Limited evidence available for the impact of school-based behavioural interventions on oral health

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The Cochrane Oral Health Group's Trials Register, and Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, PsycINFO, Current Controlled Trials, ClinicalTrials.gov, Web of Science and Dissertations and Theses via Proquest databases were searched. A number of relevant journals, (Acta Odontologica Scandinavica, ASDC Journal of Dentistry for Children, British Dental Journal, Caries Research, Community Dental Health, Community Dentistry and Oral Epidemiology, Journal of the American Dental Association, Journal of Dental Research, Journal of Public Health Dentistry, Swedish Dental Journal, International Journal of Paediatric Dentistry) not already searched as part of the Cochrane Journal Handsearching Programme were handsearched. There were no restrictions regarding language or date of publication. Randomised controlled trials (RCTs) where randomisation occured at the level of the group (cluster by school and/or class) or individual children were included. Included studies had to include behavioural interventions addressing both toothbrushing and consumption of cariogenic foods or drinks and have a primary school as a focus for delivery of the intervention. Two pairs of review authors independently extracted data related to methods, participants, intervention design including behaviour change techniques (BCTs) utilised, outcome measures and risk of bias. A qualitative synthesis was conducted. Four studies involving a total of 2302 children were included. One study was at unclear risk of bias and three were at high risk of bias. The studies were heterogeneous in both intervention and outcome measures and also suffered from poor reporting. Only one included study reported caries development as an outcome. This small study at unclear risk of bias showed a prevented fraction of 0.65 (95% confidence interval (CI) 0.12 to 1.18) in the intervention group. However, as this is based on a single study, this finding should be interpreted with caution. All three studies that reported plaque outcomes found statistically significant reduction in plaque in the intervention groups, but due to differences in plaque reporting between studies these could not be combined. Two of these studies included an active home component where parents were given tasks relating to the school oral health programme (games and homework), to complete with their children. Secondary outcome measures from one study reported that the intervention had a positive impact upon children's oral health knowledge. Currently, there is insufficient evidence for the efficacy of primary school-based behavioural interventions for reducing caries. There is limited evidence for the effectiveness of these interventions on plaque outcomes and on children's oral health knowledge acquisition. None of the included interventions were reported as being based on or derived from behavioural theory. There is a need for further high quality research to utilise theory in the design and evaluation of interventions for changing oral health related behaviours in children and their parents.