12. Oral Health (Dental health)
Click on the link for details of the Leeds Health Education Database Project, a complete listing of papers included and a listing of papers on oral health promotion reviewed but not included in the database
Albandar, J.M., Buischi, Y.A., Oliveira, L.B. and Axelsson, P. (1995) Lack of effect of oral hygiene training on periodontal disease progression over 3 years in adolescents. Journal of Periodontology 66, 255-260.Ref ID : 6135
Target Group/Country Schoolchildren in Brazil.
Intervention Methodology Two oral hygiene training programmes for the control of plaque and the prevention of gingival inflammation in adolescents were evaluated. The first group received a comprehensive program based on individual needs and included information sessions pertaining to the etiology and prevention of dental diseases together with extensive training in self-diagnosis and oral hygiene. In addition, an information session was arranged for parents and teachers of these children. The second group received a less comprehensive program consisting of conventional oral hygiene training. The third group (control) received no preventive program. During the experimental period, the two oral hygiene training programs involved 3.5 and 1.5 hours per child, respectively.
Evaluation Method A population of 227 Brazilian schoolchildren The children were examined clinically at baseline and annually over the next 3 years (1984-1987) to assess plaque and gingival bleeding and the data were analysed by a multi-level variance component analysis. were divided into 3 groups: controls (n=76), test 1 (n=79), test 2(n=72). 4% of the sample left the programme.
Impact Achieved All children showed a perpetual improvement in their oral hygiene and gingival state during the course of the study. However, the improvements observed in the comprehensive group were significantly better than that of the control group. Results from the less comprehensive group were not significantly different from the control group. Longer exposure to the programs appeared to produce more improvement; children with higher plaque and gingivitis scores prior to the program showed less favourable results; girls exhibited better results than boys. The impact at the end of 3 years was greater than after 1 yr showing importance of duration. More impact was obtained with girls. A parallel study showed that this improved oral hygiene status did not translate into reduction of periodontitis indicating the limits to what can be achieved by behaviour change alone.
Axelsson, P., Buischi, Y.A., Barbosa, M.F., Karlsson, R. and Prado, M.C. (1994) The effect of a new oral hygiene training program on approximal caries in 12-15-year-old Brazilian children: results after three years. Advances in Dental Research 8, 278-284.t. Ref ID : 6141
Target Group/Country Schoolchildren aged 13-13yrs in Sao Paulo,Brazil
Intervention Methodology This study evaluated the effects of a new oral hygiene training program on approximal caries in a population of 12-13-year-old Brazilian schoolchildren with a well-established habit of daily tooth brushing with a F dentifrice. Group I subjects were trained to establish needs-related oral hygiene habits based on self-diagnosis and a new behavioural principle, the 'linking method', for establishment of habits. The first three visits (20 minutes each) were scheduled at two-day intervals. They were recalled for a monthly check-up during the first 4 months, and then every 3 months for re-evaluation of the results based on self-diagnosis. Group II subjects were recalled at the same intervals for detailed oral hygiene instruction on how to clean every tooth surface using dental tape, toothbrush, and fluoride dentifrice
Evaluation Method Two hundred twenty-two children (118 girls, 104 boys) were randomly allocated into two test groups (I and II) and one control group (III).
Impact Achieved Group I developed significantly fewer (p < 0.001) new approximal manifest (dentin) caries lesions than groups II and III. The mean values (SEM) were 2.3 (0.29), 4.7 (0.59), and 5.3 (0.68), respectively. The conclusions from our study are: In a tooth brushing population using fluoride dentifrices and fluoridated drinking water, the oral hygiene training program with behavioural modification significantly reduced caries incidence on approximal surfaces. The study pointed to the importance of including self-diagnosis check-ups within dental health education.
Bian, J.Y., Zhang, B.X. and Rong, W.S. (1995) Evaluating the social impact and effectiveness of four-year "Love Teeth Day" campaign in China. Advances in Dental Research 9, 130-133.. Ref ID : 4178 (Borderline for inclusion in database)
Target Group/Country Mass campaign in China covering 600m people
Intervention Methodology A campaign on "Love Teeth Day" (LTD) carried out each year in China since 1989. The main activities were planned and conducted by the National Committee for Oral Health. It aims to motivate the people's awareness of dental self-care, participation, and to promote community involvement in oral health education programs. The main methods used include radio, television, newspapers, lectures/symposia, posters, pamphlets and face-to-face consultations. Detailed information on campaign including timing, content and formats are not provided though messages are listed.
Evaluation Method For feedback, two types of questionnaires were designed and sent to the public and the organizers, respectively, after each campaign, and then returned to the office for data processing. 79 forms from organizers were received in 1989 and 47 in 1992. 345 forms were received from the public in 1989 and 321 forms in 1992. Details of the methods used to obtain information on oral health knowledge not provided. There were no controls
Impact Achieved The findings from a four-year study indicated that: (1) The activities started from three municipalities, 29 capitals of provinces, and some large cities (1989), and spread to most cities in the urban area, and about 300 counties in the rural area (1992); (2) 14,000 dental professionals and health workers participated in 1989 as information providers, and increased to 40,000 in 1992; (3) oral health knowledge has increased to 76.2% (1992) from 37% (1989); 94) % of people reporting to brush teeth twice a day increased from 50% in 1989 to 69.3% in 1989; (4) The % of people who reported never visiting a dentist was 17.35% in 1989 and 18.28%in 1992. - raw data or significance tests not provided.. While this study report is of interest because of the large-scale nature of the campaign lack of controls and details of the measuring instruments and raw data reduces the value of the report.
Buischi, Y.A., Axelsson, P., Oliveira, L.B., Mayer, M.P., and Gjermo, P. Effect of two preventive programs on oral health knowledge and habits among Brazilian schoolchildren. Community Dentistry & Oral Epidemiology 22(1):41-46, 1994. Ref ID : 6143
Target Group/Country Schools in Sao Paolo, Brazil
Intervention Methodology The comprehensive program included active participation of the students and parental involvement
Evaluation Method The study group consisted of 186 Brazilian schoolchildren 13 yr of age at the start of the program. A reference group from another school of similar socioeconomic level was included in the analyses. The data were collected from questionnaires filled in by the children under surveillance after the completion of the program.
Impact Achieved Significant (p<0.05 - p<0.005) differences in knowledge as well as in reported behaviour were observed. The children enrolled in the comprehensive program in general scored higher in dental health knowledge than did those in the less comprehensive program. However, the latter group of children seemed to have acquired more correct knowledge during the period than had the control and reference children. Similar results were obtained concerning reported dental health behaviour.
Cutress, T.W., Powell, R.N., Kilisimasi, S., Tomiki, S., and Holborow, D. A 3-year community-based periodontal disease prevention programme for adults in a developing nation. International Dental Journal 41(6):323-334, 1991. Ref ID : 7359
Target Group/Country Rural population in the South Pacific islands of Tonga
Intervention Methodology A 3-year project (1986-89). Village N received supplies of toothbrushes and toothpaste without charge, health education (videos, talks, posters) , a dental clinic, periodic dental scaling (ultrasonic) and involvement of women's committees
Evaluation Method A controlled study of 3 village communities with approximately 1200 20-44 year olds in each. Village N received the full intervention. Village K received the same as N except that dental scaling was not provided. Village E received none of the services provided to the villages N and K Baseline and final dental examinations were carried out of 20-44 year olds. Sample sizes in 1986 and 1989 were: N (187, 211); K (183, 150); E (537, 493). Periodontal health was measured using a CPITN basic periodontal examination procedure. The post-test also included assessment for plaque.
Impact Achieved Baseline and final examinations of 20-44-year olds showed that unsupervised self-care promoted at the community level, when supplemented with periodic removal of subgingival calculus, significantly improved periodontal health. In village N between 1986 and 1989 there was a two-fold increase of % of sextant teeth scored as healthy (p<0.0001) but no significant increase for villages K and E. Village N had most and village E least adults with all index teeth plaque-free (raw data and significance tests not provided and no baseline data). Note that by the end of the three year intervention period more than 75 (14%) of the original survey sample had migrated from the community.
Hartshorne, J.E., Carstens, I.L., Beilinsohn, B., and Potgieter, G. The effectiveness of a school-based oral health education program - a pilot study. Journal of the Dental Association of South Africa 44:5-10, 1989.. Ref ID : 4379
Target Group/Country Coloured primary school children in South Africa
Intervention Methodology An oral health education (OHE) program on a group of coloured school children. The oral hygiene education was provided in classrooms by Metadent company who also supplied educational materials, toothbrushes and toothpaste. Teachers were provided with training in oral hygiene so that they could reinforce the oral health education. the oral health education and tooth brushing sessions were conducted during 10 minute sessions on a daily basis in classrooms and supervised by teachers
Evaluation Method All Sub A,B. and Std 1 pupils at the Levana Primary School in Retreat took part in the pilot study. A representative sample, stratified by sex was randomly drawn from each class. 70 children were examined and oral hygiene levels were measured by means of the Debris Index-Simplified (Greene and Vermillion, 1964). Pupils were given a questionnaire to determine oral health knowledge before the start of the programme, after one month and 3 months. There were no controls (authors claimed that a control was not necessary).
Impact Achieved The mean oral debris index DI-S dropped from 1.75à0.89 (boys) and 1.6à0.75 (girls) p=0.001. Knowledge scores increased from 47à60.6% for boys and 48.1à60% for girls. While the study showed that an increase in oral hygiene status can be achieved after only three months, a matter of concern is the long term sustainability of such a programme and the lack of controls.
Nyandindi, U., Milen, A., Palin-Palokas, T., and Robison, V. Impact of oral health inducation on primary school children before and after teachers' training in Tanzania. Health Promotion International 11(3):193-201, 1996. Ref ID : 4160
Target Group/Country Primary school children in Tanzania
Intervention Methodology Thus modified oral health education was designed and teacher training workshops were carried out in one district by a dental team in liaison with school administrators. After training, the teachers taught a variety or oral health issues and pupils actively studied the concepts and practical skills for dietary choices and tooth brushing,
Evaluation Method The impact of the sessions was assessed as changes in the pupils' oral health knowledge, attitudes and practices. Three random samples, each with 300 pupils, including conventional and modified session groups and a reference group not given oral health education at school, were interviewed and examined
Impact Achieved The group that received modified oral health education had better knowledge of oral health (p<0.001), reported reduced consumption of sugary foods (p<0.01) and increased self-reported tooth brushing frequency (p<0.001), and had better 'mswaki' (chewing stick) making skills (p<0.001) and slightly improved oral hygiene; in comparison with the referents. The group with conventional oral health education had better oral health knowledge but their practices were no better than the referent'.
van Palenstein Helderman, W.H., Munck, L., Mushendwa, S., Hof, M.A. and Mrema, F.G. (1997) Effect evaluation of an oral health education programme in primary schools in Tanzania. Community Dentistry and Oral Epidemiology 25, 296-300..Ref ID : 8195
Target Group/Country Primary school aged children in schools in Morogoro, Tanzania
Intervention Methodology Teachers were prepared to carry out weekly supervised toothbrushing sessions and monthly lessons on aspects of oral health for the school year in grade 4. The practical aspects of oral hygiene and information on the cause and prevention of caries and gingivitis were the components of the programme. The programme started in 1989.
Evaluation Method Eight schools were selected for the clinical effect evaluation and 4 non-participating schools served as the control. 309 children from the participating schools and 122 children from the non-participating schools were available for evaluation. Their ages varied between 9 and 14 years
Impact Achieved The mean plaque score, calculus score and gingival bleeding score at baseline and at follow-up examinations 3, 8, 15 and 36 months later were not significantly different for participating schools and controls. The mean DMFT value at baseline was 0.4 and 3 years later 0.9 in both the participating and control schools. In conclusion, the implemented school-based oral health education programme did not result in significant reductions of the clinical parameters measured. Note that authors concluded that more emphasis needs to be placed on tooth brushing skills and parental involvement. However, the basis for this recommendation is not clear. The study did not measure change in knowledge or attitudes of pupils and it is difficult to know why the programme did not have any affect on behaviour or oral health status.
Thomas,S., Tandon,S. and Nair,S. (2011) Effect of dental health education on the oral health status of a rural child population by involving target groups. Journal of the Indian Society of Pedodontology and Preventive Dentistry. 18, 115-125. Ref ID 8837 (Borderline for inclusion in database)
Target Group/Country Children aged 6-10 years and their teachers and parents in 5 Muslim schools in India
Intervention Methodology Children in Group II had 30 minutes lecture session followed by demontration of toothbrushing. In Group II training was provided to teachers who then carried out education of pupils. In Group IV home visits were made to carry out health education including demonstrations to parents on the importance of encouragement of their children. Model, flip chart and posters were developed to support the education.
Evaluation Method An interventional study of 4 months duration was conducted on 430 children aged 6-10 yrs, 7 teachers and 100 parents.P rior to the delivery of dental health education and also following the intervention Clinical oral health status was assessed. Oral health education was provided to children only (GroupII, n=103), children and teachers (Group III, n=138) and children and parents (Group IV, n=100 children). A control group received no education (Group I, n=89) . Participants in the study were not made aware of the objectives of the study.
Impact Achieved The best gingival scores were achieved by Group 3 where the teacher was involved and the worst score was in the control. (p<0.05) Of interest was the fact that home visits to parents - a costly method - did not achieve more impact than working through the teachers. Note that parents in the control group had the lowest levels of literacy and income and group II had the highest economic levels and this may have influenced the outcome.
Tumlison, G. An exercise in dental health education. P.N.G.Med.J. 20(3):125-130, 1978. Ref ID : 1106
Target Group/Country School children in Papua New Guinea
Intervention Methodology Three interventions were given in sequence. The first was a shortened version of the traditional dental therapist's lecture with demonstrations of toothbrushing and use of disclosing tablets. The second, six months later, was individual instruction by a dental therapist. the third, four months, was to train the teacher to demonstrate and carry out the dental health education lessons to children who were provided with toothbrushes.
Evaluation Method 140 students at primary school median age 10.6 yrs were examined for DMF (Decayed, missing and filled), calculus (used to derive Oral Debris Score) and Periodontal disease. Children received three interventions in sequence. 30% of the pupils were absent during the second visit and these were used as the controls. During the 3rd visit a group of 100 students at a similar school were observed and used as controls.
Impact Achieved There was no significant improvement in ODS after the first and second instructions compared with controls. However, after the third instruction the ODS had more than halved from 10 to 4 and the incidence of gum disease dropped from 71.9% to 19.4% (p=0.0001). As gum disease is the main cause of tooth loss, the author concludes that this simple intervention requiring 4 minutes per day of children's involvement is cost effective. The author also concluded that the study showed the lack of impact by an occasional visit by an external agent. This study is limited by the fact that raw data is not presented and also the unclear status of the controls
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