Brush up on brushing
A global look at oral hygiene for children and adolescents

Daily toothbrushing is a ritual so familiar that it seems trivial. But in many parts of the world, the toothbrush is still a symbol of luxury, and the habit of regular oral hygiene care remains out of reach for thousands of children and adolescents. A study of 266,000 schoolchildren from 72 countries sheds new light on the scale of this global problem. The results are alarming: in some regions, more than 10% of young people admit that they rarely brush their teeth. How is it possible that the struggle for essential hygiene habits continues in the era of smartphones and space exploration?

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The study's author, published in the Wroclaw Medical University’s journal "Dental and Medical Problems", is Rajat Das Gupta, an epidemiologist affiliated with the Arnold School of Public Health at the University of South Carolina in the US. His article, "Toothbrushing frequency among children and adolescents in 72 countries: Findings from the Global School-based Student Health Survey," is based on data collected from the Global School-based Student Health Survey (GSHS). It's an insightful look at the hygiene habits of young people internationally, highlighting both the importance of health education and existing inequalities in access to primary dental care.
How often do we brush our teeth?
Although as many as 90% of children say they brush their teeth at least once a day, only 70% meet dentists' recommendations by brushing twice a day. Differences in the frequency of brushing teeth are apparent depending on the region of the world: in Paraguay, only 0.4% of children never brush their teeth, while in Egypt, as many as 19.3% of respondents neglect this essential activity. The frequency of brushing teeth increases with age - the youngest children are more likely to neglect oral hygiene. Girls are much more conscientious than boys - in 56 of the 72 countries surveyed, boys were more likely to admit not brushing regularly.
Regions of the world and hygiene habits
Geography influences the formation of hygiene habits. The Americas region has the highest percentage of people brushing their teeth twice a day (82.9%), while in the Middle East and Northeast Africa region, the result is only 41.4%. The high percentage of people who do not brush their teeth in these regions may be related to Miswak, a traditional tooth-cleaning stick that needs to be included in standard surveys. In countries such as Egypt (19.3%), Yemen (17.8%), and Morocco (15.1%), more than 10% of children rarely or never brush their teeth, while in Belize and Paraguay, as many as 90% of children brush their teeth twice a day, placing these countries among the world leaders.
Traditional oral hygiene methods
Surveys need to consider the wide variety of traditional oral hygiene methods used around the world, as the author of the article, Rajat Das Gupta, also points out. In India and Africa, neem tree sticks are popular, providing a natural alternative to toothpaste due to their antibacterial properties. In Southeast Asia, oil pulling, which involves rinsing the mouth with coconut or sesame oil, is practiced. In Latin America, wood ash or coal is used, adapting practices to locally available resources. Miswak, popular in the Middle East region, is used as an eco-friendly hygiene method, although its use often escapes global statistics. And this is important. Oral hygiene is a daily habit and a reflection of tradition, culture, and economic conditions.
Miswak, a traditional tooth-cleaning stick (on the left)
Miswak, a traditional tooth-cleaning stick (on the left)
Economics and oral hygiene
A country's level of wealth significantly affects hygiene habits. In countries with low GDP, more than 13% of children never or rarely brush their teeth, and only 59.8% meet the recommendation to brush twice a day. Interestingly, in the wealthiest countries, the percentage of people brushing their teeth twice a day is 69.9%, which is lower compared to 78.6% in middle-income countries. This may be due to the diversity of hygiene methods, which are as effective as standard practices in many cultures, and differences in the availability of hygiene products.
Education as a tool for change
Schools have long been the place where children learn more than the alphabet - it's also where essential health habits are formed. Early oral hygiene education can change thousands of children's lives worldwide. Workshops, hands-on lessons, and interactive activities teach brushing techniques and provide an opportunity to understand why daily care of teeth translates into lifelong health.
- School-based educational programs focused on dental health, especially for younger children, can significantly foster the development of positive habits that will benefit health, now and in the future, - notes Rajat Das Gupta.
The biggest challenge remains for younger children and boys — the groups most likely to neglect hygiene. Early interventions incorporating modern tools such as mobile apps and educational videos, as well as traditional methods such as the Miswak popular in the Middle East, can effectively change these statistics. The key is to introduce new habits while respecting local traditions simultaneously.
Parental involvement further reinforces the effectiveness of such programs — it is at home that children develop routines, and adult support can be a crucial element in cementing healthy habits. However, in regions with lower levels of affluence, providing basic hygiene products, such as toothbrushes and toothpaste, is a first step that can still be challenging.
Schools can become places where healthy habits germinate and last a lifetime. This is an investment not only in cleaner teeth but also in healthier societies of the future.


What happens when we forget about oral hygiene?
Oral hygiene is one of those daily habits that is easy to neglect. However, the consequences of neglect can be more severe than it seems. Decay and gum disease not only cause pain but also lead to tooth loss, significantly reducing quality of life. What's more, untreated dental problems go beyond physical health - they affect emotional and mental well-being, often making it difficult to function normally.
The effects are particularly severe for children and adolescents. Toothache or inflammation of the gums reduces the ability to concentrate, which affects academic performance and causes more frequent absences from school. These aren't just temporary difficulties—neglect can shape the future of young people, limiting their educational and professional opportunities. For many families, medical costs become an additional burden that complicates daily life.
But that's not all. Neglected oral hygiene has far-reaching effects that can last a lifetime.
"Habits formed at these early stages often persist into adulthood. Poor oral health can result in a below-average quality of life, characterized by the pain and tooth loss many adults experience in later life," - Rajat Das Gupta says.
Uneducated habits lead to chronic diseases such as periodontal disease and even serious systemic problems - heart disease or diabetes. And while the health effects are most noticeable, the financial costs are equally significant.
Experts agree: the best weapon in this fight is prevention. Hygiene education, early intervention, and support for families are strategies that can not only improve the quality of life for individuals but also benefit entire societies. Oral hygiene is more than a matter of aesthetics - it is a fundamental element of public health that we cannot ignore.
What can we do?
Based on the results of the survey, the authors made several key recommendations:
Educational programs in schools
Regular oral hygiene lessons and hands-on workshops can increase awareness and improve habits.
Tailoring the message to gender and age
Programs should focus on boys and younger children who show lower health awareness.
Include traditional hygiene methods
Incorporating conventional oral hygiene methods into educational programs and surveys will better understand local practices and bridge cultural differences.
Supporting families
Parents should also be included in the education to reinforce children's habits at home.
The time to act
Oral health is more than aesthetics - it's the foundation of overall health. Caries is one of the most common chronic diseases in the world, and its effects reach far beyond the mouth. Early education and the formation of good oral hygiene habits can reduce the risk of health problems in adulthood.
While the world grapples with health inequities, such a simple step as brushing teeth twice a day can significantly impact the quality of life for thousands of children. The key is for schools, families, and communities to work together to make a lasting difference.
D. Sikora

Frequency of toothbrushing among children and adolescents: Frequently asked questions
What is the global frequency of toothbrushing among children and adolescents?
Using data from the 2010-2019 Global Survey of Student Health in Schools (GSHS), this study found that about 90% of students in 72 countries brushed their teeth at least once a day. However, only about 71% brushed their teeth twice or more daily, which is the recommended frequency for optimal oral health.
Do toothbrushing habits differ by region of the world?
The frequency of toothbrushing varied significantly across the World Health Organization (WHO) regions. The Americas region had the highest frequency of brushing teeth twice or more daily, while the Eastern Mediterranean region had the lowest frequency.
Are there gender differences in toothbrushing habits?
Yes, significant gender differences were observed. In most countries, girls were more likely to brush their teeth twice or more daily than boys. This finding is consistent with other studies that show similar gender differences in oral hygiene practices.
Does a country's economic status affect toothbrushing habits?
The study found that brushing teeth two or more times a day generally increased with a country's per capita gross domestic product (GDP), suggesting that economic factors play a role in oral hygiene practices. However, the highest quintile of GDP showed a slight decrease in toothbrushing frequency.
Why is promoting good oral hygiene habits in children and adolescents important?
Habits established in childhood and adolescence often carry over into adulthood. Promoting regular toothbrushing in these age groups is vital to instilling lifelong habits that contribute to good oral and overall health, potentially reducing the risk of dental problems later in life.
What strategies can be implemented to improve toothbrushing habits among young people?
School-based educational interventions focusing on dental health are particularly effective in promoting positive oral hygiene practices. These programs can educate children and adolescents about the importance of tooth brushing, proper techniques, and the consequences of poor oral hygiene.

The material is based on the article:
Rajat Das Gupta, Rohan Jay Kothadia, Shams Shabab Haider, Ananna Mazumder, Fatema Akhter, Nazeeba Siddika, Ehsanul Hoque Apu
doi: 10.17219/dmp/185842
Web. A. Hasiak
The journal "Dental and Medical Problems" is a leading dental scholarly journal in Eastern Europe founded in 1960 from the initiative of Prof. Tadeusz Owiński. It was originally called "Wrocławski Biuletyn Stomatologiczny". In 1965, the journal was renamed to "Wrocławska Stomatologia", and then the name was changed to "Dental and Medical Problems" in 2002.
"Dental and Medical Problems" is the first dentistry-profile scholarly journal in Poland and Eastern Europe in general which received a Journal Impact Factor (JIF) in the 2023 release of the Journal Citation Reports™.
"Dental and Medical Problems" is an international, peer-reviewed, open access journal covering aspects of oral sciences and general medicine, published bimonthly by Wroclaw Medical University.