Evaluation of a school oral health program among 12-14 year old children implemented by school health nurses and teachers in Kottayam – A Community Intervention study

Backgroundand Objectives

Loworal health priority and poor access to dental care have contributed to largeunmet oral health needs in rural communities in developing nations such as India.The role of school based oral health promotion delivered by teachers and schoolhealth nurses has not been evaluated so far. This study compared the changes inoral health knowledge, attitude, practices (KAP) and oral health indicatorsamong 12-14 year old children who received a school based oral health promotionto age matched controls from a different panchayat.

Methods

Aschool based cluster randomized design was used. The intervention, provided byschool teachers and school health nurses appointed by National Health Mission, consistedof oral health education (once in 3 months), weekly classroom based sodiumfluoride mouth rinsing for one year and biannual oral health screening/referral by school health nurses. The control arm did not receive theseinterventions. Oral health indicators and KAP were evaluated at baseline andone-year follow-up.  KAP was assessedusing a self-administered questionnaire in Malayalam. Oral health indicatorsincluded oral hygiene index simplified, net caries increments using DMFT/DMFS, preventedfraction, number of sites with gingival bleeding, changes in care index,restorative index, treatment index and dental attendance.

Results

The percentageimprovement in total KAP score, oral hygiene and gingival bleeding frombaseline to follow up was higher in the intervention group (p <0.05). Though the net cariesincrement in DMFT and DMFS was higher in the control group, the difference wasnot statistically significant. The prevented fraction for net caries incrementwere 23.33% and 20.51% for DMFT and DMFS respectively. Students in theintervention group had a higher proportion of dental attendance (OR 2.92, p <0.001). The changes in treatmentindex, restorative index and care index were 20.5%, 14.5% and 5.6% respectivelyin the intervention group. These were significantly higher than that observedin the control group (p <0.001).

Conclusions

Inclusionof available primary care auxiliaries like school health nurses and teachers inoral health promotion is an effective and sustainable strategy to improve oralhealth indicators and utilization in rural areas in Kerala. The adoption ofthis school oral health policy will enable us to address the problems in oralhealth and achieve progress at par with the excellent general health indicatorsof Kerala.