Byalakere Rudra Chandrashekar describes for SIIC his article published in Indian Journal of Public Health 58(4):235-241, October 2014

Bhopal, India (special for SIIC)
Dental caries and gingival diseases are amongst major dental public health problems affecting around 80% of the school children worldwide. Developing countries can never afford to treat the established dental diseases. The best possible approach for many developing nations is to focus on prevention of these diseases as the cost of neglect also has personal, financial and social implications. The upward trend in dental diseases among school children in many developing countries call for strategic approaches for health and oral health promotion. Parents, teachers and policy makers are unaware of the fact that oral diseases are preventable by simple self care practices. The school teachers whom the students respect and regard can play a significant role in molding the attitude and behavior of children. In this background, the present study evaluated the oral hygiene, plaque, and gingival status among rural children receiving dental health education (DHE) by qualified dentists and school teachers with and without supply of oral hygiene aids.

This study was conducted over six months from May to November 2009 among 15 year old children selected from four rural schools in Nalgonda district, Andhra Pradesh, India after obtaining permission from concerned authorities and parents of these children. After initial screening, and Dental Health Education (DHE), 160 children (forty in each school) who were free from systemic diseases, deleterious and parafunctional oral habits, gross oral defects, severe malocclusion and dental appliances were selected using table of random numbers. Majority of these children were from the lower middle or lower classes with only 18% - 27% of them reported using brush and paste for cleaning their teeth while others used finger with mud, charcoal etc. Almost all the children cleaned their teeth once daily in the morning. The base line examination for oral hygiene status, plaque and gingival scores was carried out by three trained and calibrated dentists using oral hygiene index – simplified (OHI-S), plaque index (PI) and gingival index (GI). Kappa co-efficient for the inter examiner consistency was found to be 0.86, 0.81 and 0.79 for OHI-S, PI and GI respectively. Then, four schools were divided into four intervention groups; Group 1 – control group with no subsequent DHE after the initial health education offered at the time of screening, Group 2: DHE was offered by a qualified dentist at three months interval using the audio-visual aids, Group 3 – DHE was offered by the trained school teachers along with screening for gross calculus deposits, debris etc on a fortnightly basis, Group 4 - DHE was offered by the trained school teachers along with screening for gross calculus deposits, debris etc on a fortnightly basis and these children were also provided the oral hygiene aids (tooth brush and tooth paste). Two teachers each from schools 3 and 4 were trained by a qualified public health dentist using a brochure prepared in local language. The brochure had color photographs of normal and diseased gingiva, calculus and debris deposits and this was handed over to the teachers. The training which was carried out in one of these two schools for a total of six hours on three different days (two hours sessions on three working days) emphasized the oral hygiene practices (method of brushing, importance of rinsing the mouth after each food intake etc.) along with a practical demonstration for carrying out screening using plastic disposable spoons for gross calculus and debris deposits on a group of children. The trained teachers spared one hour every fortnight to educate the children and screen them for gross calculus deposits. The children in group 4 were given the oral hygiene kits (100 gram tooth paste and tooth brush) at three months interval. The post intervention examination was carried out by the same investigators for oral hygiene, plaque and gingival status in one of the schools where all the children from four schools were assembled. This enabled examiner blinding as the investigators examined these children on random basis and the children’s unique ID was entered after their examination. The post intervention examination was done among 141 children from four intervention groups. The dropout rate was 11.88%. The pre and post intervention scores were compared in each group as well as between different groups using relevant statistical tests.

There was no significant difference in the mean OHI-S, Plaque Index and Gingival Index scores between the groups at baseline. However, the post intervention scores revealed a significant difference between the groups with least scores in group 4 and highest score in group 1. The results demonstrated a substantial reduction in OHI- S, PI, GI post-intervention in group 4 followed by group 3. The scores increased in group 1 and 2.

The fact that the children wish to get appreciation by their teachers whom they respect and regard might have prompted them to improve their oral hygiene practices in groups 3 and 4, which in turn might have improved their gingival health as well. The dramatic reduction in the scores in group 4 compared to any of the other groups highlights the importance of supplying the oral hygiene aids to rural children, who belong to low income families which cannot afford to buy tooth brush and paste. The supply of oral hygiene aids free of cost besides motivation and personal supervision by teachers have prompted children in this group to be enthusiastic in maintaining the oral hygiene practices. This finding highlights the need to supply low cost fluoridated tooth pastes along with tooth brushes through the school systems especially in rural areas.

The study demonstrated that the teachers could play a vital role in promoting oral hygiene among school children. The frequent DHE and screening for gross calculus deposits by trained teachers was more effective than infrequent DHE by dental professionals. The children in rural areas need supply of oral hygiene aids (tooth brush and fluoridated paste) on regular basis. However, further long term studies are desirable to validate the results of short term findings in the present study.