Assessing the Feasibility of School-Based Oral Health Programmes in Primary Schools in Saudi Arabia: A Pilot Study

Dental caries is one of the most widespread oral health diseases affecting populations worldwide, including Saudi Arabia. Several studies assessing dental caries prevalence in Saudi Arabia have revealed a tremendous increase in its prevalence among children over the last few decades. A systematic review examined the national prevalence of caries among Saudi schoolchildren from 1988 to 2010. The review revealed that dental caries is highly prevalent across Saudi Arabia, particularly in Riyadh City. The caries prevalence in primary teeth was approximately 80% with a mean dmft of 5.0, while in permanent teeth, the prevalence was estimated to be 70% with a mean DMF value of 3.5. A recent systematic review evaluated caries prevalence from 1999 to 2019. The results showed that the proportion level for caries among schoolchildren is high, ranging from 0.21 to 1.00 for primary teeth and from 0.05 to 0.99 for permanent teeth. This emphasises that dental caries remains a significant oral health issue in Saudi Arabia.

In Riyadh city, several studies have consistently indicated a high prevalence of dental caries and DMFT values in children. A national study explored caries prevalence and severity among schoolchildren across Saudi Arabia. This study included a nationwide sample of 19,870 school students. The study found that 65.6% of examined children had caries, with a mean dmft of 3.93 ± 3.60 and a mean DMFT of 2.42 ± 2.52. It was observed that Riyadh City exhibited the highest rate of missing teeth at 10.2%. Despite the lower prevalence of caries reported in this study compared to previous studies, it remained higher than that reported in other countries, such as the United Kingdom, with a caries prevalence of 29.3% among 5-year-old children. This illustrates that caries continues to be a significant concern and the primary oral health issue among Saudi children.

Implementation of oral health programmes in school settings is considered one of the most effective approaches for improving children's oral health, as they can reach many schoolchildren. The report titled "Oral Health Promotion: An Essential Element of a Health-Promoting School" recognised schools as an ideal environment for promoting oral health due to their significant impact on children's oral health status, knowledge, and behaviours. The report shed light on global evidence supporting the efficacy of oral health programmes in schools. It was noticed that countries adopting public health programmes, including school-based oral health programmes, have witnessed a reduction in caries prevalence.

On the other hand, the caries prevalence in Saudi Arabia remains high. Over the years, the Saudi Ministry of Health has been active in promoting oral health and has implemented a range of oral health programmes to enhance oral health, control and prevent oral diseases, including dental caries. However, no consistent national oral health school-based programmes are implemented in Saudi Arabia.

There is strong and sufficient evidence regarding the effectiveness of supervised toothbrushing with fluoride toothpaste on the oral health status of preschool and school children. A study evaluated evidence-based oral health promotion programmes. The findings indicated that supervised toothbrushing interventions have resulted in caries reductions of 40%. The author also reported that supervised toothbrushing interventions are cost-effective and more efficient when specifically targeted towards high-risk populations. The programmes that had the strongest evidence for preventing caries were implemented in Scotland, England, and Jordan. The study in Jordan, a country with a similar cultural background and social norms to Saudi Arabia. The programme lasted four years and involved daily supervised toothbrushing at school. The results showed that children in the supervised toothbrushing group exhibited better caries status and were up to 6 times less likely to have caries than the control group.