While the overall intention of the distribution of these toothbrushes was good and intended only to help the students of Highland schools to be able to include an extra brushing during school hours, lack of planning in respect to the distribution of this new product has raised some problems.
N-Sta-Smile is a "low pasted" disposable toothbrush that was invented by local businessman Kerry Evans who thought it would be great to give the children an opportunity to brush their teeth during the day while in school, helping them to reach American Dental Association's recommended three brushings per day. The students at the elementary school began receiving this product free of charge on their lunch trays on April 15, and the middle and high schools also began distribution the same week. The elementary students do not have a place in which to rinse the toothpaste. One parent was concerned with her child swallowing the product on a daily basis. However, the older students in both the middle and high school are able to rinse if they wish. It is not mandatory that any child use the product, however a large percentage of students do.
The parent of one 8-year-old child was outraged when her daughter came home from school after using the N-Sta-Smile product on the first day of distribution with extremely swollen and blistered gums and complaining of mouth pain. The following day, the child was taken to her dentist and had to have her Rapid Palatal Expander (RPE) device removed from her mouth due to the swelling. This is a device, which is bracketed to the teeth in a very similar manner as orthodontic braces.
The mother said her daughter has known allergies to eggs and other things that were on record with the elementary school as well as having an Epipen and Benedryl available to her child. When the child returned from school with the blisters in her mouth, her mother was terrified because she did not know what was wrong until her daughter told her about using the N-Sta-Smile brush at school. Since the parent did not have a package from the product to review the ingredients, she was terrified that it might have contained one of the child's known allergens. She said "I was never informed of them going to give this to my child or I would never have agreed. I would have sent her own toothbrush to school."
As with any new product, planning is detrimental to success. Highland High School Superintendent Ronnie Brogdon says, "I am taking responsibility for this. If I would have done what I should have done, I would have sent a letter to parents and we are sending a letter to parents. We don't want parents to be upset about this. We want parents to understand we are trying to develop their total child, if they don't want to participate that is fine, we aren't going to force anybody to participate."
He realizes notes should have been distributed, but said that, "It honestly never crossed my mind that a child would have an allergy to toothpaste." As with implementing any new product or program, it is a learning process. The child's dentist explained that children are not necessarily allergic to a particular toothpaste, but more so, ingredients contained within a product. Sulfate, the ingredient that makes toothpaste sudsy is a big allergen, because it contains the ingredient sulfur which can interact with the metal on braces if it is not rinsed. Another common allergen is mint. Because this product is not being rinsed in the elementary school, it remains on children's teeth and is swallowed. Although there is very little paste, it is a genuine parental concern. The product is approved by the Food and Drug Administration but is not approved by the American Dental Association, the association that endorses a large percentage of name brand toothpaste, brushes and other dental related products.
Evans said that N-Sta-Smile might change the product to make it have an even lower amount of paste for the smaller children. When contacted, he said that he felt terrible about the problem and that he would "do everything I can to correct any problems that might occur."
The Cherokee Village Elementary School sent out notes to parents regarding the product on April 24. Evans said he would consider some manner in which to put the ingredients and warning label on the product but did mention the very small size of the packaging.
Besides the allergen concern and the fact that elementary students do not rinse after using this product, some parents were angry regarding whether dental hygiene should be included in the realm of the education process. Others said that it should be up to the parents to take care of their children's dental concerns.
Brogdon explained that, "I think that whether we realize it or not, there is a big push across America and in particular in Arkansas about health and nutrition. We have committees that we are supposed to be working at to try to improve the health and nutrition. That is one of the reasons you don't have all these soft drinks and things in school that you used to have. All of that has to do with the total well-being of the child. Again, we are not trying to do anything to step on any parent's toes. And I realize as superintendent and I think our school board realizes that there are a lot of parents who have their children brush their teeth regularly, unfortunately there are a lot of kids who don't have that opportunity."
Other than these concerns, one parent of a Highland School District student was afraid that since the school bought into the marketing of this product, that this would make the school system a potential target for the marketing of all new innovative health related products. Brogdon said that he did not see this as being an issue.
Yet another parent was concerned with the safety of the ingredients since N-Sta-Smile is manufactured in China, a country which is renowned for their lower than American standards in respect to health and safety in the manufacturing process. Brogdon said, "This product is as safe as any product you would get off the shelves at Walmart with the exception of those who might have an allergy." He further stated regarding the manufacture in China, "It is manufactured in China but has FDA approval for shipment and for receiving in the U.S." When asked if he knew of any testing on the product, both Evans and Brogdon were in agreement that if something is approved by the FDA most anyone would assume that they test the products before being approved for use by the general public. This is, in fact, a very common misconception. Information obtained from the Food and Drug Administration's Web site states "The FDA does not develop or test products itself." Brogdon said that he hopes in the future N-Sta-Smile can be manufactured in Sharp County and create much needed jobs for residents.
When any new program is implemented questions regarding funding are often the first ones asked of the public, and N-Sta-Smile is not immune to that. At this time, the products are free but Brogdon explained that at the time they begin to cost, the district will seek donations and that there is no plan to increase lunch prices to include the expense of these toothbrushes and the rumors about getting the free lunch program to pay for them is untrue. Brogdon explained that this dental hygiene program is, "for all children in the district, not just those on free or reduced lunches," and further stated that " The free lunch system wouldn't pay for them," that it is a federal program.
While the intention of this product is only to help the children and not hurt them, perhaps implementing changes in the product's paste levels, attaching warning labels and making parents aware of the ingredients, this program will continue to be beneficial to the students and parents of the Highland School District. Brodgon made a statement to the parents of children in the district saying, "I think there is enough benefits to this program, that it could be a long term great program. It is just like anything new, there are just some wrinkles that need to be worked out."