Different Methods for Using a Validated Comic to Promote the Safe Use of Fluoridated Toothpaste Among Children

Lima, Sérgio da Silva; Zanin, Luciane; Oliveira, Arlete Maria Gomes; Flório, Flávia Martão

doi:10.1590/pboci.2026.001

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ORGINAL ARTICLE • Pesqui. Bras. Odontopediatria Clín. Integr. 26 • 2026 • https://doi.org/10.1590/pboci.2026.001 linkcopy

Different Methods for Using a Validated Comic to Promote the Safe Use of Fluoridated Toothpaste Among Children

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: To evaluate methods for utilizing a validated educational comic to promote the safe use of fluoridated toothpaste among children.

Material and Methods: This quasi-experimental study included 33 educators from four municipal preschools in Macapá, Brazil. Schools were randomly assigned to two groups: G1 (educators read the comic independently; n=19) and G2 (educators read the comic and later participated in a dentist-led discussion; n=14). Educators completed pre- and post-intervention questionnaires. Educators served as the unit of analysis, and statistical analyses were conducted at α=5%.

Results: Knowledge improved in both groups. A significant reduction was observed in the amount of toothpaste applied to children's toothbrushes, along with increased awareness of the risks associated with toothpaste sitting on the brush before brushing began (p<0.05). G2 demonstrated a higher frequency of correct responses regarding toothpaste use and quantity. Furthermore, in G2, perceptions of fluorosis risk were significantly associated with key factors, including the age-appropriate amount of toothpaste (p=0.0277), children applying toothpaste independently (p=0.0251), adult supervision (p=0.0284), swallowing toothpaste (p=0.0425), and encouraging expectoration (p=0.0152).

Conclusion: The comic effectively improved educators' knowledge of safe toothpaste use. The addition of a group discussion further enhanced this effect, underscoring the importance of integrating independent learning with interactive strategies to optimize oral health education.

Keywords:
Oral Hygiene; Health Education; Toothpastes; Fluorosis, Dental; Comic Book

Variables	Group
	G1	G2
	N (%)	N (%)
Age (years)
Mean age (standard deviation)	38.6 (11.0)	43.8 (11.5)
Minimum and maximum age	20.8 to 63.0	18.3 to 59.5
Schooling [n (%)]
Incomplete College	0 (0.0)	1 (7.1)
Completed College	19 (100.0)	13 (92.9)
Age of the majority of the children you work with
Less than 3 years	2 (10.5)	0 (0.0)
3 to 4 years	8 (42.1)	11 (78.6)
5 years	9 (47.4)	3 (21.4)
Do children brush their teeth at school?
They never do	1 (5.3)	0 (0.0)
Sometimes they do	6 (31.6)	6 (42.9)
Yes, they do it every day	12 (63.2)	8 (57.1)
The school has a designated and suitable area for children to brush their teeth.
Yes	19 (100.0)	14 (100.0)

Questions	Group	Before Reading	After Reading
			No	Yes	Yes, as long as it is children’s toothpaste
			N (%)	N (%)	N (%)
Can young children use fluoride toothpaste?	1	No	0 (0.0)	1 (5.3)	0 (0.0)
		Yes	0 (0.0)	7 (36.8)	1 (5.3)
		Yes, as long as it is children’s toothpaste	0 (0.0)	2 (10.5)	8 (42.1)
	2	No	0 (0.0)	0 (0.0)	0 (0.0)
		Yes	0 (0.0)	3 (21.4)	0 (0.0)
		Yes, as long as it is children’s toothpaste	0 (0.0)	8 (57.1)	3 (21.4)
			No	I am not sure	Yes
Do you know the ideal portion of toothpaste for a small child’s toothbrush?	1	No	0 (0.0)	0 (0.0)	0 (0.0)
		I am not sure	0 (0.0)	0 (0.0)	6 (31.6)
		Yes	0 (0.0)	1 (5.3)	12 (63.2)
	2	No	0 (0.0)	0 (0.0)	2 (14.3)
		I am not sure	0 (0.0)	0 (0.0)	7 (50.0)
		Yes	0 (0.0)	0 (0.0)	5 (35.7)

Group	Before Reading		After Reading		p-value^$
Group	Mean (SD)	Median (Min. and Max.)	Mean (SD)	Median (Min. and Max.)	p-value^$
1	7.0 (2.4)	7.0 (3.0; 11.0)	3.4 (1.7)	3.0 (2.0; 8.0)	0.0001
2	6.9 (2.2)	6.0 (3.0; 12.0)	2.8 (0.8)	3.0 (2.0; 4.0)	0.0010
p-value*		0.8555		0.5004

Topic	Group	Before Reading		After Reading		p-value^$
Topic	Group	Mean (SD)	Median (Min.; Max.)	Mean (SD)	Median (Min.; Max.)	p-value^$
An adult applying toothpaste to children’s toothbrushes	1	4.5 (0.8)	5.0 (3.0; 5.0)	4.8 (0.5)	5.0 (3.0; 5.0)	0.1508
	2	4.5 (0.7)	5.0 (3.0; 5.0)	4.9 (0.3)	5.0 (4.0; 5.0)	0.0759
p-value*			0.8179		0.8555
Paying attention to the amount of toothpaste based on the child’s age	1	4.4 (0.9)	5.0 (3.0; 5.0)	4.7 (0.7)	5.0 (3.0; 5.0)	0.1056
	2	4.5 (0.5)	4.0 (4.0; 5.0)	4.9 (0.3)	5.0 (4.0; 5.0)	0.0277
p-value*			0.7012		0.6489
Monitoring whether the child spits out the toothpaste while brushing	1	4.7 (0.7)	5.0 (2.0; 5.0)	4.8 (0.5)	5.0 (3.0; 5.0)	0.5930
	2	4.3 (1.0)	5.0 (2.0; 5.0)	4.6 (0.6)	5.0 (3.0; 5.0)	0.4413
p-value*			0.2658		0.4021
Encouraging the child to spit out toothpaste during and after brushing	1	4.8 (0.5)	5.0 (3.0; 5.0)	4.8 (0.5)	5.0 (3.0; 5.0)	0.7893
	2	4.5 (0.8)	5.0 (3.0; 5.0)	4.9 (0.3)	5.0 (4.0; 5.0)	0.0935
p-value*			0.2742		0.8555
The child has toothpaste on their toothbrush while waiting to brush their teeth at school	1	3.0 (1.6)	3.0 (1.0; 5.0)	3.7 (1.5)	4.0 (1.0; 5.0)	0.0180
	2	3.3 (1.2)	3.0 (2.0; 5.0)	4.6 (0.8)	5.0 (3.0; 5.0)	0.0254
p-value*			0.7220		0.1451
The child applies toothpaste to their toothbrush	1	3.8 (1.5)	4.0 (1.0; 5.0)	4.3 (1.3)	5.0 (1.0; 5.0)	0.1141
	2	3.8 (1.3)	4.0 (2.0; 5.0)	4.9 (0.3)	5.0 (4.0; 5.0)	0.0251
p-value*			0.9681		0.2155
An adult supervising children’s brushing	1	2.9 (1.9)	3.0 (1.0; 5.0)	2.4 (1.9)	1.0 (1.0; 5.0)	0.2626
	2	3.3 (1.6)	3.5 (1.0; 5.0)	4.7 (0.6)	5.0 (3.0; 5.0)	0.0284
p-value*			0.5952		0.0016
The child was swallowing toothpaste while brushing	1	4.1 (1.5)	5.0 (1.0; 5.0)	4.8 (0.7)	5.0 (2.0; 5.0)	0.1013
	2	3.8 (1.6)	5.0 (1.0; 5.0)	4.9 (0.3)	5.0 (4.0; 5.0)	0.0425
p-value*			0.5649		0.8780
An adult supervises the child to encourage spitting out toothpaste	1	2.7 (1.8)	2.0 (1.0; 5.0)	3.1 (2.1)	5.0 (1.0; 5.0)	0.7353
	2	2.9 (1.4)	3.0 (1.0; 5.0)	4.9 (0.4)	5.0 (4.0; 5.0)	0.0152
p-value*			0.6264		0.0535

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[TFN1] ^$Comparison between each group's time points (before and after reading the comic); *Comparison between groups at each time point; SD: Standard Deviation; Min.: Minimum; Max.: Maximum.