Health promotion interventions to improve oral health of adolescents: A systematic review and meta‐analysis

Abstract

Objectives To evaluate the effectiveness of health promotion interventions on oral health knowledge, behaviour and status of healthy adolescents. Methods This review included randomized controlled trials (RCTs) of oral health promotion interventions targeting adolescents. Primary clinical outcomes (gingival health, plaque scores, caries) and secondary proxy outcomes were evaluated. Meta‐analysis of primary outcomes was conducted where possible, with subgroup analysis based on intervention (comprehensive health promotion and education‐only). Results Thirty‐seven eligible publications reporting on 28 unique RCTs of oral health promotion interventions were included. Quality appraisal of studies ranged from 48% to 96%. Interventions reported ranged from single‐session interventions to community‐wide programmes, including clinical preventive procedures and take‐home products. Half used a health behaviour change theory to inform their intervention. The meta‐analysis pooling of results favoured the intervention over control for all clinical outcomes, except DMFS in the education‐only subgroup. Stronger intervention effects were seen in the comprehensive intervention subgroup than the education‐only subgroup for DMFS (P = .02). This effect was slight, but not as clear in all other clinical categories. The majority of studies reported improvements in oral health knowledge, attitudes and behaviours. More positive outcomes were found with longer programmes, especially for dental caries outcomes. Conclusions Oral health promotion programmes targeting adolescents have the ability to improve clinical oral health outcomes in the short and long term. Programmes should use more behavioural theory‐based interactive and strategic methods, including self‐awareness and the use of the wider community and peers for oral health promotion activities over a longer intervention duration.

The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children’s oral health: A systematic review and meta-analysis

“…As the intervention content differed greatly between studies it was not possible to clearly distinguish the most effective type of intervention. However, it can be positively stated that interventions usually employing a variety of methods such as disseminating oral health education with either provision of dental products, community engagement, dental visits or fluoride varnish application were more effective in producing behaviour change [ 22 , 27 , 34 ].…”

“…The I 2 statistic was used for heterogeneity assessment and a random effects model was used. Sub-group analysis based on intervention type- oral health education only (provided through either verbal, written or audio-visual aids) versus comprehensive intervention (including in addition to oral health education, increased level of support such as either motivational interviewing, provision of toothbrushes/toothpastes, community engagement, and fluoride varnish and sealant application) was performed [ 34 ]. Estimated 95% prediction intervals were presented to provide a range in which the point estimate of 95% of future studies will fall, in order to allow for informative inferences to be made from the meta-analyses [ 35 – 37 ].…”

Acceptability of the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial intervention: a qualitative study of perspectives of young people and school staff

“…Furthermore, independent health practices that develop during adolescence continue into adulthood [ 4 ]. Within the UK, oral health promotion initiatives predominantly target children under the age of 11 years [ 5 ] and few interventions focus on improving the oral health of those in secondary school [ 6 ]. Existing interventions have predominantly involved oral health education only, without being underpinned by behaviour change theory or embedded within the school curriculum as recommended by the World Health Organisation’s Health Promoting Schools framework [ 7 ].…”

Development of a secondary school-based digital behaviour change intervention to improve tooth brushing

“…Few interventions are aimed at reducing dental caries in adolescents despite this being a critical stage where health practices are developed [ 3 ]. Examples of current oral health promotion interventions to improve the oral health of adolescents have been categorised into oral health education interventions and more complex interventions involving additional activities such as clinical prevention measures alongside the education component [ 4 ]. However, limitations of existing research include a lack of understanding of factors influencing the oral health behaviours of adolescents has been and little is known about adolescent’s receptiveness to interventions that seek to change these behaviours [ 5 ].…”

“…However, limitations of existing research include a lack of understanding of factors influencing the oral health behaviours of adolescents has been and little is known about adolescent’s receptiveness to interventions that seek to change these behaviours [ 5 ]. Previous research has looked at short-term changes in behaviour only [ 6 ] with further research recommended to develop interventions based on behaviour change theory including long term evaluation [ 4 ].…”