Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis

A Systematic Review and Meta-Analysis of Interventions Targeted to Parents for Improving the Oral Health of Children from Culturally and Linguistically Diverse (CALD) Backgrounds

A high prevalence of dental caries is a significant health problem, especially in the pediatric population. Low-income minority groups, including the refugee and immigrant populations, are at higher risk of compromised oral health. It has been suggested that migrant parents do not have enough understanding of oral health, risk factors associated with dental caries, or the progress of dental decay. This systematic review aims to study quantitative literature on oral health interventions, health promotion programs, or behaviour change interventions targeting the parents/ caregivers of culturally and linguistically diverse (CALD) children. A systematic search of electronic databases, including MEDLINE, EMBASE, PUBMED, CINAHL, SCOPUS, WEB OF SCIENCE, COCHRANE, and PROQUEST, was conducted until August 2023. Randomised (RCT) or non-randomised controlled trials (NRCTs) were included. Two reviewers independently assessed the quality of the included studies using the Cochrane Risk of Bias (RoB) 2.0 and ROBINS-I tools. Meta-analysis was performed as appropriate. The initial search from the databases retrieved 2073 articles. After the removal of duplicates, 1683 articles remained. Finally, 69 articles were reviewed in full text, and 15 articles were considered eligible in this review. The RoB assessment for RCTs rated three as low-risk and three as high-risk. The serious RoB in these NRCTs mostly pertained to measurement bias based on self-reporting oral health behaviours. The meta-analysis pooling of results (for RCTs and NRCTs) favoured interventions for CALD parents' oral health knowledge [0.73 (95% CI, 0.08 to 1.38) for RCTs, 1.73 (95% CI; 1.45 to 2.02) for NRCTs] and attitudes [0.86 (95% CI, 0.31 to 1.42)]. Relatively high heterogeneity was observed. Oral health educational interventions can be effective in improving the oral health literacy of CALD parents' oral health knowledge and attitudes, especially when facilitated by lay health advisors. However, the low quality of evidence due to high heterogeneity and high RoB further highlighted the need for well-designed RCTs targeting CALD parents.

Effectiveness of a School-Based Oral Health Promotion Program on Dental Caries Among Iraqi School Children: A Cluster Randomised Controlled Trial

AIM

To assess the effectiveness of a school-based oral health promotion program on dental caries of permanent dentition among Iraqi children.

METHODS

A cluster randomised controlled trial was conducted with a parallel study group, comprising 8-10-year-old schoolchildren, 186 in each group. At the beginning of the study, subjects in the intervention group received oral health education and a single dose of 5% sodium fluoride varnish for all teeth surfaces while the control group only received oral health education. The primary outcome data in this study were caries increment and incidence after six months. The secondary outcome data was any change in oral health behaviors in the students of both groups after 3 months. The caries status was recorded according to International Caries Detection and Assessment System (ICDAS). Statistical analyses included the Chi-square test, McNemar test, independent t-test, simple and multiple logistic regression models.

RESULTS

Study participants included 372 children with no significant difference in baseline characteristics between intervention and control groups. An increase was evident in the mean scores of DMFS, DMFT, number of children with DMFT > 0, and DS > 0 for both control and intervention groups at six-month follow-up but this increase was significantly higher for the control than intervention group (P < .001). Among all variables included in the multiple logistic regression model, just being in the intervention group showed a significant effect in which children in the control group had a 4.2-fold (95% CI: 2.36-7.54) greater chance for developing new caries than children in the intervention group. There was a statistically significant increase in the percentage of children with favourable levels of behaviors between baseline and 3-month follow-up (P < .05, P < .001).

CONCLUSION

Providing access to oral health services such as oral examination, fluoride varnish application, and oral health education to reduce dental caries and improve oral health practices seems to be effective among primary schoolchildren.

A novel deep learning-based model for automated tooth detection and numbering in mixed and permanent dentition in occlusal photographs

BACKGROUND

While artificial intelligence-driven approaches have shown great promise in dental diagnosis and treatment planning, most research focuses on dental radiographs. Only three studies have explored automated tooth numbering in oral photographs, all focusing on permanent dentition. Our study aimed to introduce an automated system for detection and numbering of teeth across mixed and permanent dentitions in occlusal photographs.

METHODS

A total of 3215 occlusal view images of maxilla and mandible were included. Five senior dental students, trained under the guidance of an associate professor in dental public health, annotated the dataset. Samples were distributed across the training, validation, and test sets using a ratio of 7:1.5:1.5, respectively. We employed two separate convolutional neural network (CNN) models working in conjunction. The first model detected tooth presence and position, generating bounding boxes, while the second model localized these boxes, conducted classification, and assigned tooth numbers. Python and YOLOv8 were utilized in model development. Overall performance was assessed using sensitivity, precision, and F1 score.

RESULTS

The model demonstrated a sensitivity of 99.89% and an overall precision of 95.72% across all tooth types, with an F1 score of 97.76%. Misclassifications were primarily observed in underrepresented teeth, including primary incisors and permanent third molars. Among primary teeth, maxillary molars showed the highest performance, with precisions above 94%, 100% sensitivities, and F1 scores exceeding 97%. The mandibular primary canine showed the lowest results, with a precision of 88.52% and an F1 score of 93.91%.

CONCLUSION

Our study advances dental diagnostics by developing a highly precise artificial intelligence model for detecting and numbering primary and permanent teeth on occlusal photographs. The model's performance, highlights its potential for real-world applications, including tele-dentistry and epidemiological studies in underserved areas. The model could be integrated with other systems to identify dental problems such as caries and orthodontic issues.

The impact of food-based incentive behaviors on oral health among Saudi children: a cross-sectional study

BACKGROUND

Childhood dental caries is a common and significant oral health issue globally, resulting in pain, infection, and difficulties in eating and speaking. This study aimed to investigate the impact of food-based reward behaviors on the oral health of Saudi children.

METHODS

An observational cross-sectional study was conducted at Jouf University Hospital, Saudi Arabia. The study included 316 medically healthy children aged 4 to 10 years and their Arabic or English-speaking guardians. Data were collected through a structured questionnaire based on the Comprehensive Feeding Practices Questionnaire (CFPQ), gathering information on socio-demographic characteristics, dietary habits, oral hygiene practices, and the use of food as a reward. Clinical examinations by specialist pediatric dentists assessed the plaque index and decayed-missing-filled tooth (dmft/DMFT) scores. Statistical analyses included descriptive analysis, the Mann-Whitney test, the Kruskal-Wallis test, Spearman's correlation, and linear regression analysis.

RESULTS

Significant correlations were found between food rewards and poor oral health outcomes. Food rewards were positively associated with higher dmft/DMFT scores (r = 0.43, P < 0.001) and plaque index scores (r = 0.17, P = 0.002). Socio-demographic factors, such as parental education level and the amount of time spent with the child, were significant predictors of both food reward behaviors and oral health outcomes. Female and younger parents reported higher food reward scores, which correlated with poorer oral health in their children.

CONCLUSION

The study underscores the significant impact of food-based reward behaviors on the oral health of Saudi children. These findings highlight the need for targeted educational and intervention strategies that address cultural practices and promote healthier reward systems. By reducing sugary food rewards and encouraging non-food-based incentives, improvements in children's oral health can be achieved.

An Oral Health Promotion Model Implemented in the Primorje-Gorski Kotar County

Background and Objectives: Global research has shown that 60-90% of school children have caries, and that oral health care is of great public health significance. We present the data of an oral health promotion Program conducted in the Primorje-Gorski Kotar County (PGC), Croatia, from 2008 to 2019. The Program includes comprehensive preventive oral status assessments of first- and fifth-grade elementary school students, as well as oral health promotional and preventative activities for preschool children, pregnant women, and new mothers. Here, we aimed to analyze the Program data and determine its applicability and sustainability. Materials and Methods: We assessed the changes in caries prevalence in first- and fifth-grade PGC students by comparing the 2008-2019 dental registry data on decayed, missing, and filled teeth for primary teeth (dmft)/decayed, missing, and filled teeth for permanent teeth (DMFT) index means. We also analyzed the data from the administrative Program reports. Results: We analyzed the dental registry data of 44,422 children in the PGC (21,714 first and 22,708 fifth grade). The average Program response rate was 83%. We noted a dmft/DMFT index decrease from 4.66 to 3.73 (first graders) and from 2.50 to 1.00 (fifth graders). The 2017-2019 dmft was significantly smaller than that of 2008-2009. There were 2336 workshops conducted in kindergartens, 1240 in first grades, and 1015 in fifth grades; health visitors educated 26,559 women. There was an increasing trend in the number of insured people under the age of six using pediatric oral health care. Conclusions: The Program improved the behavior and oral health of children and included various stakeholders, avoided additional financial expenses, increased the number of children in care, and proved its necessity and sustainability. It has been recognized on a national level and has led to the creation of two oral health care programs.

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 school oral health programs in children and adolescents: an umbrella review

AIM

To evaluate the systematic reviews assessing the effectiveness of any type of school-based oral health programs in children and adolescents.

METHODOLOGY

A two-staged search strategy comprising electronic databases and registries based on systematic reviews was employed to evaluate the effectiveness of school-based interventions. The quality assessment of the systematic reviews was carried out using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) tool. The Corrected Covered Area was used to evaluate the degree of overlap.

RESULTS

Nine reviews were included in this umbrella review. The Critical Covered Area reported moderate overlap (5.70%) among the primary studies. The assessment of risk of bias revealed one study with a high level confidence; one with moderate whereas all other studies with critically low confidence. Inconclusive evidence related to improvements in dental caries and gingival status was reported whereas, plaque status improved in a major proportion of the reviews. Knowledge, attitude, and behavior significantly increased in students receiving educational interventions when compared to those receiving usual care.

CONCLUSIONS

The evidence points to the positive impact of these interventions in behavioral changes and clinical outcomes only on a short term basis. There is a need for long-term follow-up studies to substantiate the outcomes of these interventions.

Promoting healthy practices among schools and children in rural bangladesh: a randomised controlled trial of skill-based health education

BACKGROUND

Poor child health and hygiene practices are persistent issues in resource-constrained settings, particularly in low-income countries. This study assessed the impact of skill-based health education (SBHE) on school and child hygiene practices in rural Bangladesh.

METHODS

A cluster-randomised-controlled intervention with cross-cutting/factorial design was conducted in 180 randomly selected primary schools, stratified by school type, in Jhenaidah District, Bangladesh. Weekly SBHE sessions were delivered to half of the schools by locally recruited para-teachers for one year. A cross-cutting soap provision treatment was given monthly to half of the SBHE-treatment schools and half of the SBHE-control schools. Treatment assignment was masked to all baseline and endline surveyors. Data were collected at both the school and child levels, with child-level data aggregated at the school level. Outcome measures were grouped into five thematic families. The primary outcome families were school hygiene practice & maintenance, school-aggregated child handwashing and school-aggregated child dentalcare. Utilising the difference-in-differences estimator with seemingly unrelated regression, we estimated the average treatment effect for each family of multiple outcomes. The intervention spillover effect to neighbouring schools along with the time-period effect were also evaluated. The project's cost-effectiveness was additionally assessed.

RESULTS

Our findings revealed that SBHE had a positive impact on primary outcomes related to healthy practices and behavioural changes, resulting in a 0.32SD improvement in school hygiene practices and maintenance (p < 0.001), a 0.47SD increase in child handwashing (p < 0.001), and a 0.43SD enhancement in child dentalcare (p < 0.01). Despite its imperfect implementation, the provision of soap itself showed no significant effect. Furthermore, significant spillover effects of healthy practices were observed in neighbouring non-treatment schools. The cost-effectiveness analysis indicated that our SBHE program was cost-effective.

CONCLUSIONS

Our study provides compelling evidence of the positive impact of SBHE on school hygiene and child health practices in rural Bangladesh, with notable spillover effects. The cost-effectiveness analysis underscores the value of SBHE, affirming its potential as an effective intervention method in improving school health and hygiene practices in primary schools and beyond.

Elementary Teacher's Perception of Oral Health Education in a City of the Brazilian Amazon: A Cross-Sectional Study

This study aimed to evaluate the level of oral health knowledge among teachers in a city of the Brazilian Amazon region (Belem, Pará) and explore the association between teachers' knowledge and their proposed actions in the event of dental trauma accidents within the school environment. The descriptive cross-sectional study involved 170 elementary teachers from public schools in the Metropolitan Region of Belem, Para State, Brazil. A self-administered questionnaire with multiple-choice questions was utilized to assess teachers' oral health knowledge across various domains. The questionnaire comprised seven targeted sections: the first section focused on demographic and professional aspects of the educators, while the remaining six sections addressed the oral health knowledge related to oral health education, dental caries, dental trauma (specifically dental avulsion), periodontal disease, visits to the dentist, and the educator's role in promoting oral health. Data analysis involved descriptive statistics and χ 2 tests using Statistical Package for Social Science (SPSS; 20.0 version). Most of the sample were female (92.2%) and around 41-60 years (36.0%). Most teachers had over 5 years of teaching experience (87.0%) and held an undergraduate degree (63.0%). A significant association was found between teaching experience and the choice of storage method for avulsed teeth following dental trauma (p=0.005). However, the teachers examined in this study exhibited inadequate knowledge concerning the appropriate treatment for cavities and the recommended age for a child's first dental appointment. These findings underscore the crucial role teachers play in promoting oral health among students, particularly in regions characterized by social inequality and limited access to basic sanitation and healthcare services.

Why Is Caries Prevention in Children So Difficult? A Narrative Opinion

Caries is among the most common non-communicable diseases worldwide, yet it is commonly described as preventable. Caries prevention is, however, difficult and complex, since the disease has strong social, parental, behavioral, political, medical/genetic, and psychological elements, and the payment models are targeted at traditional conservative care. The aim of this paper is to discuss some key issues that make caries prevention in children be perceived as "difficult": i) the communication gap between researchers and clinicians, creating unrealistic expectations of intervention efficacy; ii) the skewed distribution of caries and the problem of reaching children with the highest need; iii) limited access to care, which is a threat to oral health, in particular in low-socioeconomic-status, underserviced, and remote communities; and iv) the need to adopt behavior change models to affect the modifiable risk factors that are shared with other non-communicable diseases. Dentists cannot simply rely on fluoride exposure; proper education and training in caries risk assessment, behavior change models targeted at oral hygiene and sugar intake, and collaboration with primary healthcare and local school authorities are avenues that aid in caries prevention and reduce the uneven burden of the disease. Online education and mobile apps may help to promote oral health in areas with shortages of dental work force.

A cascade training protocol for schoolteachers on oral health: Investigating the influence of primary and secondary mentors

BACKGROUND

Oral health holds paramount importance for overall well-being, particularly among school-aged children, where inadequate oral health can cause significant discomfort and impede educational performance. Despite its critical nature, oral health awareness and practices within Indian school communities remain suboptimal. There exists an urgent necessity for efficacious educational initiatives to bridge this gap and foster oral health awareness among both schoolteachers and students.

PROTOCOL

This monitored training introduces a pioneering cascade model training initiative aimed at evaluating its impact on enhancing oral health knowledge among schoolteachers and students in Indian schools. A total of 100 school teachers from 50 Centre government schools will undergo training in two distinct sessions. Following this, two teachers from each school will be selected to further train 24 class monitors from grades 6-9, who will subsequently impart knowledge to approximately 40 students per class. This phase of the training will be ongoing, ensuring training consistency through online supervision and active participation of the expert team in training activities with newly designated master trainers. Pre- and post-training assessments will be conducted at each level to gauge the monitored training's effectiveness. The entire training is projected to conclude within a year.

DISCUSSION

This cascade model monitored training initiative represents a novel approach in promoting oral health awareness in Indian schools, marking a pioneering endeavor in this domain. Through this program, we aim to empower 1200 class monitors as master trainers and reach approximately 24,000 school students across 480 supervised training sessions. The establishment of master trainers through a cascade process, coupled with the engagement of the CDER expert team, ensures accurate dissemination of information at every stage. The comprehensive evaluation facilitated by pre- and post-training assessments at each level further enhances the program's effectiveness, laying a solid foundation for future oral health initiatives within school communities.

Assessment of a combined mouthwash on pain relief in pericoronitis: a randomized clinical study

BACKGROUND

Pericoronitis, an inflammation near wisdom teeth, often occurs when they are partially emerged, especially in the lower jaw. Commonly, the gingiva partially envelops the tooth. Treatments vary from gingival surgery to extraction. This study assessed the efficacy of a mouthwash with Chlorhexidine, Benzydamine, Nanosilver, Amoxicillin, and Metronidazole for pain reduction and enhancement of maximum mouth opening in acute pericoronitis cases.

MATERIALS AND METHODS

In this randomized controlled clinical trial conducted at the Gorgan Dental Faculty, 48 pericoronitis patients were randomized into two groups. The control group used a 0.12% chlorhexidine mouthwash, while the case group used a mouthwash containing Chlorhexidine, Benzydamine, Nanosilver, Amoxicillin, and Metronidazole. The study recorded Visual Analog Scale (VAS) scores for 7 days, and Maximum mouth opening (MMO) was measured at the start and after 7 days. The analysis was performed using SPSS v20.

RESULTS

In this study, we compared the effects of a combined mouthwash with those of a chlorhexidine mouthwash on pericoronitis in 48 patients, with an average age of 21.56 years. No significant difference in pain reduction was observed between the groups; however, both groups exhibited decreased pain and improved MMO post-treatment. The gender distribution was balanced across both groups.

CONCLUSION

The results indicate that both chlorhexidine mouthwash and combined mouthwash significantly improved maximum mouth opening. Nonetheless, there were no notable differences in efficacy between the two groups. These findings suggest that these mouthwashes may be beneficial for oral hygiene, warranting further in-depth research.

TRIAL REGISTRATION

Registered on 12/03/2023, registration number IRCT20230104057046N1.

A Brief Review on Engaging and Interactive Learning for Children: Exploring the Potential of Metaverse-Based Oral Health Promotion

The importance of oral health for overall health makes it critical to establish proper oral hygiene practices in children early on. The traditional approaches to teaching children about dental health may not be successful since they may not be able to keep their interest. Metaverse technology offers a promising alternative, allowing for the design of engaging and immersive worlds that can effectively educate children about oral health. Despite the growing interest in the use of metaverse technology in healthcare, there is a lack of comprehensive reviews on its potential for oral health promotion in children. This review aims to fill this gap by providing an overview of the current state of metaverse-based oral health promotion for children, discussing its benefits and challenges, and highlighting its potential for improving children's oral health. By conducting this review, the authors hope to provide new information on the potential of metaverse-based oral health promotion for children and to contribute to the ongoing discussion on the use of metaverse technology in healthcare. This review may also provide valuable insights for dental organizations and practitioners interested in using metaverse technology to promote oral health and healthy living among children.

Effectiveness of theory-based educational interventions of promoting oral health among elementary school students

BACKGROUND

The aim of the present study was to determine the effect of oral health education programs on the oral health of primary school students.

METHODS

In this randomized controlled trial study, 190 elementary fifth-grade female students were chosen using the multistage cluster sampling method. In this study, the Plaque Index (PI), Simplified Oral Hygiene Index (OHI-S), Community Periodontal Index (CPI), tooth brushing using fluoride toothpaste, dental flossing frequency and factors affecting them were determined according to social cognitive theory (SCT). Interventions were implemented using the play method and with the help of three pamphlets, five posters, a celebration of oral health, and the creation of a Telegram group. Data were analyzed using descriptive statistics indexes, t tests, paired sample t tests, chi-square tests, and Pearson correlation tests.

RESULTS

The results showed that 3 months after the intervention, compared to before the intervention, the percentage of participants in the intervention group who brushed their teeth twice or more per day increased by 48.5%, and the percentage of participants who used dental floss at least once per day increased by 64.2%. The rate of gum bleeding decreased by 6.3%. The good OHI-S rate increased by 44.4%. Dental plaque decreased by 38.1%.

CONCLUSION

The results demonstrated that a gamification design can be effective and useful in promoting the oral health of students.

TRIAL REGISTRATION

registration timing: retrospective, registration date: 18/10/2022, registration number: IRCT20141128020129N2.

Perceptions of oral health promotion in primary schools among health and education officials, community leaders, policy makers, teachers, and parents in Gulu district, northern Uganda: A qualitative study

INTRODUCTION

One in every two cases of caries in deciduous teeth occurs in low- and middle-income countries (LMICs). The aim of the World Health Organisation's (WHO) Healthy Schools Program is to improve the oral health of children. This study explored perceptions of implementation of the Ugandan oral health schools' program in Gulu district, northern Uganda.

METHODS

Semi-structured interviews were conducted with a purposive sample of 19 participants including health and education officials, community leaders, policy makers, teachers, and parents. All interviews were transcribed verbatim and analysed thematically.

RESULTS

Our study identified three themes: (1) components of oral health promotion, (2) implementation challenges of oral health promotion, and (3) development of an oral health policy. The components of oral health promotion in schools included engagement of health workers, the community, companies, skills-based education, and oral health services. Participants were concerned about insufficient funding, unsatisfactory skills-based education, and inadequate dental screening. Participants reported that there was an urgent need to develop oral health policy to guide implementation of the program at scale.

CONCLUSIONS

Schools provided oral health promotion that aligned with existing features of the WHO's health-promoting school framework. Implementation of this strategy could be enhanced with increased resources, adequate oral health education, and explicit development of oral health policy.

Oral Health of Rural Cameroonian Children: A Pilot Study in Bamendou

Access to dental care in Cameroon is a public health issue, particularly for children living in rural areas. Given the lack of recent data, the investigation of children's oral health along with their oral hygiene behavior, needs in terms of care, and access to oral hygiene materials were investigated. This cross-sectional pilot study was conducted in Bamendou, Western Region of Cameroon. The study population included 265 children aged 3-18 years who completed a questionnaire about their oral hygiene practices. A clinical examination assessed dental caries, calculus, gingivitis, and oral hygiene. The Chi-squared test was used to identify potential factors influencing caries prevalence rates (significance threshold: p < 0.05). Among the 265 children (females: 41.5%, mean age 9.3 years), caries prevalence (ICDAS ≥ 2) was 78.5% and significantly increased with age: 62.2% (3-6 years), 80.9% (7-11 years) and 84.1% (12-18 years, p = 0.01). Virtually no children (95.1%) had ever visited a dentist. While only 23.4% of children brushed their teeth at least twice a day, 14% worryingly reported the use of products other than toothpaste (ash, soap, salt, or bicarbonate) and 13.6% no brushing product. The present study revealed a high prevalence of dental caries in this population and inadequate toothbrushing habits, which highlights the need for preventive oral health education and intervention to address these issues.

Impact of oral intervention on the oral and overall health of children living with HIV in Cambodia: a randomized controlled trial

BACKGROUND

Maintaining oral health is essential for improving overall health of children living with HIV. Therefore, we evaluated the effectiveness of an oral health intervention for improving their oral and overall health. In addition, we examined their longitudinal association between changes in oral and overall health.

METHODS

We conducted a 2-year randomized controlled trial involving children living with HIV in Cambodia. Children aged 3-15 years and their caregivers were randomly allocated either to the intervention (group A) or control (group B) arm. A second control arm (group C) included children without HIV. The group A children received oral health education sessions and practiced home-based daily care.

RESULTS

In the baseline survey, 482 children participated (group A: n = 160, group B: n = 168, group C: n = 154), and 350 completed the endline survey. An interaction effect in teeth brushing duration was observed in children in group A relative to group B (AOR = 2.69, 95% CI: 1.37-5.31) and group C (AOR = 3.78, 95% CI: 1.70-8.40). Longitudinal associations were observed between changes in oral hygiene and overall health, as presented by alterations in dental caries in permanent teeth with viral load detection (adjusted odds ratio = 3.58, 95% CI: 1.10 - 11.73), in salivary flow quantity with the overall quality of life (β = 0.07, 95% CI: < 0.01 - 0.13), as well as in dental caries, salivary pH, debris index with body mass index for age among group A children.

CONCLUSIONS

Oral health intervention may improve oral care behaviors and potentially enhance overall health among children living with HIV in antiretroviral therapy in a resource-constrained setting.

TRIAL REGISTRATION

ISRCTN 15177479.

Investigation of oral health knowledge and attitudes towards oral health education among elementary school teachers in Zunyi

OBJECTIVES

This study aimed to investigate the oral health knowledge of elementary school teachers and assess their attitude towards oral health education in Zunyi.

METHODS

A total of 636 teachers from 10 primary schools in Zunyi were selected by stratified sampling, and their general information, oral health care habits, results of oral health knowledge questionnaire, and attitude towards oral health and oral health education were investigated. Data were statistically analyzed using SPSS 21.0.

RESULTS

A total of 614 teachers answered the questionnaires. Only 8.8% brush their teeth for more than three minutes, 23.8% brush their teeth horizontally, 64.7% do not performteeth cleaning, and 78.2% do not use floss. Teachers have a weak understanding that six-year teeth are permanent, that pit and fissure sealing could prevent dental caries, and that dental floss could remove dental plaque. However, their attitude towards oral health and oral health education was found to be good.

CONCLUSIONS

Schools could improve teachers' oral health know-ledge by organizing training and other activities. Teachers could also play an active role in leading and cultivating school-age children to establish good oral habits.