Impact of school based oral health education programmes in India: a systematic review

Effectiveness of School-Based Oral Health Education for Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

The global burden of oral diseases is high, but access to oral health care is still problematic, especially in low- and middle-income countries. The prevention of oral diseases in the child and adolescent population is the key as it can be prevented and potentially reversed at its early stages. This study aimed to provide evidence on the effectiveness of school-based oral health education in low- and middle-income countries through a systematic review and meta-analysis. Eligible studies had outcomes, such as oral health knowledge, behavior, oral hygiene, gingival health, and caries index, and those published from 1995 to 2019 in English. After screening and reviewing the retrieved articles, 20 studies were included in the systematic review and six eligible studies were selected for meta-analysis. The computed effect size of school-based oral health education in low- and middle-income countries showed improved knowledge, behavior, oral hygiene, and gingival health from the selected studies. However, most of the interventions took place for less than one year, and long-term evidence is still lacking. As repetition and reinforcement are critical in maintaining long-term effects, both country context and sustainability should be considered in school-based oral health education.

Evaluation of peer role models as oral health education providers among school children in Mysuru, Karnataka, India

BACKGROUND

India lacks organized school oral health programs, resulting in limited access to oral health care among children. The peer role models, or teachers, may help in bridging the gap to enhance knowledge on self-care preventive practices. The aim of the study was to evaluate and compare the effectiveness of dental health education (DHE) offered by qualified dental professional, trained teachers, and peer role models in promoting oral hygiene status and behavior among school-going children in Mysuru, Karnataka.

MATERIALS AND METHODS

This was an interventional study conducted over a period of 3 months in an academic year in three selected schools in Mysuru City, India. A total of 120 students were divided into three groups - group 1 were given DHE (dental health education) by a dental professional, group 2 were given DHE by a trained teacher, and group 3 were given DHE by peer role models. Oral health knowledge was assessed using a close-ended questionnaire, plaque levels were assessed using Turesky Gilmore Glickman modification of Quigley Hein plaque index, and gingival status was assessed using Loe and Sillness gingival index. After 3 months, the same index and questionnaire were used post intervention.

RESULTS

The mean scores for knowledge on dental caries at baseline in groups 1, 2, and 3 were 3.75 ± 1.25, 3.65 ± 1.07, and 3.40 ± 1.17, respectively, with no significant difference between the groups, which changed to 4.43 ± 1.27, 3.37 ± 1.14, and 4.93 ± 0.99, respectively, following intervention. Similar results were observed with regard to knowledge on gingival and periodontal diseases. The mean plaque scores at baseline for groups 1, 2, and 3 were 4.17 ± 0.30, 3.24 ± 0.70, and 4.10 ± 0.31, respectively, which changed to 3.85 ± 0.32, 3.90 ± 0.39, and 3.69 ± 0.34, respectively, in three groups following intervention. Post intervention, plaque scores and gingival scores significantly improved in groups 1 and 3 but worsened in group 2. Overall, knowledge scores improved in groups 1 and 3 for some questions, but improvement was not noted in some questions.

CONCLUSION

Under the limitations of the study, it was found that peer role models were as effective as dental professionals in providing DHE in schools.

The Effect of Structured Education Training Program on Oral Health Awareness Among School-Going Children of Central India: A Cross-Sectional Study

Background

In order to curb the ever-increasing load of diseases related to the oral cavity, there is a call for generating organized school-based oral health education and training programs. It is proposed that there will be an emphasis on the primary care of oral health of school-going children proven, which is often neglected. This will be beneficial for the early detection, intervention and thus prevention of further debilitating conditions of the pathologies pertaining to the oral cavity with the assistance of the structured program suggested in this article.

Aim

The aim of the study was the evaluation of oral health programs for oral health awareness and knowledge among school-going children in the Central India region.

Settings and design

This is a cross-sectional study with measurements before and after the implementation of the oral care program. 

Materials and methods

This cross-sectional study, approved by the Institutional Ethical Committee, Datta Meghe Institute of Medical Sciences, Wardha, has been done according to the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) checklist. A study based on certain questions was carried out amongst the school-going children of Central India, especially the Vidarbha region. A total of 250 school-going children were enrolled in the study. A survey based on a questionnaire was carried out among the study participants in the age group of 12-16 years of age, which consisted of questions pertaining to knowledge of oral health and hygiene maintenance. The program consisted of presentation slides, role-plays, and demonstrations for inculcating the knowledge.

Result

A total of 200 study participants responded to the questionnaire. Overall, the baseline mean score of knowledge with scale was 2.80 ± 1.73 SD, which after the intervention was observed to be 10.70 ± 0.54 SD, which showed an increase. There was an aptly 60.4% increase in test scores related to oral health after the specific oral health inculcation program based on questionnaire execution which was statistically significant (p<0.001).

Conclusion

A properly constructed school children-based oral health education and training program induces better results in the oral health-related comprehension of students.

Relationship between Socioeconomic Inequalities and Oral Hygiene Indicators in Private and Public Schools in Karachi: An Observational Study

Background: The study investigated the relationship between socioeconomic status and oral hygiene indicators in two schools located in Karachi, Pakistan. Oral hygiene indicators of public and private school children were compared. Private schools cater to children of relatively wealthier families compared to public school, whose attendees are generally children from less affluent backgrounds. The aim of this study was to determine whether socio-economic differences and inequalities have an impact on key oral hygiene indicators. Methodology: Primary data for this research was collected from community school visits conducted by the community dentistry department of Jinnah Medical and Dental and Medical College from January to September 2019. A convenience sample of the two schools, comprising 300 school students was selected. Data was collected using modified World Health Organization (WHO) oral health care forms. A pre-tested/customized dental hygiene form based on WHO forms was created by the research team. This form was used to measure DMFT/dmft scores and key oral hygiene indicators in the sample. Results: A total sample size of 300 school-children affiliated with public and private schools was selected. The children’s age ranged from 2 to 18 years. The mean DMFT scores of private and public-school children were not significantly different (private (1.82) vs. public (1.48)). (p = 0.257). The mean of carious teeth was 1.69 in private school children compared to 1.34 in government school children, whereas the mean values of other key indicators of oral hygiene including plaque deposition (p = 0.001), dental stains (p < 0.001) and bleeding gums/gingivitis (p < 0.001), were statistically significant between public and private school children. Conclusion: Oral health inequalities can be reduced with increased awareness and public funding to cater for the oral health needs of children of less affluent families. A dynamic and practical community-oriented program is fundamental for enhancing pediatric oral hygiene status, particularly for children attending government schools.

Trends of Alcohol Use, Dietary Behaviour, Interpersonal Violence, Mental Health, Oral and Hand Hygiene Behaviour among Adolescents in Lebanon: Cross-Sectional National School Surveys from 2005, 2011 and 2017

Health risk behaviours during adolescence can have long-term negative consequences. Little is known, however, about the recent health risk behaviour trends in adolescents in Lebanon. This investigation aimed to report the trends in the prevalence of various health risk behaviours, such as alcohol use, dietary behaviour, interpersonal violence, mental health, oral and hand hygiene, among adolescents in Lebanon. Cross-sectional nationally representative data were analysed from 13,109 adolescents (14 years median age) that participated in three waves (2005, 2011 and 2017) of the “Lebanon Global School-Based Student Health Survey (GSHS)”. Results indicate that significant improvements were found among both boys and girls in the decline in interpersonal violence (bulling victimization, being physically attack and involvement in physical fighting), poor washing of hands after using the toilet, and suicide planning, and among girls only loneliness, worry-induced sleep disturbance and suicidal ideation. Significant increases were found among both boys and girls in the prevalence of inadequate fruit consumption, and among boys only unintentional injury and not always washing hands before eating. In conclusion, several decreases but also increases in health risk behaviours were found over three assessment points during a period of 12 years calling for continued health enhancing activities in this adolescent population.

Clinical and sociodemographic factors associated with oral health knowledge, attitude, and practices of adolescents in Nigeria

Objectives:

The institution of appropriate oral health promotion programs targeted at adolescents in schools in developing countries requires baseline information on their oral health knowledge, attitude, and practices as well as associated factors influencing it, which are unknown. This study assessed clinical and sociodemographic factors associated with oral health knowledge, attitude, and practices of adolescents in Ibadan, Nigeria.

Methods:

Two-thousand and ninety-seven students aged 12–18 years were recruited from 30 randomly selected secondary schools in a cross-sectional study conducted in Ibadan, Nigeria. Data were obtained through a questionnaire on oral health knowledge, attitude, and practices, and sociodemographic characteristics. Oral examination was conducted to assess the clinical oral condition of the adolescents. Data were analyzed with SPSS. The higher the percentage scores, the better the oral health knowledge, attitude, and practices, and overall awareness of oral health.

Results:

The oral health knowledge score ranged from 0% to 60%; mean oral health knowledge score was 15.1% (±6.6%). The oral health attitude score ranged from 0% to 91.3%; mean oral health attitude score was 44.5% (±14.3%). The oral health practices score ranged from 0% to 88.9%, and mean oral health practices score was 42.5% (±13.8%). The mean oral health knowledge, attitude, and practices score was 43.8% (±11.4%). A total of 1537 (73.3%) participants had unhealthy periodontium and 98 (4.7%) had dental caries. Students who were 12–15 years (odds ratio = 1.7, 95% confidence interval = 1.4–2.0, p < 0.001), females (odds ratio = 1.2, 95% confidence interval = 1.0–1.5, p = 0.024), offspring of skilled workers (odds ratio = 1.5, 95% confidence interval = 1.1–2.0, p = 0.010), previously educated about oral health (odds ratio = 1.3, 95% confidence interval = 1.0–1.7, p = 0.023), consulted the dentist (odds ratio = 1.9, 95% confidence interval = 1.2–3.1, p = 0.009), or had unhealthy periodontal condition (odds ratio = 1.2, 95% confidence interval = 1.0–1.5, p = 0.042) were more likely to have higher oral health knowledge, attitude, and practices scores or awareness than others.

Conclusion:

Better knowledge, attitude, and practices score was associated with younger age group, higher occupational class, previous oral health education, dental consultation, and having unhealthy periodontal condition.

Effectiveness of oral health education intervention among female primary school children in Riyadh, Saudi Arabia

Objective

This study aimed to examine the effectiveness of oral health intervention on the improvement in knowledge and self-reported oral health behavior among 6–8 year old female primary school children in Riyadh, Saudi Arabia.

Materials and methods

The sample consisted of 1661 girls in primary schools who are 6 to 8-year-olds (first, second and third graders). The children’s level of knowledge was assessed by a self-administered questionnaire that was formulated for this specific age and divided into two parts; oral health knowledge and self-reported oral health behavior. There were seven multiple choice questions and one true/false question with five underlying parts in the questionnaire which contained basic information about oral health knowledge, oral hygiene practices and certain habits that affect teeth. The questionnaires were distributed before and six weeks after implementation of the oral health educational program to measure the level improvement of knowledge regarding oral health among these children.

Results

All the questions showed statistically significant improvement in knowledge and self-reported behavior in the post intervention group. There was a significant increase in the level of knowledge by 11.24% and level of self-reported behavior by 25% after intervention (P < 0.001). The highest net change in the knowledge due to intervention was noted among third graders (13.3%), whereas for self-reported oral health behavior, it was noted among first graders (28.3%).

Conclusion

The results of this study showed that an easy-to-organize and inexpensive school-based intervention can, on a short-term basis, be effective in improving the knowledge and self-reported oral health behavior of children.

Consequences of orthodontic treatment in malocclusion patients: clinical and microbial effects in adults and children

BACKGROUND

Malocclusion is a common disease of oral and maxillofacial region. The study was aimed to investigate levels changes of periodontal pathogens in malocclusion patients before, during and after orthodontic treatments, and to confirm the difference between adults and children.

METHOD

One hundred and eight malocclusion patients (46 adults and 62 children at the school-age) were randomly selected and received orthodontic treatment with fixed orthodontic appliances. Subgingival plaques were Porphyromonas gingivalis (P.gingivalis), Fusobacterium nucleatum (F. nucleatum), Prevotella intermedia (P. intermedia) and Tannerella forsythensis (T. forsythensis) collected from the observed regions before and after treatment. Clinical indexes, including plaque index (PLI), gingival index (GI), sulcus bleeding index (SBI), probing depth (PD) and attachment loss (AL) of observed teeth were examined.

RESULTS

The detection rates of P.gingivalis, F. nucleatum, P. intermedia and T. forsythensis increased from baseline to the third month without significant difference, and then returned to pretreatment levels 12 month after applying fixed orthodontic appliances. Adults' percentage contents of P.gingivalis, F. nucleatum, P. intermedia and T. forsythensis were significantly higher than those of children at baseline and the first month, but not obvious at the third month. PLI and SBI were increased from baseline to the first and to the third month both in adults and children groups. Besides, PD were increased from baseline to first month, followed by a downward trend in the third month; however, all patients were failed to detect with AL.

CONCLUSIONS

Periodontal and microbiological statuses of malocclusion patients may be influenced by fixed orthodontic appliances in both adults and children, more significant in children than in adults. Some microbiological indexes have synchronous trend with the clinical indexes. Long-term efficacy of fixed orthodontic appliances for malocclusion should be confirmed by future researches.