They are a natural pairing, two elements of every good bedtime routine: reading books and brushing teeth. But many young children, especially those in underserved communities, aren’t consistently doing either. A group of students, staff, faculty, and residents from the School of Dental Medicine are part of an effort to ensure that good literacy and oral hygiene habits start early.

The seed for the program, known as Books, Brushing, and Bedtime (BBB), was planted when Stephanie Rashewsky, then a pediatric dental resident at Penn, was on an outpatient rotation at the Children’s Hospitalof Philadelphia.

She saw patients receiving books during their visits as part of the Reach Out and Read nonprofit and was inspired.

“She came to me and said, ‘Wouldn’t it be great if we got involved?’” says Rochelle Lindemeyer, director of Penn Dental’s Pediatric Residency Program.

Rashewsky and Lindemeyer applied for grants and received funding from the Dental Trade Alliance Foundation and the American Dental Association Foundation’s Samuel D. Harris Fund for Children’s Dental Health to purchase dental-themed books geared toward children ages 1 to 5.

The goal was to build on Reach Out and Read’s efforts, which have been successful in encouraging parents to read to their children and in improving preschoolers’ language skills.

Once they started giving out books in Penn Dental’s pediatric waiting room, Rashewsky and Lindemeyer saw an opportunity to deepen the BBB program’s impact.

“We decided not only to simply give the books out in our clinic, but also to spin out a research project to see what the outcomes of our outreach might be,” Lindemeyer says.

The ongoing research initiative involves giving out books to children, then following up at the next visit to see if the patients had better outcomes, such as fewer cavities, more interest in brushing at bedtime, and increased reading before going to bed.

One thing that struck the dentists when they were reviewing books for the BBB program was the dearth of stories aimed at infants and toddlers. Given that the American Academy of Pediatric Dentistry recommends that children visit the dentist as soon as they get their first tooth, this seemed problematic.

“Many of the [books] that we did find depicted going to the dentist in ways that weren’t entirely positive,” says Ashley Abraham, then a first-year student volunteering in the pediatric clinic.

The BBB team decided to fill the void by creating a book of their own. Abraham, together with classmates Kelby Okada and Giselle Galanto, crafted a short rhyming text to convey the importance of brushing at bedtime, with lines like, “Brush, brush, brush…No need to rush!”

They worked with a special education teacher to ensure the text would be accessible to their young audience, and asked classmate Elizabeth Freund to create illustrations.

“It was a chance for us to get creative and capture the essence of what reading aloud is all about,” says Abraham.

The team worked with additional dental faculty and staff to perfect the book’s message and endnotes, which give parents information on how to provide good oral care for their children. They found an affordable publisher and had the resulting books tested to make sure they were durable and nontoxic for those young readers who sometimes literally consume their reading material. The first print run of “Brushtime, Bedtime” produced 2,000 copies.

The project has made great progress. Now, not only are copies of “Brushtime, Bedtime” being given out at Penn Dental, but also at the Michigan clinic where Rashewsky works. Lindemeyer says she’s also heard from Penn Dental alumni interested in getting copies for their practices.

For Abraham, now in her final year of dental school, the impact of the program was evident in her initial experiences reading “Brushtime, Bedtime” to patients.

“The first patient I read to wasn’t even a year old, but she pointed to a puppy and a kangaroo and was so excited,” she says. “Just seeing her fully engaged and reacting to the words I was speaking, the prompts I was giving her, the cadence of reading aloud … it sounds cliché but it really was a dream come true.”