|Year : 2016 | Volume
| Issue : 2 | Page : 116-120
Impact of oral health education on plaque scores with and without periodic reinforcement among 12-year-old school children
M Padma Reddy, S Venkata Lakshmi, Suhas Kulkarni, Dolar Doshi, B Srikanth Reddy, S Sabiha Shaheen
Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, Hyderabad, Telangana, India
|Date of Web Publication||10-Jun-2016|
S Venkata Lakshmi
Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Research Centre, Road No. 5, Kamala Nagar, Dilsukhnagar, Hyderabad - 500 060, Telangana
Source of Support: None, Conflict of Interest: None
Introduction: As many oral health problems are preventable, creating awareness at a very early age has an impact on their health-related behaviors. Aim: To assess the impact of oral health education on plaque scores with and without periodic reinforcement among 12-year-old school children. Materials and Methods: An experimental study was conducted among 12-year-old children of Manchi School, Balapur in Hyderabad. The study sample comprised 140 children that was further divided randomly into study and control groups with 70 children in each. The study was conducted for a period of 1 month with clinical examination being carried out at baseline and on 30th day using Turesky, Gilmore, and Glickman modification of Quigley–Hein Plaque Index (1970). The study group received oral health education at the baseline and on the 15th day from the baseline, whereas control group received oral health education only at the baseline. Statistical analysis was done using Wilcoxon matched paired test. Results: Mean difference in the plaque scores among groups based on gender from baseline to follow-up examination (30th day) revealed that males in the study and control groups had a difference of 1.09 ± 0.3, 0.59 ± 0.3, respectively (P = 0.001). On the other hand, females in the study and control groups had 1.47 ± 0.2, 0.76 ± 0.2 difference which was statistically more significant (P = 0.0001). The study and control groups showed 61.7% and 32.6% reduction in the mean plaque scores from baseline to follow-up examination (30th day). Conclusion: Study group with reinforcement showed a prominent reduction in the mean plaque scores than control group.
Keywords: Dental health education, oral health, school children
|How to cite this article:|
Reddy M P, Lakshmi S V, Kulkarni S, Doshi D, Reddy B S, Shaheen S S. Impact of oral health education on plaque scores with and without periodic reinforcement among 12-year-old school children. J Indian Assoc Public Health Dent 2016;14:116-20
|How to cite this URL:|
Reddy M P, Lakshmi S V, Kulkarni S, Doshi D, Reddy B S, Shaheen S S. Impact of oral health education on plaque scores with and without periodic reinforcement among 12-year-old school children. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 May 27];14:116-20. Available from: http://www.jiaphd.org/text.asp?2016/14/2/116/183806
| Introduction|| |
In recent years, there is a growing emphasis on oral health as it is the fundamental and an integral part of the general health and well-being of an individual. The burden of oral diseases is growing in several developing countries mainly due to rapid transition in diet, nutrition, and lifestyles.
Poor oral hygiene contributes to the development of dental plaque which has a substantial impact on the oral health as it is the precursor of dental caries and periodontal disease in turn resulting in tooth loss if not properly managed. According to the National Oral Health Survey of India conducted among 12-year-old children in 2004, it was reported that the prevalence of dental caries was 53.8% and gingivitis was 55.4%, respectively.
The cornerstone of prevention of oral diseases such as dental caries and periodontitis is maintenance of tooth surface free from dental plaque.,, Therefore, continuous and regular disruption of plaque formation plays a pivotal role to reduce and control oral diseases that are plaque dependent.
Lack of awareness is one of the main causes for the growing burden of oral diseases. Creating awareness at a very early age has an impact on their health-related behaviors later in life.,, Primary prevention is considered as a major tool for the better oral health of children, and dental health education has emerged as one of the fundamental approaches in the primary prevention.,,
As universal structure, school environment provides an idealistic approach to teach preventive oral health practices, thereby promoting oral health.,,, As the existing oral health services, manpower and financial resources are limited; therefore, oral health education should be given more attention as it acts as a powerful means of raising awareness of community health., On the other hand, reinforcement is of utmost importance in instituting and retaining the established positive oral health behavior in the children.
Hence, the present study was carried out to assess the impact of oral health education on plaque scores with and without periodic reinforcement among 12-year-old children of Manchi School, Balapur in Hyderabad.
| Materials and Methods|| |
The present study was conducted among 12-year-old children of Manchi School, Balapur in Hyderabad. Ethical approval was obtained from the Institution Review Board. Before conduct the study, the purpose of the study was clearly explained to the higher authorities of selected school, and permission was obtained from them. Parental consent was also obtained during monthly parent–teacher meeting before the start of the study.
All the 12-year-old school children present on the day of examination and were willing to participate in the study with no history of dental visits in the past 3 months were included in the study. This school was selected as no school-based oral health education programs were conducted earlier.
Students not present on the day of the examination, children with orthodontic appliances and with dental fluorosis, physically or mentally compromised children were excluded from the study.
The total strength of the Manchi School, belonging to the age group of 12 years was 140. The study sample was further divided randomly into study group and control group with 70 children in each. Oral examination was carried out at the baseline and on 30th day from the day of the first visit. The study group received oral health education at the baseline and on 15th day from the baseline day of examination. On the other hand, the control group receives oral health education only at the baseline [Figure 1].
Oral health education was delivered using audiovisual aids such as animated video in English language for 10 min, charts, and by brushing models. Oral health education encompasses topics such as type of dentition, importance of brushing twice daily using modified bass technique to keep teeth healthy, etiology of dental caries and how to prevent it, good dietary practices, role of fluoride, regular visits to dentist, and impact of oral health on general health. All the children who were participating in the study were provided with toothbrush and toothpaste after oral health education.
Armamentarium used in the study is plane mouth mirror, kidney trays, disposable gloves, disposable mouth masks, dapendish, erythrosine dye, cotton buds, and cheek retractors. The study was conducted for a period of 1 month with clinical examination being carried out at baseline (day 0) and 30th day from the day of baseline examination. At the initial visit after oral health education, each child was made to sit comfortably on a chair, and plaque was recorded under natural light condition using Turesky, Gilmore, and Glickman modification of Quigley–Hein Plaque Index (1970).
With the help of cotton bud disclosing agent (erythrosine solution) is applied to all the tooth surfaces. Supragingival plaque is assessed on the labial, buccal, and lingual surfaces of all the teeth after application of disclosing agent. The index based on numerical six-point scale from 0 (no plaque) to 5 (plaque covers two-thirds or more of the tooth surface). The calculation of scores was determined by diving the total score by the number of surfaces examines. The plaque scores for all the children were re-recorded using Turesky, Gilmore, and Glickman modification of Quigley–Hein Plaque Index on 30th day from the baseline examination for both the groups.
Statistical analysis was done using Statistical Package for Social Sciences software (version 20; SPSS, Inc., Chicago, IL, USA) Wilcoxon matched paired test was applied to compare percentage change in mean plaque scores at different time intervals. Pairwise comparison in different groups was done using Mann–Whitney U-test. The level of significance was set at 0.05.
| Results|| |
An experimental study was conducted among 12-year-old children of Manchi School. A total of 140 subjects were randomly divided into two equal groups, study (70 subjects) and control group (70 subjects). On the day of follow-up examination, i.e., 30th day, only 127 subjects were available out of 140 yielding a dropout rate of 9.2%. Thus, the study group comprised 62 subjects (30 males, 32 females) and control group of 65 subjects (35 males, 30 females).
Group-wise comparison of mean plaque scores at baseline based on gender revealed that the males and females of the study group had high mean plaque scores on comparison to mean plaque scores of control group. Nonetheless, this comparison was not statistically significant. Similar comparison on the 30th day revealed that males and females of control group had high mean plaque scores compared to the study group which was statistically significant (P = 0.0001) [Table 1].
|Table 1: Mean plaque scores among study and control groups at baseline and follow-up examination|
Click here to view
When the mean difference in the plaque scores was compared among groups based on gender from baseline (day 0) to follow-up examination (30th day), higher significant difference in plaque scores was observed in the study group (P = 0.006) compared to control group (P = 0.01). Moreover, maximum significant difference in the plaque scores was observed among females (P = 0.0001) as compared to males (P = 0.001) [Table 2].
|Table 2: Mean difference in the plaque scores among study and control groups from baseline to follow-up examination|
Click here to view
Comparison of percentage reduction in the mean plaque scores based on groups with gender from baseline (day 0) to follow-up examination (30th day) showed overall 61.7% reduction in the study group (males - 54.7%, females - 67.1%, respectively) for the mean plaque scores. On the contrary, overall 32.6% reduction in the mean plaque scores (males - 29.7%, females - 36.5%, respectively) was noticed in the control group. Pertaining to groups, a significant reduction in mean plaque scores was apparent from baseline to follow-up examination (30th day) (P = 0.00001). Moreover, females reported high percentage reduction in the mean plaque scores on comparison to males [Figure 2].
|Figure 2: Comparison of percentage reduction in mean plaque scores from baseline (day 0) to follow-up examination (30th day)|
Click here to view
| Discussion|| |
Health education plays an important role to adopt behaviors in sustaining good oral health thereby developing positive attitude toward dental health. Oral health education and constant periodic reinforcement are the key elements in promoting good oral health as it counteracts the effect of fading over a period of time.
To get homogenous sample, all 12-year-old children of particular school were included in the study. As children tend to indulge more into animated world, pictures and cartoon characters can make them to imagine themselves as cartoon characters as their super models and lend an ear toward watching the video as it appears quite interesting for them. This concept made us to use animated video with cartoon characters as medium to impart oral health education to children that help in motivating and acquiring good oral hygiene habits.
Turesky, Gilmore, and Glickman modification of Quigley–Hein Plaque Index (1970) was considered as a reliable index for measuring plaque as it estimates the extent of plaque on the buccal or lingual surfaces covered on an ordinal scale. The disclosing agent used allows patient visualization of plaque and children can be driven in developing an efficient technique of plaque removal from the teeth.
In this study, the mean plaque scores of children in the study group were marginally higher as compared to control group at baseline which was insignificant. Moreover, on the day of follow-up examination (30th day), a significant decrease in the mean plaque scores was observed for both the groups. This differences in the mean plaque scores were greater among the study group as compared to control group showing significant difference (P = 0.006). This improvement among the study group was most likely due to repeated information received by children during oral health education program which enhanced knowledge in adopting and sustaining appropriate brushing technique, changing brushing frequency, and healthy oral habits contributing to the major difference in plaque scores from the baseline. These findings were in congruent with the study done by Hebbal et al. on school children of Belgaum city. In contrast, Ajithkrishnan et al. study revealed that where there was no significant difference in the mean plaque scores of study subjects before and after oral health education.
The present study revealed that females had higher baseline plaque scores than males in study and control groups, and this difference was not significant. On contrary, on the day of follow-up examination (30th day), females had low mean plaque scores among both the groups. Nonetheless, this difference was statistically significant only with study group (P = 0.005). Reported improvement among females as compared to males might be because females tend to be more attentive and concern about their oral health and appearance compared to males. This finding was in contrast with the study done by Shahapur and Shahapur  among 12–15-year-old schoolchildren in Bijapur city, wherein baseline plaque scores were found to be high among males compared to females and follow-up examination revealed a significant reduction in plaque scores in both males and females (P< 0.005).
A significant difference in the mean plaque scores was detected from baseline (day 0) to follow-up examination with females displaying more difference in mean plaque scores compared to males in both the groups. Similar finding was observed in a study done by Damle et al. among school children of Maharashtra. This difference can be because females are more inquisitive in nature that enables them to develop favorable attitude toward dental health.
In the existing study, the study group had prominent reduction in the mean plaque scores than control group. This could be due to reinforced education showing a long-term effect in sustaining attained knowledge and adopted behaviors leading to more reduction in the level of mean plaque scores in study group than control group. Our findings were in agreement with the results of the study done by D'Cruz and Aradhya in Bengaluru  and Yazdani et al. in Iran.
In study and control groups, females showed higher percentage reduction in the mean plaque scores compared to males. This might be because males could not put into practice what they had learned through health education.
The present study acknowledges certain limitations such as single age group (12 years) was considered in the study, so the results cannot be generalized to other age groups. Although study showed immediate positive effects, changes observed for short duration cannot be predicted in the long run. Teachers and parents were not involved in the education process, otherwise their awareness may play a potent role in evoking the motivation, raising child's health, and in turn community health even after discontinuation of the program. Further studies involving multiple institutions, parents, and teachers with longer follow-up need to be conducted to assess long-term changes in oral health behavior of children.
| Conclusion|| |
Schools act as building blocks in shaping up the children's behavior. Enhancing the levels of child's knowledge by school dental health education plays a pivotal role in improving oral health in turn overall health. The results of the present study showed a significant reduction in the mean plaque scores in both the groups (study and control) from baseline to follow-up examination after oral health education program. Moreover, study group with reinforcement showed a prominent reduction in the mean plaque scores than control group. Furthermore, females showed better oral hygiene compared to males. Therefore, schools system provides best platform for inculcating good oral hygiene habits among children thereby declining the disease risk in the near future. In developing countries like India, where majority of the population are in middle- and low-socioeconomic status school, dental health education program with constant reinforcement is feasible way to reach out all sections of children. Henceforth, oral health education program should be part of academic curriculum to achieve positive oral health and cavity-free future.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mehta A, Kaur G. Oral health-related knowledge, attitude, and practices among 12-year-old schoolchildren studying in rural areas of Panchkula, India. Indian J Dent Res 2012;23:293.
Moynihan P, Petersen PE. Diet, nutrition and the prevention of dental diseases. Public Health Nutr 2004;7:201-26.
National oral health care program implementation strategies, Project of DGHS, MOH and FW. Govt. of India, submitted by Hari Prakash and Naseem Shah, Department of Dental Surgery, Ansari Nagar, New Delhi. 2004.
D'Cruz AM, Aradhya S. Impact of oral health education on oral hygiene knowledge, practices, plaque control and gingival health of 13- to 15-year-old school children in Bangalore city. Int J Dent Hyg 2013;11:126-33.
Sanadhya YK, Thakkar JP, Divakar DD, Pareek S, Rathore K, Yousuf A, et al.
Effectiveness of oral health education on knowledge, attitude, practices and oral hygiene status among 12-15-year-old schoolchildren of fishermen of Kutch district, Gujarat, India. Int Marit Health 2014;65:99-105.
Ivanovic M, Lekic P. Transient effect of a short-term educational programme without prophylaxis on control of plaque and gingival inflammation in school children. J Clin Periodontol 1996;23:750-7.
Ferrazzano GF, Cantile T, Sangianantoni G, Ingenito A. Effectiveness of a motivation method on the oral hygiene of children. Eur J Paediatr Dent 2008;9:183-7.
Teixeira Alves FB, Kuhn E, Bordin D, Kozlowski VA, Raggio DP, Fadel CB. Infant motivation in dental health: Attitude without constant reinforcement. J Indian Soc Pedod Prev Dent 2014;32:225-30.
Gauba A, Bal IS, Jain A, Mittal HC. School based oral health promotional intervention: Effect on knowledge, practices and clinical oral health related parameters. Contemp Clin Dent 2013;4:493-9.
Lawal FB, Taiwo JO. An audit of school oral health education program in a developing country. J Int Soc Prev Community Dent 2014;4 Suppl 1:S49-55.
Shahapur RP, Shahapur PR. Evaluation of oral health education intervention on oral hygiene status among high school students. Int J Pharm Bio Sci 2013;4:39-44.
Kamran A, Bakhteyar K, Heydari H, Lotfi A, Heydari Z. Survey of oral hygiene behaviors, knowledge and attitude among school children: A cross-sectional study from Iran. Int J Health Sci 2014;2:83-95.
Bhardwaj VK, Sharma KR, Luthra RP, Jhingta P, Sharma D, Justa A. Impact of school-based oral health education program on oral health of 12 and 15 years old school children. J Educ Health Promot 2013;2:33.
Shenoy RP, Sequeira PS. Effectiveness of a school dental education program in improving oral health knowledge and oral hygiene practices and status of 12- to 13-year-old school children. Indian J Dent Res 2010;21:253-9.
Garbin C, Garbin A, Dos Santos K, Lima D. Oral health education in schools: Promoting health agents. Int J Dent Hyg 2009;7:212-6.
Biesbrock AR, Walters PA, Bartizek RD. Short-term impact of a national dental education program on children's oral health and knowledge. J Clin Dent 2004;15:93-7.
Chachra S, Dhawan P, Kaur T, Sharma AK. The most effective and essential way of improving the oral health status education. J Indian Soc Pedod Prev Dent 2011;29:216-21.
Rodrigues JA, dos Santos PA, Baseggio W, Corona SA, Palma-Dibb RG, Garcia PP. Oral hygiene indirect instruction and periodic reinforcements: Effects on index plaque in schoolchildren. J Clin Pediatr Dent 2009;34:31-4.
Turesky S, Gilmore ND, Glickman I. Reduced plaque formation by the chloromethyl analogue of victamine C. J Periodontol 1970;41:41-3.
Hebbal M, Ankola AV, Vadavi D, Patel K. Evaluation of knowledge and plaque scores in school children before and after health education. Dent Res J (Isfahan) 2011;8:189-96.
Ajithkrishnan CG, Thanveer K, Sudheer H, Abhishek S. Impact of oral health education on oral health of 12 and 15 year old school children of Vadodara city, Gujarat state. J Int Oral Health 2010;2:15-20.
Damle SG, Patil A, Jain S, Damle D, Chopal N. Effectiveness of supervised toothbrushing and oral health education in improving oral hygiene status and practices of urban and rural school children: A comparative study. J Int Soc Prev Community Dent 2014;4:175-81.
Yazdani R, Vehkalahti MM, Nouri M, Murtomaa H. School-based education to improve oral cleanliness and gingival health in adolescents in Tehran, Iran. Int J Paediatr Dent 2009;19:274-81.
[Figure 1], [Figure 2]
[Table 1], [Table 2]