Assessment of the effect of supervised tooth-brushing and use of plaque disclosing agent on oral health status of Primary School Pupils in Dar-es-salaam

Abstract

Background Use of plaque disclosing agent and supervised tooth brushing have shown to be effective in improving children’s oral hygiene status in communities where children have good oral health behavior and home care. Aim The aim of this study was to examine the effect of using plaque disclosing agent to aid tooth brushing and that of supervised tooth brushing on oral hygiene status, gingival health and tooth brushing skills of primary school pupils in Dar es Salaam. Methodology This was a cluster randomized controlled field trial study with two interventions; supervised tooth brushing and use of plaque disclosing agent to guide tooth brushing in 7 to 8 years old children. Cluster sampling design was used to select the participants using a school as a sampling and randomization unit. Following baseline data collection of 245 pupils from ten schools, the schools were randomly allocated into three groups; three schools in each intervention arm and four in a control arm. The pupils were supervised to brush their teeth or to use plaque disclosing agent to aid tooth brushing for three consecutive days and were reminded on the interventions done once a week for a period of two weeks. Interviews (social demographics and oral health related behaviors), dental clinical examination (dental plaque and gingival bleeding) and observation of required tooth brushing skills were used for data collection before and after intervention. Data entry and analysis was done by using SPSS version 20.0. Frequency distribution for proportions, means for intervention outcomes were computed and cross tabulation was conducted to bivariately compare the variables. Paired t-test and one way analysis of variance (ANOVA) were used to compare intervention outcome means from baseline to follow up and examine influence of individual intervention on the intervention outcomes, respectively. Multinomial logistic regression was performed to adjust for the effect of socio-demographics and oral health behaviors on observed changes and was reported as odds ratio and 95% confidence interval; p-value<0.05. Results A total of 245 pupils participated at baseline and 231 at follow-up. They were equally distributed in terms of sex (Female=50.2%) and age (8 years=50.2%), with parents of average education and occupational status. Children who brushed at least twice a day were only 8.2% and less than quarter (26.5%) were supervised during tooth brushing. At baseline, mean plaque score, gingival bleeding and tooth brushing skills were 26.0, 5.8 and 0.2, respectively. They were respectively, 20.3, 3.4 and 0.7 at follow up. Use of plaque disclosing agent had statistical significant effect on plaque and gingival bleeding score. The mean differences for the effect were 2.8 (0.8, 4.8) for plaque and 1.2 (0.4, 2.0) for gingival bleeding. The mean difference for the effect of supervised tooth brushing were 2.2 (0.1, 4.1) for plaque and -1.0 (-1.2,-0.6) for tooth brushing skills. Conclusion Majority of the children had poor oral hygiene, unhealthy gingiva and had no tooth brushing skills at baseline. Supervised tooth brushing showed positive effect on pupil’s tooth brushing skills and oral hygiene status. The use of plaque disclosing agent to aid tooth brushing positively influenced pupils’ oral hygiene status and gingival health. Most socio-demographics and oral hygiene practices had an insignificant influence on the observed outcomes of the interventions.