Transforming Children’s Oral Health Worldwide: Three Decades of the Colgate Bright Smiles, Bright Futures® Prevention Program

The Colgate Bright Smiles, Bright Futures (BSBF) prevention program (hereafter referred to as the program) was launched in 1991 as an initiative to promote children’s oral health through education, prevention, and partnerships. BSBF began as a demonstration program in the United States, featuring a school-based oral health education curriculum, mobile dental vans, and community outreach in Oakland, Calif., and Philadelphia. The program established partnerships with school districts, professional organizations, and community-based organizations, including the Boys & Girls Clubs of America, the YMCA, Girls Inc., and other groups serving children in underserved communities. Standardized evaluation by the University of Maryland in 1992 found that students exposed to the BSBF curriculum demonstrated greater knowledge of oral hygiene practices, preventive care, and nutrition than students in the control group. These findings informed subsequent program refinement and expansion.¹

As the Colgate-Palmolive Company’s flagship social impact program, BSBF built on these early successes and evolved into a scalable prevention model that translates evidence-based oral health messages into practical behaviors and activities for children, caregivers, educators, and community partners. At its core, the program promotes oral health by making prevention accessible, engaging, and scalable through schools, community events, professional networks, public health organizations, and local champions. The program’s early design was built on several core elements that have remained central to its success over time: child-friendly oral health education, the distribution of preventive oral hygiene products and materials (referring to samples as well as toothbrushing chart and education materials for take home), and collaborative engagement among teachers, families, and dental professionals.

A key success of the program has been its deliberate partnerships with local stakeholders who understand local community needs and can adapt program implementation to diverse settings. Program development has prioritized culturally adaptable educational materials and scalable delivery models, including BSBF’s free online curriculum and the partnership with Give Kids A Smile (GKAS) and TeamSmile. Colgate has had representation on the GKAS National Advisory Committee since 2018, with an annual support of 250,000 toothbrushes and toothpastes. The 19 years of support have amounted to more than $11 million in in-kind and financial support. Colgate has provided TeamSmile more than $1.7 million in dental care through collaborations between oral health professionals and professional and collegiate sports organizations.² These partnerships have supported BSBF’s efforts to expand across countries, languages, and healthcare systems while maintaining a consistent, prevention-oriented framework.

Global Context

Oral diseases remain among the most common chronic conditions affecting children worldwide. According to the World Health Organization (WHO) Global Oral Health Status Report (2022), the global prevalence of dental caries among children aged 1 to 9 years is estimated at 42%, affecting approximately 514 million children.² Early childhood dental caries can impair nutrition, sleep, speech development, school readiness, quality of life, and family well-being. Despite being largely preventable, childhood oral disease disproportionately affects children living in poverty, those with limited access to dental services, children from historically marginalized communities, and those living in settings where oral healthcare is not integrated with primary care, schools, and community health systems.³

The public health importance of oral disease extends beyond clinical outcomes. Untreated oral disease contributes to pain, infection, school absenteeism, caregiver work loss, emergency department visits, and increased treatment costs. Oral health is also closely linked to overall and systemic health. Despite the high burden and largely preventable nature of childhood oral disease, oral health promotion has historically been under-prioritized within broader public health systems. The WHO has identified oral health as a neglected area of global health, with preventive oral health services often insufficiently integrated into primary care and universal health coverage. This gap is particularly important for children, for whom early preventive interventions can reduce disease burden, avoid costly treatment, and establish lifelong oral health behaviors.

In many countries and communities, oral health promotion has historically received less investment than other areas of child health.³ In sub-Saharan Africa, about 70% of countries spent less than US$1 per person per year on oral healthcare in 2019. The WHO specifically attributes this to oral health being a low priority and inadequate financial and technical investment.⁴ At the same time, oral diseases affect approximately 3.5 billion (45%) people worldwide, and 75% of those affected live in low- and middle-income countries.⁵ Global initiatives such as BSBF emerged in response to this gap by emphasizing early education and prevention, community engagement, and the provision of practical resources across diverse settings and languages.

Understanding the historical evolution of BSBF provides important context for interpreting its global implementation and long-term public health impact (Figure 1). The following sections synthesize findings from more than three decades of program implementation across diverse geographic and healthcare settings. The authors chronologically describe the major phases of BSBF’s development and global expansion and summarize evidence on its reach, outcomes, capacity building, health equity, and key lessons learned.

Methods

This narrative review synthesized evidence from peer-reviewed publications, program evaluations, organizational reports, implementation documents, and partner publications related to the BSBF program spanning more than three decades. The evidence was organized into recurring themes, including workforce development, school-based prevention, community engagement, partnerships, policy integration, sustainability, and health equity. Because this review incorporates both published and unpublished program evaluations, the findings are presented descriptively rather than as a formal systematic review or meta-analysis.

Results

Since its launch, BSBF has grown into one of the world’s largest oral health promotion programs, implementing initiatives in more than 100 countries and reaching over 2 billion children and their families through school-based education, community outreach, preventive services, and public–private partnerships.⁶ The program’s materials have been translated into more than 30 languages. Although implementation strategies have varied across regions, the program has consistently emphasized prevention, oral health literacy, and expanded access for underserved populations through sustainable, community-based approaches. Key lessons from more than three decades of BSBF implementation are summarized in Table 1 and organized in the following sections around four major themes: workforce development, school-based prevention, family and community engagement, and partnerships and systems integration.

Key Lessons Learned

1. Workforce Development

Non-dental providers have consistently emerged as effective partners in delivering oral health promotion across diverse settings, demonstrating that preventive oral health interventions can be successfully integrated into children’s everyday environments rather than relying exclusively on dental professionals. The BSBF program has shown that teachers, coaches, community health workers (CHWs), nurses, and other trusted community members can reinforce oral health messages, model healthy behaviors, and increase access to preventive services while working within existing educational and community infrastructures. Grenada’s nationwide Smile Grenada program, for example, demonstrated that teachers could safely implement supervised daily toothbrushing, apply fluoride varnish after appropriate training, and support the placement of glass ionomer sealants with minimal disruption to classroom activities.⁷ Similar community-based models have been successfully implemented in Kenya and Tanzania through teachers, nurses, and CHWs. In India, accredited social health activists and Anganwadi workers were trained to provide oral health counseling, dietary guidance, early caries recognition, and referrals.^8-10 By embedding oral health education into schools, sports programs, and community-based services, these approaches increase the frequency of preventive messaging and reach children who might otherwise have limited access to oral health education and/or dental care.

Collectively, these implementation models demonstrate that expanding the oral health workforce beyond traditional dental providers can strengthen prevention efforts while improving program sustainability and expanding population reach.^7,10,11 The WHO African Region faces a severe shortage of oral health professionals, with approximately one dentist available for every 30,000 people between 2014–2019, approximately one-tenth of the global ratio.⁴ Such shortcomings have only been further compounded by the impacts of the COVID-19 pandemic.

One example of this workforce expansion is the community oral health worker (COHW) model developed by the University of California Los Angeles (UCLA) Center for Children’s Oral Health.¹² Recognizing that many underserved families face substantial barriers to accessing dental care, UCLA developed a culturally and linguistically appropriate train-the-trainer model that prepares trusted community members to deliver oral health education, promote oral health literacy, provide anticipatory guidance, facilitate early caries prevention, encourage the establishment of a dental home, and connect families with preventive dental services. The program emphasizes motivational interviewing, culturally responsive communication, care coordination, and the integration of oral health into maternal–child health and primary care settings. It demonstrates how CHWs can serve as trusted liaisons between families and the healthcare system while expanding the preventive oral health workforce. This approach closely aligns with the BSBF emphasis on prevention, community engagement, and health equity by shifting oral health promotion from episodic clinical encounters to continuous, community-based support systems.^13-15

Evaluation of the UCLA COHW model demonstrated that community oral health workers significantly improved their oral health knowledge, confidence, and preventive counseling skills following structured bilingual training. They subsequently delivered effective oral health workshops such as Early Head Start and other community settings using a peer-to-peer education model. Caregivers who participated in these community-led workshops demonstrated significant improvements in oral health knowledge, beliefs, and preventive practices related to early childhood caries (ECC), illustrating the effectiveness of leveraging trusted community members to deliver oral health education.

The UCLA COHW model has since evolved into a broader workforce development initiative that integrates oral health promotion with medical–dental collaboration, oral health literacy, and community-based care coordination. This scalable framework complements BSBF’s global strategy of empowering non-dental providers to improve access to preventive oral healthcare for vulnerable children and families. As oral health systems increasingly seek sustainable approaches to reducing disparities, the UCLA COHW model demonstrates how community health workers can translate the principles of BSBF into long-term, locally embedded prevention programs that strengthen community capacity and advance oral health equity.^13-15 These findings demonstrate that expanding the preventive oral health workforce beyond traditional dental providers is feasible, scalable, and sustainable when supported by appropriate training, strong community partnerships, and locally tailored implementation, particularly in underserved communities.

2. School-Based Prevention

School-based interventions have consistently improved oral health knowledge, toothbrushing behaviors, and preventive practices. Initial evaluations conducted by the University of Maryland demonstrated significant improvements in students’ oral health knowledge, toothbrushing skills, nutrition knowledge, and preventive behaviors.^16,17 Similar improvements in oral hygiene practices and oral health literacy were subsequently reported in BSBF programs implemented in China, India, Qatar, Australia, and Mexico,¹⁸ demonstrating that these educational benefits were reproducible across diverse cultural and healthcare settings. For example, in China, 100 million children have been reached over a 10-year period (Figure 2), and thousands of teachers have been trained and educated through their nationwide oral health promotion program, “Love Thy Teeth.”¹⁹

Beyond improving knowledge and oral hygiene behaviors, BSBF also demonstrated measurable improvements in clinical outcomes, providing evidence that school-based prevention programs can translate behavioral changes into reductions in disease burden (Table 2). One of the strongest examples comes from the 2.5-year Smile Grenada intervention, in which children experienced a 75% reduction in new cavities and demineralized lesions on first permanent molars. The program combined teacher-led classroom oral health education, daily supervised toothbrushing with fluoridated toothpaste, fluoride varnish applications, and glass ionomer sealants. The mean number of decayed tooth surfaces per child decreased from 9.02 at baseline to 6.29.⁷ Similarly, an 8-week study conducted during the early years of BSBF implementation in Beijing reported a reduction in the mean plaque index score was significant at the P <0.001 level implementation of the BSBF curriculum.¹⁸ In Thailand, a school-based program combining the BSBF curriculum with the use of fluoride toothpaste (1,450 ppm fluoride) containing 1.5% arginine achieved a 34.1% reduction in new caries incidence at the dentine threshold, with reductions reaching 40.9% in the most cooperative schools.²⁰ Together, these findings suggest that school-based oral health education is most effective when combined with evidence-based preventive measures, such as fluoride exposure and supervised toothbrushing.

Several programs also evaluated complementary preventive interventions that worked alongside the BSBF curriculum. A small study in Qatar evaluated the combination of the BSBF oral health curriculum with atraumatic restorative treatment (ART) and found that 91.2% of restorations were retained among children who participated in the program.¹⁸ Similarly, the 12-week SaludARTe study in Mexico City found that supervised school toothbrushing increased healthy gingival units by 23.3% and plaque-free surfaces by 8.8%, demonstrating a greater impact on plaque accumulation and gingivitis than on gingival bleeding.²¹ Together, these findings illustrate how oral health education can be effectively integrated with preventive clinical services to improve children’s oral health.

Ongoing research continues to strengthen the evidence base for school-based prevention. For example, researchers in the Galápagos are conducting a longitudinal study to evaluate the effectiveness of daily supervised toothbrushing at school combined with fluoride varnish applications every 6 months for managing incipient carious lesions among children aged 3 to 10 years. This study was initiated in response to a high local prevalence of white spot lesions.²² Its findings may further clarify the long-term effectiveness of combining behavioral and clinical preventive strategies in school settings. Further evidence is expected from the BEE-Smiley study, an ongoing cluster-randomized school-based trial conducted in partnership with the University of Manchester. The study evaluated the behavioral effects of a multi-component curriculum designed to engage both children and their families, providing additional insight into how family-centered interventions influence the adoption and maintenance of healthy oral health behaviors.²³

Overall, evidence suggests that school-based oral health programs achieve the greatest impact when they combine engaging educational curricula with regular reinforcement, caregiver involvement, and evidence-based preventive interventions such as supervised toothbrushing and fluoride varnish application. These findings support schools as effective, scalable settings for improving both oral health behaviors and clinical outcomes among children across diverse populations.

3. Family and Community Engagement

Programs that incorporated visual, interactive, and culturally relevant educational approaches consistently achieved high levels of engagement. For example, in Kenya, the “Talking Walls” initiative reinforced oral health messages through murals displayed in school playgrounds and other common areas (Figure 3).¹⁰ In Australia, storytelling, recurring characters, and illustrated educational materials helped preschool children retain key oral health messages and establish home toothbrushing routines (Figure 4).²⁴ The program delivered early childhood education and care settings, aiming to equip educators, children, and parents with knowledge and skills to build healthy oral hygiene habits early in life and reduce ECC.²⁵ Within the program, the family plays a central role in reinforcing these habits at home. Here, parents reported that the program encouraged their children’s toothbrushing and improved message retention, attitudes, and routines around oral health within the family. Similarly, New York City’s Soccer for Success program demonstrated that integrating oral health education into youth sports improved children’s oral health behaviors while also positively influencing nutrition, self-esteem, and school engagement (Table 3).¹¹

A qualitative study not yet published, “Exploring How Supervised Toothbrushing in Early Years Settings Influences Home Toothbrushing in Young Children,” found that supervised toothbrushing appeared to encourage home toothbrushing to some extent, according to the study’s lead author, Dr. Zoe Marshman, Professor/Honorary Consultant in Dental Public Health at the University of Sheffield. The authors concluded, however, that this connection could be strengthened through improved communication with families, practical demonstrations, and co-designed take-home materials and resources, thereby maximizing the potential of supervised toothbrushing programs to promote positive family-based oral health behaviors.

Beyond direct child outcomes, interventions routinely generated secondary benefits within the wider household. Teachers reported greater parental involvement in daily toothbrushing routines, caregivers became more engaged in preventive oral health practices, and educational materials encouraged family discussions about oral hygiene.^10,25 By delivering anticipatory guidance through children, school- and community-based activities successfully positioned youth as “change agents” who transformed individual habits into sustained family hygiene routines.

4. Partnerships and Systems Integration

BSBF programs demonstrate the importance of collaboration with governments, ministries of health, educational systems, and public and private health organizations. In Mexico, BSBF partnerships contributed to legislation supporting daily supervised toothbrushing in public schools, followed by program expansion across multiple states.^6,21 Similarly, a national public–private initiative led by the Department of Health and Social Care and the Department for Education in partnership with Colgate-Palmolive introduced a targeted, supervised toothbrushing program.⁶ Designed to reach up to 600,000 children aged 3 to 5 years in early years settings across the most deprived areas, the scheme integrates daily toothbrushing routines with donated oral care packs to mitigate severe ECC. Together, these initiatives demonstrate how oral health promotion can be embedded within existing public systems to strengthen long-term integration, sustainability, and population reach.

In addition to government collaborations, the BSBF program has partnered extensively with professional organizations and community agencies to expand access to preventive oral healthcare. Collaborations with the National Dental Association, Hispanic Dental Association, and Society of American Indian Dentists supported mobile dental programs that combined oral health education with preventive services in underserved communities. Partnerships with the US-based nonprofit organization TeamSmile integrated dental screenings and oral health education into professional sports events, extending the program’s reach across diverse communities and institutional settings while maintaining its prevention-oriented approach.²⁶ Collaborations with Head Start and Early Head Start, federally funded programs that promote early learning, health, and family well-being for children from low-income families, integrated supervised toothbrushing, oral health education, dental referrals, and family engagement into early childhood programs.²⁷ BSBF also supported the American Academy of Pediatric Dentistry’s Dental Home concept by providing oral health screenings and referrals through school- and community-based outreach, helping to connect children to ongoing sources of dental care.

Beyond national partnerships, Colgate BSBF and Colgate-Palmolive have established collaborations with international organizations to align community-based oral health promotion with global public health priorities. Through partnerships with the WHO Foundation, FDI World Dental Federation (FDI), International Association of Pediatric Dentistry (IAPD), Save the Children, ministries of health, national dental associations, and academic institutions, the program has expanded its global reach while supporting international oral health and prevention initiatives.²⁸ These partnerships support the WHO Global Oral Health Action Plan by integrating oral health into primary healthcare and broader noncommunicable disease prevention efforts. Collaboration with FDI advances Colgate-Palmolive’s Vision 2030 framework by promoting equitable access to care,²⁹ community-based prevention, and National Dental Association Smile Grants. Partnerships with the IAPD further pediatric oral health education through professional training resources, the Bright Smiles, Bright Futures Award, and the global Fluoriders initiative, which promotes twice-daily toothbrushing with fluoride toothpaste.³⁰ Collectively, these collaborations have strengthened workforce capacity, supported policy development, and expanded prevention-focused oral health programs worldwide.

Altogether, these examples demonstrate that partnerships were not just supportive of BSBF implementation, but were the primary mechanism through which the program expanded, adapted to local contexts, and became integrated into existing national and local health and education systems. These collaborations enabled the program to translate oral health promotion efforts into sustainable, community-based practices across diverse settings. By engaging teachers, school nurses, community health workers, and other trusted local partners, BSBF expanded access to preventive oral health education beyond traditional clinical settings. This adaptable implementation model strengthened local capacity, facilitated the integration of oral health into existing health and education systems, and promoted more equitable access to preventive services for underserved populations.

Discussion

The sustained success of BSBF for more than three decades reflects the interaction of multiple complementary factors rather than any single intervention (Table 4). Strong leadership, oral health advocacy, long-term partnerships, evidence-based prevention, community engagement, medical/dental integration, and the ability to adapt implementation to diverse cultural and healthcare contexts enabled the program to expand while maintaining a consistent prevention-focused mission. This balance between global consistency and local flexibility allowed BSBF to remain relevant across more than 100 countries and reach over 2 billion children and their families through schools, community organizations, healthcare systems, and public–private partnerships. Long-term institutional commitment and strategic partnerships have been fundamental to BSBF’s continued expansion. Sustained investment by Colgate-Palmolive, together with collaborations involving governments, universities, professional organizations, and community partners, created an implementation infrastructure capable of supporting programs across diverse settings. Rather than functioning as isolated outreach efforts, many initiatives became integrated into existing schools, public health systems, and community organizations, increasing local ownership and supporting long-term sustainability.

BSBF also demonstrated that global prevention programs can maintain scientific consistency while adapting implementation to local cultures, languages, and educational systems. Instead of relying on a single standardized curriculum, the program encouraged locally relevant educational approaches while preserving its core evidence-based prevention messages. This flexibility fostered community ownership without compromising program fidelity. Another defining characteristic of BSBF has been its emphasis on practical proactive prevention strategies that can be delivered through existing community settings. By expanding the preventive oral health workforce beyond dentists to include teachers, coaches, nurses, community health workers, physicians, pediatricians, and other trusted community members, the program substantially broadened its reach while reinforcing healthy behaviors through repeated community-based interactions. These workforce innovations demonstrate that effective oral health promotion can be integrated into children’s everyday environments rather than relying exclusively on clinical care.

The experience of BSBF demonstrates that sustainable improvements in children’s oral health are achieved not through isolated clinical interventions but through long-term investment in prevention, community partnerships, workforce development, and systems integration. As countries continue to address persistent oral health disparities, the implementation principles underlying BSBF provide a practical, scalable, and evidence-informed framework for designing, implementing, and sustaining future global oral health promotion initiatives.

United Nations Sustainable Development Goals and the Oral Health Gap

The United Nations Sustainable Development Goals (SDGs) opens with the 2030 Agenda’s adoption by 193 nations, then highlights a striking omission: none of the SDGs’ 17 targets explicitly mention oral health, despite oral disease being the world’s most prevalent health condition. The initiative traces the policy evolution from the 2021 World Health Assembly resolution, through the WHO Global Oral Health Action Plan’s 10% relative reduction target in the combined global prevalence of main oral conditions by 2030, to the World Economic Forum white paper (2024) (co-authored with Colgate)³¹ that explicitly argued oral health equity advances the SDGs.³² Launched in 1991, BSBF predates the SDGs by nearly three decades, then maps the structural alignment: school-based delivery serving SDG 3’s prevention emphasis, shared risk factors making BSBF education a dual-purpose NCD intervention, focus on underserved communities embodying the “leave no one behind” principle, and Ministry of Health partnerships aligning with strengthening country-led systems. SDG 4 (school absenteeism), SDG 8 ($323B productivity losses), SDG 10 and SDG 1 (inequity and financial hardship from out-of-pocket dental costs) trace BSBF’s intersections with adjacent goals. Figure 5 shows one of the present authors, Dr. Ramos-Gomez, who presented and testified at the United Nations, where he advocated for children’s health and emphasized that SDG 3, which calls for health and well-being for people of all ages, should include oral health.

In summary, these SDGs frame three key impact pathways (pain, absenteeism, systemic burden) and set the attribution boundary: disease contribution, not direct mortality attribution. Ultimately, without oral health a person can never achieve total health. Oral health needs to be advocated for as a key health outcome measure for all the United Nations sustainable health goals in each of the SDG relevant areas of focus.

Future Directions

For over three decades, BSBF has demonstrated that a prevention-focused, culturally adaptable, and partnership-driven program can achieve broad reach while remaining relevant across diverse settings. The program’s legacy extends beyond oral health education and resource distribution to include community engagement, workforce development, systems integration, and the promotion of a broader culture of prevention in children’s oral health. Building on this foundation, the next phase of BSBF should emphasize standardized evaluation, measurement of program impact, and stronger integration of oral health into child health systems to better assess long-term clinical, economic, and population health outcomes. Overall, BSBF provides a practical, scalable, and equity-driven implementation model that can inform the design and implementation of future global oral health initiatives.

Future global oral health initiatives should build on these implementation lessons by strengthening standardized evaluation methods, incorporating long-term clinical and economic outcome measures, and expanding integration with primary healthcare, schools, and community organizations. Furthermore, continued investment in workforce development, culturally responsive education, and implementation research will be essential to sustain improvements in children’s oral health and reduce global oral health disparities.

The Organization for Economic Co-operation and Development (OECD) Development Assistance Committee (DAC) framework provides a useful structure for guiding the next phase of BSBF evaluation and implementation. Existing evaluations illustrate how the OECD-DAC domains can be applied to BSBF implementation. For example, evaluations conducted in rural Honduras demonstrated the program’s relevance in communities with limited access to dental care,³³ while studies from Grenada, Kenya, Mexico, and India demonstrate its effectiveness, sustainability, and successful integration into existing educational systems. Future assessments should examine not only program reach but also long-term relevance, effectiveness, sustainability, and efficiency across various settings (Figure 1).

As independent observers and experts on oral health prevention, the authors recommend that the BSBF program consider a strategic framework for the upcoming decade that aligns its global children’s oral health mission with the six OECD-DAC evaluation criteria: relevance, coherence, effectiveness, efficiency, impact, and sustainability. By mapping each OECD-DAC domain to a strategic question, a set of example metrics, a vision of success, and an institutional commitment, the framework provides a unified logic model for planning, measuring, and communicating BSBF’s contribution to child oral health worldwide. The overarching vision statement anchors the entire grid: a world where every child has the knowledge, tools, and access to achieve lifelong oral health and well-being.

The first domain, relevance, asks whether BSBF is reaching the populations with the greatest need and whether its content is culturally and contextually appropriate. Metrics include population coverage, cultural adaptation of materials, and alignment with community priorities. Success is defined as BSBF reaching and resonating with the children and communities who need it the most. BSBF’s commitment is to listen, adapt, and prioritize based on local data and community voice, ensuring the program remains demand-driven rather than supply-driven.

The second domain is coherence, which examines how well BSBF fits within broader health, education, and social-policy systems. Metrics focus on partnerships formed, policy adoption at national or sub-national levels, and degree of systems integration. The success state is one in which BSBF is embedded in policies, partnerships, and systems that support child oral health rather than operating as a standalone initiative. BSBF commits to collaborating across sectors to strengthen policies and systems for lasting change, positioning the program as a catalyst within larger multi-sectoral frameworks.

The third domain, effectiveness, tracks whether the program changes behavior and improves clinical outcomes. Metrics span brushing frequency, fluoride use, dmft/DMFT (decayed, missing, filled teeth indices for primary and permanent dentition), preventive dental visits, risk assessment, fluoride varnish applications, anticipatory guidance, and data-gathering quality. Success is achieved when children adopt healthy behaviors and experience better oral health outcomes over time. BSBF’s commitment here is to use evidence-based strategies and continuous learning to drive results, signaling an iterative, data-informed approach to program design.

The fourth domain is efficiency and asks whether BSBF delivers value for money and whether its delivery model can scale. Metrics include cost per child reached, return on investment, digital engagement levels, and workforce productivity. The success vision is maximum impact through smart resource use and scalable approaches. BSBF commits to innovation and technology leverage to deliver high-value, cost-effective programs, acknowledging that digital tools and workforce optimization are central to reaching more children without proportional cost increases.

The fifth domain, impact, looks beyond individual behavior change to population-level health and equity. Metrics include ECC prevalence, hospitalizations related to oral disease, oral health–related quality of life, disparity reduction, and the availability of valid data screening instruments per region and per country. This underscores that impact measurement must be regionally calibrated. Success means BSBF improves population oral health and reduces inequities across all communities. BSBF commits to measuring what matters and focusing on equity to ensure no child is left behind.

The sixth and final domain is sustainability, which addresses whether or not the program can endure after initial or external support diminishes. Metrics include long-term funding diversification, institutionalization within government or educational systems, leadership succession planning, workforce retention, and local partnerships, including state ministry support. Success is defined as a program that is locally owned, financially sustainable, and led by strong advocacy, future-ready systems, and people. BSBF commits to building local capacity and securing diverse resources to sustain the program for generations.

Several design principles emerge across all six domains. First, the framework elevates equity as a cross-cutting concern, as it appears explicitly in “impact” and implicitly in “relevance” and “sustainability.” Second, the framework emphasizes local ownership and adaptation over one-size-fits-all delivery, reflecting a shift from a centrally produced program to a globally supported, locally implemented model. Third, data and measurement are treated as foundational: valid regional screening instruments, dmft/DMFT tracking, cost-per-child metrics, and disparity indicators all signal a commitment to evidence over anecdote. Fourth, the framework recognizes systems integration as essential to durability. BSBF positions itself not as a parallel program but as a component embedded within existing health, education, and policy infrastructure. Finally, the commitment statements across all six domains consistently emphasize action verbs: listen, collaborate, innovate, measure, build—signaling an implementation-oriented culture rather than a purely aspirational one.

In summary, the BSBF strategic framework for the next decade uses the OECD-DAC evaluation criteria as an organizing spine to translate a broad vision of every child achieving lifelong oral health into six actionable, measurable, and accountable domains. Each domain pairs a diagnostic question with concrete metrics, a defined success state, and an institutional pledge. It creates a self-reinforcing logic chain from needs assessment (relevance) through systems fit (coherence), behavior and clinical outcomes (effectiveness), resource stewardship (efficiency), population-level equity gains (impact), and long-term institutional endurance (sustainability). The result is a comprehensive yet practical roadmap designed to guide BSBF’s global strategy, resource allocation, and impact reporting over the next 10 years.

Looking toward 2040, BSBF can evolve from one of the world’s largest oral health education initiatives into a globally recognized, evidence-driven implementation model for equitable, prevention-focused child oral health (Figure 1). Continued investment in standardized evaluation, implementation science, workforce development, and cross-sector partnerships will enable the program to demonstrate not only sustained improvements in oral health outcomes, but also lasting contributions to health equity, health system strengthening, and public policy.

ACKNOWLEDGMENTS

Dr. Marsha Butler, Mary Kate Goldstein, Esha Gupta, Dr. Matilde Hernandez, Janni Kinsler, Dr. Luciana Rinaudi Marron, Stephanie Parkinson, Ella Torres Paras, Christine Wu Speith, and Ariana Waters.

CONFLICT OF INTEREST DISCLOSURE

Both authors received financial support from Colgate-Palmolive in connection with the development of this work. This funding is disclosed in accordance with requirements regarding financial and potential conflicts of interest.

AI USE DISCLOSURE

During the preparation of this manuscript, the authors used ChatGPT and Gemini Notebook to support summarization and improve readability, grammar, and language. The authors independently reviewed, fact-checked, and revised all AI-generated outputs. The authors retain full responsibility for the manuscript and confirm that the use of AI was transparent and consistent with standards of scientific rigor and editorial integrity.

ABOUT THE AUTHORS

Francisco Ramos-Gomez, DDS, MS, MPH

Professor and Chair, Section of Pediatric Dentistry, School of Dentistry, University of California Los Angeles (UCLA); Director, UCLA Center for Children’s Oral Health; Founder and Co-Principal Investigator, University of California San Francisco (UCSF)/UCLA Center to Address Disparities in Children’s Oral Health; Diplomate, American Board of Pediatric Dentistry; Fellow, American College of Dentistry

Yan Wang, PhD

Adjunct Assistant Professor, Section of Public and Population Health, Division of Oral and Systemic Health Sciences, School of Dentistry, University of California Los Angeles (UCLA); Principle Investigator, Analytical and Translational Oral Microbiome Lab, UCLA

Figures and Images

Figure 1

Table 1

Figure 2

Figure 3

Table 2

Table 3

Figure 4

Table 4

Figure 5

Figure 1

Program timeline. (Note: Colgate developed an early childhood oral health curriculum, and the University of Maryland conducted the first efficacy study in Washington D.C. The Bright Smiles, Bright Futures [BSBF] program was then launched.)

Table 1

Figure 2

Improvements in oral hygiene practices and oral health literacy have been reported in BSBF programs implemented in numerous countries such as China, where 100 million children have been reached over a 10-year period.

Figure 3

The “Talking Walls” initiative in Kenya supports oral health messaging through murals displayed in school playgrounds and other common areas.

Table 2

Table 3

Figure 4

The use of storytelling, characters, and illustrated educational materials, as shown here in Australia, helps preschool children retain key oral health messages and establish toothbrushing routines.

Table 4

Figure 5

Dr. Ramos-Gomez testified at the United Nations advocating for children’s oral health.