Employment, Social Affairs & Inclusion

Oral Health Education Programme

Evidence level:
 
Evidence of effectiveness:
? - 0 + ++
Transferability:
? - 0 + ++
Enduring impact:
? - 0 +

Project overview

The oral health education programme attempted to reduce caries incidence in infants through better diet and oral hygiene. The mothers were given an interview and counselling for at least 15 minutes at home every 3 months for the first 2 years and twice a year in the third year. This education was given through home visits, commencing at or soon after the time of the eruption of the first deciduous teeth. The focus on diet and oral hygiene varied among treatment groups and the advices mainly consisted of suggesting substituting bottle with feeder cup, brushing child’s teeth twice a day with fluoride toothpaste, and visiting a dentist regularly. The evaluation took place in the UK from 1995 to 1999 on the sample of 228 mothers with children born between 1st January and 30th September 1995 from low socio-economic/high caries suburbs of Leeds.

Practice category

  • Supporting Parenting and Assisting with Childcare
  • Helping Vulnerable Children

Recommendation pillars

  • Enhance family support and the quality of alternative care settings
  • Improve the responsiveness of health systems to address the needs of disadvantaged children
  • Reduce inequality at a young age by investing in early childhood education and care

Countries that have implemented practice

  • United Kingdom

Age groups

  • Young Children (age 0 to 5)

Target groups

  • Low-income Families
  • Mothers
  • Children

Years in operation

  • 1995  - 1999

Scope of practice

  • Local level

Type of organisation implementing practice

  • State/district or Other Sub-national Government

Mode of delivery

  • Face-to-face
  • Individual sessions

Delivery dosage

  • Frequency: Every 3 months for the first 2 years and twice a year in the third year
  • Duration: Less than 1 hour sessions 

Location of practice

  • Family/home based

Evidence of effectiveness

The authors find a strong statistical evidence of improvement in all observed risk factors and outcomes for children and also their mothers. Specifically, the children were given sweets less often, visited dentist more often, and both the children and their mothers had improved oral health both across time and in comparison with the control group. Moreover, the outcomes seem to be improving with additional training, suggesting importance of repetitive visits by the educators.

Evaluation 1

Kowash, M. B., et al. "Dental health education: effectiveness on oral health of a long-term health education programme for mothers with young children." British dental journal 188.4 (2000): 201-205

The study conducted between 1995 and 1996 in the Leeds, UK used a randomized controlled trial design on a randomly selected cohort of 228 mothers with young children from low socio-economic/high caries suburbs. The children were recruited when they were about 8 months of age. The 228 pairs were randomly allocated into our treatment groups, A-D, that received at least 15 minutes interview and counselling in their own home every 3 months of the first 2 years of the study and twice a year in the third year of the study (groups A to C) or once year for all three years (group D). The division was as follows: in Group A, primary emphasis was on diet and with brief instructions regarding oral hygiene; Group B received counselling focused on oral hygiene instruction and briefly on diet; in Group C, counselling was balanced between those two; and Group D received balanced counselling once a year for three years (i.e. less often). The children’s oral health was examined at the end of each year (that is, three times in total). Out of the initial 228 mothers with children who completed the initial assessment, 179 completed the final assessment (i.e. 49 families dropped out).

The control group of 55 mothers and children was formed from mothers included in the eligible population but not selected by a random number algorithm to be included in the treatment groups. They never received any form of relevant formal education as a part of the study and were traced toward the end of the study to agree with dental examination. The control group was examined only once at the end of the study.

All of the treatment groups showed significantly better risk factor outcomes (e.g. lesser consumption of sweets) than the control group (with p-values <0.001). In terms of actual health impacts, 33% of children in the control group were found to have dental caries, whereas only 4% and 0% of children in groups A and B-D (p-value of difference in means <0.001), respectively, had caries during the three years. Overall, the small differences between treatment groups suggest that the focus or frequency of counselling has just a minor effect on the outcomes. At the same time, comparison of outcomes across time shows continuous improvement in risk factor outcomes, meaning that repetitive visits seem to be important.

Summary of Results for Evaluation 1

 

Group A

(diet)

Group B 

(OH)

Group C 

(diet +OH)

Group D

(yearly DHE)

Group E 

(control)

Outcomes improved (statistically significant)

Children with carries

 

4%

0%

0%

0%

33%

Children with gingivitis

 

7%

0%

0%

0%

16%

Frequency of sweet consumption (once a week/once a day/more than once a day)

 

58%/

33%/

9%

64%/

36%/

0%

51%/

47%/

2%

50%/

42%/

8%

5%/

62%/

33%

Frequency of tooth brushing (rarely/once a day/more than once a day)

 

0%/

13%/

87%

0%/

2%/

98%

0%/

10%/

90%

6%/

8%/

86%

33%/

24%/

43%

Frequency of dental visits (never/every 6 months/every 12 months)

 

11%/

85%/

4%

8%/

88%/

4%

16%/

76%/

8%

8%/

89%/

3%

43%/

57%/

0%

Note: All values are in percentage of group population.

Transferability

We have not been able to find any other evaluation of the selected programme beyond the original study.

Practice Materials

  • Practice materials are not available 

Cost information

  • Implementation cost information is not available

Enduring impact

No follow-up on the baseline evaluation was performed.

Evaluation details

The authors were interested in both the actual prevalence of caries and in the development of overall risk factors leading to them. According to the results, all of the treatment groups showed significantly better risk factor outcomes than the control group (with p-values <0.001). Specifically, more than half of the children in the control group were given drinks on demand rather than at meal time (whereas it was <= 17% for groups A-C), 95% consumed sweets at least once a day (compared to <= 50% in the treatment groups), 33% never had their teeth brushed, and 43% never visited dentist. Moreover, groups A-C (those attended more often) also show significantly better mean outcomes in terms of dinking frequency.

In terms of actual health impacts, 33% of children in the control group were found to have dental caries, whereas only 4% and 0% of children in groups A and B-D (p-value of difference in means <0.001), respectively, had one during the three years.

Overall, the small differences between treatment groups suggest that the focus or frequency of counselling has just a minor effect on the outcomes. At the same time, comparison of outcomes across time shows continuous improvement in risk factor outcomes, meaning that repetitive visits seem to be important. Finally, the authors argue that midwives or health visitors could be just as effective as dental personnel in giving counselling as the two educators in the study were a dental hygienist and an outreach paediatric nursing sister and there were no statistically significant differences found in terms of the dental caries or oral hygiene results across these researchers.

Study population

The study conducted between 1995 and 1996 in the Leeds, UK evaluated the effects of oral health education on randomly selected cohort of 228 mothers with young children from low socio-economic/high caries suburbs born between 1st January and 30th September 1995. The study population was chosen by the Office of Population Statistics (OPCS); mothers were approached directly to give their consent with the evaluation.

The control group was formed from mothers in the selected postal districts that were initially selected as meeting the entry requirements but not selected by the computer to be included in the treatment groups. They were traced and approached at the end of the study to agree to a dental examination in order to provide data for comparison. There were 55 mothers with children in the control group. Before that, the control group was never visited or given any form of formal health education. Children’s age at the baseline examination was 11.4 months on average (SD = 3.4).

The population was initially assessed using a structured questionnaire to obtain information regarding demographic and socio-economic status of the family, feeding history and dietary habits, dental health, and oral hygiene practices. There were no significant differences in the mean age of children or their mothers, as well as mother’s level of education between the groups.

Study design

The study was conducted as a randomised controlled trial. The selected children were randomly assigned to one of four treatment groups, A-D, that received at least 15 minutes interview and counselling in their own home every 3 months of the first 2 years of the study and twice a year in the third year of the study (groups A to C) or once year for all three years (group D). The division was as follows: in Group A, primary emphasis was on diet and with brief instructions regarding oral hygiene; Group B received counselling focused on oral hygiene instruction and briefly on diet; in Group C, counselling was balanced between those two; and Group D received balanced counselling once a year for three years (i.e. less often).

The oral examination of children and their mothers in the study groups was conducted by one of the authors in the volunteers’ homes with the help of a mouth mirror and a pen light source. The children in the group E (the control group) were examined at two nursery schools. To assess intra-examiner reproducibility, 10% of mothers and children were examined twice within a 10-day interval. Initial caries was defined as a demineralised area with loss of translucency and manifested caries as the presence of actual cavitation; the periodontal status was examined by scoring gingivitis, debris and calculus using the diagnostic criteria of the Children’s Dental Health Survey in the UK. The examination was done every year with the control group only being assessed once, at the 3 years of children’s age. Out of the initial 228 mothers with children who completed the initial assessment, 179 completed the final assessment (i.e. 49 families dropped out).

Issues to consider

Although not explicitly discussed in the study, it is possible that the observed effects were partially caused by the screening process itself rather than by the education (note that the control group was only examined once at the end of the study). In other words, just the prospect of having teeth examined on a regular basis may have had a ‘disciplining’ effect on the treatment groups.

We were unable to contact the authors to confirm whether there were any later studies using the particular design in the EU or not. However, we have conducted a thorough search through the online databases and have not identified any studies that would specifically target mothers with newborn children and give them equivalent training in similar intervals.

Available resources

Not available

Bibliography

  • Kowash, M. B., et al. "Dental health education: effectiveness on oral health of a long-term health education programme for mothers with young children." British dental journal 188.4 (2000): 201-205

Last updated

June 2019

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