Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis

Abstract

Background Risk factors for oral disease can potentially be ameliorated by school-based interventions. This review evaluates the effectiveness of primary school-based interventions in improving oral health among children in low-and middle-income countries (LMICs). Methods Our systematic review was conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of effectiveness. Medline, Embase, Global Health, CINAHL, Emcare, Scopus, Web of Science, WHO website, Google Advanced and Google Scholar were searched for experimental and observational studies published between 1995 and 2021 in English. Quality assessment and data extraction of the articles were performed by two independent reviewers. The primary outcome was decayed, missing, and filled teeth/surfaces [dmft(s)/DMFT(S)] scores. Seven meta-analyses were conducted. Results The search yielded 1178 publications and after removing duplicates, 753 remained. A further 648 publications were excluded after screening titles and abstracts. 105 publications were reviewed in full and 34 were included. Narrative synthesis showed school-based interventions had a positive effect on oral health outcomes. Meta-analysis showed a significant positive effect on dental caries measured by DMFT scores (standardised mean difference (SMD) = − 0.33; 95% CI − 0.56 to − 0.10; P = 0.005), net increment in DMFS scores (SMD = − 1.09; 95% CI − 1.91 to − 0.27; P = 0.009), dmft and DMFT/S score > 1 (Risk Ratio = 0.70; 95% CI 0.53 to 0.94; P = 0.02) and plaque scores (SMD = − 0.32; 95% CI − 0.46 to − 0.18; P < 0.00001). Non-significant positive effect was observed for dental caries measured by net increment in DMFT scores (SMD = − 0.34; 95% CI − 0.69 to 0.02; P = 0.06) and DMFS scores (SMD = − 0.26; 95% CI − 0.70 to 0.18; P = 0.24), and gingival health (SMD = 0.12; 95% CI − 0.32 to 0.55; P = 0.60). Certainty of evidence was assessed as very low for all oral health outcomes. Conclusion School-based interventions can be effective in reducing the burden of oral disease among primary school children in LMICs, with skills-based education, teacher training, provision of access to oral health services and parental engagement emerging as particularly promising. Further research is required to provide evidence of effectiveness of primary school-based interventions to improve oral health. Systematic review registration The title of this review was registered with PROSPERO (registration number: CRD42020202599).

A Brief Review on Engaging and Interactive Learning for Children: Exploring the Potential of Metaverse-Based Oral Health Promotion

“…These include: Collaboration between health sectors and metaverse developers: Developers of the metaverse should work with the public and private health sectors to produce tailored content and experiences that support the objectives of oral health education [ 32 ]. Integration into school curriculum: It can enhance accessibility and reach a larger number of children [ 33 ]. Enhancing access and infrastructure: It can be achieved through providing schools and community centers with necessary resources [ 32 ].…”

“… Parental involvement and education: Parental support, participation, and education are important to provide resources and learning materials to their children to grasp the advantages and potential disadvantages of this strategy [ 33 ]. Research and evaluation: The success of metaverse-based oral health promotion for children, including its influence on oral health outcomes, children's engagement and satisfaction, and the program's long-term sustainability, must be continually researched and evaluated [ 33 ]. Addressing equity and inclusion: Efforts should be taken to guarantee that oral health promotion programs built in the metaverse are inclusive and accessible for all kids, regardless of their socioeconomic status, geography, or physical capabilities [ 32 ].…”

“… Educator training and support: To successfully use metaverse-based oral health promotion in their teaching practices, educators need proper training and support. Understanding the technology, the subject matter, and how to provide educational opportunities that are worthwhile for children are all part of this [ 33 ]. Feedback and iterative improvement: The metaverse-based oral health promotion program should regularly gather input from children, parents, educators, and dental professionals.…”

“… Feedback and iterative improvement: The metaverse-based oral health promotion program should regularly gather input from children, parents, educators, and dental professionals. By using an iterative approach, the program remains up-to-date, effective, and in line with the wants and preferences of its users [ 33 ]. Advocacy and policy support and: Supporting policies that encourage the incorporation of metaverse-based oral health promotion in educational and healthcare institutions can promote their wider acceptance and sustainability.…”

Impact of oral intervention on the oral and overall health of children living with HIV in Cambodia: a randomized controlled trial

“…Previous studies identified oral care behavior changes in a relatively short period (2 weeks to 9 months) from oral health education programs [ 22 – 24 ]. Interventions shorter than 2 years are unlikely to significantly improve oral hygiene, such as DMFT scores [ 25 ]. Another meta-analysis revealed insufficient evidence regarding the effectiveness of oral health education programs in reducing dental caries, except for an intervention implemented for > 4 years [ 22 ].…”