Cochrane · intervention · CD009378
Primary school‐based behavioural interventions for preventing caries
Cooper, AM, O'Malley, LA, Elison, SN, et al. · Cochrane Database of Systematic Reviews · 2013 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
9
current version
GRADE rated
2
No studies
2
Included studies
4
as reported
No studies 2 · 22.2%Ungraded 5 · 55.6%Very low 0 · 0%Low 2 · 22.2%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children aged 4 to 12 years at the start of the study attending a primary/elementary/infant or junior school in any country; irrespective of baseline dental caries level, fluoride exposure (topical and via water), current dental treatment, attendance levels and nationality | 2302 children participated across the four studies (1529 intervention, 773 control); sample sizes ranged from 30 to over 400 per group; studies conducted in Brazil (Zanin 2007), Iran/Tehran (Saied-Moallemi 2009), Italy (Petrecca 1994) and the UK (Worthington 2001); ages 4 to 7 years (one study), 8 to 12 years (two studies), and one study with age unclear (primary school years 1 to 3, approximately 6 to 9 years) |
| Intervention | Behavioural interventions (education and/or skills and/or behaviour change) delivered in a school setting addressing oral health/hygiene and frequency of cariogenic food and drink consumption; interventions required to focus on toothbrushing and cariogenic foods, use schools as the focal delivery site, and contain skills, instructions and educational components; one or more behaviour change techniques | Educational programmes broken down into classroom-based lessons (n=4); toothbrushing instruction and skill lessons (n=4); information on fluoride toothpaste use (n=4); dietary elements via group discussion/lessons/instruction/leaflets (n=4); supervised toothbrushing practice sessions (n=2); 'active' home component involving parents (n=2) |
| Comparison | Usual curriculum-based health education programmes (non-intervention control); or waiting list control groups | Non-intervention controls (n=3); dental treatment (fillings and extractions) plus an annual supervised toothbrushing session (n=1) |
| Outcomes | Primary: (1) caries increment measured by dmft/DMFT; (2) caries increment on tooth surfaces dmfs/DMFS; (3) plaque scores for permanent and deciduous teeth. Secondary: frequency of toothbrushing; frequency of cariogenic food and drink consumption; behavioural outcomes (reported and/or other measures); changes in dental attendance; adverse events | Caries increment DMFT (n=1, not analysable - no SD); caries increment DMFS - prevented fraction (n=1); plaque indices (n=3); frequency of toothbrushing (n=1); frequency of cariogenic food and drink consumption (n=1); change in oral health knowledge and skills (n=1); changes in dental attendance (n=1); adverse events (n=0, none reported) |
| Study designs | Randomised controlled trials (RCTs) with randomisation at the group level (cluster by school and/or class) or individual children; all other studies excluded during screening or at the point of data extraction | Randomised controlled trials (n=4): two cluster-randomised at the school level (Saied-Moallemi 2009; Worthington 2001) and two individually randomised (Petrecca 1994; Zanin 2007); one used a cross-over design (Worthington 2001) |
| Timing | Studies included with or without a follow-up period after completion of the intervention | Post-intervention outcomes reported at 3 months (Saied-Moallemi 2009), 6 months (Zanin 2007) and 1 year (Petrecca 1994); the cross-over study reported at 4 months (phase one) and 3 months (phase two) (Worthington 2001) |
Search date: 2012-10. Databases: The Cochrane Oral Health Group's Trials Register; The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; CINAHL via EBSCO; PsycINFO via OVID; Current Controlled Trials; ClinicalTrials.gov; ZETOC; Web of Science Conference Proceedings; ProQuest…
Questions and results
Current version onlyPrimary school-based behavioural intervention (both oral hygiene and dietary components) vs No intervention or delayed intervention (non-intervention control; one trial's control received dental treatment plus an annual supervised toothbrushing session)
Population: Children aged 4 to 12 years attending primary school
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in oral health knowledge and skills | Worthington 2001 reported changes in oral health knowledge and skills: improvement was apparent in both intervention and control groups at the 4-month follow-up (phase one) but greater in the intervention group (34%… | 1 study | Ungraded |
Behavioural outcomes (reported and/or other measures, e.g. data tracking toothbrushes and collecting food wrappers) | No other behavioural outcomes (e.g. objective toothbrush tracking or food-wrapper collection) were measured by the four included studies. | 0 studies | No studies |
Adverse events | No study reported any adverse events. | 0 studies | No studies |
Plaque indices (permanent and deciduous teeth) 3 to 15 months | SoF (Plaque indices, follow-up 3 to 15 months): 'All 3 RCTs showed a reduction in plaque in the intervention group compared to control group'; 827 participants (3 RCTs); GRADE low; comment 'Data not suitable for… | 3 studies · 827 participants | Low Downgraded: risk of bias, inconsistency |
Changes in dental attendance | Worthington 2001 found no change in reported dental visits over the course of the programmes, with 97% of children at baseline reporting visiting the dentist every 2 years. | 1 study | Ungraded |
Caries increment on tooth surfaces (dmfs/DMFS) (prevented fraction) 15 months | PF 0.65 [0.12, 1.18] | 1 study · 60 participants | Low Downgraded: risk of bias, imprecision |
Caries increment measured by the difference in decayed, missing and filled teeth (dmft/DMFT) 2 years | PF 0.49 | 1 study | Ungraded |
Frequency of cariogenic food and drink consumption | Worthington 2001: few children had problems identifying foods containing sugar; only 15% of intervention and 19% of control participants reported routinely consuming sugary snacks on arriving home from school; snacking… | 1 study | Ungraded |
Frequency of toothbrushing | Worthington 2001 reported children's brushing frequency: almost all children (99%) at baseline reported twice daily brushing, and this level was maintained across all groups throughout the intervention (in baseline… | 1 study | Ungraded |
School-based behavioural intervention (education and/or skills and/or behaviour change) addressing toothbrushing and cariogenic food and drink consumption vs Usual curriculum-based health education (non-intervention control) or waiting list control
Population: Children aged 4 to 12 years attending a primary/elementary/infant or junior school (any country), irrespective of baseline caries level, fluoride exposure, dental treatment or attendance
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Changes in dental attendance | no estimate extracted | NR | No studies |
Behavioural outcomes (reported and/or other measures, e.g. data tracking toothbrushes and collecting food wrappers) | no estimate extracted | NR | No studies |
Caries increment measured by the difference in decayed, missing and filled teeth (dmft/DMFT) | no estimate extracted | NR | No studies |
Frequency of toothbrushing | no estimate extracted | NR | No studies |
Caries increment on tooth surfaces (dmfs/DMFS) | no estimate extracted | NR | No studies |
Adverse events | no estimate extracted | NR | No studies |
Frequency of cariogenic food and drink consumption | no estimate extracted | NR | No studies |
Plaque scores (permanent and deciduous teeth) | no estimate extracted | NR | No studies |