Transient effect of a short-term educational programme without prophylaxis on control of plaque and gingival inflammation in school children.

Abstract

The development of chronic inflammatory periodontal diseases is strongly correlated with the growth and maturation of subgingival bacterial colonies. Consequently a major preventive goal should be the control of plaque formation. We conducted a randomized, controlled trial to examine the short-term effect of an intensive instructional program without professional prophylaxis on the gingival health of 240, 11-14 year old school children. Plaque index (PlI), gingival index (GI), bleeding index (BI) and probing pocket depth (PD) were examined 4 x by 1 examiner blinded to the instruction. During the period of instruction, subjects in the experimental groups were involved in a plaque and gingivitis prevention program provided in separate educational sessions. One of the experimental groups (E-1; n = 80) was provided with a new toothbrush, toothpaste and instruction while the second experimental group (E-2; n = 80) was provided with toothbrush, toothpaste, dental floss and instruction. In the control group (C; n = 80) only dental examinations were provided: no preventive program or oral health measures were conducted. Examinations were conducted every 3 months during the instructional period and at 6 months following the completion of the active preventive programme. During the experimental period there was a significant decrease (p < 0.001) in the mean PlI, GI and BI of the experimental groups following the program while in controls there was a slight but not significant increase of mean values (p > 0.05). During the preventive program experimental groups exhibited small but not significant (p > 0.05) reductions of PD. Experimental group 1 showed similar PlI, GI, BI and PD scores as experimental group 2 during the study. After the instructional program was completed and a period of 6 months had passed, there was a large and significant (p < 0.001) increase of mean PlI, GI and BI scores in both experimental groups back to the baseline levels. We conclude that a short-term preventative program without professional instrumentation induces a transient improvement of gingival health of schoolchildren but only during the instructional period. The maintenance of improved gingival health over longer time periods requires prolonged, repeated instruction by professionals. These measures may be difficult to institute and are of questionable cost-effectiveness.