One-year oral health outcome of a community-based trial in schoolchildren aged 6-7 years old in Tehran, Iran

Abstract

Promoting schoolchildren's oral health is important, particularly in developing countries. This study was conducted to monitor the oral health of schoolchildren aged 6-7 years old following the implementation of an oral health promotion program in Tehran, Iran. The protocol was registered in the Iranian Registry of Clinical Trials (Code: IRCT20090307001749N4). A cluster random sampling method was applied, and the schools were randomly allocated to intervention and control groups. An intervention package consisting of a one-day workshop for parents and supervised toothbrushing for children was employed. In both groups, the Caries Assessment Spectrum and Treatment (CAST) and Oral Hygiene Index Simplified (OHI-S) were evaluated at baseline and at one-year follow-up in addition to the questionnaire data. Clinical data were collected by calibrated examiners at both intervals (Kappa = 89.8%, 87.68%) and analyzed using the SPSS software ver. 22.0. Of 739 children included at baseline, 593 were re-examined after one year (response rate = 74%). According to the Generalized Estimating Equation (GEE) analysis, considering the confounding effect of time, significantly more children in the control group had deciduous molars with a score of 3 and higher compared to the intervention group (OR = 1.79; 95% CI:1.17-2.73, p = 0.007). The oral hygiene status of the children significantly improved in the intervention group compared to the controls (B = -0.27; 95% CI: -0.45 --0.08, p = 0.005). After one year, the improvement in the oral health-related attitude of parents and children's oral health behavior was marginally significant in the intervention group compared to the control group [0.2 (0.17) vs. -0.13 (0.05), p = 0.096] and [0.06 (0.06) vs. -0.05 (0.04), p = 0.09], respectively. However, the impact on the oral health-related knowledge and self-reported behavior of the parents was not significant. In the intervention group, children had less caries and a better oral hygiene status compared to the controls after one year.

Fig 1. Overview of the study at baseline and one-year follow-up according to the CONSORT flow diagram.

Fig 2. Weekly guide of supervised toothbrushing for children for use at home.

Fig 3

Caries status according to the CAST index in the primary and first permanent molars in the control and intervention groups at baseline (A and B) and 1-year follow-up (C and D).

Fig 4. The mean OHI-S score in children at baseline, one-month follow-up, and one-year follow-up in intervention and control groups.