities (inclusive of the activity booklets prepared for data collection) and offered that the Roehampton student volunteers were well professional, confident and organised. As well, teachers remarked that the giftbags for the children was great reinforcement to motivate the children to brush with the activities in mind. Each child was given a giftbag with a bamboo toothbrush, bio-degradable minty floss, fluoride toothpaste, and an apple. Pupils and teachers were also enlightened by our sustainable research practices as the project resources (e.g. used carrots, potato teeth, oranges and soil) were returned to the Roehampton campus plots as a delicious treats for our campus chickens. In line with Growhampton’s drive for environmental sustainability the Sugarless Green project was designed to be 100% environmentally friendly and promote the idea of oral care sustainability to primary school pupils.

 

What’s the impact on children?

It is expected that engaging with garden textures (e.g., soil, carrots, oranges) would entice the children to recall the oral hygiene techniques learned through the project at home. It is also expected that the sustainable, ‘green’, context for educating the children about vegetables, combined with the contrasting presentation of sugar will inspire and empower the children to make healthier food choices for their teeth.

 

Dental disease can impact children’s abilities to eat, sleep, speak, play and socialise with other children. It is interesting to consider that in the UK 1 in 8 children (12%) have nightmares about their teeth and 1 in 5 children (18%) are unhappy about their smile and stressed about the appearance of their teeth (Oral Health Foundation, 2020). Often it causes children to miss school (tooth aches, or dental extractions) and parents to lose income due to time off work.

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Supporting research-led policy making

In a 2019 global survey of 13 high-GDP countries by FDI World Dental Federation, the UK ranked last in promoting good oral health for children (BDA, 2019). Although Public Health England (2017) has published an evidence-based toolkit for dental teams, which includes guidance on changing patients’ attitudes to oral care and principles of toothbrushing, these are generalised and do not address the commitment of children beyond the clinical setting. This project can support in this latter regard. Furthermore, higher-level consultations by the UK government which stress preventative measures for dental care are resource-driven, seeking to decrease availability of sugary products (2018) and increase fluoride uptake and supervised brushing (2019). These recommendations have also been taken up at the local level in Mayor Khan’s Healthy Schools London and Healthy Early Years London schemes.

 

However, as recognised by the London Assembly of the Greater London Authority (2019), such schemes work best only from the earlier ages and where there is absolute buy-in and resource allocation for teachers and schools. ‘Sugarless Green’ avoids the centralised targeting of such resources by educating and empowering children to take individual responsibility for maintaining their teeth, and also focuses on the intermediate 7 to 11-year group of children who may be more resistant to transitioning out of poor oral health habits. In these respects, ‘Sugarless Green’ can complement local borough schemes and combine with other London-centred initiatives to scale up joint oral health interventions at the national level. Our students at Roehampton will be working with the young children and facilitating the programme activities, which are free for the children in the local primary schools.

Research Funding & Next Steps:

This research project, designed and led by Dr Melissa Jogie from the School of Education, is funded by Research England QR Strategic Priorities Fund. Currently, the data collected is being analysed to evaluate the extent to which this study has made an impact on primary pupil’s knowledge of oral care practices. Findings based on this seeded venture will be taken into consideration for the next project.

Dr Jogie has successfully secured an additional grant for a summer project called 'Gardening & Gums' (funded by The Cathedrals Group) which involves a knowledge exchange between specialised dentists and parents with children from the local Wandsworth community, which will be delivered through Growhampton and be facilitated through university student volunteers.

For the summer project ‘Gardening & Gums’ we are seeking parents from the local community or any association facilitating children’s clubs (e.g. Scouts, Sunday Schools), who are interested in participating in this project. Activities will take place on the Roehampton campus. For more information or to become involve in this summer project please get in touch for more project information.

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