text:
- Research article
- Open Access
- Open Peer Review
An assessment of the impacts of child oral health in Indonesia and associations with self-esteem, school performance and perceived employability
© The Author(s). 2017
- Received: 16 April 2016
- Accepted: 3 March 2017
- Published: 21 March 2017
Previous surveys have indicated that a majority of Indonesian children have poor oral health. However, little detailed information is available on underlying causation and none that examine impacts of oral health on child self-esteem, school performance and perceived employability. The aim of this study was to determine levels of child oral health in primary school children in Indonesia, the prevalence of key causal factors; and, to determine relationships between oral health, self-esteem and school academic performance.
Cross-sectional epidemiological study in a sample (n = 984) of children aged 6–7 and 10–11 years old attending three public schools in Indonesia. A dental visual impact study was conducted, in which teachers reported their perceptions of the impact of child oral health on school academic performance. Oral health behaviors, self-esteem, and school performance were assessed. The children were clinically examined to measure dental caries and oral cleanliness.
Teachers believe that children with visually poor oral health and impaired smiles are more likely to perform poorly at school, be socially excluded and have lower job prospects than their peers with visually good oral health and healthy smiles. The percentages of children with decayed teeth were 94 and 90% in the 6-7- and 10–11-year age groups, respectively. Families reported high levels of child consumption of sugar-containing foods and drinks; many had irregular use of fluoride toothpaste. Children with substantial plaque on their teeth achieved significantly lower levels of school performance than their peers with clean teeth. Significant associations were found between school performance and self-esteem for these children.
The study findings highlight the need for preventive care programs to improve the oral health of children in Indonesia and prospective determination of associations between child oral health; self-esteem and school academic performance.
- Caries
- Children
- Indonesia
- Oral health
- Self-esteem
Indonesia faces significant challenges in relation to poor oral health in children; this problem continues into teenage and adult years, when more than 70% are affected by experiences related to dental caries [1]. Previous studies have shown that inequality in dental care persists in Indonesia [2, 3]. Undoubtedly, broader social determinants of health have a major impact on expressed oral health and life opportunities [4]. The recent Bali Declaration, expressed at the 7th Asian Conference of Oral Health Promotion for School Children, declared that oral diseases, particularly dental caries, are major public health problems in the Asian region and that the burden of disease in children causes significant negative impacts on their health in terms of growth, and social and emotional well-being [5]. Untreated dental caries in children causes toothache, generalized pain and oral sepsis, leading to reduced food choices, lost days from school for children and lost time from work for parents. In other countries, a clear association has been shown between poor dental health in children and school performance, affecting their future employment prospects [6, 7]. No such data have been available regarding Indonesia. The critical role played by the frequent consumption of sugared foods and drinks in caries development has been recognized. Dental experts need to work closely with other professionals to support families to decrease child caries prevalence by reducing sugar intake. Brushing teeth twice daily with fluoride-containing toothpaste can adjust the oral balance towards re-mineralization [8].
- (1)
Teachers associate children's oral health and smile appearance with predicted school performance and job prospects.
- (2)
Presence of dental caries in Indonesian children is associated with reported toothbrushing habits, reported sugar consumption, and observed oral cleanliness (plaque and gingivitis).
- (3)
Primary school children's school performance is associated with the following variables; reported tooth brushing habits, observed oral cleanliness (plaque), dental caries experience, school absentee rate, and children's self-esteem.
- (4)
Dental caries experience and their sequelae e.g. toothache are associated with primary school children's self-esteem
Ethics committee and study approvals
The study protocol was considered and approved by the Ethics Committee of the Faculty of Dentistry, Universitas Indonesia (reference number 91/XI/13). Other approvals were obtained from the Department of Health and Head Teachers of the selected schools.
The population for this study included children attending three public elementary schools (Jatibening IV, Kayuringin XIII and Kayuringin XXIII) in Bekasi, a city in West Java, on the eastern border of Jakarta, the capital city of Indonesia. Bekasi is one of the Indonesia's most populated suburbs and serves as a commuter city for Jakarta; although it has notable trade, business and processing industries, substantial urban areas surround the city. These three schools are typical of the Indonesian public elementary school system in terms of size, infrastructure and systems, receiving full support and provisions from the Government. All three schools are similar in terms of location and socio-demographics and are attended only by children aged 6–12 years. The socio-demographic profile of the children attending these schools and their families are similar, representing the second lowest socio-economic quintile of the Indonesian population. The schools were chosen in partnership with the Education Department as being representative of public schools in the area and willingly took part in the study.
All parents with children aged 6–7 years (grades 1 and 2) and those with children aged 10–11 years (grades 5 and 6) were invited to join the study and were provided with a participant information leaflet and a consent form. Purposive sampling was used to ensure that the samples were representative of the majority school children in Indonesia who are from the second lowest socio-economic quintile. Sampling involves the selection of a number of study units from a defined study population [11]. Unfortunately, few research articles on dental health in Indonesia have been published [2]. Therefore, many of the parameters to be explored within this population were unknown, thus limiting the ability to undertake an accurate formal sample size calculation. In these circumstances WHO Oral Health Surveys Basic Survey Methods (WHO, 2013) [12] advises a sample size of 25–50 children per age group. Parameters in addition to oral health were to be assessed, therefore, to obtain sufficient data for comparison and hypothesis testing, a sample size of at least 400 children aged 6–7 years and 400 children aged 10–11 years was estimated [13]. The samples were to be selected from a minimum of twenty classes (clusters). This sampling methodology was approved by the Ethical Committee. All children in the two age groups in all three schools were included in the sampling frame. The inclusion criteria were children for whom a parent or guardian had given consent to participate in the study and agreed to complete the questionnaires.
Dental visual impact study: Teachers' assessment of the impact of child oral health on school performance
A Teachers' Workshop was conducted by a local dental expert from the University of Indonesia (AR). The teachers are Government Employee who live in Bekasi city and represent the middle class of the population. Teachers viewed a short series of slides showing children's smiles. After viewing each slide, each teacher was asked to complete a form (see Additional file 1). This gave their judgments of the child's likely health status, school performance and employment prospects. Each slide was standardized by showing only the smile of the child (not the rest of their appearance), thus excluding the possibility that the teachers might be influenced by other factors e.g., general attractiveness and other facial features. Moreover, the slides did not show any "ugly duckling stage" of the mixed dentition phase. The slides showed either healthy smiles (teeth without visible decay) or impaired smiles caused by decayed upper primary teeth only. Children represented the same broad ethnic population as the teachers (Indonesian family backgrounds); thus, lip shapes and skin color were familiar. No information was provided regarding the child's academic record or their health. The children were all of primary school age, approximately 6 to 11 years and they were not pupils in the schools where the teachers were employed. All teachers in the selected schools were invited to a workshop, and the dental visual impact study was part of the workshop. This explorative study sought to assess teachers' perceptions of the impact of children's oral health, as judged by their smile appearance, on children's predicted school performance and job prospects. Therefore, the dental visual impact study was a pilot study, with a convenience sample size of 30 participants. For descriptive studies, this sample size was large enough to reflect important variations in the study population, but small enough to facilitate the study [14]. Face and content validity were assessed through panel discussions between experts (academics and clinicians working in the field), as well as through a small scale pilot study of a sample drawn from the target population. These procedures explored the comprehensiveness, relevance and understanding of the content of the dental visual impact study form [15].
Measures of oral health behavior, self-esteem, and child's school performance
Children aged 6–7 years and 10–11 years were asked to complete a specially developed simple measure describing their hygiene habits both general (hand and face washing) and oral (such as tooth brushing) as a self-report of their daily hygiene routines (see Additional file 2). This questionnaire had been previously developed and piloted in children in a multi-cultural community in the UK (Pine, personal communication, 2016). The simple questionnaire was found to be easily understood and completed by children in the schools in Indonesia. Children aged 10–11 years were asked to complete a self-esteem measure, (see Additional file 3) including sub-scales of peer and school connectedness [16, 17].
Parents were asked to complete the oral health behaviors questionnaire (see Additional file 4), which was developed as part of an international study of childhood caries [18]. The questionnaire was developed within an international consortium to analyze familial and cultural perceptions and beliefs of oral hygiene and dietary practices. The oral health behaviors questionnaire was developed with parents from a wide range of countries, of diverse ethnic groups, from deprived and non-deprived backgrounds and for those with children who had experienced caries and those who had not [18]. This questionnaire reports on child and parental oral health behaviors, including dental attendance and children's experience of toothache. It measures parental self-efficacy in relation to child tooth brushing and the control of child dietary sugar; and, oral health-related beliefs and attitudes. The questionnaire was developed in English. Translation into the Indonesian language was conducted by a native speaker, pre-tested and then back translated by another native speaker to ensure comparability to the original form. The school performance of the children was measured objectively based on the results of recent tests in mathematics [19] (range of scores 0–100), from which the following categories were defined: Underachieving (0–54), Fair (55–64), Good (65–79), and Excellent (80–100).
Clinical examinations
All children for whom parental consent had been obtained and who were present in school received a clinical examination of their oral health by one of two clinical examiners who were trained and experienced in standardized clinical survey measurements. The criteria used for the diagnosis of dental caries are those described by the World Health Organization [12]; very early enamel-only caries is not scored; however, caries that included an unmistakable cavity, undermined enamel, or detectably softened floors or walls was scored. Child oral cleanliness was measured by plaque assessments at dental examinations using a dental probe [20, 21]. For all children, the buccal surfaces of index teeth were examined. Index teeth for those aged 10–11 years were all first permanent molars and the upper left and lower right lateral incisors. For children aged 6–7 years, index teeth were upper and lower incisors and upper right molars and lower left molars. This measure was categorized into no visible plaque deposits, substantial plaque visible, and abundant bleeding on gentle probing.
Statistical analysis
Descriptive statistics were conducted to analyze the visual impact study, demographic profile of the children and families, child oral health, and parental report of child oral health-related behaviors. The chi square test and ANOVA was employed for categorical variables and comparisons of variables related to oral health respectively (significance level: p < 0.05).
Demographic profile of the children and families, child oral health, and parental report of child oral health-related behaviors
6–7 years old
10–11 years old
Child gender
n = 539
n = 445
245 (46%)
188 (42%)
255 (47%)
201 (45%)
Missing gender data (no parent questionnaire)
39 (7%)
56 (13%)
Decayed teeth
Mean number of decayed primary teeth (SD)
7.8 (4.4)
1.4 (2.0)
Mean number of decayed permanent teeth (SD)
0.8 (1.2)
2.7 (2.4)
Percentage of children with no decayed teeth
% dt = 0
31 (6.4%)
207 (51.8%)
301 (62.5%)
73 (18.3%)
% dt and % DT = 0
29 (6.0%)
41 (10.3%)
Child oral cleanliness
Substantial plaque visible
238 (49.4%)
153 (38.3%)
Abundant bleeding on gentle probing
63 (13.1%)
68 (17.0%)
Missing data
57 (10.6%)
45 (10.1%)
Mothers' education level
Primary education
107 (20%)
68 (15%)
Secondary education
217 (40%)
152 (34%)
Higher education
95 (18%)
68 (15%)
Missing data
120 (22%)
157 (35%)
Parent report of their own tooth-brushing behavior
Less than twice daily
77 (24%)
49 (22%)
Twice daily or more
187 (59%)
126 (56%)
Missing data
53 (17%)
51 (23%)
Parent report of their child's tooth-brushing behavior
7 (1.6%)
3 (1.0%)
Not every day/every other day
20 (4.6%)
13 (4.2%)
Once a day
23 (5.3%)
16 (5.2%)
Twice a day
338 (77.7%)
230 (74.9%)
Three times a day
47 (10.8%)
45 (14.7%)
Missing data
104 (19.3%)
138 (31.0%)
Parent report of their child's sweet-eating frequency
Every day
90 (21.1%)
42 (14.1%)
Most days
102 (23.9%)
60 (20.1%)
Once a week/occasionally
234 (43.4%)
195 (43.8%)
1 (0.2%)
2 (0.7%)
Missing data
112 (20.1%)
146 (32.8%)
Parent report describing how they sweeten their child's drinks
Sweeten with sugar
187 (44.2%)
149 (51.0%)
Sweeten with honey
66 (15.6%)
28 (9.6%)
Sweeten with condensed milk
62 (14.7%)
39 (13.4%)
Never sweeten drinks
115 (27.2%)
77 (26.4%)
Missing data
116 (21.5%)
153 (34.4%)
Parent report of what drinks are sweetened
Sweeten milk
131 (31.0%)
70 (24.1%)
Sweeten water
9 (2.1%)
6 (2.1%)
Sweeten tea
260 (61.6%)
196 (67.4%)
Missing data
117 (21.7%)
154 (34.6%)
Dental visual impact study
The dental visual impact study measured teachers' perception, of whether a child was healthy and their likely future school performance and employment prospects based on slides of individual children smiling showing their teeth. Of the 30 teachers who participated in the dental visual impact study, 29 (97%) of those viewing a slide showing a child's smile with caries-free teeth judged that the child was healthy, and 26 (87%) of those viewing a slide showing a child's smile with decayed upper primary teeth judged that the child was unhealthy. A child with a healthy smile was judged by 21 (70%) of teachers to be more likely to do well academically; the opposite was the case for a child showing teeth that were decayed, with 20 (67%) of teachers judging such a child as less likely to do well academically in the future. Similarly, 21 (70%) of teachers judged a child presenting a healthy, caries-free smile to be more likely to have good employment prospects; only 5 (17%) of teachers judged a child with their front teeth affected by tooth decay to be more likely to have good employment prospects. In fact, a child exhibiting poor oral health was judged by 12 (40%) of teachers to be less likely to have good employment prospects; 8 (27%) of teachers were uncertain regarding the future employment prospects of a child with an unhealthy smile; but only 10% of teachers were uncertain regarding the future employment prospects of a child with a healthy dental appearance.
Parent and child-completed questionnaires and dental examinations of children
Data from dental examinations was available for 482 (89%) of the children aged 6–7 years and for 400 (90%) of the children aged 10–11 years. The remaining children were absent from school on the day of the clinical examinations. Not all parents completed the questionnaires; for example, in relation to children's tooth brushing habits, data were available for 331 (61%) of the children aged 6–7 years and 307 (69%) of the children aged 10–11 years. Most (89%) of the children aged 10–11 years were able to complete the child self-esteem measure, and 85 and 86% completed the peer and school connectedness measures, respectively.
Clinical measures: dental caries experience and oral cleanliness
Parental reporting of their children's oral care habits
Tooth brushing was a commonly reported habit; only 10 parents reported that their children did not brush. The most common reported frequency was twice daily (78% of children aged 6–7 years and 75% of 10–11 years). However, the reported frequency of brushing was not consistent with the clinical examination of the plaque present on the children's teeth. In 49% of children aged 6–7 years and in 38% of children aged 10–11 years, substantial amounts of visible plaque were present on at least one tooth surface. This indicates that, either brushing frequency was overestimated by the parents or, that tooth brushing was ineffectively performed by many of the children.
Parental reporting on their child's toothache experience
Association between child's dental caries and toothache during the previous 12 months (Chi square test)
No toothache reported during the previous 12 months
Toothache reported during the previous 12 months
Decayed teeth (children aged 6–7 years)
Yes (n = 379)
184 (48.6%)
195 (51.5%)
No (n = 24)
21 (87.5%)
3 (12.5%)
p < 0.001**
Missing data (n = 136)
Decayed permanent teeth (children aged 10–11 years)
Yes (n = 240)
113 (47.1%)
127 (52.9%)
No (n = 51)
34 (66.7%)
17 (33.3%)
p = 0.011*
Missing data (n = 154)
Children's sugar consumption, child and parent toothbrushing behaviours and child oral cleanliness
The very high levels of dental caries found in the children studied here are likely to have occurred due to a combination of two key behaviors: very frequent sugar consumption and brushing with fluoride toothpaste less than twice a day. To obtain greater insight into these factors in this population, parents were asked about the nature and frequency of sugar intake by their children, the child's use of toothbrush and toothpaste, and the parents' own tooth-brushing behavior. Over 50% of children aged 6–7 years were reported by their parents to eat sugary foods between their meals, either every day (22%) or on most days (29%). Similar but lower levels (39%) were reported for children aged 10–11 years; sugary foods were consumed between meals either every day (14%) or on most days (25%). Soft drinks containing sugar were not the most common source of sweetened drinks consumed; two thirds of parents reported that their children drank soft drinks only occasionally (64% for children aged 6–7 years and 66% for children aged 10–11 years). Daily consumption of soft drinks containing sugar was reported to be relatively low at 9% for children aged 6–7 years and 3% for children aged 10–11 years. However, sugar was commonly added to sweeten drinks by 73% of parents of children aged 6–7 years and by 74% of parents of children aged 10–11 years. Among parents with children aged 6–7 years that sweetened drinks, 83% sweetened the drinks with sugar, 29% sweetened them with honey and 28% sweetened them with condensed milk. For children aged 10–11 years, the proportions were different; again, most parents sweetened the drinks with sugar (69%), but fewer used honey (13%) or condensed milk (18%).
The types of drinks being sweetened was of considerable concern; 31% of parents of children aged 6–7 years sweetened milk, 62% sweetened tea, and 2% sweetened water. Similar figures were found for parents of children aged 10–11 years; 24% sweetened milk, 67% sweetened tea, and 2% sweetened water. From a health promotion perspective, this implies that drinks that are often recommended as "healthy" (such as milk, tea and water) will become cariogenic as sugar has been added.
Although use of added sugar was widespread, brushing teeth with toothbrush and toothpaste was reported as a very common occurrence; only 1.4% of parents of children in both age groups never used toothpaste, and over 99% used a toothbrush. Thus, this prevention method is established; the remaining challenge is to ensure that teeth are brushed twice daily and effectively. Given the levels of children exhibiting substantial plaque on their teeth, it is possible that the parents over-reported their child's brushing frequency. To gain insight into this possibility, parents were asked about their own frequency of tooth brushing. Asking about specific tooth brushing times (before or after breakfast, at bedtime, etc.) may reduce the likelihood of parents giving the socially desirable answer of "twice daily". When the parent-reported data from the baseline questionnaires were analyzed in this way, approximately 1 in 3 (34%) parents reported brushing their own teeth only once a day.
Association between toothache and school performance
Association between child's oral cleanliness and school performance and between toothache during the previous 12 months and school performance (Chi square test)
Substantial plaque. Children aged 6–7 years
Yes (n = 233)
23 (9.8%)
35 (15.0%)
109 (46.8%)
66 (28.3%)
p = 0.032*
No (n = 244)
24 (9.8%)
20 (8.2%)
106 (43.4%)
94 (38.5%)
Missing data (n = 62)
Children aged 10–11 years
Yes (n = 152)
10 (6.6%)
22 (14.5%)
82 (54.0%)
38 (25.0%)
p = 0.002**
No (n = 239)
10 (4.2%)
18 (7.5%)
110 (46.0%)
101 (42.3%)
Missing data (n = 54)
Reported toothache during the previous 12 months. Children aged 6–7 years
Yes (n = 215)
19 (8.8%)
34 (15.8%)
97 (45.1%)
65 (30.2%)
p = 0.089
No (n = 220)
23 (10.5%)
18 (8.2%)
101 (45.9%)
78 (35.5%)
Missing data (n = 104)
Children aged 10–11 years
Yes (n = 155)
4 (2.6%)
18 (11.6%)
90 (58.1%)
43 (27.4%)
p = 0.042*
No (n = 154)
7 (4.6%)
14 (9.1%)
69 (44.8%)
64 (41.6%)
Missing data (n = 136)
Association between oral cleanliness and school performance
The presence of substantial plaque on teeth results from infrequent or inadequate tooth brushing. The presence of substantial plaque was found to have a significant association with child's school performance at both age groups; 6–7 years and 10–11 years (Table 3).
Associations between self-esteem and oral health
Self-esteem was measured through self-reports by children aged 10–11 years using a validated measure. As might be expected, child's self-esteem was significantly associated with child's school performance, such that significantly more children that self-rated as having higher levels of self-esteem had good or excellent school performance. However, no significant associations were found between child's self-esteem and toothache or caries experience.
Dental caries was found to occur at very high levels in children attending public schools in Indonesia. This was found to be associated with high sugar consumption and inadequate tooth brushing, which together cause substantial dental plaque. Preventive programs should advise sugar restriction [22] and brushing of the teeth with fluoride toothpaste twice daily. Dental diseases are prevalent globally and, despite great improvement in their prevention and treatment, issues such as pain, anxiety, functional limitations (including poor school performance) and social handicaps (due to tooth loss) remain. The treatment of dental disease is expensive, consuming 5–10% of health care budgets in industrialized countries, and, if the same treatment approaches were used, could consume the entire financial resources available for health care in most low-income countries. Therefore, taking a preventive approach to enhance health provides an economically sound argument. For both adults and children, the World Health Organization recommends limiting sugar intake to less than 10% of total energy intake [22]. A small reduction in the risk of dental caries in childhood is of significance in later life [23]. School settings provide an ideal opportunity to reinforce prevention routines and, where these routines have not yet been established at home, schools represent an excellent opportunity to support children and families to establish the routine of twice daily tooth brushing [24]. Although the schools studied here are typical of the Indonesian public elementary system, they are not necessarily representative nationally. This study is cross-sectional, and the conclusions that can be drawn relate only to associations between the studied factors.
Based on the results of the dental visual impact assessments, teachers were clearly able to identify a child as having decayed teeth based on their smile, and the vast majority viewed that child as unhealthy. Most of the teachers judged that a dentally unhealthy appearance (e.g., decayed front teeth), even in children, could adversely impact their future employment prospects. Caries can affect child health in a variety of ways, including toothache, which is associated with lower school performance. Although the reason for absence was not specified in the school records, given the high occurrence of caries experience and associated morbidity, it is likely some days were lost due to the impact of poor oral health [6, 7]. Caries in permanent incisors can markedly affect smile and self-image. Moreover, parents' own self-esteem can significantly affect their child's self-esteem during life transitions [25]. The critical role of parents and teachers in influencing change is key to enhancing the tooth brushing behaviors of children aged 6–7 years and 10–11 years. These two age groups were selected because they represent important life transitions; at 6–7 years, the first permanent molars are erupting; if these teeth can be prevented from developing dental caries, lifelong benefits can ensue. From a child-development perspective, anterior deciduous teeth begin to shed at this age, and self-awareness emerges. At 10–11 years, children are completing their primary education and stand on the threshold of the transition to senior school, a time of considerable personal challenge and self-identity within a new environment [26].
The dental visual impact study results showed that children with good oral health were perceived by teachers to be more likely to have good employment prospects. Visual screening performed by teachers in detection of dental caries has been shown to correlate with clinical dental examination [27]. Previous findings show that caries in the primary dentition are predictive of caries in permanent teeth [28]. Socio economic status (SES), as measured by educational attainment and employment type is associated with oral health of young adults and over the life course. The health selection hypothesis proposes that childhood health is linked to adult SES and SES gradients in adult health through potential health selection and social causation effects [29]. In short, this cross-sectional study does not verify a cause-and-effect relationship between poor oral health, poor school performance, and perceived employment prospects. The study demonstrates an association which can be investigated further to determine whether improving children's oral health improves their school performance and perceived future employment prospects.
This study was conducted in Indonesia, to explore child oral health and to assess the impact of child oral health on self- esteem, school performance and perceived employability. The cross- sectional study design limits analysis to associations between variables but provides an important starting point for a longitudinal cohort study. Most of the variables, except oral health status measured by clinical examination, were through questionnaires and self-reported measures, introducing the possibility of information bias, and bias due to social desirability. Any study attempting to measure reported behavior and attitudes must consider the extent to which socially acceptable answers could impact on the interpretation of the results [18]. The visual dental impact measure could also have been influenced by the teachers' own perceptions. Although not a nationally representative sample, the population selected typically represents Indonesian public elementary schools. The study is limited to examining associations only, due to the cross-sectional study design and a future prospective cohort study could explore causation. Overall the research is the first of its kind in Indonesia and throws light on the patterns of sugar consumption and its effect on oral health and future life prospects. It also highlights the need to take necessary preventive measures to address these issues.
Important oral health and related behavioral data are provided for the first time for children in disadvantaged communities in Indonesia. Longer follow-up times and additional studies are warranted to determine the impact of enhancing oral health on children's academic performance in school. Understanding how individual behaviors within the family, community and broader society can affect health is critical for enhancing prevention [30, 31]. Repairing the damage caused by dental caries is difficult and costly; therefore, the vast majority of children's caries remains untreated in Indonesia [32]. As secondary prevention and curative care are inefficient and expensive, the primary prevention of dental caries remains a key objective for Indonesia.
Dental caries is common among Indonesian children due to the frequent use of added sugar and inadequate tooth brushing with fluoride toothpaste. Caries has a wide variety of impacts on child health, including toothache which is associated with lower self-esteem and poorer school performance. Preventive programs should advise sugar restriction, particularly addressing the practice of adding sugar to milk and water. As tooth brushing with toothpaste is an established social norm that has the potential to improve oral health in Indonesia, school programs that increase tooth-brushing frequency with fluoride toothpaste to twice daily can also be recommended.
We thank Putu ADS Ustriyana and Nisallina Apridini for their support of the fieldwork and thank Arathi Rao, Ratu M Afifah (Unilever), and the Oral Epidemiology and Clinical Studies in Dentistry Research Cluster Faculty of Dentistry Universitas Indonesia for supporting this study. The authors are also grateful to the children and families who participated in this study and to the teachers in the three schools who took part in the Visual Impact study and supported and facilitated this study.
Unilever financially supported this project.
Availability of data and materials
The raw data is available from the authors to any author who wishes to collaborate with us.
Authors' contributions
DAM organized and performed the dental examination, translated all the study documentation, coordinated and supervised the data entry, managed the study logistics, and finalized the manuscript. MA dealt with local bureaucracy and obtained study permits from local officers/staff. AR acted as a liaison to obtain ethical clearance and organized and conducted the teachers' workshop. GB performed the statistical analyses and edited the manuscript. CP designed the study, wrote the study protocol, developed the materials, developed some of the measures used, drafted and edited the manuscript. All authors read and approved the final manuscript.
Authors' information
Not applicable.
Competing interests
Professor Pine undertook aspects of this work in her capacity as the Managing Director of Kippax Design, Ltd.
Consent for publication
Not applicable.
Ethics approval and consent to participate
The study was approved by the Faculty of Dentistry, Universitas Indonesia Institutional Review Board (91/XI/13) and each subject gave informed consent.
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информация о приложении TrackMy.Services
- Имя приложенияTrackMy.Services
- Название приложенияservices.trackmy
- Дата публикацииNovember 23, 2015
- Размер файлаUndefined
- ТребованияAndroid 4.0 and up
- Версия1.1.2
- РазработчикMauris
- Количество установок10+
- ЦенаБесплатно
- КатегорияTools
- РазработчикUkraine, Kiev, Shota Rustaveli 39/41, 608
- Google Play Link
Mauris Ещё...
TrackMy.Services 1.1.2 APK
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CreditUP – приложение, позволяющее получитьденьги на карту любого банка Украины. Высокая скорость принятиярешения по выдаче кредита позволит Вам занять нужную сумму денег засчитанные минуты, не выходя из дома, без залога и справки о доходах.Ключевая характеристика:- кредитный калькулятор;- процесс принятия решения о выдаче кредита занимает всего 20секунд;- зачисление на карту - 2 минуты;- CreditUP выдает кредиты в режиме "24/7" онлайн на карту любогоукраинского банка;- 100% автоматизированный процесс (процесс принятия решения овыдаче кредита проходит полностью без участия человека);- приложение позволяет продлевать срок пользования кредитом сколькоугодно раз;- идентификатором в системе служит номер мобильного телефона илиemail;- с помощью приложения CreditUP вернуть кредит можно со своей картыонлайн.Мы стремимся работать гибче и быть для клиентов доступнее,эффективнее и надежнее, чем традиционные поставщики финансовыхуслуг.CreditUP - an applicationthat allows you to get the money on the card of any bank ofUkraine. High speed decision on the loan will allow you to take theright amount of money in a matter of minutes, without leaving home,without collateral and statement of earnings.Key feature:- credit calculator;- Decision-making process of the loan in just 20 seconds;- Credited to the card - 2 minutes;- CreditUP provides loans in the "24/7" online at the map of anyUkrainian bank;- 100% automated process (the process of making a decision ongranting a loan takes place entirely without humanintervention);- The application allows you to extend the term of the loan as manytimes;- ID system is a mobile phone number or email;- Using the application CreditUP back the loan possible with itsonline maps.We strive to work more flexibly and be accessible to clients,more effective and more reliable than traditional financial serviceproviders.
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Winners Academy 0.4.2 APK
Приложение Winners AcademyВ этом приложении содержится все самоенеобходимое для обучения в Winners Academy:- Прямые трансляциизанятий;- Новости Winners Academy и полезные статьи;- Записипрошедших занятий;- Возможность купить или продлить обучение прямоиз приложения...- ...и много другое!Winners Academy — знаниямиулучшаем качество жизни людей!Appendix Winners AcademyThis appendixcontains everything you need to study in the Winners Academy:- Livebroadcasts of sessions;- News Winners Academy and useful articles;-Entries for past activities;- Ability to purchase or extend thetraining directly from the app ...- ...And much more!WinnersAcademy - Knowledge improve the quality of life!
Тьма за спиной. Виталий Зыков 1.1.1 APK
ИНТЕРАКТИВНЫЙ КВЕСТТебе нравится фантастика и фэнтези? Книгаписателя-фантаста всегда с собой? Ты часто фантазируешь, любишьзагадки и квесты, представляешь другие миры? Ты фанат ВиталияЗыкова? Тогда наше приложение тебе точно понравится!Наше приложение– новинка в мире чтения, новый формат подачи рассказов в жанрефантастики. Ты можешь играть оффлайн - без интернета, без wi-fi:просто нужно скачать и установить приложение.Тьма за спиной – этоинтерактивный текстовый квест с элементами фантастики. Концепцияпроекта была разработана вместе с популярным на просторах СНГписателем-фантастом Виталием Зыковым. Судьба главного героя в твоихруках. В нашей интерактивной истории только ты сможешь решить, чтоделать главному герою, и повлиять на исход рассказа.История.Управлять тебе придется жизнью Лангфора Сардо, бывшего офицераимперии Нордолов. Его жизнь – одно большое испытание, которое таитв себе много интересного. Действия квеста разворачиваются накаторге, где главный герой искупает свои грехи. Жизнь на каторге немедом намазана, поэтому у Лангфора зарождается план побега, которыйтрудно осуществить без верных подельников. Одним из них станешьименно ты!Возможности, которые бесплатно открывает загрузкаприложения:1) Первая глава квеста под названием «Побег невозможен»:непредсказуемый сюжет тебя удивит2) Скрытые уровни, которые тыможешь открыть во время прохождения квеста3) Доступ к инвентарю,карте прохождения, показателям здоровья персонажа4) Интерактивныезадания: проверка твоей ловкости5) Бои: пошаговый бой даствозможность продумать каждое решение6) Читать новости от писателя:приложение синхронизировано с блогом Виталия Зыкова7) Отличныйспособ скрасить свое время!Если ты такой же любитель фантастики,как и мы, то квест Тьма за спиной точно для тебя!INTERACTIVEQUESTDo you like science fiction and fantasy? The book is a sciencefiction writer is always with you? You often fantasize, likepuzzles and quests, imagine other worlds? You are a fan of VitalyZykov? Then our app you just love it!Our application - a novelty inthe world of reading, a new format of filing stories in the genreof science fiction. You can play offline - no internet, no wi-fi:just need to download and install the application.The darknessbehind - an interactive text adventure with elements of fantasy.The project concept was developed together with the CIS popularscience fiction writer Vitaly Zykov. The fate of the main characterin your hands. In our interactive stories only you can decide whatto do the main character and influence the outcome of thestory.History. You have to manage life Langfora Sardo, a formerofficer of the Empire Nordolov. His life - one big test, which isfraught with a lot of interesting things. Actions quest takes placein prison, where the main character atones for his sins. Life inprison is not smeared with honey, so Langfora conceived escapeplan, which is difficult to implement without the faithfulaccomplices. One of them will become exactly you!The possibilitiesthat opens free application download:1) The first chapter of thequest titled "Escape impossible": unpredictable plot will surpriseyou2) Hidden levels that you can discover during the passage of thequest3) access to inventory, map of passage, the health indicatorsof the character4) Interactive task: checking your dexterity5)Battles: turn-based combat will provide an opportunity to thinkthrough every decision6) Read news from the writer: The applicationis synchronized with the blog Vitali Zykov7) A great way tobrighten up your time!If you are a fan of science fiction, like us,the quest Darkness behind exactly for you!
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Duo Mobile works with Duo Security's two-factor authenticationservice to make logins more secure. The application generatespasscodes for login and can receive push notifications for easy,one-tap authentication. Additionally, you can use Duo Mobile tomanage two-factor authentication for other application and webservices that make use of passcodes. Note: For Duo accounts, DuoMobile needs to be activated and linked to your account before itwill work. You will receive an activation link as part of Duo'senrollment process. You may add third-party accounts at any time.Additionally, we will request access to use your camera for thesole purpose of scanning QR codes when activating accounts.Accounts can be activated by other methods if you choose not to doso. License agreements for third-party Open Source libraries usedin Duo Mobile can be found athttps://www.duosecurity.com/legal/open-source-licenses. For thelatest Terms and Conditions see https://duo.com/legal/terms
Email TypeApp - Mail App 22.214.171.124 APK
TypeApp is a beautifully designed email app providing a top-notchemail experience while managing all your email accounts from onecompletely customizable mail app. With instant smart pushnotifications, packaged in an intuitive & easy to use design,TypeApp is the perfect replacement for your stock email clientUnified Inbox – All Your Mail Accounts in One Email App SupportingIMAP, POP3 as well as all Exchange protocols including EWS &ActiveSync (EAS) for Outlook, Hotmail, Yahoo and Office365. TypeAppautomatically configures them once you sign in. View & sync allyour email accounts from one Unified Inbox, while enjoyinglightning fast true push email. People-Centric – Bringing PeopleTogether Communicating with people is important and with TypeApp'sinnovative people-centric features, it becomes even more simple.Focus on mail from people much faster with the People Switch, or benotified when specific VIP Notifications. Group Mail – Quick &Easy Mailing Bringing the power of productivity of groups withoutthe need for a corporate IT to manage it. You can create a SharedGroup with all your contacts at your work and personal accounts,which every member can view, to receive and send emails.Simplifying Email with Clusters Automatically combine relevantemails into a single expanding slot using TypeApp smart Clusters aswell as set different notification sounds for specific services.With Clusters, you can control all emails from a specific senderand with multi-edit quickly moving, deleting, or marking clustersas spam is simple. FEATURE RICH EXPERIENCE ● Instant, Smart PushNotifications - Quiet Hours, Custom Sounds, Vibrate, LED Light,Snooze Alerts and other preferences per each of your accounts● Smart Conversations – Makes mail app convenient and easy ● RichText - Easily configure text styles and add your logo ● CalendarSync and Contacts – Get your ActiveSync work account in sync ●Android Wear - Intelligent email on your wrist ● Configurable Menus– Customize your menus with actions that really matter to you ●Wireless Printing – Integrated with any supported printer ● Days toSync – Saves memory for offline use ● Unread and Scrollable Widgets- Access your mails inbox at a glance ● Beautiful Dark Mode &Themes ● Account Color Coding - Know from which account a mail hasbeen received Getting Stuff Done Reach Zero Inbox even faster.Quickly mark emails that you wish to be handled later & setyourself reminders. When you finish handling an email, you cansimply mark it done and get it out of your way without having todelete the email. Use Type's Smart Filters to easily filter emailsby unread/starred. Visually Appealing – Beautifully Designed Easilyrecognize popular services by their icons and give your friends andcontacts an avatar photo to help you process your incoming mailfaster. Quickly see how many unread emails are in your inbox withthe TypeApp icon (for supported devices) or with the 1x1 unreadwidget for any account of your accounts including the UnifiedInbox. Set colors for your accounts to help them stand out or useTypeApp's automatic Dark Theme which switches per the daylighthours in your area. Security – Private & Secured TypeApp takesyour security and privacy seriously by utilizing industry leadingencryption. You can rest easy knowing your data is always encryptedto protect all your email communications and keep your informationsecured. With passcode and lock screen, you can set a timed lockscreen to protect your private emails, or use SMS verification toensure your email app is safe. We ❤ getting your feedback! Please email us anytime: [email protected] with any questions orsuggestions you may have! For news, please follow us on Twitter& Facebook: http://www.typeapp.comhttp://www.twitter.com/typeapp (@TypeApp)https://www.facebook.com/typeapp
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Do you want to know if your Wireless Access Point is vulnerable tothe WPS protocol? Wps Wpa Tester is the app that you need! Withthis app, you can try the connection to an Wi-Fi Access Point viaWPS PIN. PINs are calculated with several algorithms throught MACAddress and there are others PINs included in a local database formany Access Point. Luckily just a small part of Wireless AccessPoint are vulnerable to WPS protocol. If you will find out thatyour Access Point has WPS protocol enabled, we suggest to disableit. The purpose of the app is educational to let the customers knowabout vulnerability of their own Access Point. There are manyconnection mode with this app and you can try the bruteforce modeeither. App also discovers if an Access Point with WPS enabled isinvulnerable (WPS LOCKED). App allows users with root permissionsto see Wi-Fi passwords saved. Some important Notes: NOTE: you cantest the PINs with this app and you can connect, but you cannot seethe password without root permissions. Use this app only with yourown AP not to go against the law.
WPS Connect 1.3.6 APK
With this app you'll can connect to WiFi networks which have WPSprotocol enabled. This feature was only available in version 4.1.2of Android.App developed with educational purposes. I am notresponsible for any misuse.Released under license CC BY-NC-ND 4.0:https://creativecommons.org/licenses/by-nc-nd/4.0/WPS:http://es.wikipedia.org/wiki/Wi-Fi_Protected_SetupWPS Connect isfocused on verifying if your router is vulnerable to a default PIN.Many routers that companies install own vulnerabilities in thisaspect. With this application you can check if your router isvulnerable or not and act accordingly.Includes default PINs, aswell as algorithms such Zhao Chesung (ComputePIN) or StefanViehböck (easyboxPIN).Tested on:- LG G2- Nexus 5- Samsung GalaxyS3IMPORTANT!!Prior to an assessment, understand that it serves theapplication.
XPOSED IMEI Changer 1.7 APK
ROOT REQUIREDXPOSED FRAMEWORK REQUIREDIF You dont know What isXPOSED Framework then do not try this application (it wont work)HiGuys,I read about the Xposed framework in xda and otherwebsites.some websites have really good tutorials about it.So whatI understand is that we can modify a function and its return valuesusing the Xposed Framework.I have created and Xposed Module ForChanging (MASKING) the IMEI No of the PhoneChange Means How OtherApplication gets the IMEI No of the device using below codeAs youall know,The Value is not permanent as it is an Xposed Module:)XDA-DevelopersThreadhttp://forum.xda-developers.com/xposed/modules/xposed-imei-changer-t2847187Proversion :https://play.google.com/store/apps/details?id=com.vivek.imeichangerproStepsInstall app Enable module in xposed framework Come back to app andenter new value Press Apply Go to xposed module Open framework pageDo a soft reboot Open the app And you can see new valuecheck thevalue by dialing *#06#, you can see the new value
XAPK Installer 1.4 APK
Say goodbye to Android APK OBB Installing error problem, XAPKInstaller makes that easier and faster than ever.• Scan and preview all .apk file on your phone and SD Card• Delete or install APK, XAPK ( APK with cache data or obb file)automatically• Download XAPK, APK free online with your Android phone andtabletXAPK Installer for PC is available that allows you to install.apk files from Windows XP, Vista, 7, 8. 8.1 to Android devices.Learn More: http://apkpure.com/apk-install.htmProblems downloading or installing APK with XAPK Installer? Seehttp://apkpure.com/xapk.htmStill need more help? Please tell us more about the issue onFacebook. https://www.facebook.com/apkpure
Administrator 1.3 APK
AnyCut APK
WiFi Master Key - by wifi.com 4.5.78 APK
With a hundreds of millions of free Wi-Fi hotspots shared by ourusers globally, you can connect to free Wi-Fi with WiFi Master Key(by en.wifi.com - LinkSure Singapore)! Search & connect toshared WiFi hotspots indicated by a Blue Key. Easy and safe. THEWIFI MASTER KEY EXPERIENCE - Cost Savings: Save data costs byconnecting to free shared WiFi hotspots. - Easy and Fast: justsearch for the blue key and tap to connect WiFi! - Safe andSecured: All shared password are not revealed. It is encrypted toprotect sharer's privacy and security. - Easy to understand in yourown language: Available in 19 languages across 223 countries andregions. English,Thai, Bahasa Indonesia, Malay, Vietnamese,Simplified Chinese, Traditional Chinese TW,Traditional Chinese HK,Japanese, Korean, Portuguese, Spanish, Russian, Arabic,Turkish,Hindi, French, Italian, German...more languages coming soon.Disclaimer: WiFi Master Key is not a hacking tool. It does notassist in unlocking passwords of Wi-Fi hotspots that are not sharedby the users. Hacking is illegal. With our growing community ofover 900 MILLION users (Chinese and Global version combined), weaim to build a trusted platform for everybody to enjoy theInternet. So, come join the world's largest WiFi sharing communitytoday! If you don't find shared hotspot yet, don't worry, give thecommunity some time to grow. We are handling over 4 BILLIONconnections daily and the number is growing rapidly. There will bemore and more shared WiFi to help you get connected online and surfthe Internet free! Rate us to show us your love! It means a lot tokeep us going! Have a question? Wanna leave a feedback orsuggestion? Sure, we'd love to hear them— tell us here or on ourFacebook page! https://www.facebook.com/wifimasterkey. Spread theword, and keep sharing WiFi!
VPN Over HTTP Tunnel:WebTunnel 2.2.5 APK
WebTunnel : TunnelGuru for Android WebTunnel is a powerful HTTPtunneling tool which helps you to protect your online privacy whereyour local Network Administrator allows you to Access outsidenetwork via HTTP/SSL Proxy only. WebTunnel : How it works Itsinbuilt VPN carries your data over HTTP/SSL Tunnel hence you canget complete protection from underlying VPN. It Supports followingTunneling methods HTTP Normal Half Duplex Tunnel. HTTP Non-Persistent Half Duplex Tunnel using GET method HTTP Half DuplexTunnel using GET method. HTTP Half Duplex Tunnel using POST method.HTTP Full Duplex Tunnel using POST method. HTTP Full Duplex Tunnelusing MIME method. Full Duplex Tunnel using SSL method. WebTunnelFeatures > No speed limitation. > Daily Free privacyprotection on your 100 MB Data. > HTTP Tunnel Server locationsin over 15 countries. > All HTTP Tunnel Servers are deployed in1 Gbps network. > A simple and easy to use HTTP Tunneling toolfor your phone and tablet. > No registration required. This Appneeds a few permissions: Access Current Location. Access ExternalStorage. Access Network. Access Phone State. Access Task List. Howto use WebTunnel Please check above screenshots. For more helpplease visit: http://tunnelguru.com/webtunnel For any Issue pleasecontact WebTunnel Support: [email protected]

subset: commoncrawl


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Tour Deposit: Your tour reservation will be confirmed upon receipt of your deposit. Deposit payment applies for land packages only, air travel will be purchased separately. If you are paying by check, your deposit payment must be received in our office within 10 business days to avoid cancellation.
Prices: tour prices are for land package only and inclusive of land and services taxes. Rates are per person in US dollars and based on double occupancy in a room. Our tour package rates do not include airfare, airport taxes, fuel surcharges and all other taxes related to your airfare. All rates for our tours reflect a 3% discount for purchases paid by check. Discounts are not provided for sales paid by credit card. In case of human or computer error, Tony's Tours, reserves the right to re-invoice for the correct price or service.
Final Payment: Final payment is due 60 days prior to departure. Payments made within 21 days of departure must be in the form of a certified check or credit card.
Reservations & Payments:Your tour reservation will be confirmed based on availability at the time of booking. Receipt of a deposit of $250 per person, and signed Registration Form is required to hold your reservation. The balance is due 60 days before departure. Tony's Tours accepts all major credit cards. Credit card must be owned by the traveler.
Cancellation Policy: Once a deposit or full payment has been made, cancellations will only be accepted in writing. Cancellation terms will be applied based on the date that the written cancellation is received. Please read our tour cancellation terms on your tour registration form. Most charges may be avoided by obtaining our "worry free" travel protection plan. Refunds for flights cancellation will be processed as per Airlines and/or tickets conditions/regulations. Land tour cancellation as follows:
* Up to 90 days or more prior to departure – $100 per person service charge will apply.
* Between 89 and 60 days prior to departure – $250 per person cancellation fee per person will apply.
* Between 59 and 31 days prior to departure – cancellation fee of 50% per person of the tour cost will apply.
* Between 30 days to day of departure or no show – cancellation fee of 100% per person of the tour cost.
No refund will be paid for unused land services such as: transfers, sightseeing, meals, hotel accommodation, entrance fees, or any others unused services that are listed in the tour program
Prices: Prices are per person and are based upon shared twin room occupancy. In case of human or computer error, Tony's Tours, reserves the right to re-invoice for the correct price or service. A full refund will be made to passengers who choose not to pay an increase, provided Tony's Tours receives a written cancellation within five days of the price increase notification.
Credit Cards: We accept Visa, MasterCard and American Express. Credit card charges will only be processed upon completion of tour registration form and must be owned by the traveler. Third-party credit cards are not acceptable. Payments made within 21 days of departure must be in the form of a certified check or credit card.
Travel Insurance: Travel insurance is not included in the tour price. Tony's Tours strongly recommends the purchase of comprehensive travel insurance package, which covers health, lost luggage, trip cancellation and trip interruption. Please note that we cannot accept responsibility for any losses or expenses, which you or any member of your party may incur as a result of failing to secure adequate coverage. Please call us for information about our "worry-free" protection plan.
Passport and Documentation: Your passport must be valid for at least six months following your entry date to your travel destination. For more specific visa requirement, please contact the relevant consulate for update information. Tony's Tours is not responsible to provide any travel documents to any of our destinations, including visas. It is the sole responsibility of the traveler to confirm with the consulate of each country visited, about any necessary travel documentation/visas required to enter these countries.
Airlines and Air Tickets: Passengers are responsible to ensure that Tony's Tours has the correctly spelled names for air tickets reservations. Due to newly introduced security measures, any name change including minor spelling corrections may require airline reservations to be canceled and rebooked. Tony's Tours will not be held responsible for the denial of services by a carrier due to any name discrepancy. Subsequent name corrections will be subject to an airline rebooking fee of up to $300 per ticket. Air reservations are subject to availability at the time of rebooking. All airline tickets issued in conjunction with this tour are subject to air penalties per individual carrier's rules and regulations which will be applied. We suggest you contact the carrier several weeks prior to departure for seat assignments. Passengers are responsible to reconfirm their flights 72 hours prior to departure for all flights.
Airfare & Ticket Revisions: Passengers are responsible to provide accurate passport names for air tickets reservations. Tony's Tours will not be held responsible for the denial of services by a carrier due to any name discrepancy. Once tickets are issued, name/s change/s or any ticket revisions will be subject to air carrier rebooking fee of up to $400 per ticket. Passengers are responsible to reconfirm their flights 72 hours prior to departure for all flights.
Airport Taxes and Fees: All airline tickets are subject to a variety of foreign and domestic government taxes which include security charges, the September 11th Security Fee, airport facility charges, customs and immigration fees, inspection fees, fuel surcharges and more. The total of these taxes may vary and will be approximately anywhere between $50 and $350 per passenger and are collected by Tony's Tours. Taxes and fees are subject to change. Airport taxes & fees which appear on the invoice reflect the taxes and fees that are applicable when the original reservation is completed. These taxes and fees may vary prior to airline tickets being issued. We reserve the right to amend the airport taxes & fees to reflect any changes prior to ticketing.
Baggage: Luggage is the responsibility of the passenger/s and that of the airlines. For lost/delayed luggage claims, the passenger is responsible for notifying the airline directly. If travel insurance policy was purchased, all damage/loss must be reported at time of incident and documented in writing by local authorities for submission to the insurance company. As all airlines differ and restrictions change periodically, we recommendthat you call the airline directly with questions about your baggage allowance. Tony's Tours shall not be held responsible for any delay or damage to or loss of luggage and/or personal items.
Tour Itinerary: Tony's Tours reserves the right to change the itinerary due to unforeseen circumstances. In all cases, Tony's Tours will do its best to maintain the content of the tour. If the tour services as indicated by the itinerary cannot be supplied or there are changes in the itinerary for reasons beyond the control of Tony's Tours we will arrange for provision of comparable services. Tony's Tours reserves the right to make changes in the itinerary whenever Tony's Tours deems it necessary to the comfort, convenience and safety of the participant at any time. No refund will be paid for unused services such as: transfers, sightseeing, meals, hotel accommodation, entrance fees, and others that are listed in the tour program.
Tour Cancellation: Escorted tour packages are based upon a minimum number of participants. Tony's Tours reserves the right to cancel any listed tour departures in case of lack of participation. Cancellation of any tour for lack of participation will be advised at least 30 days prior to the tour's departure. In case of tour cancellation, tour payments will be refunded excluding airfare cancellation penalty and cost of travel insurance. Alternatively, in case of tour cancellation, you will be offered an equivalent tour in similar departure date.
Gratuities: Tour packages do not include tipping for tour guide, bus driver, porters and hotel staff. Please consult with your tour specialist for up-to-date tipping recommendation in your travel destination.
Suggested Tipping: Tour guide 6$ per person per touring day. Driver: $3 per person per touring day.
Private car tours: $10 to $12 per person per day for each day of sightseeing. Porter: 0.5$ per bag per person.
Wait staff: $1.50 per person (dinner only). Chamber maid: $1.00 per person per day
Meals: Meals are based on the hotel's or restaurant's buffet or set menu. In general, beverages are not included, unless specifically stated.
Hotels Accommodation: Hotels will be provided in accordance with the itinerary or similar. We reserve the right to make substitutions with hotels of equal standard. There will be no refunds for any difference in the cost of those accommodations. All rooms are standard twin-bedded rooms with private facilities, unless you have specifically requested and paid for an upgraded room category. Special requests such as bed types, smoking preference and connecting rooms are subject to availability. Room selection in all cases, unless otherwise reserved, is strictly at the discretion of the hotel's management on a run-of-house basis. Triple rooms consist of standard twin beds plus a sofa/folding bed or cot for third person. Hotel check-in time is generally not before 4:00 p.m. and check-out time is prior to noon. Please be sure that adequate arrangements for accommodations have been taken into consideration when a late night flight is being used.
Not Included: Items of personal nature such as laundry, wines, mineral water, beverages, coffee, tea, meals other than described in the tour details, any other service not described as included, passport and visa fees, insurance, and air port taxes and fuel surcharges.
Passenger Information:
Passengers are responsible to ensure that Tony's Tours has the correctly spelled name, address, email and fax data for all passengers. Names printed on the invoice must exactly match the first and last name written in their passport (middle names or initials are not needed). Tony's Tours will not be responsible for passengers who do not receive an invoice or documents due to inaccurate information.
Documents: Your tour documents including: paper air tickets or E Ticket receipts, tour confirmation voucher and all other related information will be sent approximately two to three weeks prior to departure provided full payments has been received. Post Office Box numbers cannot be used for delivery of travel documents. Please provide a complete street address. For shipping by 2nd Day Air, a $15 fee will apply; for Next Day Air, a $25 fee will apply. One set of documents will be mailed per reservation.
Escorted Tours Cancellations: Escorted tours are based upon a minimum number of participants. Cancellation of any tour for lack of participation will be advised at least 30 days prior to the tour's departure, and all money will be refunded. Tony's Tours will not be held responsible for any costs relating to the issuance and/or cancellation of airline tickets or visa fees. Voluntary cancellations due to political instability, acts of terrorism, government intervention or US State Department warning will be subject to the above fees, provided the program is deemed able to continue. Should Tony's Tours elect to cancel a departure for any of these reasons, every effort will be made to obtain refunds from suppliers, however no guarantees can be provided on their behalf.
Customer Service: All customer service issues and refund requests must be submitted in writing and received no later than 30 days after your return. Refunds are subject to a processing fee of $50 plus any hotel and/or supplier charges incurred. Airline flight cancellations and delays for any reason are not the responsibility of Tony's Tours. Submit your claim directly to the airline. Tony's Tours does not guarantee airline response.
Privacy Policy: Tony's Tours has created this privacy statement in order to demonstrate our firm commitment to privacy. The following statement discloses our information gathering and dissemination practices for Tony's Tours. Tony's Tours will not disclose or sell any of your personal information, including your name, address, credit-card number, shopping, or transaction history to any third party except as to what may be required by law. Tony's Tours is a strong advocate of permission marketing. This means you will only receive information about vacations that you have told us you want to receive
Links: This web site contains links to other sites. Please be aware that Tony's Tours is not responsible for the privacy practices of such other sites. We encourage our customers to be aware when they leave our site and to read the privacy statements of each and every web site that collects personally identifiable information. This privacy statement applies solely to information collected by Tony's Tours,
Website: Tony's Tours: Your use of www.tourwithtony.com/ constitutes your agreement to all such terms, conditions, and notices. Liability Disclaimer: The information, products, and services published on this web site may include inaccuracies or typographical errors. Changes are periodically made to the information which appears on the website. The content of this site is not guaranteed to be complete, accurate, or available and may be changed at any time without notice. Tony's Tours may make improvements or changes on this web site at any time. In no event shall Tony's Tours be liable for any direct, indirect, punitive, incidental, special, or consequential damages arising our of, or in any way connected with, the use of this web site, or for any information, products, and services obtained through this web site, or otherwise arising out of the use of this web site. Our site uses a booking form for customers to reserve and purchase travel services. We collect your contact information (like your email address), financial information (like your account or credit card numbers), and demographic information (like your zip/postal code and age). if necessary, we will share information about you and your purchase with the cruise line, airline, hotel, or car rental agency you designate. We will only provide the necessary information to ensure your travel arrangements are confirmed with these travel suppliers. The travel suppliers will use your credit-card information to process your ticket or reservation.
Cookies: Many Web sites, including www.tourwithtony.com use cookie technology to help our customers navigate more efficiently. The cookie is a small text file that resides on your hard drive. From time to time, our site will request the cookie from your browser so that we can retrieve the stored information. This prevents you from having to provide the same information over and over again. Knowing how you use the site enables us to better tailor our content and services to most effectively suit your needs www.tourwithtony.com never uses cookies to store personal information, such as credit-card numbers, nor can any Web site other than ours read the information we store in the cookie.
Special Offers & Newsletters: We send all new members a welcoming email. Existing members will occasionally receive information on tour products, services, special deals, and a monthly newsletter. Out of respect for the privacy of our customers, we present the option to not receive these types of communications.


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What Kinds of Fruits Can Diabetic Nephropathy Patients Eat
The diet plays an important role in controlling the development of diabetic nephropathy, so we often received question like that what kinds of fruits diabetic nephropathy patients can eat, how much fruits and vegetables intake is proper for diabetic nephropathy patients and Here is a lists for patients.
Most people think that there is too much sugar in fruits, so diabetic nephropathy patients has better eat less fruits or don't eat fruits. In fact, that is a wrong idea. Avoiding fruits intake is unsuitable for diabetic nephropathy patients for there are too much vitamins and mineral substances in fruits which also are very important for the diabetic nephropathy treatment. In addition, the sugar in fruits can be divided into many kinds such as glucose, fructose, saccharose and others, among of them, the fructose metabolism need not the participation of insulin, so if the blood sugar level is controlled well, diabetic nephropathy patients can eat some fruits with low sugar.
Fruits whose sugar content below 10 grams in each hectogram include cheery, greengage, grape, watermelon, strawberry, melon, apricot, coconut milk, orange, lemon, peach, plum, loquat, pineapple, sugar cane, lychees, coconut, olive and so on, diabetic nephropathy patients can take some properly. Fruits whose sugar content in 11-20g per hectogram include banana, apple, pomegranate, pomelo, orange, pear, mango and so on, patients should consider more before eating them. And fruits whose sugar content more than 20g per hectogram include jujube, red fruits, especially raisins, dried dates, dried apricot, jujube, dried persimmon, longan and so on, which are not suitable for diabetic nephropathy patients.
Some vegetables such as cucumbers and tomatoes also can be regarded as fruits to eat and their sugar content are below 5g per hectogram and rich in vitamins, they are proper for diabetic nephropathy patients.
In addition, when take these fruits, diabetic nephrpathy patients also should pay more attention to their specific physical condition. If patients has suffered renal insufficient, some fruits with high potassium also should be limited. All in all, the fruits intake should protect the kidney function and control blood sugar at the same time, now if you want to know more about the diabetic nephropathy diet, you can contact our online doctors, leave us messages or send email to firstname.lastname@example.com, we will reply you within 24 hours.
Previous: Can Diabetic Neohropathy Patients Eat Litchi in Their Daily Diet
Next: Diet Therapy Principles for Diabetic Nephropathy


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11 Amazing White Metal Baby Crib Pic Ideas
Cribs Ideas - 11 Amazing White Metal Baby Crib Pic Ideas
A lot of moms and dads will interested discover the specifics of their child even model of child cribs. inspiration and information to all parent who still waiting his baby born.|So, here we will share a bit inspiration and information to all parent who still waiting his baby born.} Prior to you are a baby given birth to parent should put together several things such as child cribs. It is the important part of baby need, making baby cribs should be prepared long time before your baby born. Because baby cribs design is not about either girl or boy, don't worry about your gender of baby. But, how to make the humorous and luxury child cribs design and style, child can not understand some thing about sex, they may fascination on the colorful and cartoon drawing.
Obtain the inspiration and idea about child cribs design and style will not be hard, you may embrace coming from a cartoon motion picture. There are plenty of kinds cartoon videos, such as nickelodeon, Disney world, even pet. This means you make absolutely certain your room is fairly useful to you, you have to concentrate on the place capable never use place too small or too large. In order to accommodate parent need while stay close to your baby, you need ensure your baby room has enough fresh air, you can design your baby cribs based on your want and add some baby equipment. Making a child cribs design and style concepts is very effortless you can do it yourself. Definitely parent want to the ideal for their child, you should create baby's place based on your character and present your adore via your design and style.
Developing child cribs should implement parent products also it signifies you are making the child cribs weather conditions effectively for child and also for mother who usually be careful when. You can now improve your information and facts plus some thought, allow you to try and design and style your little one cribs as great as possible. Give the greatest thing to your child, so that you can display your little one will become adults flawlessly. Let discover much more creativity about child cribs such as our, image and YouTube art gallery. Our company offers 11 Amazing White Metal Baby Crib Pic Ideas you need to see and adapted to your residence.


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en route message alerts
irrespective of FG version and aircraft and hardware, once the aircraft loads sitting on a runway, there
is a mesage displaying the airport id and after the you are on runway message.
sometimes I get another airport id message shortly before landing.
On some irregular occasions I get airport id messages once en route either ahead (miles away according
to the map) or when passing the en route airport.
That seems to happen more when the route manager is not active, but somehow seems erratic.
So the question is what triggers these messages as I do not seem to be able to trace it in a nasal
module nor anywhere else.
The second question is, could the particular code be adapted to not only show airports, but also fixes and
other waypoints once route manager is active? Guess this could be useful alerts in absence of vnav to change altitude if required.
Thank you


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browse words by letter
a b c d e f g h i j k l m n o p q r s t u v w x y z
|more about department
2 definitions found From Webster's Revised Unabridged Dictionary (1913) [web1913]: Department \De*part"ment\, n. [F. d['e]partement, fr d['e]partir. See {Depart}, v. i.] 1. Act of departing; departure. [Obs.] Sudden departments from one extreme to another. --Wotton. 2. A part portion, or subdivision. 3. A distinct course of life, action study, or the like appointed sphere or walk; province. Superior to Pope in Pope's own peculiar department of literature. --Macaulay. 4. Subdivision of business or official duty; especially, one of the principal divisions of executive government; as the treasury department; the war department; also in a university, one of the divisions of instruction; as the medical department; the department of physics. 5. A territorial division; a district; esp., in France, one of the districts composed of several arrondissements into which the country is divided for governmental purposes; as the Department of the Loire. 6. A military subdivision of a country; as the Department of the Potomac. From WordNet r 1.6 [wn]: department n 1: a specialized division of a large organization; "you'll find it in the hardware department"; "she got a job in the historical section of the Treasury" [syn: {section}] 2: the territorial and administrative division of some countries (such as France) 3: a specialized sphere of knowledge; "baking is not my department"; "his work established a new department of literature"
more about department