Background and Objectives

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

Methods

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

Results

The percentage improvement in total KAP score, oral hygiene and gingival bleeding from baseline to follow up was higher in the intervention group (p <0.05). Though the net caries increment in DMFT and DMFS was higher in the control group, the difference was not statistically significant. The prevented fraction for net caries increment were 23.33% and 20.51% for DMFT and DMFS respectively. Students in the intervention group had a higher proportion of dental attendance (OR 2.92, p <0.001). The changes in treatment index, restorative index and care index were 20.5%, 14.5% and 5.6% respectively in the intervention group. These were significantly higher than that observed in the control group (p <0.001).

Conclusions

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