Effect of regular small group instruction per se on oral health status of Danish schoolchildren

A scoping review of intervention components of school-based oral health-related behavioural interventions using the Theoretical Domains Framework

The aim of this study was to review the intervention components of school-based oral health-related behavioural interventions using the Theoretical Domains Framework (TDF). We identified relevant papers from the review of Cooper et al., and these papers came from both the original inclusion and exclusion article lists. We also modified and updated their search strategies (2013 - April 2019). The 53 included papers reported on 79 interventions (experimental groups = 57 interventions, control groups = 22 interventions). Most of the papers used three to nine domains (average = 5.6) in their experimental interventions, and the most commonly used domains were 'knowledge,' 'skills,' 'social influences,' and 'environmental context and resources.' Considering the complexity of intervention components in one programme, there is no one specific domain or domain set that can determine the success of behavioural interventions. The design of future programmes should be guided by a complex intervention methodology. However, the best combination set might not exist, and the choice of domains should depend on local context or resources. This study can be used as a resource for identifying previous papers, which have used the same domains.

Evaluation of the Effectiveness of the Use of the Diode Laser in the Reduction of the Volume of the Edematous Gingival Tissue after Causal Therapy

Aim: The aim of this study was to evaluate and compare two different techniques for the treatment of plaque-induced gingivitis, demonstrating whether the causal therapy supported by diode laser can allow a resolution of the edema caused by gingivitis in less time compared to the single traditional causal therapy. Materials and methods: Twenty-five patients between 20 and 60 years of age with a specific diagnosis of gingivitis were evaluated at the CLID-HSR oral hygiene department. Once the clinical parameters (bleeding index, plaque index, recession, and clinical attack level) were recorded, each of them was subjected to a professional oral hygiene session and instructed in correct home hygiene procedures. Through a split-mouth protocol for each individual patient, hemi-arches were treated by simple randomization to be treated with causal therapy supported by the action of the diode laser (experimental therapy) and which with traditional causal therapy (control therapy). A first intraoral scan was performed before therapy (T0), which was repeated 20 min after rinsing with CHX. The intraoral scans were repeated at a control 7 (T1) and 14 days (T2) after the session. For each intraoral scan, a volumetric value was calculated, proportional to the edema of the gingival tissues, using special digital software. The operator who carried out the volumetric measurements on the software was not aware of the therapy implemented on each half-arch. The operator who carried out the statistical analysis was not aware of the therapy applied to each group. The collected data were statistically compared in order to detect any differences between the volumetric variations between the two therapy groups and within the therapy groups over time. After evaluating the distribution of data by means of the Kolmogorov-Smirnov statistical test, the appropriate nonparametric tests were chosen to carry out the statistical comparisons. Results: Based on the analysis of the gingival-periodontal health parameters and the volumetric value of the treated areas, no statistically significant differences were detected between the areas treated with the adjuvant action of the diode laser compared to those treated with causal therapy alone. Conclusions: With the limitations of this study, in accordance with the statistical results obtained, diode laser therapy does not allow a faster resolution of gingival edema compared to traditional therapy; the two treatment techniques for plaque-induced gingivitis, therefore, have the same efficacy.

Effectiveness of supervised toothbrushing and oral health education in improving oral hygiene status and practices of urban and rural school children: A comparative study

OBJECTIVE

To evaluate and compare the oral health status and the impact of supervised toothbrushing and oral health education among school children of urban and rural areas of Maharashtra, India.

MATERIALS AND METHODS

A total of 200 school children in the age group 12-15 years were selected by stratified random sampling technique from two schools and were further divided into two groups: Group A (urban school) and Group B (rural school). Both the groups were again subdivided into control group and study group. Supervised toothbrushing was recommended for both the groups. The toothbrushing teaching program included session on oral health education, individual toothbrushing instructions, and supervised toothbrushing. Dental caries increment, plaque scores, and gingival status were assessed as per the World Health Organization (WHO) criteria (1997), Turesky-Gilmore-Glickman modification of the Quigley Hein Plaque Index, and Loe-Silness Gingival Index (1963), respectively. Cronbach's alpha, Chi-square test, paired t-test, and unpaired t-test were utilized for data analysis.

RESULTS

The mean plaque and gingival score reduction was significantly higher in the study groups as compared to the control groups. An increase in the mean of Decayed, missing, filled teeth (DMFT) and Decayed, missing, filled teeth and surfaces (DMFS) scores throughout the study period was seen in children who participated in study.

CONCLUSION

Oral health education was effective in establishing good oral health habits among school children and also in enhancing the knowledge of their parents about good oral health.

Primary school-based behavioural interventions for preventing caries

BACKGROUND

Dental caries is one of the most common global childhood diseases and is, for the most part, entirely preventable. Good oral health is dependent on the establishment of the key behaviours of toothbrushing with fluoride toothpaste and controlling sugar snacking. Primary schools provide a potential setting in which these behavioural interventions can support children to develop independent and habitual healthy behaviours.

OBJECTIVES

To assess the clinical effects of school-based interventions aimed at changing behaviour related to toothbrushing habits and the frequency of consumption of cariogenic food and drink in children (4 to 12 year olds) for caries prevention.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 18 October 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), MEDLINE via OVID (1948 to 18 October 2012), EMBASE via OVID (1980 to 18 October 2012), CINAHL via EBSCO (1981 to 18 October 2012) and PsycINFO via OVID (1950 to 18 October 2012). Ongoing trials were searched for using Current Controlled Trials (to 18 October 2012) and ClinicalTrials.gov (to 18 October 2012). Conference proceedings were searched for using ZETOC (1993 to 18 October 2012) and Web of Science (1990 to 18 October 2012). We searched for thesis abstracts using the Proquest Dissertations and Theses database (1950 to 18 October 2012). There were no restrictions regarding language or date of publication. Non-English language papers were included and translated in full by native speakers.

SELECTION CRITERIA

Randomised controlled trials of behavioural interventions in primary schools (children aged 4 to 12 years at baseline) were selected. Included studies had to include behavioural interventions addressing both toothbrushing and consumption of cariogenic foods or drinks and have a primary school as a focus for delivery of the intervention.

DATA COLLECTION AND ANALYSIS

Two pairs of review authors independently extracted data related to methods, participants, intervention design including behaviour change techniques (BCTs) utilised, outcome measures and risk of bias. Relevant statistical information was assessed by a statistician subsequently. All included studies contact authors were emailed for copies of intervention materials. Additionally, three attempts were made to contact study authors to clarify missing information.

MAIN RESULTS

We included four studies involving 2302 children. One study was at unclear risk of bias and three were at high risk of bias. Included studies reported heterogeneity in both the intervention design and outcome measures used; this made statistical comparison difficult. Additionally this review is limited by poor reporting of intervention procedure and design. Several BCTs were identified in the trials: these included information around the consequences of twice daily brushing and controlling sugar snacking; information on consequences of adverse behaviour and instruction and demonstration regarding skill development of relevant oral health behaviours.Only one included study reported the primary outcome of development of caries. This small study at unclear risk of bias showed a prevented fraction of 0.65 (95% confidence interval (CI) 0.12 to 1.18) in the intervention group. However, as this is based on a single study, this finding should be interpreted with caution.Although no meta-analysis was performed with respect to plaque outcomes (due to differences in plaque reporting between studies), the three studies which reported plaque outcomes all found a statistically significant reduction in plaque in the intervention groups with respect to plaque outcomes. Two of these trials involved an 'active' home component where parents were given tasks relating to the school oral health programme (games and homework) to complete with their children. Secondary outcome measures from one study reported that the intervention had a positive impact upon children's oral health knowledge.

AUTHORS' CONCLUSIONS

Currently, there is insufficient evidence for the efficacy of primary school-based behavioural interventions for reducing caries. There is limited evidence for the effectiveness of these interventions on plaque outcomes and on children's oral health knowledge acquisition. None of the included interventions were reported as being based on or derived from behavioural theory. There is a need for further high quality research to utilise theory in the design and evaluation of interventions for changing oral health related behaviours in children and their parents.

Treatment of plaque-induced gingivitis, chronic periodontitis, and other clinical conditions

The inflammatory components of plaque induced gingivitis and chronic periodontitis can be managed effectively for the majority of patients with a plaque control program and non-surgical and/or surgical root debridement coupled with continued periodontal maintenance procedures. Some patients may need additional therapeutic procedures. All of the therapeutic modalities reviewed in this position paper may be utilized by the clinician at various times over the long-term management of the patient's periodontal condition.

The effect of behaviour modification techniques on oral hygiene and gingival health of 10-year-old Canadian children

Good oral hygiene habits in children are most desirable but are difficult to establish through conventional health education programmes. This study was designed to test the efficacy of a programme based on the use of several behaviour modification strategies. A sample of sixteen classes of 10-year-old children was randomly selected and assigned to either an experimental or control group. To monitor the oral health comparability of the groups, data were collected on caries experience, sugar intake and oral hygiene behaviour several times during the study period. The programme included the following elements: (1) dental examinations, (2) periodic visits by dental hygienists to the schools to teach brushing and flossing techniques and to monitor the quality of the children's performance, and (3) 'contracts' agreed by each child with the director of the programme and with one parent, to encourage commitment and to reinforce the desired behaviour. Loë and Silness plaque and gingival indices were used to measure the efficacy of the programme. For both indices, the difference between the mean scores of the experimental and control groups were statistically significant after a 4-month intensive phase of the programme. One year after all activities had stopped, the plaque index of the experimental group was still lower than that of the control group but insufficient to maintain a significant difference on the gingival index.

Oral health knowledge and habits of senior elementary school students

Despite improvements in children's dental health, and significant resource allocation to health education programs, few recent studies have investigated the associations of oral health knowledge, behaviors, and status. This study of 11-year-old children (N = 6,329) in northeastern Ontario used a supervised self-complete questionnaire and a clinical examination to gather baseline data on, and test associations of, caries and periodontal knowledge, self-reported oral health behaviors and source of knowledge, and oral health status. Results show the children had poor knowledge of caries preventive measures such as water fluoridation, dental sealants, and choice of snack foods. Periodontal knowledge was better, but children confused plaque and calculus. Respondents claimed good oral health habits, with 73 percent claiming to brush at least twice daily, 88 percent claiming to use toothpaste, 42 percent claim to floss at least twice weekly, and 84 percent claiming an annual dental visit. Children with the best knowledge claimed dentist and school as the sources. High knowledge was associated with good oral health habits (P less than .001) and low DMFT score (P less than .001). Good habits were not related to DMFT score (P = .1095). Logistic regression showed high knowledge was associated with English cultural status, urban school area, good habits, having a dental sealant, and attending a fluoride-rinse school (P less than .05). Findings suggest a need to reinforce caries preventive teaching, to investigate the effect of cultural status, dental experience, and residence status on oral health knowledge, and to further test the efficacy of different oral health education programs delivered by different sources.

Report on caries reduction in French schoolchildren 3 years after the introduction of a preventive program

A combination of preventive methods have been used to reduce dental caries in children aged 7-8 at baseline, living in a non-fluoridated area in the West of France. The preventive program involved a daily supervised toothbrushing at school with 180 mg of fluoridated toothpaste, professional prophylaxis every 2 months with topical application of fluoride gel and reinforced motivation. The oral hygiene level was measured using the Silness-Löe plaque index and caries were recorded using the def and DMF surface indices, including incipient lesions. The 3-yr results showed a significant 52% plaque reduction in the test group compared with the control group. Caries reduction was significant at the 0.01% level: 44% for primary teeth and 60% for permanent teeth.

Dental caries in preschoolchildren in Gizan, Saudi Arabia

296 preschoolchildren attending the pediatric clinic at Gizan Hospital were examined over a period of 3 months. Caries was recorded using the criteria described by WHO. One third of the children had untreated caries and none of the children had received any restorative dental care. A strategy for development of preventive dental services for this age group is discussed.

Relationship of oral hygiene and sugar consumption to risk of caries in children

The associations of dental caries with poor oral hygiene and high sugar consumption were analyzed taking into account possible confounding and factor interaction. The series consisted of 543 children from low-fluoride areas (0.10-0.46 parts/10(6)), aged 5, 9 and 13 years. Plaque accumulation and sugar consumption were slightly confounded throughout the observations. Effect-modification appeared to exist, since the effect of one factor was greater at higher levels of the other. The association between the amount of plaque and dental caries was statistically significant at all levels of sugar consumption. With increasing total sugar consumption the risk of caries increased significantly only when oral hygiene was simultaneously poor. Effect estimates (E) and attributable risk estimates (AR) were calculated for increased plaque accumulation and sugar consumption. For the total sets of tooth surfaces in the various age groups, the proportions of the total caries load associated with increased plaque accumulation were 35.2-63.0%, and those associated with higher total sugar consumption 0.7-5.4%. The fractions varied greatly with the tooth group. The effect estimates for the two factors in combination were always greater than the sums of the separate effects, indicating synergistic interaction between the two caries determinants.

Four years of monthly professional toothcleaning and topical fluoride application in Brazilian schoolchildren. I. Effect on gingivitis

The effect on gingivitis of monthly professional toothcleaning, without oral hygiene instruction, was evaluated in 103, 7- to 11-year-old Brazilian children. Plaque and gingivitis (PlI and GI) were recorded initially and after 1, 2, 3 and 4 years. The baseline examination showed a similar high level of plaque (PlI approximately 1.55) and low level of gingivitis (GI approximately 0.32) around permanent teeth of both test and control groups. The test children were given monthly professional toothcleaning followed by topical application of fluoride gel (APF), totaling 32 sessions. At all annual follow-up examinations, the mean PlI in the test group was significantly lower than in the control group. However, even in the test group, at least 80% of the tooth surfaces harbored plaque. In spite of this, no child in the test group showed overt gingivitis (mean individual GI greater than or equal to 1.0) and the distribution of "GI score = 2" was very low. In the control group the percentage of children with overt gingivitis increased from 3% at the baseline to 20% at the final examination and areas scoring GI = 2 doubled in number. It is suggested that for young children, monthly thorough removal of plaque is sufficient to prevent the development of gingivitis.

Oral hygiene and caries. A review

On the basis of existing literature, efficient oral hygiene was found to have a caries preventive effect. The quality of the cleaning appears to be more important than the frequency of its performance. Professional tooth cleaning at regular intervals may inhibit caries on all tooth surfaces. The effect of self-performed oral hygiene has been demonstrated mainly on free smooth surfaces and on front teeth.

Effect of an instructional motivation program on oral health in Danish adolescents after 1 and 2 years

A 2-year study of the isolated effect of an intensive motivation program in the oral health of 11--15-year-old schoolchildren was carried out in a Danish provincial town. The motivation program consisted of small-group sessions during which maximum effort was made to obtain active engagement from the children. After 1 year the experimental group was supplemented with two new groups of children who in addition to the motivation participated in a competition on dental hygiene. The effect of the motivational program on knowledge and behavior was evaluated. While the program seemed to result in a reinforcement of the already existing positive attitude, the cognitive level was only slightly improved and no change in behavior resulting in improved oral health was registered.