The present study was conducted to estimate the prevalence of dental caries and gingival disease among preschool children attending anganwadi centers and to compare the impact of two oral health training packages on knowledge and skills of anganwadi workers (AWW) and on oral health status and habits of preschool children attending anganwadi centers (AWC). The sample size was determined taking alpha error as 0.05 (likelihood of association by chance alone as less that 5%), beta error 0.20 (i.e. statistical power of the study as 80%), and assuming baseline poor dental hygiene of the children as 40% and expected decrease in poor dental hygiene by intervention (oral health training package) to be approximately 15% (effect size) and drop-out rate as 10%. Thus a minimum sample size of 495 children was estimated. Assuming that an anganwadi will contain around 20-25 children in age group of 3-6 years, a total of 21 anganwadis were selected for the study by lottery method.

Baseline oral health examination of children present on the day of visit was done in their respective anganwadis using plain mouth mirror and probe in the broad day-light. Caries was recorded based on dmft index as per WHO criteria .The mothers were also interviewed regarding oral habits of their children .A total of 534 anganwadi children in 3-6 year age group from 21 AWC were examined. Samples of saliva (0.2 ml) of children of AWC were taken in tubes with Snyder media to detect caries susceptibility and incubated at 37 degrees C. The readings were taken at 24, 48, 72 & 96 hrs to detect the colour change in media.

After the survey, the anganwadi workers of Project-1 (n=112) were provided with oral health training package-1 (knowledge only) by means of a power-point presentation on oral health care and hygiene practices. The anganwadi workers of Project-2 (n=98) were provided with oral health training package-2 ( knowledge plus skills) by means practical on the spot demonstration for detection of dental morbidity, brushing and flossing techniques and disclosing dental plaque. The anganwadi workers of intervention groups were distributed a story on oral hygiene. They were told to recite the story to children in their anganwadi centres every day. A poster was also designed with pictorial presentation of dental plaque, dental caries, nursing bottle caries and cariogenic food for putting up in their respective anganwadi centres. Their knowledge and skills were also assessed before and after imparting training. These were then made responsible to impart oral health education to the parents and children during their day to day activities. After 2 months the AWC were visited again for reexamination of children for dental morbidity. The mothers were also interviewed similar to pre-intervention visit regarding change in oral habits of their children. Saliva was also collected in tubes to detect caries susceptibility.

Prevalence of caries in children aged 3-6 years in anganwadis of Chandigarh was found to be 48.3%.It was highest in the age group of 5-6 years (63.2%) and in males (51.2%).The prevalence was highest in urban area (48.3%) and in lower socio-economic group (77.7%). There were no cases of filled teeth in any of the children examined. Out of the total teeth examined for caries, mandibular second molar was most affected. Mean dmft (decayed, missing, filled teeth) score in the population was 2.1± 3.20. The knowledge of anganwadi workers increased significantly post-intervention about brushing habits (reason, duration, frequency of brushing; type of toothbrush, when to change toothbrush), use of toothpaste (amount of toothpaste, level of fluoride required), mouth rinsing habit, primary and secondary dentition, gingival hygiene and flossing. The overall knowledge score of AWWs in both the projects increased significantly after the intervention, but the increase in score was more in Project-2 as compared to Project-1. AWW of project-2 demonstrated better skills in brushing and flossing techniques as compared to project-1 after their respective training.

There was significant increase in brushing habits (twice or more daily) from 4.2% to 9.9%, and rinsing of mouth after meals from 39.5% to 52.2% post-intervention. Caries activity (Snyder test) among children decreased from 48.2% pre-intervention to 31.2% post- intervention. It is therefore justified to say that imparting knowledge and skills to anganwadi workers brings about a desired change in the oral habits and dental morbidity among preschool children.