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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 2  |  Issue : 2  |  Page : 99-102

The impact of a school based oral hygiene instruction program on the gingival health of middle school children in Riyadh: Saudi Arabia


1 Department of Preventive Dental, Dental Administration, Ministry of Health, Riyadh, Saudi Arabia
2 Department of Oral of Maxillofacial Surgery and Diagnostic Oral Sciences, Research Center, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
3 Eshbelia Dental Center, Ministry of Health, Riyadh, Saudi Arabia

Date of Web Publication14-Jul-2015

Correspondence Address:
Hessa Alwayli
Department of Preventive Dental, Dental Administration, Ministry of Health, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-6816.160775

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  Abstract 

Aim: To determine the impact of a school-based oral hygiene instructions program on the gingival health of children in randomly selected middle schools in Riyadh, Saudi Arabia.
Materials and Methods: Nine hundred and fourteen children were selected from nine schools that were randomly determined from Riyadh City public schools. After obtaining the parents' consent, the criteria-guided enrolment of study participants yielded 457 children in the control group and 457 students in the experimental group. The intervention design was 90 days experimental period with an intermediate follow-up visit at 45 days. A calibrated examiner (HW) measured the plaque index (PI) and the gingival index (GI). The indices were measured at day 1, day 45 and day 90 in both the control and the experimental groups. Results were analyzed with Wilcoxon sign rank test for each index, site, and by sessions for each group to determine if the scores had increased, decreased, or remained the same between intervals.
Results: Plaque and gingival scores in the control group showed a steady improvement throughout the experimental period when compared with the baseline scores. Scores in the experimental group were significantly improved at each session between baseline and session 2 (45 days) and session 3 (90days) respectively.
Conclusions: The continued reduction of GI and PI scores at the end of the intervention observed in this pilot study suggest that a school-based oral hygiene measures program can significantly improve oral health among school children in Saudi Arabia.

Keywords: Childhood gingivitis, preventive dentistry, school oral health


How to cite this article:
Alwayli H, Mosadomi HA, Alhaidri E. The impact of a school based oral hygiene instruction program on the gingival health of middle school children in Riyadh: Saudi Arabia. Saudi J Oral Sci 2015;2:99-102

How to cite this URL:
Alwayli H, Mosadomi HA, Alhaidri E. The impact of a school based oral hygiene instruction program on the gingival health of middle school children in Riyadh: Saudi Arabia. Saudi J Oral Sci [serial online] 2015 [cited 2019 Jun 20];2:99-102. Available from: http://www.saudijos.org/text.asp?2015/2/2/99/160775


  Introduction Top


Saudi Arabia is a country with a serious early childhood oral health problem. While research on this problem has focused mainly on the issue of dental caries, there have been a few studies that have looked at the problem from the perspective of oral hygiene. [1],[2] Studies on attitudes toward oral hygiene in Saudi Arabia have shown that the attitude of school children toward oral hygiene remains negative, and there have been calls for the introduction of school based oral hygiene education. [1],[3],[4]

School based oral hygiene instruction programs are designed to instill oral hygiene habits into children at a young age. [5] Traditionally these programs target preschool, kindergarten, or primary school children. [6],[7],[8] However, literature in Saudi Arabia has shown that teenagers and adolescents continue to have a negative attitude toward oral hygiene, thus suggesting that oral hygiene education is needed not only in primary school, but also in middle school and high school. [1],[2],[9]

While the primary aim of brushing is the prevention of periodontal diseases and tooth decay, a smaller number of studies have been concerned with the therapeutic effect of toothbrushing on gingivitis in school children. [10],[11],[12],[13] This study aimed to evaluate the impact of a school based oral hygiene instruction program on the gingival health of middle school children in Riyadh, Saudi Arabia.


  Materials and Methods Top


Sample selection

Nine public schools in Riyadh, Kingdom of Saudi Arabia were selected using a randomized selection from the list of public middle schools in Riyadh. All students in these enrolled in these schools, aged between 9 and 11 years were screened by a visual examination with a mouth mirror and probe (WHO type II examination) and students who had minimal abnormal gingival inflammatory changes, no evidence of periodontitis and had at least 24 teeth. Students whose teeth had large overhangs, large overcontoured restorations, temporary restorations, or orthodontic applicants were not included. Those who have taken drugs that could the gingiva were also excluded. A total of 914 children were selected from the schools after obtaining informed parental consent. The students who enrolled in the study were randomly divided into experimental (1e) (n = 457) and control (2c) (n = 457) groups.

Intervention design

The study consisted of 90 days experimental period with an intermediate follow-up visit at 45 days. One examiner (Dh) was previously appointed. The students were evaluated by means of a plaque index (PI) and gingival index (GI). The same examiner saw the same sets of students at each session. At baseline (day 0), all children were examined for the baseline PI and GI scores. Following an initial examination, children were subjected to interventions depending on their group.

Control group

Children in the control group were given a soft toothbrush and toothpaste and were told to brush twice a day. No additional oral hygiene measures were administered.

Experimental group

Children in the experimental group were administered detailed oral hygiene instructions. A dental hygienist provided instructions to groups of six to seven students for 15 min. Mouth mirrors, worksheets, and toothbrushes were used for the demonstration. The importance of complete plaque removal twice a day was emphasized, and each student was asked to designate a time of day most convenient for performing a thorough brushing.

All students were re-examined in 45 days. PI and GIs were determined. Final evaluations were made 90 days after the baseline examination.

Statistical analysis

Wilcoxon sign rank test was performed for each index, site, and by sessions for each group to determine if the scores had increased, decreased, or remained the same between intervals.


  Results Top


The data collected were analyzed for each surface, group and session. This was performed for both plaque and gingivitis scores.

Plaque and gingival scores for Group 2c showed a steady improvement throughout the experimental period when compared with the baseline examination [Table 1] and [Table 2].
Table 1: Mean PI scores for Group 1e and 2c

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Table 2: Mean GI scores for Group 1e and 2c

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The result of the sign test are reported for total surfaces in [Table 3] and [Table 4]-A highly significant (P < 0.01).
Table 3: Sign test of PI scores of each site and group comparison for total surfaces

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Table 4: Sign test for GI scores of each site and group comparison for total surfaces

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Scores in Group 1e were significantly better at each session between baseline and session 2 and 3.

However, in Group 1 improvement found between sessions 1 and 2 only. Analysis showed the improvement in plaque scores of Group 1e to be significantly better than Group 2c. This was true for all surfaces at all sessions. The significance of oral hygiene instruction is magnified by the fact that Group 1e continued to show significantly greater improvement than Group 2c (given no oral hygiene instruction).


  Discussion Top


The role of oral hygiene instructions in helping to improve the oral health of communities is a well-established one. [6],[14] There is data from Saudi Arabia shows that plaque and lack of oral hygiene are one of the main causes for the high levels of dental caries in the kingdom. [9] The results of this study show that the same holds good for gingival health as well. The continued reduction of GI and PI scores at the end of the intervention observed in this study suggest that oral hygiene measures can significantly improve oral health in school children.

While traditional school based brushing programs target preschool or primary school children, [6],[15] the decision to implement the intervention in middle school children was taken after reviewing the existing literature from Saudi Arabia that emphasized the need for oral health education among middle school and high school students. [1],[2],[4] The baseline scores obtained in this intervention support the findings of Farooqi et al. who demonstrated high plaque scores and low motivation to brush teeth among Saudi Middle school children.


  Conclusion Top


The acceptance of the oral hygiene instructions by the participants of this study is promising, but should be viewed with caution. While further studies with a longer follow-up period are needed to evaluate the effectiveness and timing of school based intervention, the results of this study are definitely encouraging. Dental public health officials in Saudi Arabia should consider the possibility of implementation of mandatory oral hygiene education among the students of public schools in Saudi Arabia.

Financial support and sponsorship

Nil.

Conflict of interest

There are no conflicts of interest.

 
  References Top

1.
Al-Kheraif AA, Al-Bejadi SA. Oral hygiene awareness among female Saudi school children. Saudi Med J 2008;29:1332-6.  Back to cited text no. 1
    
2.
Al-Otaibi M, Angmar-Månsson B. Oral hygiene habits and oral health awareness among urban Saudi Arabians. Oral Health Prev Dent 2004;2:389-96.  Back to cited text no. 2
    
3.
Amin TT, Al-Abad BM. Oral hygiene practices, dental knowledge, dietary habits and their relation to caries among male primary school children in Al Hassa, Saudi Arabia. Int J Dent Hyg 2008;6:361-70.  Back to cited text no. 3
    
4.
Bhayat A, Ahmad MS. Oral health status of 12-year-old male schoolchildren in Medina, Saudi Arabia. East Mediterr Health J 2014;20:732-7.  Back to cited text no. 4
    
5.
Okada S, Hirayama Y, Kawaguchi Y, Ohara S, Yonemitsu M, Sasaki Y, et al. Effect of careful tooth-brushing instruction by teachers on incipient gingivitis in school children. Kokubyo Gakkai Zasshi 1991;58:113-7.  Back to cited text no. 5
    
6.
Monse B, Benzian H, Naliponguit E, Belizario V, Schratz A, van Palenstein Helderman W. The Fit for School Health Outcome Study - A longitudinal survey to assess health impacts of an integrated school health programme in the Philippines. BMC Public Health 2013;13:256.  Back to cited text no. 6
    
7.
Santamaria RM, Basner R, Schüler E, Splieth CH. Inequalities in dental caries experience among 6-year-old German children after the caries decline. Acta Odontol Scand 2015;73:285-91.  Back to cited text no. 7
    
8.
Yekaninejad MS, Eshraghian MR, Nourijelyani K, Mohammad K, Foroushani AR, Zayeri F, et al. Effect of a school-based oral health-education program on Iranian children: Results from a group randomized trial. Eur J Oral Sci 2012;120:429-37.  Back to cited text no. 8
    
9.
Farooqi FA, Khabeer A, Moheet IA, Khan SQ, Farooq I, ArRejaie AS. Prevalence of dental caries in primary and permanent teeth and its relation with tooth brushing habits among schoolchildren in Eastern Saudi Arabia. Saudi Med J 2015;36:737-42.  Back to cited text no. 9
    
10.
Alves LS, Susin C, Damé-Teixeira N, Maltz M. Tooth loss prevalence and risk indicators among 12-year-old schoolchildren from South Brazil. Caries Res 2014;48:347-52.  Back to cited text no. 10
    
11.
Chiapinotto FA, Vargas-Ferreira F, Demarco FF, Corrêa FO, Masotti AS. Risk factors for gingivitis in a group of Brazilian schoolchildren. J Public Health Dent 2013;73:9-17.  Back to cited text no. 11
    
12.
Gopinath VK, Rahman B, Awad MA. Assessment of gingival health among school children in Sharjah, United Arab Emirates. Eur J Dent 2015;9:36-40.  Back to cited text no. 12
  Medknow Journal  
13.
Yitzhak M, Sarnat H, Rakocz M, Yaish Y, Ashkenazi M. The effect of toothbrush design on the ability of nurses to brush the teeth of institutionalized cerebral palsy patients. Spec Care Dentist 2013;33:20-7.  Back to cited text no. 13
    
14.
Amato JN, Barbosa TS, Kobayashi FY, Gavião MB. Changes in the oral-health-related quality of life of Brazilian children after an educational preventive programme: An 1-month longitudinal evaluation. Int J Dent Hyg 2014;12:226-33.  Back to cited text no. 14
    
15.
Benzian H, Naliponguit EC, Schratz A, Monse B. Philippine school-based toothbrushing program provides daily mass fluoridation. J Dent Res 2012;91:805.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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