Objective
To examine the frequency of toothbrushing or cleaning among middle school students from 44 low- and middle-income countries.

Methods
Secondary analysis of nationally representative data from 146,462 middle school students who participated in the Global School-based Student Health Survey (GSHS) between 2003 and 2010.

Results
In 39 of the 44 countries, more than 80% of students reported brushing or cleaning their teeth at least once each day. In 23 countries, more than 5% of participants reported brushing their teeth less than once a day or never. In 37 countries, boys reported a significantly lower frequency of toothbrushing or cleaning than did girls. Countries where miswak (chewing stick) use is common reported lower toothbrushing or cleaning frequency, perhaps because the questionnaire item did not clarify that this counts as a form of tooth cleaning.

Conclusion
School-based dental health education programmes that target early adolescents may help students to develop habits that improve their immediate and long-term health.