Source 32

Children who suffer from poor oral health are 12 times more likely to have more restricted-activity days, including missing school, than those who do not. Annually, more than 50 million hours are lost from school due to oral diseases.

Few aspects of health are as accessible to personal control as oral hygiene, which can be improved by simple behavioral changes. A dental health education [DHE] program, which has as its objective, the improvement of the oral hygiene status of the participants would have obvious merits. DHE encompasses publicity campaigns, occasional talks at an elementary school, a showing of dental health films, and an extensive, reinforced program in a school curriculum. Several factors are important for effective DHE such as repetition and reinforcement of oral hygiene instructions. These concepts show significant, positive, short-range and long-term effects.

Adolescents are in particular need of preventive programs as they have high levels of plaque and their oral hygiene practices are based on short-term rewards [to improve appearance and social attractiveness].

Therefore, this study was conducted with the following objectives:

To determine whether DHE given at three-week intervals for 18 weeks was more effective than DHE given at six-week intervals for 18 weeks in improving oral health knowledge, practices, oral hygiene status, and gingival health in 12- to 13-year-old schoolchildren.
To determine if there was retention of oral health knowledge and improved practices, 18 weeks after cessation of the program, in subjects who received DHE at three-week intervals for 18 weeks.
To determine if the socioeconomic status played a role in influencing oral health knowledge, practices, oral hygiene status, and gingival health of schoolchildren.


The study design prevented 'contamination' and ensured that the responses obtained were due to the intervention, in contrast to studies with the test and control groups from the same school, where the carry-over effect could not be disregarded.

The lecture-demonstration method of DHE used was similar to the other studies. Bass method of tooth brushing was taught as it is the easiest and most effective technique for children to learn. The initially low twice-daily tooth brushing frequency increased significantly in the intervention schools in contrast to another study.

At baseline, approximately 19% of the study subjects knew that bleeding from the gums was symptomatic of gum disease. This increased markedly to almost 100% for the intervention schools at the end of the study. No significant differences were noted between the social classes. Intervention schools showed significant reductions in plaque and gingival scores as compared to the controls at the end of 36 weeks.

At baseline, 31% of the subjects knew that sticky/sugary foods caused dental caries. Correct responses increased significantly at the end of the study. There were significant differences between schools 1A and 1B (Oral health knowledge scores of 1A were better), but not between the two social classes. When asked about the best time to eat sugary foods, only a few correct responses ('at meal times') were obtained at baseline. These increased significantly in all the intervention schools at the end of the study, in contrast to another study. There were no differences between the social classes or between schools receiving differing interventions .

Reinforcement through repeated DHE sessions in the intervention schools resulted in significant improvements in oral health knowledge and practices, and reductions in plaque and gingival scores. There was retention of oral health knowledge and maintenance of reduced plaque and gingival scores even after cessation of the program, as seen in schools 1A and 2A at the end of 36 weeks. On almost all aspects evaluated, schools with more frequent exposures to the program [1A and 2A] scored better than schools with fewer exposures [1B and 2B], in contrast to studies of short duration with no reinforcement, which showed good immediate results but failed to show long-term positive results.

In comparison to social class V, social class I scored better on questions about: 'Importance of teeth,' 'oral hygiene aids used,' 'frequency in change of toothbrush' and 'ideal time to change a tooth brush.' This may be due to the differences in socioeconomic status and the lesser importance that lower socioeconomic classes attach to their teeth. No significant differences were found between the two social classes on general topics like, 'why we need teeth in our mouth', 'number of deciduous and permanent teeth' and 'diet and its effects on oral tissues.'

Limitations of this study are: (a) schools were not randomly allocated to intervention and control groups; (b) long-term value of the improvements seen need to be confirmed by further studies because improved oral hygiene in children may exist only during the program or for a short period thereafter; (c) DHE was given only once in the residual control group, withholding the benefits of reinforcement; (d) school personnel and teachers were not involved - they might have ensured enduring benefits after discontinuation of program; (e) intervention groups may have derived information from other sources - a difficulty of carrying out research in real-life settings; (f) intervention was targeted only at schoolchildren - not a complete health promotion scenario, as no changes in environment or lifestyle were advocated; (g) an inherent bias was that one of the outcome variables (practices) was measured as self-reported - an over-report of favorable behaviors might be expected; (h) children of other socioeconomic classes were not considered; (i) interference with school curriculum might be an added problem; (j) clinical significance of the changes observed needed to be estimated and interpreted in terms of the overall cost of the intervention (with respect to monetary resources, manpower, and time).

Results of this study can be generalized to situations in India and parts of Southeast Asia, which share similar socioeconomic profiles and cultural traditions, with regard to the importance of oral hygiene.
I thought that this study was interesting because it shows the health education can help improve oral health. This could important for helping the current oral condition of India to improve. This program could be applied to different age groups and there would probably be improvement across the board. I thought that it was a well done study.