# Supervised Toothbrushing and Silver Diamine Fluoride Application of Rohingya Children in a Refugee Camp in Bangladesh

## TL;DR

A school-based oral health program in a Rohingya refugee camp in Bangladesh improved children's toothbrushing habits and reduced dental caries using silver diamine fluoride.

## Contribution

This study pilots a low-resource oral health intervention combining supervised toothbrushing and silver diamine fluoride application in a refugee camp setting.

## Key findings

- 87.5% follow-up rate showed increased toothbrushing and handwashing habits among children.
- Plaque and bleeding scores decreased significantly after the intervention.
- SDF application achieved a 54.3% caries arrest rate in treated teeth.

## Abstract

Previous studies have highlighted the high burden of oral diseases in refugee camps, but there are few robustly evaluated school-based oral health programmes in these settings. The objective of this study was to pilot a school-based toothbrushing, handwashing, and silver diamine fluoride (SDF) application in a refugee camp in Bangladesh. It hosts the world’s largest number of refugees with over 1 million Rohingya from Myanmar.

A prospective cohort study that consisted of a multipronged oral health intervention: supervised daily toothbrushing, handwashing, and SDF application of active caries in the primary and permanent dentition. Clinical examination of the children and child and parental questionnaires were completed at baseline and the 6-month follow-up.

A total of 176 children were assessed at baseline, with a follow-up rate of 87.5%. The number of children reporting regular toothbrushing and handwashing significantly increased between baseline and 6-month follow-up, with a corresponding fall in plaque and bleeding scores. There was a 54.3% caries arrest rate in teeth where SDF was applied.

Supervised toothbrushing and SDF application in learning centres in refugee camps can improve the oral health of refugee children and instil healthy hygiene habits. Further research is warranted to robustly assess the long-term impact of this intervention and scalability across humanitarian settings.

In the absence of accessible oral health care in refugee camps, low-resource oral health interventions can safeguard oral health and instil healthy hygiene habits from a young age.