Abstract
Aim
The aim of this study was to improve the oral health of Northland children. The research questions were: (1) does a supervised tooth brushing programme reduce caries and improve oral health-related quality of life in a high caries community; and (2) can an in-school tooth brushing programme successfully be implemented in low-decile schools in Northland?
Background
There are still clear inequalities in the oral health of New Zealanders, with Māori and low socio-economic status families experiencing a high proportion of oral disease, mainly dental decay. The Northland population has high proportions of Māori and a high number of the population reside in low socioeconomic status. Dental caries experience in children in Northland is the highest in the country, and there is no fluoridated water supply. Tooth brushing with fluoride toothpaste is known to reduce the incidence of dental decay. Studies of supervised brushing in schools have shown measurable improvements in oral health, (including a pilot study in Northland). A larger-scale study is needed to reach more children and to examine the feasibility of tooth brushing interventions in the New Zealand setting.
Methods
An ethical review process and funding application were made, along with consultation with the Northland District Health Board (NDHB) and Northland schools. A sample of Intermediate school-age children from five schools was chosen. The children had a full clinical dental examination with radiographs, completed a questionnaire (to assess oral hygiene behaviour and self-reported oral health-related quality of life), and were given a toothbrush and tube of toothpaste to take home. The International Caries Detection and Assessment System (ICDAS) was the index used to record the caries status of the teeth. Four schools were chosen to be control schools, and one of the larger Intermediate schools was chosen to be the intervention school. Children in the latter had a supervised tooth brushing programme throughout an entire school year. A baseline clinical examination with radiographs and questionnaire was repeated at the end of the school year (9 months later). Data were entered into a statistical programme and analysed. Follow-up Oral Health Related-Quality of Life (OHRQoL) data were analysed by calculating the change in score between the baseline and follow-up data for the Child Perception Questionnaire11-14 (CPQ11-14) scores and for each domain. Effect sizes were analysed for each domain and CPQ total. Net caries increment and incidence were calculated for ICDAS data, and traditional DMF data with radiographic adjustment. Multivariate analysis was conducted on the caries data.
Results
This quasi-experimental study has demonstrated that a tooth brushing programme can be successfully implemented in a Northland Intermediate school. The study has shown that, over a one-year period, OHRQoL improved more for children who took part in a supervised tooth brushing programme with a 0.4 (moderate) effect size, than for those who did not with a 0.2 (small) effect size. The children who took part in the brushing programme had improvements in oral health, with more caries reversals and a lower prevalence of new carious lesions than those in the control group. The ICDAS net caries increment for the children in the tooth brushing group was a mean of 11.7 surfaces improved; those in the control group had a mean of 8.6 surfaces which had deteriorated over the course of the school year. Caries incidence for those in the tooth brushing group was 7.3%; the caries incidence for the control group was 71.5%. The multivariate analysis showed that membership of the brushing group was the only statistically significant predictor of a lower net caries increment. Tooth brushing at school removed all oral health inequalities.
Conclusion
The aim of this study—to improve the oral health of Northland children—has been successfully achieved with a supervised tooth brushing programme. This programme has been the first large-scale, fully evaluated tooth brushing programme to be set up and run successfully in New Zealand. The findings show improved caries outcomes at one year for children involved in a supervised tooth brushing programme; it is the first New Zealand study to show this. It is also the first study in the world to show that an overall improvement in OHRQoL can occur in children who take part in a supervised tooth brushing programme. This reinforces the need for policy to consider other approaches to improve children’s oral health in communities that experience high caries and poor oral health.