The effectiveness of behavioral interventions to improve oral health in adolescents at different periods of follow-up: A systematic review and meta-analysis

Effectiveness of school-based oral health education interventions on oral health status and oral hygiene behaviors among schoolchildren: an umbrella review

OBJECTIVE

To summarize evidence of the effectiveness of school-based oral health education interventions on oral health status and oral hygiene behaviors among schoolchildren.

METHODS

A comprehensive search was conducted across seven databases MEDLINE Ovid, Google Scholar, Web of Science, Scopus, EBSCO-APA PsycInfo, ProQuest, and CINAHL, with two independent reviewers screening titles and abstracts including full texts. Data extraction procedure and quality appraisal of this umbrella review adhered to the JBI critical appraisal checklist. Systematic reviews of RCTs in which schoolchildren of 5 to 18 years of age received oral health education in a classroom-based school setting from dentists, schoolteachers, or caregivers were included. Key outcome measures included distinct oral health indices, as well as knowledge, attitudes, and practices.

RESULTS

A total of 27 relevant systematic reviews were included for the umbrella review. Methodological quality was substantial among most systematic reviews, thus enhancing the strength of reliability of findings. Nineteen were graded excellent (scores 30 to 33), four were classified as good quality (scores 26 to 29), four rated as fair quality (scores 21 to 25) and none rated as poor-quality (scores 20 or below). Numerous studies from various nations were identified, with reviews peaking in 2019 and 2021. The overlap assessment reveals slight degree of overlap (3.73% overlap, -0.45% CCA-corrected covered area). Meta-analyses show that oral health education interventions had a favorable impact on a number of outcomes, such as reduced plaque and gingivitis, enhanced knowledge, attitude, and behavior, and improved oral cleanliness.

CONCLUSION(S)

This umbrella review provides a comprehensive synthesis of the effectiveness of oral health education interventions in school settings. Positive outcomes in plaque reduction and gingivitis prevention affirm the benefits of these programs, though the evidence for caries prevention remains inconclusive. The findings highlight the broader impact of these interventions on students' knowledge, attitudes, and behaviors, emphasizing the need for tailored approaches and further research to optimize oral health education. This review serves as a valuable resource for educators, healthcare professionals, and policymakers dedicated to improving pediatric oral health.

PROSPERO REGISTRATION NUMBER

CRD42023401903.

Effectiveness of oral health promotion in children and adolescents through behaviour change interventions: A scoping review

OBJECTIVE

To explore the interventions for change in oral health behaviour that are effective in improving oral health behaviours in 8 to 18-year-old children during oral health promotion.

METHODS

The Joanna Briggs Institute framework of evidence synthesis for conducting a scoping review was implemented for the methodology. Included studies related to the objective, measured clinical or non-clinical outcomes, were in English, 2011-2023, and were experimental, observational or reviews. PUBMED, Science-Direct, Scopus and Sabinet were systematically searched with predetermined search strings. Studies were selected by appraisal of the title, abstract and full text. Data were extracted using a standardised template and the key questions were addressed via a qualitative analysis.

RESULTS

Searches yielded 407 articles from electronic databases. Of these, 290 articles were excluded, and 47 full-text studies were assessed for eligibility, with 23 studies and two systematic reviews finalised for inclusion. In addition, a PEARL search was conducted from the reference lists of other studies. Most studies (91.3%) focused on educating children directly; 8.7% indirectly influenced parents, guardians, and teachers. Interventions focused largely on traditional oral health education presented in diverse forms and via different platforms. Studies differentiated clinical outcomes (indices) from non-clinical outcomes (knowledge, behaviour). All included RCTs were of different quality regarding selection, performance and detection bias. But all studies indicated a low risk of bias in attrition and Reporting bias. Seventeen of the 25 studies (68%) were not based on any behaviour change theory.

CONCLUSIONS

Oral health interventions based on motivational interviewing and the social cognitive theory have been shown to be to be effective. Interventions could also include practical tooth brushing activities, gamification, audio-visual components, as well as reinforcement and repetition in the longer term. Future oral health promotion in children should be designed to include these elements. There is a need for higher quality studies in this field, with future research being urged to provide detailed intervention descriptions and incorporate longer follow-up periods.

Factors Influencing Adolescents' Knowledge, Practices, and Attitudes Towards Oral Health in the Rupa-Rupa District, Peru

Aim

This study aimed to identify factors associated with adolescents' knowledge, practices, and attitudes (KPA-OH) regarding oral health in the Rupa-Rupa district, a high jungle region of Peru.

Materials and Methods

An analytical study was conducted with a sample of 408 adolescents (aged 13-17 years) from seven public schools in the Rupa-Rupa district (elevation: 649 meters above sea level). The sample was stratified by sex, age, and school. Data were collected using a 49-item questionnaire, which included sections on knowledge (10 items), practices (10 items), and attitudes (13 items) toward oral health, as well as 16 sociodemographic variables. The reliability of the questionnaire was confirmed (KMO ≥ 0.537, Bartlett's test: P < 0.001, ω ≥ 0.7). Multiple linear regression models were used to analyze associations, with significance set at P < 0.05, using Jamovi software.

Results

Correct knowledge regarding oral health was highest for understanding the functions of teeth (speech, chewing), the link between caries and bacteria-sugar interaction, the relationship between gingivitis and gum inflammation, fluoride as a remineralizing agent, and the use of dental floss for cleanliness (73.3%-99.8%). Appropriate oral health practices, such as using an individual toothbrush, replacing it quarterly, and brushing twice a day for 2 minutes (89.8%-99.8%), were associated with being the only child and not having reading difficulties (P ≤ 0.03). Positive attitudes toward brushing and dental visits for caries and gingivitis prevention were more prevalent in females (P < 0.001). Multiple regression analyses revealed that demographic factors explained 21.4% of the variance in oral health knowledge (F = 2.05, P < 0.001), but had no significant predictive value for oral health practices (P = 0.127) or attitudes (P = 0.230). Significant predictors of better knowledge included being female (β = 0.3257, P = 0.026), aged 15-17 years (β = 0.6477-0.8246, P ≤ 0.006), and having part-time employed parents (β = 0.5097, P = 0.007). Negative associations with knowledge were observed in adolescents with reading difficulties (β = -0.6376, P = 0.018) and comorbidities (β = -0.5405, P = 0.031).

Conclusion

Factors such as sex, age, sibling position, general health, reading abilities, and parental employment status were found to influence adolescents' oral health knowledge, practices, and attitudes. Clinically, these findings suggest that targeted oral health education programs should consider these demographic factors, especially for adolescents with reading difficulties and comorbidities, to improve oral health outcomes in underserved populations. The results also highlight the need for interventions that emphasize preventive oral health practices, particularly among younger adolescents and those from lower socioeconomic backgrounds.

Effectiveness of psychological intervention in improving adolescents' oral health: A systematic review and meta-analysis

OBJECTIVES

This systematic review aimed to evaluate the effectiveness of psychological interventions in improving oral health behaviors and status among adolescents.

SOURCES

A comprehensive search was conducted in the following six electronic databases, PubMed, Ovid Medline, Ovid Embase, Cochrane Library, APA PsycINFO (ProQuest) and Web of Science.

STUDY SELECTION

The PICO format was used to select eligible studies. Population was adolescents 12 to 18 years old. Intervention was psychological interventions based on psychological theories or models. Comparison was conventional oral health education or negative control. Outcomes were oral health-related behaviors, oral health status, oral health-related quality of life (OHRQoL), self-efficacy and psychological cognitive factors. The risk of bias tool used was RoB 2.

DATA

Sixteen papers on 14 studies met the inclusion criteria. The studies were conducted in school or clinic settings. Regarding risk of bias, most studies had some concerns and the others had a high risk. The psychological interventions improved adolescent's oral hygiene and periodontal status in the short-term (up to 6 months), with the overall SMD = -0.97 (-1.45, -0.49) in plaque level and SMD = -1.18 (-2.32, -0.04) in periodontal status. No significant difference in plaque level was found in the long-term (12 to 24 months), with the overall SMD = -0.31 (-0.64, 0.02). There was improvement in OHRQoL in the short-term, with the overall SMD = 1.04 (0.34, 1.73). Additionally, significant differences were found regarding self-efficacy, oral health-related behaviors (tooth brushing and dental flossing) and psychological cognitive factors between the intervention group and control group (all p < 0.05) in the short-term. Due to the heterogeneity of the studies, meta-analysis could not be conducted in the above three outcome measurements.

CONCLUSIONS

Low certainty of evidence shows that psychological intervention is effective in improving adolescents' oral hygiene in short-term. In addition, very low certainty of evidence was found in improving periodontal status, self-efficacy, oral health-related behaviors, psychological cognitive factors, and OHRQoL in short-term.

CLINICAL SIGNIFICANCE

By targeting the psychological process and cognitive factors of oral health-related behaviors among adolescents, psychological interventions have the potential to improve oral health behaviours and promote oral health among adolescents. Implementing evidence-based psychological interventions in dental practice can lead to more comprehensive and effective dental care for adolescents.

Behavior Change Techniques to Reduce Sugars Intake by Adolescents: A Systematic Review

INTRODUCTION

The adolescent diet is high in sugars compared with other age groups. Effective approaches to support sugar reduction by adolescents are needed as part of caries prevention.

OBJECTIVE

To systematically review peer-reviewed evidence (1990 to 2023) to identify effective behavior change techniques (BCTs) for sugars reduction in adolescents aged 10 to 16 y.

METHODS

Nine databases (CINAHL, Cochrane, Dental and Oral Sciences Source, EMBASE, MEDLINE, PubMed, PsycINFO, Scopus, and Web of Science) were searched. Identified articles were screened independently in duplicate for eligibility. Interventions were eligible if they aimed to change adolescent dietary behavior(s) and reported pre- and postsugar-relevant outcome measures. Interventions from included studies were coded using a 93-item BCT Taxonomy (Michie Taxonomy v1). Risk of bias was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Evidence synthesis by vote counting (number of studies showing positive versus null or negative effects) was applied to BCTs that were present in more than 5 interventions.

RESULTS

Of 16,271 articles identified, 764 were screened in full, yielding 35 studies (in 43 papers), of which 3 were uncodeable. BCTs coded in interventions covered 11 of 16 BCT clusters and 25 of 93 individual BCTs in the BCT taxonomy. The median number of BCTs applied per study was 3 (interquartile range 2-6). Evidence synthesis indicated that the BCTs most positively associated with a positive reduction in sugars were (with the percentage of strong-/moderate-quality studies applying these techniques that successfully reduced sugars intake in brackets) feedback on behavior (100%), information on social and environmental consequences (100%), problem solving (75%), and social comparison (75%).

CONCLUSION

Notwithstanding limitations in available data, the current evidence most strongly supports the use of BCTs relating to feedback on behavior, providing information on the social and environmental consequences, include problem solving and making social comparisons, to lower sugars intake in adolescents.

KNOWLEDGE TRANSFER STATEMENT

The results of this study will enable clinicians to provide more effective dietary advice when supporting dietary behavior change to reduce sugars intake in adolescents. The results may also be used by researchers to guide future directions for research into effective sugars reduction in adolescents.

Development and validation of dental visiting behavior among adults based on health belief model

Aim

This study aimed to develop and validate an instrument, Dental Visiting Behavior Based on Health Belief Model among Adults (DVBHBM), and to assess factors influencing adults' dental visiting behavior based on Health Belief Model.

Materials and methods

This cross-sectional study was conducted among 277 adults in Hyderabad, India. The DVBHBM instrument, based on Health Belief Model, was developed, validated, and distributed among participants. Exploratory factor analysis, reliability analysis, descriptive analysis, independent t-tests, and path analysis were conducted to explore construct validity, internal consistency, attitudes, and relationship among variables.

Results

Participants with discomfort exhibited higher perceived susceptibility (3.70 ± 1.15) compared to those with regular dental visits (2.84 ± 1.26, p < 0.05). Conversely, individuals with regular dental visits demonstrated significantly greater perceived benefits (22.32 ± 2.5) than those experiencing discomfort (19.76 ± 3.36, p = 0.001). Perceived barriers were lower among individuals with regular dental visits (11.01 ± 4.61) compared to those experiencing discomfort (12.71 ± 4.26, p = 0.001). Participants with regular dental visits also perceived the severity of not visiting a dentist (3.87 ± 0.95) more strongly than those experiencing discomfort (2.91 ± 1.03, p = 0.000). Cues to action were more pronounced in individuals with discomfort (3.34 ± 1.06) compared to those with regular dental visits (2.98 ± 1.07, p < 0.05).

Conclusion

Participants exhibiting discomfort in dental visits had significantly higher perceived susceptibility, perceived barriers, cues to action and self-efficacy towards dental visits. However, factors such as age, gender, marital status, income, brushing, flossing and tobacco use did not impact dental visiting behaviour of adults.

Change in parental knowledge and beliefs about early childhood dental caries following a pragmatic community-based trial

OBJECTIVES

To evaluate parent knowledge and belief changes following the MySmileBuddy (MSB) early childhood caries (ECC) intervention.

METHODS

Pre- and post-intervention surveys were completed by 669 parents of children with visually-evident ECC from among 977 participants in a 6-12-month pragmatic community-based caries management trial administered by community health workers (CHWs). Six domains of knowledge about caries and motivating and facilitating determinants were assessed via 26 survey items. Principal components analysis and reliability testing reduced dataset dimensionality. Parent and CHW characteristics were analyzed as potential moderators. Paired T-tests measured pre-to-post-intervention changes. Generalized estimating equations accounted for within-participant correlation with significance set at p < 0.05.

RESULTS

Twenty items consolidated into five factors (saliva, hygiene, diet, seriousness/susceptibility, and outcome expectations). Six additional items were evaluated individually. Positive post-intervention changes (p < 0.0001) were observed across all factors and all but one individual item (tooth decay is very common). Greatest knowledge increases related to caries as a bacterial disease in two measures, the saliva factor and a single caries belief item tooth decay is an infectious disease (0.59 unit increase, 95% CI [0.55, 0.64] and 0.46 unit increase, 95% CI [0.4, 0.51], respectively), and in the value of fluoridated water over bottled (0.46 unit increase, 95% CI [0.39-0.53]). Most parents improved knowledge of ECC salivary (72%) and dietary risks (57%), and preventative hygiene behaviors (59%).

CONCLUSIONS

MSB enhanced knowledge and beliefs about caries and confirmed hypothesized mediators of behavior change among parents of high-risk children. Engaging peer-like CHW interventionists may have moderated intervention effects, warranting further exploration.

Are technology-based health education methods able to reduce oral health inequalities between the sexes in adolescents? A cluster randomized trial

PURPOSE

Determine if different technology-based health education interventions can reduce oral health inequalities between the sexes in a sample of adolescents.

METHODS

A cluster randomized clinical trial was conducted in three phases with an initial sample of 291 male and female adolescents 14-19 years of age. Phase I (n = 288) comprised a clinical examination performed by a calibrated examiner using the simplified oral hygiene index (OHI-S) and gingival bleeding index (GBI). Phase II involved two educational interventions: video (VD; n = 147) or oral counselling (OR; n = 141) with standardized content. In phase III, an App was made available to half of the clusters (OR + App; n = 66/OR without App; n = 71/VD + App; n = 63/VD without App; n = 63), and the clinical examination was performed a second time. Data were evaluated using descriptive analysis and nonparametric tests.

RESULTS

In phase I, boys had a lower standard of oral hygiene compared with girls, with higher mean OHI-S (p = 0.039) and GBI (p = 0.015). After VD and OR interventions, no significant difference between sexes was found regarding the mean OHI-S. However, males had a higher mean GBI compared with females in the OR group (p = 0.006). When the App was added to OR and VD groups, males in the 'OR without App' group had a higher mean GBI compared with females (p = 0.007).

CONCLUSION

This clinical trial demonstrated that educational interventions involving information technologies were effective at reducing oral health inequalities between the sexes among adolescents. However, oral counselling alone was not efficient in reducing GBI in male adolescents.

A systematic review of school-based student peer-led oral health interventions to promote the oral health of school children

BACKGROUND

Poor oral health in children highlights the need for prevention and effective interventions. During late childhood and adolescence, peer relationships can play a vital role in adopting and maintaining positive health behaviours.

AIM

To identify the oral health outcomes of school-based student peer-led delivery of oral health interventions.

METHODS

A search strategy was developed, piloted, and run in four electronic databases: Medline via Ovid, Web of Science, CINAHL via EBSCO, and CENTRAL (Cochrane Central Register of Controlled Trials) using key concepts of peer, oral health and adolescent in the school context. Methodological quality was assessed using QuaDs quality assessment tool. All articles were independently screened by two researchers and data was analysed using narrative data synthesis. The PRISMA checklist complemented by aspects of the Synthesis Without Meta-analysis (SWiM) was used to report this systematic review.

RESULTS

There were 7572 identified, 24 studies progressed to full-text review, ten studies met the eligibility criteria and were included in the review. Only six studies based their interventions on psychological & behavioural theory. Intervention delivered by peers showed improvements in both clinical and self-reported outcomes when compared to other delivery methods (e.g., professionals). Quality of included studies was reported according to QuaDs guidance.

CONCLUSION

Peer-led interventions were more effective in improving oral health status and behaviours when compared to other modes of delivery. Future research should assess if a bi-directional impact of peer-led interventions can be seen. Specifically, if there is added value for school-based student peer-leader's including their own oral health knowledge, skills, attitude and preventative behaviours.

Palliative Care Interventions Effects on Psychological Distress: A Systematic Review & Meta-Analysis

BACKGROUND

Managing psychological distress is an objective of palliative care. No meta-analysis has evaluated whether palliative care reduces psychological distress.

OBJECTIVES

Examine the effects of palliative care on depression, anxiety, and general psychological distress for adults with life-limiting illnesses and their caregivers.

DESIGN

We searched PubMed, PsycInfo, Embase, and CINAHL for randomized clinical trials (RCTs) of palliative care interventions. RCTs were included if they enrolled adults with life-limiting illnesses or their caregivers, reported data on psychological distress at 3 months after study intake, and if authors had described the intervention as "palliative care."

RESULTS

We identified 38 RCTs meeting our inclusion criteria. Many (14/38) included studies excluded participants with common mental health conditions. There were no statistically significant improvements in patient or caregiver anxiety (patient SMD: -0.008, P = 0.96; caregiver SMD: -0.21, P = 0.79), depression (patient SMD: -0.13, P = 0.25; caregiver SMD -0.27, P = 0.08), or psychological distress (patient SMD: 0.26, P = 0.59; caregiver SMD: 0.04, P = 0.78).

CONCLUSIONS

Psychological distress is not likely to be reduced in the context of a typical palliative care intervention. The systemic exclusion of patients with common mental health conditions in more than 1/3 of the studies raises ethical questions about the goals of palliative care RCTS and could perpetuate inequalities.

Oral Health Behaviors and Oral Health-Related Quality of Life Among Dental Patients in China: A Cross-Sectional Study

Background and Purpose

Oral health plays an important role in overall health. But little is known about the problems with oral health behaviors and oral health-related quality of life (OHRQoL) among dental patients in China. This study aimed to investigate oral health behaviors and OHRQoL, as well as to examine the effects of oral health behaviors and associated factors on OHRQoL among dental patients.

Methods

This cross-sectional study was conducted from June 2022 to July 2022 in the Department of Stomatology of the First Mobile General Hospital of Armed Police, Hebei, China. The five-item short form of the Oral Health Impact Profile (OHIP-5) was used to evaluate OHRQoL. Oral health behaviors were assessed by a 16-items oral health behavior questionnaire, and socio-demographic data were collected by a socio-demographic questionnaire. The t-test, one-way ANOVA, and multiple linear regression analysis were used to investigate the associations between the study variables.

Results

186 participants were included in the study. The average age of the participants was 24.62 years (SD = 10.67). The mean OHIP-5 score was 4.31 (SD =3.35). Oral health-related quality of life differed significantly by smoking history, history of alcohol consumption, work status, economic pressure, self-rated oral health status, daily brushing frequency, dental caries condition, and whether they take the initiative to learn about oral health. Multivariate analysis found that the self-rated oral health status and work status were significantly associated with the OHIP scores. The retired people and those with poor self-rated oral health displayed poor OHRQoL.

Conclusion

In general, dental patients' oral health needs to be improved, the majority of patients reported practicing poor oral health behaviors, among which the retired population and hose with poor self-rated oral health showed poor OHRQoL. OHRQoL in dental patients is a complex issue associated with social and behavioral factors.

The Efficacy of a Multi-Theory-Based Peer-Led Intervention on Oral Health Among Hong Kong Adolescents: A Cluster-Randomized Controlled Trial

PURPOSE

This study aimed to investigate the effects of a peer-led oral health intervention based on the Health Belief Model and the Social Cognitive Theory on improving oral health among Hong Kong adolescents.

METHODS

The study adopted a cluster-randomized controlled trial design, and 1184 students in 12 schools were randomized to intervention or control groups. After baseline assessment, the intervention group received a peer-led theory-based oral health intervention, while the control group received booklets for oral health promotion. Self-reported brushing and flossing, Health Belief Model/Social Cognitive Theory constructs, and oral health-related quality of life (OHRQoL) were measured at baseline, 6 months, and 12 months, and dental plaque accumulation and caries status were measured at baseline and 12 months. The trial was registered at https://www.clinicaltrials.gov (NCT03694496).

RESULTS

Brushing, flossing, and OHRQoL improved more in the experimental group than in the control group at the 6-month follow-up compared with baseline (p < .001). The mean gain score difference was .81 for brushing, .47 for flossing, and -2.51 for OHRQoL. At the 12-month follow-up, the mean gain score of brushing frequency, plaque index, caries status, and OHRQoL were .18, -.28, -.32, and -2.79, respectively, which all sustained the significant difference (p < .001).

CONCLUSIONS

Our findings suggested that the Health Belief Model combined with Social Cognitive Theory in a peer-led intervention is effective to increase self-reported brushing frequency and improve oral hygiene status and OHRQoL among adolescents.

The efficacy of peer-led oral health programs based on Social Cognitive Theory and Health Belief Model among Hong Kong adolescents: a cluster-randomized controlled trial

Oral diseases are preventable through the building of good oral health behaviors. Theory-based behavior change was key to the efficacy of oral health promotion since conventional promotion strategies achieved only short-lived and limited improvements. The objective of the study was to investigate the efficacy of a peer-led oral health intervention based on the health belief model (HBM) and the social cognitive theory (SCT) on oral self-care behaviors among Hong Kong adolescents. One thousand one hundred and eighty-four adolescents in 12 schools participated and were randomly assigned to either intervention or control group, utilizing a cluster-randomized controlled trial design. Brushing/flossing frequency, HBM/SCT constructs, oral health knowledge, and dental anxiety were measured at baseline and 6-month follow-up. Changes in behaviors were assessed using mixed-effects model and the mediators of behavioral change were identified with parallel multiple mediation analysis. At 6 months, the intervention group showed a significant increase in the frequency of brushing and flossing compared with the control group. Self-efficacy was identified as mediator between treatment condition and behavioral changes of brushing and flossing. Combining theories of HBM and SCT is a promising avenue for efficacy in oral health behaviors. The effects were mediated through cognitive variables, which provided guidance for both theory and health intervention development.

Efficacy of Behaviour Change Techniques to improve oral hygiene control of individuals undergoing orthodontic therapy. A systematic review

AIM

This study aims to review the available evidence on the efficacy of behaviour change techniques to improve compliance in young orthodontic patients and to compare these with conventional oral hygiene instructions.

METHODS

The review was conducted according to the PRISMA statement. PICO method was used to define eligibility criteria. Two independent reviewers performed the research, examined electronic databases (MEDLINE, Scopus and CENTRAL) and manually checked relevant journals. Only RCTs with more than 10 participants and 3 months follow-up were included. Data extraction and their qualitative analysis were performed for included studies.

RESULTS

Search strategy identified 320 articles. After screening for titles, abstracts and full texts, 10 articles were then selected for qualitative analysis. High methodological heterogeneity was present among studies and therefore no meta-analysis was performed. Low risk of bias was detected for one study only. The most common intervention was "mobile phone communication," which was investigated in five studies. Motivational interviewing, repeated reinforcements and visual-aided approach were also examined.

CONCLUSION

The interest in remote control of patients compliance appears to be fruitful, nonetheless there is no consensus as to a unique treatment protocol. Every other treatment looks beneficial but higher methodological homogeneity should be sought for in future investigations.