Oral health education program among pre-school children: an application of health-promoting schools approach

Implementation and Effectiveness of a Nurse-Led Oral Hygiene Program for Schoolchildren: A Quasi-Experimental Study

OBJECTIVES

Good oral hygiene is essential for schoolchildren's well-being. However, lack of knowledge, negative attitudes, and poor oral hygiene practices may predispose to oral-related diseases. This study aimed to examine the effectiveness of a nurse-led oral hygiene program on schoolchildren's knowledge, attitudes, and practices.

DESIGN

A quasi-experimental design with pre-and-post-test was used.

SAMPLE

Using the convenience sampling technique, we recruited 400 schoolchildren, aged 11-12 and in grades 5-6, from two primary schools in Egypt.

METHODS

The study was conducted from September 2022 to May 2023. The Oral Hygiene Program served as the primary intervention. This program contains health education topics (e.g., the importance of oral hygiene, techniques for effective tooth brushing, and dietary choices that promote dental health). Three visits were conducted (Visit 1: introduction of the program purpose and objectives and pre-test scores collection, Visit 2: implementation of oral hygiene topics, and Visit 3: post-test scores collection). We used three self-report instruments (Oral Health Knowledge Questionnaire, Hiroshima University's Dental Behavioral Inventory, and Oral Health Practice Questionnaire) for pre- and post-test. Paired T test and Pearson correlation analysis were used for data analysis.

RESULTS

After the intervention program, the oral hygiene program effectively enhanced schoolchildren's knowledge, attitudes, and practices. The post-intervention mean scores were 7.83 ± 0.488 (knowledge), 6.63 ± 1.7 (practices), and 9.33 ± 1.1 (attitudes). High statistically significant differences were noted between schoolchildren's oral health knowledge, attitudes, and practices before and after implementing the program (p = 0.000).

CONCLUSION

There were enhancements in the level of knowledge, with improved positive attitudes and satisfactory practices among schoolchildren after the implementation of the oral hygiene program. Integrating oral hygiene programs into the general curriculum in primary schools and training school nurses, caregivers, and teachers in implementing oral hygiene programs could improve oral health knowledge, attitudes, and practices for preventing oral problems.

The effects of school-based hygiene intervention programme: Systematic review and meta-analysis

Children are susceptible to infections due to frequent participation in school group activities and their often-suboptimal hygiene practices. Frequent infections in children affect school attendance, academic performances, and general health. The effectiveness of school-based hygiene-related intervention programmes need to be informed by updated high-quality synthesised evidence. In this systematic review, we searched PubMed and Cochrane CENTRAL for randomised and non-randomised interventional studies that evaluated school-based hygiene-related interventions. We assessed risk-of-bias (Cochrane risk-of-bias 2 tool), performed random-effect meta-analysis (RevMan 5.4) and rated certainty-of-evidence (GRADE). Thirty-nine trials (41 reports), published from 2011 to 2024 from 22 countries were included. Twenty-three studies contributed data for meta-analysis. All school-based interventions were compared with standard curriculum and demonstrated very low to low certainty-of-evidence due to study methodological limitations and imprecision. Hand-body hygiene interventions may improve knowledge, attitudes and practices (SMD 2.30, 95%CI 1.17 to 3.44, 6 studies, 7301 participants), increase handwashing practices (RR 1.75, 95%CI 1.41 to 2.17, 5 studies, 5479 participants), and reduce infection-related absenteeism (RR 0.74, 95%CI 0.66 to 0.83, 5 studies, 1017852 observations). Genital hygiene interventions may improve attitude (SMD 6.53, 95%CI 2.40 to 10.66, 2 studies, 2644 participants) and practices (RR 2.44, 95%CI 1.28 to 4.68, 1 study, 1201 participants). However, intervention effects on oral hygiene appeared mixed, with worsening of the oral hygiene score (SMD 3.12, 95%CI 1.87 to 4.37, 2 studies, 652 participants) but improved dental hygiene (SMD -0.33, 95%CI -0.53 to -0.13, 3 studies, 4824 participants) and dental caries scores (SMD -0.34, 95%CI -0.52 to -0.16, 4 studies, 2352 participants). Limited evidence suggests that interventions targeting hand-body and genital hygiene practices may improve knowledge, practices, and infection-related absenteeism. However, the effects on oral hygiene intervention appeared mixed. Future research should strengthen randomisation and intervention documentation, and evaluate hygiene-related behaviour, academic performances and health outcomes.

A qualitative study of barriers and facilitators to the implementation of a pilot school-based, toothbrushing programme

BACKGROUND

While supervised toothbrushing programmes have been established in many countries of the world, little is known about different perspectives on their implementation. The aim of the study was to explore stakeholders' barriers and facilitators to implementation of a school-based toothbrushing programme in Taiwan.

METHODS

Focus groups and interviews were used to explore the views of elementary school students, teachers, staff, and nurses in a piloted school-based toothbrushing programme. The topic guides were developed according to the Theoretical Domains Framework (TDF) to cover the behavioural factors systematically and comprehensively. Data were analysed with content analysis.

RESULTS

Overall, 36 students, 29 teachers/staff, and five school nurses (N = 65) were included. The overarching theme was the importance of habit formation for both staff and children to ensure that toothbrushing as part of the programme was embedded into the school schedule and routine. While children did not necessarily appear to retain the dental knowledge which was taught in the programme, the provision of fluoride toothpaste and toothbrush for their use in schools allowing teachers and staff to choose the timing of the brushing and engaging classmates to supervise each other were found to be key factors.

CONCLUSIONS

Implementing a school-based toothbrushing programme with the support of staff and active engagement of children can help children to develop a toothbrushing habit. Classmate-supervised toothbrushing may reduce the burden on teachers and staff to implement the programme.

Phytogenic Blend Improves Intestinal Health and Reduces Obesity, Diabetes, Cholesterol and Cancers: A Path toward Customised Supplementation

Poultry production is among the most challenging industries for pathogen control. High animal density and abundance of faecal material demand strict biosecurity measures and continual vigilance in monitoring animal health parameters. Despite this vigilance, dealing with disease outbreaks is a part of farmers’ routines. Phytogenic feed additives comprised of herbs, spices, essential oils, and oleoresins have potent antimicrobial and anti-inflammatory actions. Related studies are gaining substantial interest in human and animal health worldwide. In this study, a commercial blend phytogenic feed additive was supplemented to layers in an industrial free-range production system with 20,000 birds in both control and treatment groups. At the end of the trial, the ileum tissue was sampled for RNAseq transcriptomic analysis to study the host reaction to the supplement. Phytogenic supplement significantly inhibited four cholesterol-related pathways and reduced the Arteriosclerosis disease category towards improved cardiovascular health. The supplemented birds exhibited reduced disease susceptibility for 26 cancer categories with p-values in the range from 5.23 × 10⁻⁴ to 1.02 × 10⁻²⁵. Major metabolic shifts in Lipid metabolism in combination with Carbohydrate metabolism have resulted in a decrease in the Obesity category, altering the ratio of fat and carbohydrate metabolism toward lower fat storage.

Associations between Awareness of the Risk of Exposure to Pollutants Occurring at Fire Scenes and Health Beliefs among Metropolitan Firefighters in the Republic of Korea

Firefighters are repeatedly exposed to various pollutants that occur at fire scenes. There are three levels of exposure: primary exposure to pollutants, secondary exposure to pollutants on personal protective equipment (PPE), and tertiary exposure to contaminated fire stations and fire engines due to pollutants on PPE. Therefore, it is important for firefighters to be aware of the risk of exposure to pollutants and to practice health behaviors such as appropriate PPE management. No clear association has been established in the existing literature between firefighters' risk perception level and their health beliefs about the health impact of awareness of exposure to hazardous substances at fire scenes. This study aims to evaluate the relationship between awareness of the exposure risk to primary, secondary, and tertiary pollutants and health beliefs. It was designed as a cross-sectional study, in which a web-based survey was conducted from 13 May to 31 May 2021. The analysis was conducted in 1940 firefighters working in the Seoul metropolis who agreed to participate in the research. Participants who perceived susceptibility were likely to be aware of the primary (adjusted odds ratio (AOR) = 2.10, 95% confidence interval (CI) 1.16-3.80), secondary (AOR = 2.77, 95% CI 1.77-4.32), and tertiary (AOR = 2.73, 95% CI 1.85-4.03) exposure risks. Participants who perceived barriers were unlikely to be aware of the risk of exposure to primary (AOR = 0.67, 95% CI 0.49-0.91), secondary (AOR = 0.77, 95% CI 0.61-0.96), and tertiary (AOR = 0.75, 95% CI 0.62-0.91) pollutants. Educational intervention is recommended to improve perceived susceptibility and awareness of the risk of exposure to pollutants and reduce perceived barriers. Consequently, educational intervention is expected to positively impact firefighters' management of appropriate PPE. We confirmed an association between occupational exposure risk and firefighters' health beliefs. In the health belief model (HBM), health beliefs that affect health behavior also affect awareness of the exposure risk level. Therefore, an intervention for health beliefs can also be used to raise job-related exposure risk awareness. Regular training on the health impacts of fire scenes is necessary for both newcomers and incumbents to enable firefighters to better recognize the risks of each occupational exposure level. Additionally, laws and regulations are necessary for the removal of harmful substances that contaminate PPE, such as self-contained breathing apparatus (SCBA), during exposure to a fire scene. Our research can be used as a basis for improving fire policies and education programs in the future.

Peer-led oral health education model for elementary school-aged children in British Columbia, Canada

Objective

To examine the effectiveness of peer-led preventive oral health education for elementary school-aged children.

Methods

A controlled, non-randomized interventional study included children in grades 4 to 6 (N = 372) from 6 schools in British Columbia, Canada. The control group (3 schools) received a class-based lecture on oral health. In the intervention group (3 schools), each sixth grader mentored a small group of fourth and fifth graders. The study outcomes were 1) need for oral care referrals (visual screening); 2) oral health knowledge (self-reports); 3) oral self-care practice (OSC-P); and 4) oral self-care skills (OSC-S). Assessments of OSC-P and OSC-S were based on disclosed dental biofilm levels. Study group comparisons were done at baseline and 8 to 12 months.

Results

A high need for oral care referrals was found, with a substantial reduction achieved during the study period. Dietary knowledge improved minimally in the intervention group. In both study groups and within age groups, there was a wide variation in OSC-P and OSC-S. Overall, children's OSC-P scores were substantially higher than their OSC-S scores. Oral self-care outcomes improved over time in both groups (except for fourth graders in the control group), with a more substantial improvement in the intervention group. From baseline to study end, the mean OSC-P improved by 11.9% (intervention group) and 5.9% (control group). Improvement values for OSC-S were 12.8% and 5.2%.

Conclusions

The need for oral care referrals was reduced, but improvement in oral health knowledge was minimal. Oral self-care outcomes improved more in the intervention than in the control group.

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.

Impact of an oral health education program in Egyptian children with attention deficit hyperactivity disorder: A cross sectional study

AIM

This study was conducted to assess the oral health status in a group of Egyptian children, living with ADHD, before and after the implementation of an oral health education program.

METHODS

A total of 29 Egyptian children, aged 8-12 years old diagnosed with ADHD were enrolled in this study. Their oral health status was assessed using OHI-S. Oral health education program using audiovisual and verbal methods was addressed to the children and their caregivers. The children were advised to limit eating sugar to be once per week, and to brush their teeth twice a day. Modified Bass Technique of tooth brushing was demonstrated to the children using jaw model and toothbrush. A motivational visit was performed for the children after 1 month. At the end of the 3 months program, oral health status of the children was reassessed.

RESULTS

The results showed that there was a significant increase in cases with "Good" scores after the oral health education program (p < .001), moreover, there was a significant decrease of OHI-S scores after the program (p < .001).

CONCLUSION

The oral health education program was efficient in achieving improvement in the oral health status of children with ADHD.

A comparative study of the effect of two educational methods of motivational interviewing and peers on self-efficacy of female high school students in relation to puberty health

BACKGROUND

Adolescents experience many physical and psychological changes during adolescence. Not paying attention to the issue of girls' puberty may have a negative impact on their mental health and self-efficacy in future. The aim of this study was to compare the two methods of motivational interviews and peers on puberty health of female high school students.

MATERIALS AND METHODS

This study was performed semi-experimental intervention on 334 high school students in 2019 through multi-stage randomization. Data using two demographic questionnaires and Scherrer self-efficacy questionnaire in three stages (pre-test, immediately after the test and one month after the test). It was collected that in the motivational interview group, 5 training sessions were presented, and in the peer group, only one training session was taught to the peers and the control group was not trained in any intervention.

RESULTS

Immediately after, and 1 month after the intervention, the two intervention groups had significantly better scores in self-efficacy compared to the control group (P = 0.001). The mean score of self-efficacy in the control group in the three time periods before, immediately, and one month after the intervention, respectively (50.75 ± 5.322, 50.45 ± 5.34, 50.45 ± 5.37), in the motivational interview group (50.56 ± 5.95, 53.63 ± 5.83, 56.03 ± 6.49) and in the peer group (50.10 ± 5.62, 54.40 ± 4.28, 59.19 ± 4.43) was. Moreover, there were significant differences in self-efficacy scores within and between the groups by time (P < 0.001) in intervention groups.

CONCLUSION

This study showed that puberty health education increases students' self-efficacy, that correct information should be conveyed by peers and motivational interview, and motivational interview is more effective.

Design, implementation, and evaluation of a PRECEDE-PROCEED model-based intervention for oral and dental health among primary school students of Rafsanjan city: a mixed method study

Background

Oral and dental health has a significant impact on public health as well as the quality of life among individuals and families. This study aims to design, implement, and evaluate an intervention based on the PRECEDE-PROCEED model for oral and dental health among primary school students in Rafsanjan city, Southern Iran.

Methods

According to the nature of the model and with the focus group discussion and interview methods, in phases 1 to 4 (PRECEDE), predisposing, enabling, and reinforcing factors related to oral health were identified. The training program was designed and consisted of six sessions for students (250 students) with a brushing session, three sessions for parents, and two sessions for teachers. Process evaluation and the effect of the program on behavioral and factors affecting oral health were evaluated (PROCEED).

Results

In the qualitative section, seven predisposing factors, five enabling factors, and two reinforcing factors were identified. A training program based on the PRECEDE-PROCEED model was found to be effective in increasing the mean scores of the above constructs and the students’ brushing behavior (P < 0.001).

Conclusion

Based on the model planning phases, the factors affecting the brushing behavior of children aged 6–12 years were identified. The educational program has had a significant effect on improving the scores of predisposing, enabling and reinforcing factors and children’s brushing behavior.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11585-z.

Effect combined learning on oral health self-efficacy and self-care behaviors of students: a randomized controlled trial

BACKGROUND

In order to prevent oral diseases, the use of appropriate oral health education at childhood is one of the most important strategies for improving oral health knowledge and by extension positive oral health habits. Therefore, the present study aimed to evaluate the effect of animations and games as a strategy for improving oral health self-efficacy and self-care behaviors among 6-12-aged students.

METHODS

In this interventional study, 82 students were selected based on cluster random sampling including 38 for the case and 44 for the control group. The case group received four sessions of combined learning per week including animations and games while the control group received routine school education. The data were collected in six domains including demographics, self-care, knowledge, attitude, behavior and self-efficacy before and 5 months after the intervention using a questionnaire. SPSS version 20 was used for data analysis.

RESULTS

Five months after the intervention, the mean score of self-care, self-efficacy, behavior increased from 3.8 to 4.8, 36.8 to 48.9, and 17.07 to 18.29, respectively indicating a significant change (p < 0.05). However, no significant change was reported in these variables in the control group (p  > 0.05).

CONCLUSION

The use of animation combined with other strategies for oral health self-care education can positively influence the students' performance and self-efficacy. IRCT registration number This trial was registered at IRCT. IRCT2017042133565N1 Registration date: 2017-05-17 https://en.irct.ir/trial/25851.

Longitudinal Follow-up Survey of Effects of Oral Comprehensive Healthcare Measures on Early Childhood Caries

PURPOSE

To assess the effect of oral comprehensive healthcare on the prevalence of early childhood caries in urban areas of China.

MATERIALS AND METHODS

A total of 398 children aged 4-5 years from six different kindergartens in Qingdao were recruited to participate in a 1-year single-blind randomised controlled clinical trial. They were randomly assigned into either an experimental group (187 children) or a control group (211 children). The experimental group received comprehensive oral healthcare including oral health examinations, oral health education for children and their guardians, and local fluoride application and dental treatment, whereas children in the control group only received oral health examinations twice a year. The children's parents finished a comprehensive oral health questionnaire before and after the experiment. After a year, the oral health status of two groups of children was statistically analysed to determine the effect of oral comprehensive healthcare on early childhood caries.

RESULTS

After 1 year, the numbers of decayed teeth (dt), decayed tooth surfaces (ds), filled teeth (ft), and filled tooth surfaces (fs) in the experimental group were significantly lower than the control group (p <0.001). The dmft and dmfs were also significantly different between the two groups (p <0.05). Statistically significant differences were additionally shown in oral hygiene habits and eating habits of both the children and their parents in the two groups compared with 1 year before (all p <0.001).

CONCLUSION

Implementation of comprehensive oral healthcare measures both prevents and reduces early childhood caries.

Effects of an educational playful intervention on nasal hygiene behaviors of preschoolers: a quasi-experimental study

Background: To determine the effects of an educational playful intervention on nasal hygiene behaviors among preschool (3-4 years old) children.

Methods: A quasi-experimental before-after study was conducted with 39 children attending public daycare center in Sao Paulo, Brazil. A group-based intervention consisted of two educational sessions to promote healthy behaviors for nasal hygiene. It was adopted playful strategies such as a story told by puppets, card games and simulation of nasal hygiene in front of the mirror. The outcome was evaluated by observing six healthy behaviors for nasal hygiene one week before and after the intervention. Differences in the outcome before and after the intervention were tested using Wilcoxon signed rank test and McNemar’s test.

Results: The median of healthy nasal hygiene behaviors went from 3.0 to 4.0 after the intervention, with a significant statistical difference (P=0.0004) and a difference of behaviors. After the intervention, forcing the air out of one opened nostril increased from 5.1%to 30.8% (P=0.001, CI 95%: 0-0.440), forcing the air out of the other nostril increased from 5.1% to 28.2% (P=0.003/CI 95%: 0-0.50), throwing the piece of toilet paper in the garbage increased from 53.8% to 87.21% (P=0.04, CI 95%: 0.035-0.65), and sanitizing the hands with soap and water increased from 15.4% to 43.6% (P=0.039-0.76).

Conclusion: the educational playful intervention improved the autonomy of preschoolers to adopt healthy nasal hygiene behaviors.