Oral hygiene and periodontal status of 12 and 15-year-old Greek adolescents. A national pathfinder survey

The Influence of Coordinative Skills on the Oral Health of Children and Adolescents in Permanent Dentition

Removing dental plaque by using a toothbrush is the most important measure for oral hygiene. The aim of the present study was to estimate the impact of the coordination skills of children and adolescents on their oral health (plaque level, DMF/T: decayed, missing, filled teeth). Within a prospective cohort study, 996 children (10 to 18 years) were examined. The results of three coordination tests from the Motorik Modul (MoMo) were included to evaluate the coordination skills. Other parameters taken into account were age, sex, orthodontic treatment and socioeconomic status (SES). Univariate and various multivariate analyses were performed to evaluate relationships. Better results in precision coordination tests were significantly related to a better oral hygiene (backward balancing: logistic regression OR 0.86, 95%CI: 0.73−0.99, p = 0.051, proportional odds model OR 0.86, 95%CI: 0.75−0.99, p = 0.037; one-leg-stand: logistic regression OR 0.78, 95%CI: 0.63−0.96, p = 0.018, proportional odds model OR 0.77, 95%CI: 0.64−0.92, p = 0.003). Higher scores on one-leg-stand were significantly related to a lower caries prevalence (logistic regression OR 0.81, 95%CI: 0.66−0.99, p = 0.037; Poisson regression exp(ß) 0.82, 95%CI: 0.74−0.91, p < 0.001). Coordination test under a time constraint (jumping side-to-side) showed no significant relation. Oral hygiene was poorer in younger children, boys and low SES. Caries prevalence increased with low SES and increasing age. The present results suggest that oral health is influenced by coordinative skills.

Oral Health in 12- and 15-Year-Old Children in Serbia: A National Pathfinder Study

The aim of the paper is to present the oral health profile of 12- and 15-year-old schoolchildren in Serbia. Basic Methods for Oral Health Surveys of the WHO were implemented to record: Decayed, Missing, and Filled Teeth/Surfaces Index (DMFT/DMFS), gingival bleeding, enamel fluorosis and other structural anomalies, dental erosion, dental trauma, and oral mucosal lesions. In addition, Silness and Löe plaque index and orthodontic status were assessed. A total of 36% of 12-year-olds and 22% of 15-year-olds in Serbia were caries-free. The mean DMFT was 2.32 ± 2.69 for 12-year-olds and 4.09 ± 3.81 for 15-year-olds. DMFT was made up largely by the decayed component. Gingival bleeding was present in 26% of examined 12-year-old and 18% of 15-year-old children. Dental plaque was observed in 63% of both 12- and 15-year-olds. Fluorosis, structural anomalies, dental erosion, dental trauma, and oral mucosal lesion were rarely detected. Low prevalence of malocclusions was found. Oral disease is still a common public health problem among schoolchildren in Serbia. A significant increase in the prevalence of caries disease between 12- and 15-year-old groups implies that preventive care for adolescents requires special attention. Corrective actions and reforms to the current school-based oral health prevention program are needed to further improve oral health in Serbian children.

A model for implementing oral health-promoting school: Integration with dental students' educational curriculum: A protocol study

BACKGROUND

Schools are ideal setting for children's oral health-promoting programs. It is an integrated model for oral health-promoting schools (OHPS) with the capacities of dental school's curriculum and dental students as workforces. In this protocol, the principle of planning and implementation of the oral health program is described.

MATERIALS AND METHODS

Based on the PRECEDE-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (PROCEED) planning model, a framework for determining the potential predisposing, reinforcing, and enabling factors that could be intervening was diagnosed. To adapt the phases of the planning model for integration of the "OHPS" principles and the dental students' curriculum, the following steps are supposed to be considered: Phases 1-5 which are to assess the baseline data will include the assessment of children oral health status and parents and teachers' knowledge, attitude, and performance. Phase 6 or implementation phase will be allocated to oral health education interventions for students, parents, and teachers, professional screening, prevention, and referral. Phase 7 or the process assessment phase will be to record the number of screened students, the amount of fissure sealant and fluoride provision, and percentage of trained parents and teachers. Phase 8 or the impact assessment phase will assess the students' improvement in knowledge and practice, decayed, missing, and filled teeth scores, teachers and mothers' oral health attitudes and behaviors, and brushing and flossing behaviors. At the last, cost analysis of the program and long-term monitoring of the interventions is suggested.

CONCLUSION

In case that the effectiveness of this model is proven, it can be implemented by other dental schools for the primary schools in their regions. Considering the number and distribution of dental schools in the country, this model is executable as targeted population oral health promotion approach in 6-12-year-old schoolchildren.

National survey of periodontal diseases in adolescents and young adults in Morocco

AIM

National surveys of periodontal diseases in children are rare. This study describes the first national survey of oral health of adolescents attending public schools in Morocco. We report the prevalence and demographic determinants of periodontal diseases, and generate population estimates for this young population.

MATERIALS AND METHODS

This study used a multi-stage probability sample comprising 14,667 students in 87 schools and 520 classrooms, representative of students attending grades 6-12 (age 12-18 years) in Morocco. The students were interviewed and then examined clinically to assess their periodontal status, which was classified according to the 2017 World Workshop. In addition, the diagnosis of aggressive periodontitis (AgP) was assessed.

RESULTS

Of approximately 3 million students in this age cohort, 12.3% (or approximately 360,894 subjects) had periodontitis and 46.9% (1.4 million) had gingivitis. They comprised 10.8%, 2.9%, and 6.1% subjects with periodontitis stage I, II, and III/IV, respectively; 5.0%, or 148,336 subjects, had AgP. The prevalence rates were not significantly different by gender or urban status. However, the prevalence of AgP was particularly high in certain regions of Morocco.

CONCLUSIONS

The prevalence of staged periodontitis and AgP in this young population is among the highest reported in national surveys worldwide.

Orthodontic Status and Orthodontic Treatment Need of 12- and 15-Year-Old Greek Adolescents: A National Pathfinder Survey

The purpose of this research was to assess the orthodontic status and orthodontic treatment needs of 12- and 15-year-old schoolchildren in Greece, in relation to sociodemographic factors and parental education level. A total of 1102 12-year-old children and 1131 15-year-old adolescents across Greece were assessed using the Modified Dental Health component (DHC) of the Index of Orthodontic Treatment Need (IOTN). An amount of 38.7% of 12-year-olds and 33.7% of 15-year-olds were in definite need of orthodontic treatment. The most common etiologic factors were tooth eruption and position anomalies. A higher rate of orthodontic treatment need was recorded among subjects with lower parental education level. Class I malocclusion was found in 50.9%, Class II in 38.4% and Class III in 10.8% of the total sample. A higher incidence of dental trauma was found in the 12-year-olds presenting with a Class II molar relationship and >3 mm overjet. The need for orthodontic treatment in Greece was higher, in comparison to other European countries, with one out of two children presenting a severe overjet associated with a high incidence of dental trauma. One out of three adolescents were still judged as having a need for orthodontic treatment by the age of 15.

Dental caries experience in primary school-age children following "Students' Oral Health Promotion Program," Iran

OBJECTIVES

This study aimed at determining the changes in dental caries experience in elementary school-age children following 5 years of the Students' Oral Health Promotion Program implementation.

METHODS

In the present study, totally 2920 elementary school students participated and were selected by multistage cluster sampling. Based on the WHO Oral Health Survey Methods manual (4^th edition), dental caries indices in primary and permanent teeth were assessed by clinical examination in schools. Data on socio-demographic characteristics and dental factors were collected through interviews based on questionnaire. The logistic and linear regression was used for data analysis.

RESULTS

The mean (SD) age of the elementary school children was 9.45 (1.71) years, and 1481 (50.7%) were boys. There was a significant difference between genders, age, dental pain experience and student's parent supervision with dmft, DMFT and their caries status. For 1-year increase in age, 1.67 times increase in DMFT and 0.33 decrease in dmft were predicted. Girls had higher odds of DMFT. In contrast, the odds of dmft for girls were significantly lower compared with boys. Students with dental pain experience had significantly higher odds of DMFT and dmft. The Significant Caries Index (SiC) score for permanent dentition in 12-year-old children was 5.47. Sex was significantly correlated with SiC index. The odds of developing Sic was 0.98 times lower in girls than in boys.

CONCLUSIONS

Dental caries was identified as a major public health problem among the elementary school students despite the implementation of the national project for oral health promotion.

The correlation of altitude with gingival status among adolescents in western China: a cross-sectional study

Periodontal disease is common in Chinese adolescents. There is little information about the effect of different altitudes on gingival health. This study aimed to investigate the gingival status at different altitudes and to identify relative factors that affect adolescents' gingival status. A total of 1033 adolescents aged 12-14 years were included in this cross-sectional study in Ganzi (plateau, 1400 m, 2560 m, 3300 m) and Suining (plain, 300 m). Gingival status was assessed by the presence of gingival bleeding on probing (BOP) and dental calculus (DC). Demographic variables, socioeconomic status, dairy habits and oral health-related knowledge, attitudes and behaviors were obtained via questionnaire. Univariate and multivariate binary logistic regression analyses were performed to identify potential relative factors. A total of 64.09% and 77.15% of adolescents had BOP and DC, respectively. The prevalence rates of BOP and DC were higher in the plateau than the plain (P < 0.05). After adjusting for all other factors and interaction terms, residence altitudes of 2560 m [300 m as reference: P < 0.001, odds ratio (OR) = 4.072] and 3300 m (300 m as reference: P = 0.002, OR = 4.053) were significant relative factors of BOP, and an altitude of 2560 m (300 m as reference: P = 0.001, OR = 3.866, 1400 m as reference: P = 0.001, OR = 3.944) was an important relative factor of DC. Gingival bleeding and calculus deposits were common at different altitudes. High altitude was a significant relative factor of gingival bleeding and calculus deposits.

Periodontal Status Among Schoolchildren in the Republic of Moldova: A Cross-Sectional Study Using the Pathfinder Study Design

Objectives

To screen a sample of Moldavian schoolchildren to establish their periodontal condition using the Pathfinder study design of the World Health Organization (WHO).

Methods

Two cohorts – 12- and 15-year schoolchildren – were screened in 12 schools around the country: four schools in the capital city; four more schools in two other larger cities (two schools in each city); and four village schools (one school in each village). In addition to demographic data, the periodontal parameters dental plaque, calculus and bleeding on probing (BOP) were collected. Periodontal pocket depth (PPD) was also measured but only in the cohort of 15-year-old schoolchildren. Measurements were recorded for the six Ramfjord index teeth.

Results

In total, 720 children were surveyed: 365 (50.7%) were 12 years of age and 355 (49.3%) were 15 years of age; 351 (48.8%) were girls and 369 (51.2%) were boys; 490 (68%) lived in an urban area and 230 (32%) lived in a rural area. Only 4.5% of 15-year-old children presented with a pocket depth of ≥3.5 mm. Children who lived in rural areas had higher plaque scores than children who lived in urban areas (64.8% vs. 54.1%, P = 0.007). In addition, children who lived in urban areas had significantly less calculus (P = 0.047) and shallower PPDs (P = 0.019). Deeper PPD was associated with higher PI and calculus scores.

Conclusions

Moderate-to-deep periodontal pockets were not uncommon in children in the 15-year-old cohort. Periodontal status was worse in children from rural areas than in children from urban areas. It is therefore suggested that an educational programme, together with preventive and interceptive protocols, should be adopted in early adolescence and especially in rural regions.

Socio-demographic determinants as predictors of oral hygiene status and gingivitis in schoolchildren aged 7-12 years old: A cross-sectional study

OBJECTIVE

Gingivitis and poor oral hygiene status are the most prevalent oral diseases among primary school students. Poor oral hygiene status, gingivitis and socio-demographic determinants have been shown to be associated with periodontal diseases. There is limited information on the gingivitis and oral hygiene status among Iranian children. In the present study, the status of gingivitis, oral hygiene status, and their association with socio-demographic determinants among schoolchildren aged 7-12 years old in Hamadan were investigated.

METHODS

In this cross-sectional study, 988 primary school students aged 7-12 years old were selected. The oral hygiene status was measured through Simplified Oral Hygiene Index (OHI-S) and Community Periodontal Index (CPI) was used to evaluate gingival bleeding and calculus. CPI was measured using a standardized protocol to investigate gum bleeding and calculus. The oral hygiene was classified as good, fair or poor based on calculus and debris measurements. Age, gender, educational level, occupation and residence district of parents, dental pain experience in the last year and whether parents supervised their children while brushing were assessed by the questionnaires. The collected data were analyzed using descriptive statistics and logistic regression analysis.

RESULTS

The oral hygiene status was good in 644 students (65.20%), fair in 341 (34.50%) and poor in three (0.30%). Moreover, the results of CPI depicted that 639 students (64.07%) had healthy periodontium, 320 (32.40%) had periodontal bleeding and 29 (2.9%) were with calculus. Higher percentage of the boys in the age group of 12 years old had periodontal bleeding and fewer good oral hygiene. The results of CPI and OHI-S scores depicted that more than half of the primary school students had healthy gums and periodontium (64.1%) and good oral hygiene status (65.2%). There were significant statistical associations between age and residence district with calculus measured by the CPI, also between gender, age, residence district, and mother's occupation with the gingival bleeding measured by the CPI. Furthermore, age and mother's occupation were significantly associated with OHI-S index.

CONCLUSIONS

In general, the periodontal health status is poorer in students attending suburban schools compared to those in urban schools in Hamadan. Since there are significant associations between gender, school districts and mother's occupation with oral hygiene index among schoolchildren in primary schools, considering them in schools' oral health program design might be useful.

Relationship between Healthy Lifestyle and Sociodemographic Factors in Adolescents in Catalonia: Application of VISA-TEEN Questionnaire

Introduction

There is a clear relationship between the way of life and the health of individuals, and therefore, we can speak of healthy and unhealthy lifestyles. There are different surveys and questionnaires that evaluate the lifestyles of adolescents, but none of them offers a final score that can quantify the healthfulness of an adolescent’s lifestyle. It was with this goal that the VISA-TEEN questionnaire is developed and validated. The objective of this study is to apply the questionnaire to a sample of adolescents who attend school in Catalonia to evaluate the healthfulness of their lifestyles and to relate the scores obtained to different sociodemographic variables.

Methods

Cross-sectional study. A total of 2,832 students from 25 schools in Catalonia responded to the questionnaire. A descriptive analysis was performed, calculating the mean (Standard deviation), median (p₂₅, p₇₅), and confidence interval. The results were calculated for the total population, factoring according to gender, age, urban/rural population, origin (native/immigrant), and family wealth, which was based on the Family Affluence Scale (FAS II). The significance of the difference was calculated for each factor with the appropriate statistical test.

Results

For the total score of healthy lifestyle, the youngest students and those with the highest family wealth obtained higher scores. With respect to eating habits, girls scored higher than boys, and higher scores were observed in natives and those with high family wealth. For physical activity, boys scored higher, as well as younger individuals, natives, and those from rural areas. With respect to substance abuse, the worst scores were found in older individuals, students from rural areas, and natives. The rational use of leisure technology was only associated with age (worsening scores with older age). Lastly, hygiene was better with girls, decreased with age, and was worse with natives than immigrants.

Epidemiology of gingivitis in schoolchildren in Bucharest, Romania: a cross-sectional study

BACKGROUND AND OBJECTIVE

Gingivitis is the most prevalent oral disease in children, being strongly associated to social gradients. Many studies have reported different results concerning the extent and intra-oral distribution of gingivitis in children. The aim of this study was to investigate the epidemiologic parameters and socio-related risk factors of gingivitis in the 10-17-year-old Bucharest schoolchildren population and to analyze its intra-oral distribution.

MATERIAL AND METHODS

Cross-sectional data were obtained from 1595 schoolchildren, social condition being assigned using a simple questionnaire. Classes of students were used as clusters in a single-stage cluster sampling method. An intra-oral exam was performed for all the children included in this study. Silness and Löe scores, prevalence and the extent of gingivitis were calculated.

RESULTS

The gingival scores showed a mild inflammation and the prevalence of gingivitis was 91%. Boys had a higher gingival (0.19 vs. 0.18; p < 0.05) and plaque scores (0.71 vs. 0.59; p < 0.01) than girls. Children who did not live in overcrowded households, whose parents had a better education and those who had direct access to school dental services displayed better gingival conditions (p < 0.05). Gingivitis was more severe on the upper teeth, with the maximum score being reached at the right upper lateral incisor (0.63 on distal surface).

CONCLUSIONS

Gingival condition in Bucharest schoolchildren population was associated to social gradients. School dental services are also another factor that seems to be related with gingivitis.

Socioeconomic inequalities and determinants of oral hygiene status among Urban Indian adolescents

OBJECTIVES

To assess the socioeconomic inequalities in oral hygiene and to explore the role of various socioeconomic and psychosocial factors as determinants of these inequalities among adolescents residing in Delhi National Capital Territory.

METHODS

A cross-sectional study was conducted among 1386 adolescents aged 12-15 years from three different socioeconomic groups according to their area of residence (middle-class areas, resettlement colonies and urban slum colonies). Level of oral hygiene was examined clinically using the Simplified Oral Hygiene Index (OHI-S), and an interviewer-administered questionnaire was used to measure key socio-demographic variables and psychosocial and health-related behaviours. Logistic regression analysis tested the association between area of residence and poor oral hygiene.

RESULTS

Poor oral hygiene was observed in 50.2% of the adolescents. There was a socioeconomic gradient in poor oral hygiene, with higher prevalence observed at each level of deprivation. These differences were only partly explained, and the differences between adolescent groups remained statistically significant after adjusting for various demographic variables, standard of living, social capital, social support and health-affecting behaviours (OR: 1.96, 95% CI: 1.30-2.76; and OR: 2.50, 95% CI: 1.60-3.92 for adolescents from resettlement colonies and urban slums, respectively, than middle-class adolescents).

CONCLUSION

Area of residence emerged as a strong socioeconomic predictor of prevalence of poor oral hygiene among Indian adolescents. Various material, psychosocial and behavioural factors did not fully explain the observed inequalities in poor oral hygiene among different adolescent groups.

Prevalence and severity of gingivitis in school students aged 6-11 years in Tafelah Governorate, South Jordan: results of the survey executed by National Woman's Health Care Center

Background

A cross-sectional census was conducted on 994 public school students aged 6-11 years living in 3 different parts of Tafeleh Governorate—South of Jordan, to determine the prevalence, and severity of gingivitis and to evaluate the oral hygiene habits among them as a part a survey executed by National Woman’s Health Care Center. All students were examined for gingival index (GI) and plaque index (PI), information about oral hygiene habits was recorded.

Results

Only 29.8 % had healthy gingiva, 38.5 % had mild gingivitis, 31.4 % had moderate gingivitis, and 0.3 % had severe gingivitis. The difference between both genders was not statistically significant P > 0.05. 36.8 % of the examined students never brushed their teeth. Average gingival index (GI) and average plaque index (PI) were 0.77 and 0.61 respectively.

Conclusions

Fair oral hygiene with mild to moderate gingivitis is highly prevalent among Tafelah school children. This study indicated that oral health status among schoolchildren in Tafelah is poor and needs to be improved. Long-term school based oral health education programme is highly recommended.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-015-1532-y) contains supplementary material, which is available to authorized users.

Oral Hygiene Facilitators and Barriers in Greek 10 Years Old Schoolchildren

Aim: The aim of this study was to determine the oral hygiene facilitators and barriers for 10 years old Greek children, via a questionnaire and clinical examination.

Materials and methods: This was a cross-sectional study of 266, 10 years old, children recruited from schools in 3 locations in Greece. Data were collected via questionnaires and clinical examination. Questionnaires referred to Children’s oral hygiene knowledge, behavior and attitude as well as parents’ oral hygiene behavior and educational level. Children were clinically examined by two calibrated pediatric dentists using a WHO probe and artificial light to assess dental plaque (hygiene index-HI), gingivitis (simplified gingival index-GIs) and dental caries (DMFT-BASCD criteria).

Results: Regarding oral hygiene knowledge, although 80% of the children were literate of the proper means of oral hygiene, only 58.64% brushed their teeth twice daily and 36.84% used dental floss. Children’s oral hygiene knowledge was positively correlated with both parental brushing frequency (ρ = 0.175, p < 0.05) and educational level (ρ = -0.216, p < 0.05). Toothpaste use was reported by 92.11% of the children. Regarding Children’s attitude, 62.28% were concerned whether their teeth were clean, with girls showing greater concern than boys (p < 0.001). Their reported beliefs regarding brushing avoidance were boredom (84.06%), low oral health literacy (73.91%) and forgetfulness (56.52%).

Conclusion: Oral hygiene facilitators were found to be the concern about how clean were their teeth, oral health literacy of both children and parents and toothpaste appeal to children. Oral hygiene barriers were Children’s boredom, low oral health literacy, forgetfulness and low socioeconomic level.

How to cite this article: Angelopoulou M, Kavvadia K, Oulis C, Reppa C. Oral Hygiene Facilitators and Barriers in Greek 10 Years Old Schoolchildren. Int J Clin Pediatr Dent 2015;8(2):87-93.

Oral health conditions in an Albanian adolescent population: an epidemiological study

Background

The aim of this study was to determine the oral health conditions of an adolescent population of Tirana.

Methods

A cross-sectional epidemiological study was carried out in a sample (n = 1885), aged 16-19, mean age 17.4 (SD = 1.0), attending public schools in Tirana and province; 1200 adolescents were included into the analysis. A clinical observation without radiographs was conducted in the medical room of the schools during the 2012-2013 school year.

Results

Very severe and severe orthodontic treatment need, grade 5 and 4 of IOTN (Index of Orthodontic Treatment Need), were found in 17.0 % of the sample. DMFT (Decayed, Missing and Filled Teeth) was 4.9, whereas OHI (Oral Hygiene Index) was documented in the highest number of subjects (n = 384), 32 % of the total sample possessed “good” grade of oral hygiene. CPI (Community Periodontal Index) was observed at score 0 (healthy gingival condition) in most of the subjects (53.1 %), score 1 (gingival bleeding) in 33.4 % of the total sample. PI (Plaque Index) results showed 43.9 % of the sample (527 subjects) with score 0.

Conclusions

The study findings highlight the need for preventive care programs to improve oral health conditions as well as to reduce oral pathology risk factors in Albania.

Comparative clinical study testing the effectiveness of school based oral health education using experiential learning or traditional lecturing in 10 year-old children

BACKGROUND

School based oral health education through traditional lecturing has been found successful only in improving oral health knowledge, while has low effectiveness in oral hygiene and gingival health. The aim of this study was to evaluate the effectiveness of experiential learning (EL) oral health education to traditional lecturing (TL), on enhancing oral health knowledge, attitude and behavior as well as oral hygiene, gingival health and caries of 10-year-old children.

METHODS

Eighty-four children were recruited for the EL and 100 for the TL group from 3 locations in Greece. Data regarding oral health knowledge, attitude and behavior were collected via questionnaires. Data regarding dental plaque, gingivitis and caries were collected by clinical examination. The evaluation using questionnaires and clinical examination was assessed at baseline and 6 and 18 months afterwards. Two calibrated pediatric dentists examined the students using a periodontal probe and artificial light. Modified hygiene index (HI) was used for dental plaque recording, the simplified gingival index (GI-S) was used for gingivitis and DMFT, based on BASCD criteria, for dental caries. Based on a dedicated manual, the teacher applied in the classroom the oral health educational program using EL.

RESULTS

EL group had statistically significant better hygiene than the TL at 6 months (p < 0.05). Within the same group, both groups had enhanced oral health knowledge at 6 and 18 months (p < 0.05) and improved oral health behavior (p > 0.05) and attitude (p > 0.05) at 6 months in comparison to baseline.

CONCLUSION

EL program was found more successful than TL in oral hygiene improvement. Both oral health education programs improved the oral health knowledge, attitude and behavior of children.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02320162).

School-based oral health-education program using experiential learning or traditional lecturing in adolescents: a clinical trial

The aim of this project was to compare the effectiveness of experiential learning (EL) and traditional lecturing (TL) school-based oral health education on the oral health knowledge, attitude, habits, oral hygiene, gingival health and caries incidence of 13-year-old Greek children. Eighty-seven children for the EL group and 80 for the TL group were selected from two areas of Greece. Information on oral health knowledge, attitude and behaviours were obtained using a questionnaire. Dental plaque was recorded using a modified hygiene index, gingivitis was assessed using the simplified gingival index and dental caries was measured by recording the number of Decayed, Missing and Filled teeth (DMFT) using the British Association for the Study of Community Dentistry (BASCD) criteria. All children were examined by two calibrated dentists, using a World Health Organisation (WHO) periodontal probe and artificial light. Questionnaires were delivered and clinical examinations were performed at baseline and at 6 and 18 months post-intervention. The EL oral health educational programme was implemented by teachers using the programme's manual. Oral health knowledge had improved significantly (P < 0.001) in both groups at 6 and 18 months post-intervention. Oral health behaviour (P < 0.001) and attitude (P < 0.05) had improved significantly at 6 months, and oral hygiene and gingival health had improved significantly at both 6 (P < 0.001) and 18 (P < 0.05) months for the EL group. Lower caries incidence was recorded for the EL group, 18 months post-intervention (P < 0.05). School-based oral health EL for adolescents was found to be more effective than TL in improving oral health attitude and behaviour at 6 months, in improving oral hygiene and gingival health at both 6 and 18 months and in reducing caries incidence 18 months post-intervention.