Background: So that resources and manpower are allocated in a way of most benefit to the population, systematic review of available evidence on the effectiveness of programmes and interventions is required. Objectives: To assess the quality of evidence presented in studies carried out to investigate the effectiveness of oral health education in children. Methods: The MEDLINE (PubMed) bibliographic database was searched for English-language articles published from 2005 to 2011. Fifty-five articles were identified by the literature search, and the relevance of each article was determined by examining the title and the abstract. Sixteen original research studies met the inclusion criteria. These articles were read in full and scored independently by two reviewers, with scoring based on predetermined criteria. Articles scoring less than 10 were excluded from the study. For each paper that achieved a validity score of more than 10 (n = 11), data concerning the objectives of the intervention, the types and numbers of participants and the outcomes were extracted from the article. Considering the absence of homogeneity among the articles (as a result of variation in the age of subjects, type of intervention and outcome measures) quantitative analysis was not conducted. The publications were grouped based on their outcome measures: (i) plaque and gingival health; (ii) caries incidence; (iii) knowledge, attitude and oral health-related behaviour; and (iv) toothbrushing skills. Results: The results of this analysis suggest that further efforts are required to synthesise, systematically, current information about dental health education, along with the maintenance of rigorous scientific standards in research.
Key words: Systematic review, health education, children, oral healthSince the 1900s, dental health education has been considered an important and integral part of dental health services and has been delivered to individuals and groups in settings such as dental practice, schools, the workplace, and day-care and residential settings for older adults. The population as a whole has also been targeted using mass-media campaigns. The educational interventions used have varied considerably, from the simple provision of information to the use of complex programmes involving psychological and behaviour-change strategies. The goals of the interventions have also been broad, so that knowledge, attitudes, intentions, beliefs, behaviours, use of dental services and oral health status have all been targeted for change. These efforts are testimony to dentistry’s long-standing, and perhaps pioneering, concern with the prevention of oral disease via changes in knowledge, attitudes and behaviours and the adoption of healthier lifestyles 1 .
Since 2000, substantial literature has emerged describing studies purporting to evaluate the effectiveness of various types and combinations of educational and behaviour-modification techniques. Brown reviewed 57 such studies published between 1982 and 1992 and concluded that dental health education can result in improvements in dental health behaviours and in objective measures of oral health status but was less effective in changing attitudes and knowledge 2 . Perhaps the most important issue is the quality of the designs used in the studies themselves. In order to avoid bias, error and various threats to validity, only the results of randomised controlled trials are usually included in systematic reviews. Locker and Kay reviewed the literature and concluded that the quality of the evidence pertaining to the effectiveness of dental health education is poor 1 .
Dental health education can be delivered to individuals and groups in settings such as dental practice, schools, the workplace and day-care and residential settings for older adults. The importance of giving health education to children is that they are at an early point in their health career. Also, educating children can help us reach their families and community members. Logically, this provides a prime opportunity for influencing attitudes and behaviours at a formative stage. There is debate about the effectiveness of health education and, as a result, evidence-based information should be made available. Hence, this study was conducted with the objective of assessing the quality of the evidence presented in studies, published from 2005 to 2011, on the effectiveness of oral health education in children.
We aimed to identify all randomised controlled trials educating children about oral health. The unit of randomisation was defined as the individual or the group (school, school class, etc.), as long as this was taken into account in the analysis.
The following intervention groups were considered: