Non-Cochrane · intervention · PM35015771
The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children's oral health: A systematic review and meta-analysis.
Faisal Mehreen Riaz, Mishu Masuma Pervin, Jahangir Faisal, et al. · PloS one · 2022 · PubMed · doi:10.1371/journal.pone.0262118
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
6
current version
GRADE rated
0
No studies
0
Included studies
59
linked below
No studies 0 · 0%Ungraded 6 · 100%Very low 0 · 0%Low 0 · 0%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, for improving oral health outcomes (interventions targeting parents/carers) | 36 studies; children mean age newborn (1-5 days) to 5.2 years; conducted in Australia, Belgium, Brazil, Cambodia, Canada, Hong Kong, India, Iran, Ireland, Israel, Peru, Thailand, UK and USA |
| Intervention | Behaviour change interventions / oral health promotion delivered by non-dental professionals and health workers | Oral health education in all studies, combined with caries-risk/oral-health assessment (n=6), fluoride varnish (n=6), and toothbrush/toothpaste provision (n=21); delivered by nurses (n=11), community health workers (n=7), health visitors (n=6), physicians (n=3), health-centre staff (n=3), and others |
| Comparison | Comparison or control group (RCTs and controlled quasi-experiments); single-arm pre-post designs also eligible | 17 RCTs (47.2%) and 19 quasi-experimental designs (52.8%; 7 pre-post studies and 12 with a comparison/control group) |
| Outcomes | Clinical oral health outcomes (caries experience: dmfs/dmft/defs, ECC, CAST, plaque/gingival indices) and behavioural/knowledge outcomes (oral hygiene, diet, knowledge, dental attendance/registration, OHRQoL); behaviour change techniques (BCTs) of effective interventions | Meta-analyzed (SMD): caries experience dmfs (12 studies, SMD -0.15, 95% CI -0.25 to -0.04) and dmft (6 studies, SMD -0.34, 95% CI -0.54 to -0.13). Narratively synthesized: clinical outcomes in 21 studies (10/21, 47.6%, significant); oral hygiene behaviours 9/13 significant; dietary behaviours 9/15 significant; oral health knowledge 7/10 significant; dental registration/attendance 4/7 significant; OHRQoL 1 study (improved). 28/36 studies showed a significant effect in clinical and/or behavioural/knowledge outcomes; 27 distinct BCTs identified in effective interventions (Table 1) |
| Study designs | Randomised controlled trials and quasi-experimental studies (including pre-post designs) | 17 RCTs and 19 quasi-experimental studies; effect size estimable for 33 studies |
| Timing | Not specified (databases searched from inception to March 2021; no follow-up-time restriction) | Mean child age newborn to 5.2 years; intervention/outcome follow-up varied by study and was not pooled by time point |
Search date: Inception to March 2021 (Medline/PubMed 1946-March 2021). Databases: Ovid MEDLINE, PubMed, CINAHL, Cochrane Library (including CENTRAL), Web of Science, TRoPHI, ProQuest (theses/grey literature); hand-searching of reference lists of previous systematic reviews; English-language only
Questions and results
Behaviour change / oral health promotion interventions delivered by non-dental professionals and health workers (nurses, midwives, health visitors, community health workers) vs Control (usual care, no intervention, or comparison group)
Population: Children (mean age newborn to ~5.2 years) and their parents/carers
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries experience at the surface level (dmfs/defs) Behaviour change interventions delivered by non-dental health workers produced a small, statistically significant reduction in caries experience at the surface level (dmfs SMD -0.15, 95% CI -0.25 to -0.04; 12 studies); the review judged the overall evidence to be of low quality (not GRADE-rated). Source: Meta-analysis (Results); Fig 2 (dmfs forest plot); Abstract · same question in other reviews | SMD -0.15 [-0.25, -0.04] | 12 studies | Ungraded |
Caries experience at the tooth level (dmft) Behaviour change interventions delivered by non-dental health workers produced a small-to-moderate, statistically significant reduction in caries experience at the tooth level (dmft SMD -0.34, 95% CI -0.54 to -0.13; 6 studies); the review judged the overall evidence to be of low quality (not GRADE-rated). Source: Meta-analysis (Results); Fig 3 (dmft forest plot) · same question in other reviews | SMD -0.34 [-0.54, -0.13] | 6 studies | Ungraded |
Comprehensive oral health intervention (oral health education plus additional support: motivational interviewing, toothbrush/toothpaste provision, community engagement, and/or fluoride varnish/sealant application) delivered by non-dental health workers vs Control (usual care, no intervention, or comparison group)
Population: Children (mean age newborn to ~5.2 years) and their parents/carers
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries experience at the surface level (dmfs/defs) Comprehensive intervention (vs oral health education only) Comprehensive interventions produced a small, statistically significant reduction in surface-level caries (dmfs SMD -0.14, 95% CI -0.26 to -0.02; 10 studies; not GRADE-rated). Source: Meta-analysis subgroup (Results); Fig 2 (dmfs forest plot, Comprehensive subgroup) · same question in other reviews | SMD -0.14 [-0.26, -0.02] | 10 studies | Ungraded |
Caries experience at the tooth level (dmft) Comprehensive intervention (vs oral health education only) Comprehensive interventions produced a statistically significant reduction in tooth-level caries (dmft SMD -0.47, 95% CI -0.84 to -0.10; 4 studies; not GRADE-rated), though heterogeneity was very high. Source: Meta-analysis subgroup (Results); Fig 3 (dmft forest plot, Comprehensive subgroup) · same question in other reviews | SMD -0.47 [-0.84, -0.10] | 4 studies | Ungraded |
Oral health education only (verbal, written, or audio-visual education) delivered by non-dental health workers vs Control (usual care, no intervention, or comparison group)
Population: Children (mean age newborn to ~5.2 years) and their parents/carers
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries experience at the tooth level (dmft) Oral health education only (vs comprehensive intervention) Oral-health-education-only interventions showed at most a marginal effect on tooth-level caries (dmft SMD -0.11, 95% CI -0.21 to -0.00; 2 studies; not GRADE-rated). Source: Meta-analysis subgroup (Results); Fig 3 (dmft forest plot, Oral health education subgroup) · same question in other reviews | SMD -0.11 [-0.21, 0.00] | 2 studies | Ungraded |
Caries experience at the surface level (dmfs/defs) Oral health education only (vs comprehensive intervention) Oral-health-education-only interventions did not show a statistically significant effect on surface-level caries (dmfs SMD -0.20, 95% CI -0.43 to 0.03; 2 studies; not GRADE-rated). Source: Meta-analysis subgroup (Results); Fig 2 (dmfs forest plot, Oral health education subgroup) · same question in other reviews | SMD -0.20 [-0.43, 0.03] | 2 studies | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Partial Yes | no |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | Yes | no |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Partial Yes | no |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | No | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Partial Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: Partial Yes · RCT: Partial Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Partial Yes | no |
| Overall | Critically Low | Low | no |
Included primary studies 59
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Biordi 2015 Improving access and provision of preventive oral health care for very young, poor, and low-income children through a new… PMID:25689183 | 1 other review | not stated | not extracted yet | not extracted yet |
| Gibbs et al. 2015 Teeth Tales: a community-based child oral health promotion trial with migrant families in Australia. PMID:26068509 | 1 other review | Caries experience at the surface level (dmfs/defs) | not extracted yet | not extracted yet |
| Vichayanrat 2012 The evaluation of a multi-level oral health intervention to improve oral health practices among caregivers of preschool children. PMID:23082602 | 1 other review | not stated | not extracted yet | not extracted yet |
| Villena 2019 Reducing carious lesions during the first 4 years of life: An interprofessional approach. PMID:31470971 | 1 other review | not stated | not extracted yet | not extracted yet |
| Villena et al. 2019 Reducing carious lesions during the first 4 years of life DOI:10.1016/j.adaj.2019.04.003 | 1 other review | Caries experience at the tooth level (dmft) | not extracted yet | not extracted yet |
| Batliner et al. 2014 Motivational interviewing with American Indian mothers to prevent early childhood caries: study design and methodology of a randomized… PMID:24735707 | this review only | Caries experience at the surface level (dmfs/defs) | not extracted yet | not extracted yet |
| Bentley & Holloway 1993 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Bentley 1993 An evaluation of the role of health visitors in encouraging dental attendance of infants. PMID:8269339 | this review only | not stated | not extracted yet | not extracted yet |
| Biordi et al. 2015 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Braun et al. 2016 A Cluster-Randomized, Community-Based, Tribally Delivered Oral Health Promotion Trial in Navajo Head Start Children. PMID:27439724 | this review only | Caries experience at the surface level (dmfs/defs) | not extracted yet | not extracted yet |
| Chaffee et al. 2013 Cluster-randomized trial of infant nutrition training for caries prevention. PMID:23690364 | this review only | Caries experience at the surface level (dmfs/defs) | not extracted yet | not extracted yet |
| Davies 2005 A staged intervention dental health promotion programme to reduce early childhood caries. PMID:15984138 | this review only | not stated | not extracted yet | not extracted yet |
| Davies et al. 2005 matched by author and year (probable) | this review only | Caries experience at the surface level (dmfs/defs) | not extracted yet | not extracted yet |
| Feldens 2010 Long-term effectiveness of a nutritional program in reducing early childhood caries: a randomized trial. PMID:20406273 | this review only | not stated | not extracted yet | not extracted yet |
| Feldens et al. 2010 Long‐term effectiveness of a nutritional program in reducing early childhood caries: a randomized trial DOI:10.1111/j.1600-0528.2010.00540.x | this review only | Caries experience at the tooth level (dmft) | not extracted yet | not extracted yet |
| Hallas 2015 OHEP: an oral health education program for mothers of newborns. PMID:25547319 | this review only | not stated | not extracted yet | not extracted yet |
| Hallas et al. 2015 OHEP: An Oral Health Education Program for Mothers of Newborns DOI:10.1016/j.pedhc.2014.11.004 | this review only | not stated | not extracted yet | not extracted yet |
| Harrison & Wong 2003 An oral health promotion program for an urban minority population of preschool children DOI:10.1034/j.1600-0528.2003.00001.x | this review only | Caries experience at the surface level (dmfs/defs) | not extracted yet | not extracted yet |
| Harrison 2003 An oral health promotion program for an urban minority population of preschool children. PMID:14667011 | this review only | not stated | not extracted yet | not extracted yet |
| Harrison 2007 Effect of motivational interviewing on rates of early childhood caries: a randomized trial. PMID:18041508 | this review only | not stated | not extracted yet | not extracted yet |
| Harrison et al. 2007 matched by author and year (probable) | this review only | Caries experience at the surface level (dmfs/defs) | not extracted yet | not extracted yet |
| Heilbrunn-Lang 2020 Family-centred oral health promotion through Victorian child-health services: a pilot. PMID:31006023 | this review only | not stated | not extracted yet | not extracted yet |
| Heilbrunn-Lang et al. 2020 Family-centred oral health promotion through Victorian child-health services: a pilot DOI:10.1093/heapro/daz025 | this review only | not stated | not extracted yet | not extracted yet |
| Henshaw et al. 2018 Randomized Trial of Motivational Interviewing to Prevent Early Childhood Caries in Public Housing. PMID:30238060 | this review only | Caries experience at the surface level (dmfs/defs) | not extracted yet | not extracted yet |
| Hoeft et al. 2016 Effectiveness evaluation of Contra Caries Oral Health Education Program for improving Spanish-speaking parents' preventive oral health… PMID:27517458 | this review only | not stated | not extracted yet | not extracted yet |
| Kowash 2000 Effectiveness on oral health of a long-term health education programme for mothers with young children. PMID:10740903 | this review only | not stated | not extracted yet | not extracted yet |
| Kowash et al. 2000 Effectiveness on oral health of a long-term health education programme for mothers with young children DOI:10.1038/sj.bdj.4800431 | this review only | Caries experience at the surface level (dmfs/defs) | not extracted yet | not extracted yet |
| Kressin et al. 2009 Pediatric clinicians can help reduce rates of early childhood caries: effects of a practice based intervention. PMID:19786919 | this review only | not stated | not extracted yet | not extracted yet |
| Leung et al. 2015 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Mattheus 2014 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Mattheus 2014 Efficacy of oral health promotion in primary care practice during early childhood: creating positive changes in parent's oral health… PMID:24984640 | this review only | not stated | not extracted yet | not extracted yet |
| Maupomé 2010 Dental caries in American Indian toddlers after a community-based beverage intervention. PMID:21305835 | this review only | not stated | not extracted yet | not extracted yet |
| Maupome et al. 2010 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Mohebbi 2009 A cluster randomised trial of effectiveness of educational intervention in primary health care on early childhood caries. PMID:19321988 | this review only | not stated | not extracted yet | not extracted yet |
| Mohebbi et al. 2009 A Cluster Randomised Trial of Effectiveness of Educational Intervention in Primary Health Care on Early Childhood Caries DOI:10.1159/000209343 | this review only | not stated | not extracted yet | not extracted yet |
| Nair 2009 Effectiveness of a community oral health awareness program. PMID:19279380 | this review only | not stated | not extracted yet | not extracted yet |
| Nair et al. 2009 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Neumann 2011 Impact of an oral health intervention on pre-school children < 3 years of age in a rural setting in Australia. PMID:21309883 | this review only | not stated | not extracted yet | not extracted yet |
| Neumann et al. 2011 Impact of an oral health intervention on pre‐school children <3 years of age in a rural setting in Australia DOI:10.1111/j.1440-1754.2010.01988.x | this review only | Caries experience at the surface level (dmfs/defs) | not extracted yet | not extracted yet |
| Raj et al. 2013 Short-term impact of oral hygiene training package to Anganwadi workers on improving oral hygiene of preschool children in North Indian… PMID:24279468 | this review only | Caries experience at the tooth level (dmft) | not extracted yet | not extracted yet |
| Sgan-Cohen 2001 Community-oriented oral health promotion for infants in Jerusalem: evaluation of a program trial. PMID:11474913 | this review only | not stated | not extracted yet | not extracted yet |
| Sgan-Cohen et al. 2001 Community‐oriented Oral Health Promotion for Infants in Jerusalem: Evaluation of a Program Trial DOI:10.1111/j.1752-7325.2001.tb03374.x | this review only | not stated | not extracted yet | not extracted yet |
| Smith 2018 Results of a two year dental health education program to reduce dental caries in young Aboriginal children in New South Wales, Australia. PMID:30113789 | this review only | not stated | not extracted yet | not extracted yet |
| Smith et al. 2018 Results of a two year dental health education program to reduce dental caries in young Aboriginal children in New South Wales, Australia DOI:10.1922/cdh_4293smith06 | this review only | Caries experience at the surface level (dmfs/defs) | not extracted yet | not extracted yet |
| Turton Evaluation of a community-based early childhood caries (ECC) intervention in Cambodia. PMID:33200439 | this review only | not stated | not extracted yet | not extracted yet |
| Unkel 2020 Perinatal Oral Health Education and Compliance with the First Dental Visit. PMID:33349299 | this review only | not stated | not extracted yet | not extracted yet |
| Unkel et al. 2020 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Vachirarojpisan 2005 The process and outcome of a programme for preventing early childhood caries in Thailand. PMID:16379164 | this review only | not stated | not extracted yet | not extracted yet |
| Vachirarojpisan et al. 2005 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Van den Branden 2013 Effect evaluation of an oral health promotion intervention in preschool children. PMID:24367066 | this review only | not stated | not extracted yet | not extracted yet |
| Van den Branden et al. 2013 Effect evaluation of an oral health promotion intervention in preschool children DOI:10.1093/eurpub/ckt204 | this review only | not stated | not extracted yet | not extracted yet |
| Vichayanrat et al. 2012 matched by author and year (probable) | this review only | Caries experience at the tooth level (dmft) | not extracted yet | not extracted yet |
| Villalta et al. 2019 Developing an Effective Community Oral Health Workers-"Promotoras" Model for Early Head Start. PMID:31334211 | this review only | not stated | not extracted yet | not extracted yet |
| Whittle 2008 A randomised control trial of oral health education provided by a health visitor to parents of pre-school children. PMID:18435231 | this review only | not stated | not extracted yet | not extracted yet |
| Whittle et al. 2008 matched by author and year (probable) | this review only | Caries experience at the surface level (dmfs/defs) | not extracted yet | not extracted yet |
| Wilson et al. 2013 Evaluating two oral health video interventions with early head start families. PMID:24285957 | this review only | not stated | not extracted yet | not extracted yet |
| Yuan 2007 Evaluating a community-based dental registration program for preschool children living in areas of high social deprivation. PMID:17394892 | this review only | not stated | not extracted yet | not extracted yet |
| Yuan 2019 Evaluating an Oral Health Education Intervention in Chinese Undocumented Migrant Mothers of Infants in Northern Ireland. PMID:30669476 | this review only | not stated | not extracted yet | not extracted yet |
| Yuan et al. 2007 Evaluating a community-based dental registration program for preschool children living in areas of high social deprivation DOI:10.1007/bf03262571 | this review only | not stated | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).