Patterns in Oral Hygiene and Dietary Habits in School Children during the COVID-19 Pandemic

islands last year-specifically in three church schools and two state schools in Gozo (an island that is part of the Maltese archipelago) as part of a research study.The urgent need for such programs was felt even more strongly after recent studies found that the deft of 3-year olds in Malta and Gozo was 1.44 (with one third of them being at risk for caries) and the deft of 5-years old was found to be 3.77.15 This was also confirmed to be the case in Gozo.16 Furthermore, Malta ranked last of all European countries for toothbrushing habits in 11-and 15-years-old children and Malta also has an obesity problem as can be seen in the Health Behaviours in School Aged Children report (HBSC) in 2017/2018.17 This also shows the importance of diet as a common risk factor for both caries and general health.18 The school programs introduced in Gozo in 2019 came to an abrupt halt as per a legal notice issued by the Superintendence IntroductIonDental caries affects 60-90% of school children and most adults 1 and is the fourth most expensive disease to treat. 2 Apart from the financial burden imposed, caries has global societal and individual burdens on children such as missed school days, social withdrawal, pain, attention deficit at school, poor academic performance, sleep deprivation, poor esthetics, malnutrition, and growth retardation.[3][4][5][6][7] Caries in permanent teeth ranked first out of 354 diseases with chronic sequelae while caries in the deciduous dentition ranked twelfth.8,9 The main risk factors for caries are: a sugar-rich diet, low fluoride availability, and poor oral hygiene.The high prevalence, substantial burden, and preventability of dental caries make it a top public health priority.Schools are identified as the ideal setting for introduction of health policies for school-aged children.10 This is because children spend most of their time at school, and are there exposed to a constant routine, life skills, and good habits to then take back home to their families.Many schools worldwide have adopted school programs such as supervised tooth brushing or mouth rinsing, fluoride varnish programs, and healthy lunch policies to prevent dental caries as well as other general diseases.Supervised tooth brushing and supervised mouth rinsing have both been found to be effective at reducing caries in children, [11][12][13][14] and while evidence for brushing with a fluoride toothpaste is now indisputable, supervised mouth rinsing was also found to reduce caries by 27% caries at meta-analysis level.14 Despite the strong evidence in favor of school oral health programs, these have only been introduced on the Maltese 1,