#Care4YoungTeeth<3

The #Care4YoungTeeth<3 project set out to improve dental health among all adolescents, regardless of their social, geographic, or economic background. Over the past 30 years, dental health among children and youth in Norway has improved significantly. Still, a substantial proportion of 18-year-olds have experienced tooth decay or other oral health issues such as erosion or gum inflammation. Such problems may worsen when children become teenagers, that is, during the period when they have recently gotten all their permanent teeth and begin to take on the responsibility for brushing, flossing, and using fluoride without parental help. Adolescents in vulnerable life situations are particularly at risk. This includes those from families with low socioeconomic status, children with immigrant backgrounds, youth with parents suffering from serious physical or mental illness, and those receiving support from child welfare services. When adolescents visit public dental clinics, an important part of the appointment is for dental professionals to provide good oral health information in addition to conducting examinations. However, appointments are often infrequent, and the time available for follow-up is limited. Before the project began, we knew little about adolescents’ actual oral health habits or what might successfully support them in taking care of their teeth. Together with ten partners, we conducted practice-based research and facilitated interdisciplinary collaboration involving young people, dental health professionals, designers, and researchers. Our process was inspired by the Double Diamond model and grounded in participatory research and human-centered design. We combined qualitative methods like interviews, observations, and workshops, with quantitative analyses of patient records and registry data. A key finding was that over 30% of adolescents brush their teeth only once a day or less. This led to the project's central vision: To increase the number of adolescents who brush their teeth twice daily with good technique, and to make dental services feel like a supportive companion throughout their teenage years and beyond. As part of the project, we developed 2x2 – an engaging concept co-created with adolescents. The name 2x2 communicates the core message: Brush your teeth for two minutes, twice a day. The 2x2 concept includes: • A school-based lesson (the 2x2 hour) for lower secondary schools • An intervention tool (the 2x2 goal card) for use in dental clinics The 2x2 hour is designed to be both engaging and educational. Students play a fact-or-fiction game, called ‘Fake eller Fakta’, about dental health and watch short videos on toothbrushing and dental erosion. Design-led testing in school classes helped fine-tune the format, duration (45 minutes), and interaction between students and dental hygienists, between peers, and with teachers and school nurses. The 2x2 goal card is completed by the adolescent and the dental professional in cooperation. Together they formulate a concrete and realistic goal for dental care, making the link between the clinic visit and everyday life both clear and motivating. The 2x2 concept was tested in the counties of Trøndelag, Rogaland, and Møre og Romsdal during 2023 and 2024. It was officially launched for national use on May 19, 2025. Feedback from the public dental service confirms that 2x2 meets the need for relevant and feasible health promotion efforts targeting adolescents. #Care4YoungTeeth<3 has contributed new knowledge, practical tools, and innovative forms of collaboration that can help make dental health services in Norway more targeted, inclusive, and evidence-based. Scientific and dissemination contributions: • 4 academic articles • 2 academic book chapters • 1 conference paper • 19 dissemination contributions • 1 PhD thesis (submitted, awaiting assessment) • 2 master’s theses • 1 master’s thesis (submitted, awaiting assessment) • 2 popular science publications • 1 article in a professional journal featuring the project, based on an interview with project representatives In May 2025, we hosted a webinar to present 2x2. All counties in Norway were represented among the participants. Going forward, we will continue encouraging national adoption through professional channels, and we are also exploring possibilities for an international launch. Materials and information for dental professionals are available at the Tannvern website: • Dental professionals can access information and download materials for use in clinics and school visits here https://www.tkmidt.no/tannvern/2x2 • Training video for the 2x2 hour https://vimeo.com/1092372716/2fd3d7b186 Resources for Adolescents: • A youth-oriented website offering reliable oral health information, videos on toothbrushing and dental erosion, and an app with a timer and brushing reminders. https://www.2ganger2.no/

2x2 is an innovative health promotion concept developed by the #Care4YoungTeeth project through co-creation with youth and dental health professionals. It provides the dental health service with a practical tool for working systematically with health promotion and strengthening adolescents' ability to maintain a healthy mouth. The concept supports the Norwegian Parliament’s Report on Prioritization by promoting initiatives with high impact, low resource use, and a focus on those with the greatest need. 2x2 also offers valuable experiences with user involvement in service innovation, to help improve overall quality. There is a strong connection between socioeconomic conditions and oral health. Efforts to improve oral health is not only a public health measure, but can also help reduce social inequalities. 2x2 has a broad reach, as it can be implemented in dental clinics across the country—and thereby offered to all adolescents. People with oral health problems are more likely to fall out of the workforce, due to pain, fatigue, and low self-esteem linked to shame about appearance. This pain is often chronic, affecting sleep, overall health, nutrition, and social functioning. In Norway, dental services are free until a person turns 19. Still, caries and erosion accumulate over time and require repeated treatment. A health promotion and prevention approach is essential—not only to reduce the need for costly treatments, but also because more adults report being unable to afford dental care. 2x2 aims to empower adolescents with the knowledge and motivation to care for their oral health. Recall intervals at the clinic are set individually, based on oral hygiene and caries history (6–24 months). Skills and knowledge-based health promotion and prevention can help lengthen intervals and reduce the need for transport and disposable equipment. Many people feel anxious about going to the dentist, and around 9% of children suffer from odontophobia. This is treated in part through repeated, familiar visits. Knowledge builds confidence. Meeting dental professionals in a safe setting and understanding what happens during a visit can reduce anxiety. The 2x2-hour includes a section on safety. The concept combines a digital presentation and a reusable card game. Oral health is closely linked to general health. Diseases in the mouth are associated with cardiovascular disease, diabetes, Alzheimer’s disease, and some cancers. Prevention through knowledge and motivation can reduce resource use in both dental and general healthcare. Adolescence is a vulnerable time for oral health. 2x2 works to prevent oral diseases through awareness, motivation, and knowledge. Dental hygienists play a key role in school-based health promotion. With a complete, quality-assured, and easy-to-use product, 2x2 frees up valuable time in their daily work.

In #Care4YoungTeeth<3 we address a major societal challenge within oral health: social inequality. This inequality is apparent from childhood and seems to persist into adulthood. The caries rate increases in adolescence, i.e. in the same period as children get permanent teeth and are expected to take more responsibility for their health habits. Poor oral health is particularly common among vulnerable groups, such as families with low socio-economic status and children in child welfare. Scientists, Public Dental Service (PDS) and oral care product industry possess limited knowledge about the underlying reasons for the adverse changes during adolescence and how to reach youth as dental patients and consumers. The adolescents themselves call for new solutions enabling them to take care of their oral health. We aim to improve oral health in adolescence, regardless of socio-economic status, living conditions or environmental factors. #Care4YoungTeeth<3 will address and directly engage adolescents aged 12-18. The overall objective is to co-create solutions targeted at adolescents enabling them to take better care of their teeth. The long-term purpose to improve oral health status by inducing lifelong oral health promotive habits and contribute to a reduction of social inequalities in oral health. The solutions will be both population-wide and adaptable to individual needs to reach both vulnerable and non-vulnerable adolescents. #Care4YoungTeeth<3 will establish an innovative collaboration between adolescents, PDS, industry and research partners nationally and internationally to develop new knowledge of relevant solutions that support young people on their premises drawing on their peer cultures. Our project will engage stakeholders to co-create oral health products, digital information and communication tools and service touchpoints, implement them within a clinical context, conduct summative evaluations, develop recommendations and develop an implementation plan.