School-based strategies for oral health education and examination of adolescents

Objective: To compare the effectiveness of dentist-led (DL), teacher-led (TL), peer-led (PL) and self-learning (SL) strategies of oral health education (OHE) and examination in school setting. Background: OHE and examination in schools have largely been undertaken by dental professionals. Considering the substantial cost of this expert-led approach, the strategies relying on teachers, peer leaders and learners themselves have also been utilized. However the evidence for comparative effectiveness of these strategies is lacking in the dental literature. Methods: A 2-year cluster RCT was conducted involving five groups of adolescents (n=1517) aged 10-11 years at the start of the study. The trial involved process as well as four outcome evaluations. The trial also involved simplified oral examination of 632 adolescents participating in the TL and PL strategies by dentist, teachers and peer leaders at baseline, six and twelve month intervals. Results: All the three educator-led strategies of OHE had statistically higher mean oral health knowledge, behavior (OHB) and oral hygiene status (OHS) scores than the SL and control groups (p<0.001). The PL strategy had statistically better knowledge and OHS scores than the DL and TL strategies (p<0.05). The OHB score of the DL group was significantly higher than those of the PL and TL groups (p<0.05 and p<0.001 respectively). The study showed an acceptable degree of agreement among dentist, teachers and peer leaders regarding oral examination for caries, plaque and calculus (kappa:0.8). Conclusions: The PL strategy of OHE was almost as effective as the DL strategy and comparatively more effective than the TL strategy in improving the knowledge, behavior and oral hygiene status of the study participants. The simplified oral examination performed by teachers and peer leaders was found to be reasonably valid and reliable in school setting.