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ORIGINAL ARTICLE
Year : 2022  |  Volume : 20  |  Issue : 1  |  Page : 43-48

Effectiveness of game-based oral health education method on oral hygiene performance of 12-year-old private school children in Lucknow City: A field trial


1 Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Public Health Dentistry, Anil Neerukonda Institute of Dental Sciences, Visakhapatnam, Andhra Pradesh, India

Date of Submission27-Feb-2021
Date of Decision17-Aug-2021
Date of Acceptance08-Nov-2021
Date of Web Publication25-Feb-2022

Correspondence Address:
Panchali Kashyap
Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_26_21

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  Abstract 


Background: Health education is a part of health promotion and disease prevention measures to improve the oral health and well-being of all children. When education and entertainment are combined to make the process of learning a joyful one, it facilitates and reinforces child's learning in a thought-provoking and self-motivating format. Aim: The aim of this study was to compare the effectiveness of conventional and game-based oral health education on oral hygiene performance of 12-year-old private school children of Lucknow city. Materials and Methods: The study population aged 12 years comprised 160 participants. This was followed by a school survey in which the 12-year-old school children were randomly assigned into two groups: Group A and Group B after the necessary inclusion and exclusion criteria. A pretest evaluation of their knowledge regarding oral health and the estimation of debris index simplified and plaque index was carried out. Children in Group A were given oral health education through PowerPoint presentation once daily for 7 days. Children in Group B were educated through the play method (i.e., crosswords and quiz with PowerPoint presentation). The evaluations regarding oral health-related knowledge were done using pretested, predetermined questionnaire, and debris scores, and plaque scores were recorded using debris index simplified component of OHI-S by (J. C Green and Jack R Vermillion 1964) and Plaque Index by Loe H (1967), respectively, on postintervention 1, 3, and 6 months. Statistical analysis was done using the t-test and ANOVA test which was carried out using the SPSS software version 21.0 for Windows, and the value of P < 0.001 was considered statistically significant. Results: In Group B, high knowledge scores of 4.05, 4.73, and 6.02 were obtained on postintervention 1, 3, and 6 months, respectively. In both the groups, there was a significant increase in good oral hygiene scores and a significant decrease in debris scores and plaque scores on postintervention 1, 3, and 6 months' follow-up, but much better scores were seen in group B compared to Group A at both the follow-ups. Conclusion: As the knowledge scores of children increased and debris score and plaque score decreased considerably, thereby the implementation of game-based oral health education program is an easy and effective method in improving the oral health and preventing oral diseases.

Keywords: Knowledge, oral hygiene, plaque index


How to cite this article:
Kashyap P, Reddy L V, Sinha P, Verma I, Adwani J. Effectiveness of game-based oral health education method on oral hygiene performance of 12-year-old private school children in Lucknow City: A field trial. J Indian Assoc Public Health Dent 2022;20:43-8

How to cite this URL:
Kashyap P, Reddy L V, Sinha P, Verma I, Adwani J. Effectiveness of game-based oral health education method on oral hygiene performance of 12-year-old private school children in Lucknow City: A field trial. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2022 May 24];20:43-8. Available from: https://www.jiaphd.org/text.asp?2022/20/1/43/338515




  Introduction Top


The children with undiagnosed oral health issues in their day-to-day life often suffers from persistent pain, embarrassment at discolored and damaged teeth, inability to eat comfortably or chew well, and distraction from play and learning. It was stated that due to dental-related illness, an estimated 51 million school hours are lost per year.[1] According to the studies conducted (among index age groups) in various parts of India from January 2000 to April 2016 and information from the National Oral Health Survey and Fluoride Mapping (2002–2003), the mean deft/Decayed Missing Filled Teeth (DMFT) was 1.95 among 12 years age group. The mean prevalence of dental caries is almost similar at 5 years and 12 years which is at 49%.[2]

Nearly half of the 12-year-old population was affected by caries, even though DMFT among them was found to be 1.9 which falls under “low” group according to the WHO.[2] Twelve years is considered the global monitoring age for caries for international comparisons and monitoring of disease trends, because, at this age, all permanent teeth except the third molars have almost erupted.[3] Moreover, among the school-going children, this age group (12 years) is observed as the mean age group which shows the highest frequency of snacking habit and act as a high-risk factor for caries in young age.[4]

As high rates of snacking are observed among young people, especially school-going students, it is established that Government school children reported to consume snacks including aerated drinks and junk foods lesser than the children belonging to private schools, the reason being attributed to the higher purchasing capacity.[5] This is turn, leads to increase in the oral diseases specially dental caries among the private school-going children.[4]

Imparting oral health education of school children plays the most important role as far as prevention of oral health problems is concerned. Therefore, a wide group of children is benefitted in improving oral health knowledge and behavior because of such programs due to its exceptionally low cost. Conducting oral health promotion in schools in a detailed and interesting manner can help in the betterment of the oral health status of the children. To create awareness among the children, conventional methods like lectures have always shown to provide lesser effect on the maintenance of the children's teeth. Therefore, to make the process of learning fun for them, education and amusement can be well merged. Thus, the mode of learning through games is a recently used technique with promising results where learning comes from experience.[6]

In both the learning and teaching process, implementing games in the classroom is a beneficial instrument and thus for the purpose of improving teaching effectiveness, educators have involved various exploratory approaches. Crossword puzzles have turned out to be one of the most practical, useful, and impressive game-based modes of oral health education which can help in greater retention and memorization of facts. This technique involves various important student skills such as terminology, reasoning, and pairing key concepts with related names and spelling. Apart from these, their engagement in the design procedure is also another important factor.[7] Currently, such creative and new preventive techniques have started due to the increasing number of oral health problems in the country which is the necessity of the moment.[8]

A field trial is basically a study which is conducted in a population free of disease with an aim to prevent disease and promote health. Here, we evaluate whether an intervention reduces the risk of developing a disease. Thus, the present field trial was undertaken to compare the effectiveness of conventional and game-based teaching and if retention of complicated information and oral hygiene status is better with varied learning techniques among 12-year-old private school children of Lucknow city.


  Materials and Methods Top


The present school-based field trial was conducted to compare the effectiveness of conventional and game-based oral health education on oral hygiene performance of 12-year-old private school children of Lucknow city. The study was conducted for a period of 6 months from January 1, 2019, to June 30, 2019, in morning hours between 11 a.m. and 1 p.m. Subjects included private school-going children aged 12 years. A pilot study was conducted on 20 school children aged 12 years (10% of the total sample) to check the reliability of the questionnaire, feasibility of the study, and appropriateness of the field trial. These participants were not included in the main study.

The sample was selected by simple random sampling technique. Four private schools from the list of (District Inspector of Schools) were randomly selected to avoid spillover information or contamination effect. This was followed by a school survey in which by the process of randomization, the 12-year-old school children were randomly assigned (with the help of attendance register) into two groups: Group A and Group B after the necessary inclusion and exclusion criteria [Figure 1].
Figure 1: Schematic representation of the study procedure

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A pretest evaluation of their knowledge regarding oral health and the estimation of debris index simplified and Plaque Index was carried out. In Group A, oral health education was given through PowerPoint presentation. The presentation was an audiovisual lecture on oral health-related knowledge and behavior. In Group B, oral health education was given through play method-crossword puzzles + PowerPoint presentation. At first, the children were given a 15-min lecture on oral health knowledge and behavior. Then, the children were explained the rules of the crossword game. The crossword consisted of 15 questions arranged horizontally and vertically based on functions of teeth, what is dental caries, dental plaque etc., The correct answers were given a score of “1”, and wrong answers were given score “0.” Education was provided once daily for 7 days. The evaluations regarding oral health knowledge oral hygiene status were recorded on postintervention 1, 3, and 6 months.

The study proforma had two parts:

  1. First part consisted of a pretested, predetermined questionnaire which was used to record demographic details, and the knowledge of the study participants regarding oral health (using 15 close-ended questions)
  2. The second part consists of clinical examination using debris index simplified component of OHI-S by (J. C Green and Jack R Vermillion 1964) and Plaque Index by Loe H (1967).


Cronbach's alpha was applied for the reliability of the questionnaire as the questionnaire items were analyzed for understanding, interpreting, and answering correctly without difficulty and it was found to be 0.84. Single examiner was trained and calibrated for recording the abovementioned indices on 20 children (10% of the total sample size) aged 12 years prior to the study and was accompanied by the recording clerk. Subjects were re-examined on successive days using the same diagnostic criteria. The results of the two examinations were compared to obtain an estimate of the extent and nature of diagnostic variability measured by Kappa statistics. The kappa statistics for intra-examiner reliability was estimated to be 0.86. The calculation of sample size was performed to seek the results at 95% confidence level for which the value of z = 1.96. The allowable error taken was e = 0.05. The sample size was estimated to be 160 participants.

Ethical clearance was obtained from the Institutional Ethical Committee of the college vide letter No. PHD/01/1819/IEC. The study procedure was explained to the participants, and informed consent was obtained from all the participants before the study. All the patients were explained about the study procedure and those who accepted to participate in the study were included in the study as per the inclusion and exclusion criteria.

The data were collected, tabulated, and subjected to statistical analysis using the IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. was performed using the t-test and ANOVA test. All the values were considered statistically significant at P < 0.001.


  Results Top


[Table 1] and [Graph 1] shows that in Group B on postintervention, the oral health knowledge score dramatically increased from 2.81 to 4.05 and for Group A scores increased from 2.77 to 3.2 at 1 month. In follow-up, data were collected 3-month postintervention, the mean oral health knowledge scores were 3.68 and 4.73 for Groups A and B, respectively. The lower scores in 3-month postintervention indicate less retention of knowledge over a period of time, but still, the scores were higher than baseline and more knowledge retention was seen in Group B. Significant improvement in the knowledge scores of the children after 6-month postintervention was seen in both the groups with mean score of 4.62 in Group A and 6.02 in Group B.
Table 1: Intergroup and intragroup comparison of knowledge scores at different time intervals

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[Table 2] and [Graph 2]: shows that in Group B on postintervention, the mean debris score decreased from 1.853 to 0.521 and for Group A scores decreased from 1.862 to 0.961 at 1 month. In follow-up, data were collected 3-month postintervention, the mean debris scores were 0.481 and 0.353 for Groups A and B, respectively. Significant decrease in the debris scores of the children after 6-month postintervention was seen in both the groups with mean score of 0.0165 in Group A and 0.109 in Group B thus showing dramatically increased improvement in the oral hygiene.
Table 2: Intergroup and intragroup comparison of debris scores at different time intervals

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[Table 3] and [Graph 3]: shows that in Group B on postintervention, the mean plaque score decreased from 2.14 to 0.874 and for Group A, scores decreased from 2.16 to 1.15 at 1 month. In follow-up, data were collected 3-month postintervention, the mean plaque scores were 0.573 and 0.469 for Groups A and B, respectively. Significant decrease in the plaque scores of the children after 6-month postintervention was seen in both the groups with mean score of 0.412 in Group A and 0.304 in Group B thus showing dramatically increased improvement in the oral hygiene.
Table 3: Intergroup and intragroup comparison of plaque scores at different time intervals

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  Discussion Top


Knowledge of proper oral hygiene practices is one of the key factors in maintaining good oral health. School-based oral health programs can benefit a wide group of children with extremely low costs in improving oral health knowledge and behavior. Games can make studying more entertaining and have been widely utilized for study by students as well as teachers, across all age groups, and areas of education.

The present study included reinforcement of messages on oral health knowledge through crosswords and quizzes which is associated with the game-based oral health intervention and is similar to the study of Malik A et al.[6] The study showed that the social and academic skills of students can be improved by crossword puzzle solving which is also depicted in the study of Jaramillo CM et al., 2012.[7]

Very few schools provide proper stress on oral health educational interventions, although most of the schools encourage health programs with professional awareness on the subject (Malik A et al., 2017).[6] Because of this reason, although the programs in almost all schools usually try to provide a great deal of information in a short period of time, they fail to consider several important aspects required to improve oral health habits.

In the present study, there was significant increase in the knowledge scores [Table 1] in Group B (which implemented game-based oral health education) than that in Group A (with conventional mode of teaching). The mean increased from 3.2 in Group A and 4.05 in Group B in 1 month to 4.62 in Group A and 6.02 in Group B in 6 months due to increase in student's interest and motivation in the topic. Our findings are in accordance with the results of Malik A et al.,[6] which showed that game-based education proved very effective in improving oral health knowledge.

In this study, a game-based intervention program that depended on visual stimuli among children in Group B helped them grasp oral health instructions easily, such as good dental hygiene and dietary habits. There was even better memorization as well as retention of these instructions for a long period of time which was reflected as significantly increase in knowledge scores and a significant reduction of debris scores and plaque scores calculated at 1-, 3-, and 6-month follow-up. Similar findings were also reported by Maheswari UN et al. and Malik A et al., respectively.[6],[9]

The study showed a statistically significant decrease in the debris scores [Table 2] in Group B than that in Group A. The mean decreased from 0.961 in Group A and 0.521 in Group B in 1 month to 0.109 in Group A and 0.0165 in Group B in 6 months and also that there was significant decrease in the plaque scores [Table 3] in Group B than that in Group A. The mean decreased from 1.15 in Group A and 0.874 in Group B in 1 month to 0.412 in Group A and 0.304 in Group B in 6 months due to visual coding which increased the visual alertness among the children in Group B that helped them understand oral health guidelines very easily. These findings were in agreement with the study conducted by Malik A et al.[6] and Maheswari UN et al.[9]

The game-based education interventional program proved very effective in improving the oral health knowledge and practice of the children in Group B as compared to PowerPoint-based oral health interventional program that involved didactic learning. Thus, the crosswords game with oral health instructions can be an effective interventional aid for teaching basic oral health concepts to the children and motivating children for better oral health leading to lower debris and plaque scores.

Limitations

The schools used in the present study may not be representative of all the schools as only private schools were considered. Although the presentations were standardized, environmental factors such as communication barriers and efficiency of educators could have added a modifying effect on the health educational intervention. The study was conducted only for a short period. Long-term retention of knowledge is not assessed. The present study did not check how far the knowledge gained by the school children translated into positive practice and its applicability in the field.


  Conclusion Top


The oral health status of the children can be improved if health promotion in schools is conducted in a comprehensive and interesting manner. From this study, it can be concluded that as the knowledge scores of children increased and debris score and plaque score decreased considerably, thereby, implementation of game-based oral health education program is an easy and effective method in improving the oral health and preventing oral diseases. Regular reinforcement of the topic at a specific interval will increase the knowledge and efficacy of the children toward maintaining positive oral health.

Recommendations

The duty of giving oral health education can be shared with other community members. School teachers can play a major role by playing the oral health education in compact disk format every day in their classes. By doing so, it will increase sustainability of information given and standardization of information given can be made. More and more school-based oral health programs should be organized which can benefit a wide group of children with extremely low cost in improving oral health knowledge and behavior. Although most of the schools are encouraging health programs with professional awareness on the subject, very few focus on interventional oral health programs, therefore, proper emphasis should be provided over game-based interventional oral health education programs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sinor MZ. Comparison between conventional health promotion and use of cartoon animation in delivering oral health education. Int J Humanit Soc Sci 2011;1:169-73.  Back to cited text no. 1
    
2.
Janakiram C, Antony B, Joseph J, Ramanarayanan V. Prevalence of dental caries in india among the WHO index age groups: A meta-analysis. J Clin Diagn Res 2018;12:8-13.  Back to cited text no. 2
    
3.
WHO. Oral Health Surveys, Basic Methods. 5th ed. Geneva, Switzerland: WHO; 2013.  Back to cited text no. 3
    
4.
Iftikhar A, Zafar M, Kalar MU. The relationship between snacking habits and dental caries in school children. Int J Collab Res Intern Med Public Health 2012;4:1943-51.  Back to cited text no. 4
    
5.
Kandukuri V, Peram V. Comparison of snacking behavioral pattern between government school and private school going children aged (10-17 years old) and assessment of their nutritional status. Int J Sci Healthc Res 2019;4:102-12.  Back to cited text no. 5
    
6.
Malik A, Sabharwal S, Kumar A, Singh Samant P, Singh A, Kumar Pandey V. Implementation of game-based oral health education vs. conventional oral health education on children's oral health-related knowledge and oral hygiene status. Int J Clin Pediatr Dent 2017;10:257-60.  Back to cited text no. 6
    
7.
Jaramillo CM, Losada BM, Fekula MJ. Designing and solving crossword puzzles: Examining efficacy in a classroom exercise. Dev Bus Simul Exp Learn 2012;39:213-22.  Back to cited text no. 7
    
8.
Saran R, Kumar S. Use of crossword puzzle as a teaching aid to facilitate active learning in dental materials Medical Science. Indian J Appl Res 2015;5:456-7.  Back to cited text no. 8
    
9.
Maheswari UN, Asokan S, Asokan S, Kumaran ST. Effects of conventional vs. game-based oral health education on children's oral health-related knowledge and oral hygiene status – A prospective study. Oral Health Prev Dent 2014;12:331-6.  Back to cited text no. 9
    


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