Reduction In Incidence Of Caries Research Articles

MODERN SCIENTIFIC TRENDS IN THE TREATMENT AND PREVENTION OF DENTAL CARIES

Background. Dental caries remains the most common disease of humanity today. The results of scientific research and clinical observations show that dental caries is most often treated surgically. The most effective way to reduce caries incidence is through primary prevention. Objective. The purpose of the study is to determine the current state of the problem of treatment and prevention of dental caries, to outline promising directions for solving this problem. Methods. In order to find out the main world trends in the treatment and prevention of dental caries, we studied the English-language papers of authors from Portugal, the USA, Saudi Arabia, Korea, Brazil, China, Argentina, the United Kingdom, Cote d'Ivoire, Italy, Ireland, Germany, France, Norway, Sweden, Denmark, Switzerland, Turkey, Belgium, Poland and Croatia published in 2019–2023, including literature reviews that tracked the fundamental data of previous years. The analysis of literary sources made it possible to determine that world scientists have made significant achievements with methodological and methodical conclusions, conducted a comparative assessment and proposed new ways to solve the problem in modern conditions. Results. The issue of modern scientific trends in the treatment and prevention of dental caries are presented in this paper. It was established that the main methods of primary prevention in dentistry were the use of sealants for pits and fissures, local professional use of fluoride preparations, use of fluorine-containing toothpaste, chlorhexidine mouthwash at home, use of xylitol, recommendations for regular visits to the dentist, adherence to a non-cariogenic diet and oral hygiene habits. An analysis of various treatment approaches for dental caries is presented. An evaluation of the proposed treatment methods was carried out in the aspect of a critical approach to preventive removal of hard tooth tissues. The main prospective directions for improvement of treatment and preventive measures are outlined. Conclusions. Dentistry should begin with the identification and elimination of cariesogenic factors, preventive measures should be dominant. With the elimination of carious disease, the need for related specialties will significantly decrease

DentaSeal: A school-based dental sealant efficiency assessment tool to support statewide monitoring and reporting: A field report.

The evidence base supports effectiveness of dental sealants for prevention of childhood caries in school-aged children. This study describes planning, development, usability testing and outcomes following implementation of DentaSeal, a web-based application designed to accurately track unique student data and generate reports for all Wisconsin school-based sealant placement (SP) programs. Application software development was informed by a steering committee of representative stakeholders who were interviewed to inform design and provide feedback for design of DentaSeal during development and evaluation. Software development proceeded based on wireframes developed to build architectural design. Usability testing followed and informed any required adjustments to the application. The DentaSeal prototype was beta tested and fully implemented subsequently in the public health sector. The DentaSeal application demonstrated capacity to: 1) track unique student SP data and longitudinal encounter history, 2) generate reports and 3) support administrative tracking. In 2019, DentaSeal captured SP data of 47 school-based programs in Wisconsin that sponsored > 7,000 program visits for 184,000 children from 62 counties. Delivery of > 548,000 SP services were catalogued. For public health initiatives targeting reduction in caries incidence, web-based applications such as DentaSeal represent useful longitudinal tracking tools for cataloguing SP in school-based program participants.

Do additional high-fluoride interventions among low caries prevalence orthodontic cases using fixed appliances reduce caries incidence?

Design Three-arm randomised controlled trial (RCT). Three groups were contrasted: group one used only a 1,450 ppm fluoride toothpaste as an adjunctive caries prevention method. Group two used only 5,000 ppm fluoride toothpaste as an adjunctive caries prevention method. Group three was similar to group one but with the addition of a fluoride mouth rinse (0.2% sodium fluoride). The Decayed Initial Filled Surfaces (DIFS) index based on progress radiographs was used as the primary outcome variable.Case selection Prospective orthodontic patients with a low caries prevalence are willing to participate in the RCT.Data analysis Non-parametric statistical tests were used to compare the changes in DIFS between the groups. A Cochrane-Mantel-Haenszel method was applied to control for differences in baseline values during relative risk calculations.Results All groups had an increase in DIFS during treatment (between 36% and 48% of the participants). Caries incidence was not significantly affected in either treatment group when considering two cut-off values for DIFS (one and two points). The same applied to the use of decayed filled teeth as the outcome variable.Conclusions This clinical trial assessed the potential impact of supplementary, high-fluoride interventions on caries incidence during orthodontic treatment with fixed appliances. Included cases had a low caries history. Adjunctive, fluoride-based interventions had no bearing on the incidence of caries as measured through the DIFS index.

Optimization of prevention of dental diseases in pregnant women

Effective prevention of dental diseases during pregnancy, as well as the correct tactics of a dentist and obstetrician-gynecologist is important factors in improving the level of dental health in pregnant women. The aim of research was to increase the effectiveness of the prevention of dental caries and periodontal diseases by introducing a complex of prophylactic and therapeutic measures in pregnant women. The implementation of the prophylaxis scheme is performed in 136 women aged 18-35 years. In the main group (70 women) prophylaxis was carried out using the complex of prophylactic and therapeutic measures developed by us, which includes: professional oral hygiene, oral health treatment, nutrition correction, prescribing the medicines of systemic and local action, training in proper teeth brushing, active sanitary and educational work. In the control group (66 women), the generally accepted prophylaxis scheme was used. Evaluation of the effectiveness of prophylactic and therapeutic measures was determined by indicators of caries incidence during pregnancy, reduction of caries, the dynamics of Papillary-Marginal-Attached Index and Papillary Bleeding Index. The effectiveness of the proposed algorithm of dental diseases prevention for pregnant women was confirmed by 3.45 times lower incidence of dental caries in women of the main group compared to the control group (0.44±0.06 versus 1.52±0.13 tooth, respectively); significant decrease (p<0.001) of Papillary-Marginal-Attached Index values (14.01±1.17 versus 49.25±1.86%), as well as bleeding indices (0.32±0.08 versus 1.82±0.13) and Green-Vermilion (0.89±0.08 versus 1.71±0.12 scores). Regular prophylactic and therapeutic examinations of pregnant women by a dentist, hygienic education and training of expectant mothers, active motivation of women to carry out individual oral hygiene with a constant monitoring of its implementation, correction of nutrition and mineral metabolism, influence on cariogenic and periodontal microbiota of the oral cavity, improvement of physiological enamel mineralization and increasing of hard tooth tissues resistance contributed to the reduction of caries incidence by 71.05±5.42% and the effectiveness of periodontal diseases treatment by 88.46±3.81% in the main group versus 36.84±5.94% in the control group (p<0.001).

Can dental home visits really reduce caries incidence in pre-school children?

Design This was a non-blinded multiple-site randomised controlled clinical trial.Case selection Children, aged 5-6 years, were recruited from 11 government-funded kindergartens (pre-schools) in Selangor, Malaysia. The kindergartens were randomly allocated to either the Intervention Group (n = 185 children) or the Control Group (n = 142 children). A clinical examination was conducted to determine the participants' baseline caries experience. Over a 24-month period (commencing in 2015), the Intervention Group received six -monthly dental home visits (DHVs) to provide the families with oral hygiene and dietary instruction, along with educational leaflets. The Control Group received only the educational leaflets. Caries incidence was measured in terms of both the proportion of children who developed new carious lesions, and the number of primary molars in which new carious lesions were seen at 24 months.Data analysis A chi-squared test was used to compare baseline socioeconomic characteristics as well as the proportion of children in each arm who developed new carious lesions. A t-test was used to compare the mean number of primary molars that developed new caries in each group. In addition, the number needed to treat (NNT) was determined.Results There was a 70% (n = 132) and 71% (n = 100) completion rate for participants in the Intervention and Control Groups, respectively. At 24 months, the key finding was that significantly fewer children in the Intervention Group (14.4%; n = 19) had developed new caries lesions compared to the Control Group (60%; n = 60) (p = 0.001). The NNT was calculated as 2.2, to prevent new caries in one child. After controlling for parental education level and household crowding, children in the Control Group were 8.2 times more likely to develop caries in their primary molars than those in the Intervention Group.Conclusions The authors concluded that in a middle-income country such as Malaysia, six -monthly dental home visits are an effective caries prevention strategy for children aged 5-6 years old from low-income families.

Brushing Teeth and Acute Respiratory Infections in Day Care Facilities: An Ecological Study in Selected Regions of Lower Saxony, Germany (2013-2018)

Dental group prophylaxis in day-care centers with teeth brushing as one of its components is intended to reduce caries incidence and promote dental health. However, various barriers can hinder implementation of this preventive measure. One concern relates to an increased risk of transmission of acute respiratory infections (ARI) in day-care centers. The ZINFEKT study aimed at determining whether and to what extent there are differences in the occurrence of ARI between day-care centers that implement vs. those that do not implement teeth brushing. In an ecological study, 2013-2018 data from the ARI surveillance of the Public Health Agency of Lower Saxony were merged with information from the Dental Services on teeth brushing for n=33 day-care facilities from the urban municipality of Braunschweig, the region of Hannover, and the administrative district of Osnabrück (all Lower Saxony, Germany). Following the concept of patient days from hospital infection surveillance, "ill child weeks" were specified as observational units, defined as weeks for which an ARI had been reported for a registered child. Besides cross-tabulations, relative risks for ill child weeks by teeth brushing and Breslow-Day Tests for interactions with area, size of day-care center, ARI season and time slot with ARI seasons were computed. Overall, the ARI-rate, defined at the proportion of ill child weeks, was 4.6% higher in day-care centers in which teeth brushing took place, vs. centers in which this measure was not implemented (17.9 vs. 13.3%, p<0.0001). In analyses stratified by the geographic and temporal co-variables, the direction of this difference did not change (with one exception: day-care centers with 50 or less registered children) . The assumption that regular teeth brushing is associated with higher ARI rates in day-care centers does seem to have an empirical basis. However, despite the study's limitations (primarily its ecological design and possibly limited representativeness of the day-care centers), the identified difference - due both to its magnitude and possibly improvable hygiene compliance - to our assessment does not speak against brushing teeth as a component of dental group prophylaxis in day-care centers.

Dental drive through model of care to reduce caries incidence

Aim or purposeAn increase in number of people seeking emergency care due to inability to access dental services for general care was seen during COVID-19. This drive through model was developed to screen, educate and prioritise, based on individual risks, patients who were otherwise unable to get dental care due to COVID-19 restrictions.MethodsOn World Oral Health Day, 2021 dental examinations were conducted for patients while they drove through an existing COVID-19 screening clinic. The ICDAS-II index (International Caries Detection and Assessment System), score two to six, was used for caries assessment and management. Patients were categorised into three groups based on number of decayed teeth (less than three, three to six or more than six). The management criteria was based on the ICDAS score of teeth under each of the three categories.ResultsA total of 247 patients were screened and educated on the day. 102 patients with ICDAS score two to four were given education and preventative treatment appointment. While 118 patients with ICDAS score five or six were identified to be at risk of dental emergency in the near future and were booked in for emergency or general treatment. Another 27 patient were given clinical priority based on their periodontal or denture related needs. Patient survey revealed a high satisfaction rate of 92%.ConclusionsThis public health initiative was a great success in providing dental care to the patients during these unprecedented times who would not have had any care otherwise due to COVID-19 restrictions.

Modelling the impact of increase in sugar prices on dental caries in India.

This study aims to assess the impact of raising the price of sugar and/or sugar-sweetened beverages (SSBs) on caries incidence in the Indian population. A tooth-level decision-analytic model was developed to evaluate a change in caries increment after increasing the price of Sugar and SSBs. The transition of a tooth from a caries-free state to the state of tooth loss in both scenarios was modelled with the help of a Markov model for a time horizon of 63years, ranging from 2021 to 2083 for the 12-year-old population cohort of India. A conceptual framework was designed to implicate the possible effects of an increase in sugar prices on the reduction of caries incidence. Health effects were estimated in terms of the number of carious lesions and tooth-loss in both the scenarios and modelled as a product of the dose-response relationship between sugar intake and caries incidence. The model was thus used to establish the number of caries lesions prevented, and tooth-loss avoided. Uncertainties in the parameters were assessed using probabilistic sensitivity analysis. The Monte Carlo method was used for simulating the results 999 times. A 20% rise in the price of sugar is expected to result in the prevention of an average of 1.32 teeth in a lifetime of an individual and prevent 27.96 million tooth-loss incidents among the population cohort of India that will eventually lead to a saving of INR (₹) 3116.32 billion (US$ 42.69 billion) on account of dental caries treatment. Similarly, increasing-price of SSBs by 20% will lead to a 0.86% reduction in carious teeth incidence in an individual's lifetime. Increasing the cost of sugar and/or SSBs will reduce the daily intake of sugar, which will reduce caries incidence and subsequent progression, thereby preventing caries-attributed tooth-loss and saving treatment costs.

Providing sealants at the general anaesthetic assessment visit for children requiring caries-related dental extractions under general anaesthetic: a pilot randomised controlled trial.

Introduction Children experiencing a caries-related dental general anaesthetic (GA) are at high risk of developing new caries. It is thus important to maximise opportunities for prevention.Aim To undertake a pilot randomised controlled clinical trial (RCT) to assess the feasibility of delivering and evaluating the effectiveness of sealing sound permanent molars at the pre-GA assessment appointment in children needing caries-related extractions under GA.Methods Children (5-15 years) scheduled for GA extractions at Birmingham Dental Hospital were randomised to control or sealant groups. At the pre-GA assessment appointment, sound permanent molars were sealed. Participants were followed up at two years.Results In total, 132 children were assessed for eligibility and 100 randomised (50 control, 50 sealant). Forty-nine children in the intervention group had sealants applied. At two years, 82 children returned for follow-up (43 control, 39 sealant). Sealants were retained on 93.5% (244/261) of surfaces sealed at baseline. Overall, 42% (n = 18) of control group participants had dentine caries in at least one permanent molar that was sound at baseline compared with none in the sealant group.Conclusion Following caries-related extractions under GA, children are at high risk of developing new caries in permanent molars that were sound at the time of the GA. Sealant placement during the pre-GA assessment visit is feasible and may reduce caries incidence in this vulnerable group. High-risk families were found to be reliable study participants.

Should dentists recommend sugar-free chewing gum to help prevent decay?

Data sources The following electronic databases were searched: MEDLINE, EMBASE, PsycoINFO, Scopis, WoS, AMED, CENTRAL Open alongside the Open Grey database and Cochrane Library of systematic reviews. In addition, reference lists of included studies and systematic reviews were searched.Study selection Initial screening was undertaken by two independent reviewers against the PICO and inclusion/exclusion criteria. Discrepancies between reviewers were resolved by a third reviewer.Data extraction and synthesis Data were extracted from included studies using a standardised form. Three summary measures were calculated: prevented fraction (PF); standardised mean difference (SMD); and standardised effect size (ES). Where concerns about incomplete data were encountered, authors were contacted to provide clarification; if data were not able to be completed, the study was excluded.Results Following screening, 38 selected manuscripts explored the impact of sugar-free gum (SFG) across all aspects of oral health. From this, data was extracted from 12 studies with dental caries outcomes included; of these, eight explored xylitol gum as the intervention and were analysed separately. A significant reduction in caries incidence was found with the use of SFGs - PF of 28% (95%CI 7%-48%). In the eight trials that used xylitol-only gum as the basis of the intervention, the PF increased to 33% (95% CI 4%-61%). No adverse effects were recorded. There was a high level of heterogeneity among the trials included.Conclusions The use of SFG was shown to have a significant, but tentative, effect in reducing the incidence of caries, compared to those who do not or use other sugar-free alternatives. The authors comment that a considerable degree of variability was noted between the trials reviewed. Further research is required in this field to provide robust empirical evidence.

Lasers to prevent dental caries: a systematic review

ObjectiveTo assess the effectiveness of lasers (at sub-ablative parameters) in reducing caries incidence compared with traditional prophylactic interventions (TPIs) when used alone or together with other TPIs such as pits...

Should dentists recommend sugar-free chewing gum to help prevent decay?

Data sources The following electronic databases were searched: MEDLINE, EMBASE, PsycoINFO, Scopis, WoS, AMED, CENTRAL Open alongside the Open Grey database and Cochrane Library of systematic reviews. In addition, reference lists of included studies and systematic reviews were searched.Study selection Initial screening was undertaken by two independent reviewers against the PICO and inclusion/exclusion criteria. Discrepancies between reviewers were resolved by a third reviewer.Data extraction and synthesis Data was extracted from included studies using a standardised form. Three summary measures were calculated: prevented fraction (PF); standardised mean difference (SMD); and standardised effect size (ES). Where concerns about incomplete data were encountered, authors were contacted to provide clarification; if data was not able to be completed, the study was excluded.Results Following screening, 38 selected manuscripts explored the impact of sugar-free gum (SFG) across all aspects of oral health. From this, data was extracted from 12 studies with dental caries outcomes included; of these, eight explored xylitol gum as the intervention and were analysed separately. A significant reduction in caries incidence was found with the use of SFGs - PF of 28% (95%CI 7%-48%). In the eight trials that used xylitol-only gum as the basis of the intervention, the PF increased to 33% (95% CI 4%-61%). No adverse effects were recorded. There was a high level of heterogeneity among the trials included.Conclusions The use of SFG was shown to have a significant, but tentative, effect in reducing the incidence of caries, compared to those who do not or use other sugar-free alternatives. The authors comment that a considerable degree of variability was noted between the trials reviewed. Further research is required in this field to provide robust empirical evidence.

Controversias del uso de agua potable fluorada

One of the most effective public health measures for controlling the caries has been the drinking water fluoridation. Usually, drinking water contains fluor to reduce caries incidence. In 90s, Chile started a debate about the legitimation of the utilization of drinking water fluoride in whole population and the effects that fluor has on the body, creating a polemic about this policy. The goal of this paper is to explore the controversy between the use of fluoridate drinking water for reducing caries like public health policy, from the point of view of Actor-Network theory. Experts and people of community do not agree about the effectiveness of this measure because of the lack of permission of consumer or the potential negative effects in the human health.

Rol de los Probióticos como Bacterioterapia en Odontología. Revisión de la Literatura

According to WHO and FAO, probiotics are “live microorganisms which when administered in adequate amounts confer a health benefit on the host”. The aimof this paper is to describe the beneficial effects of probiotics on oral disease prevention. The search included the last five years in the Web of Science, PubMedand SciELO. Results showed that probiotics can produce antimicrobials, compete for cell adhesion sites, modulate the immune system and degrade toxins. Thishas led to dental studies that focus on reducing caries incidence, improving the prognosis of periodontitis and decreasing halitosis and candidiasis. Probioticsmay be a valuable adjunct for the prevention of oral diseases. However, there are still doubts about which are the best bacterial strain, dose and timing of administration. Therefore, future longitudinal studies are required.

Regular oral health education is effective in reducing caries incidence whereas fluoride varnish seems to have no added benefit

Memarpour M, Dadaein S, Fakhraei E, Vossoughi M. Comparison of oral health education and fluoride varnish to prevent early childhood caries: a randomized clinical trial. Caries Res. 2016;50(5):433-442. http://dx.doi.org/10.1159/000446877.

Caries Preventive Effect of Sodium Fluoride Varnish on Deciduous Dentition: A Clinical Trial.

The aim of the study is to evaluate the efficacy of intensive application of sodium fluoride varnish in reducing caries incidence among children aged 6 to 7 years. The study was a randomized controlled trial conducted among 6- to 7-year-old children of Sangamner, Maharashtra, India. Nearly 200 randomly selected children were randomized into two groups: Control group and intervention (varnish) group. Dental examination to record the caries experiences was conducted at baseline and at 1-year follow-up. The fluoride varnish was applied for three times in a week for a period of 1 year. Mean decayed, missed, and filled teeth (DMFT) were compared between and within groups using t-test. Out of 200 participants, there were 3 dropouts for control group and 4 for intervention group. Nearly 55% study participants were males and remaining were females. There was a statistically significant difference between the baseline and follow-up caries levels in varnish group for deciduous dentition. Mean caries reduction in this study was 26%. After 1 year of study, we found significant caries reversal in deciduous dentition among the 6- to 7-year-olds after intensive fluoride application. Such a regimen can be advocated to encourage the practitioners and the caregivers alike for early caries prevention. Intensive fluoride application (three times a week) once a year was found to be effective in reducing the incidence of detectable carious lesions and can be advocated to the dental professionals to be incorporated in their routine preventive clinical practice.

Are fluoride releasing dental materials clinically effective on caries control?

Objectives(1) To describe caries lesions development and the role of fluoride in controlling disease progression; (2) to evaluate whether the use of fluoride-releasing pit and fissure sealants, bonding orthodontic agents and restorative materials, in comparison to a non-fluoride releasing material, reduces caries incidence in children or adults, and (3) to discuss how the anti-caries properties of these materials have been evaluated in vitro and in situ. MethodsThe search was performed on the Cochrane Database of Systematic Reviews and on Medline via Pubmed. ResultsCaries is a biofilm-sugar dependent disease and as such it provokes progressive destruction of mineral structure of any dental surface – intact, sealed or restored – where biofilm remains accumulated and is regularly exposed to sugar. The mechanism of action of fluoride released from dental materials on caries is similar to that of fluoride found in dentifrices or other vehicles of fluoride delivery. Fluoride-releasing materials are unable to interfere with the formation of biofilm on dental surfaces adjacent to them or to inhibit acid production by dental biofilms. However, the fluoride released slows down the progression of caries lesions in tooth surfaces adjacent to dental materials. This effect has been clearly shown by in vitro and in situ studies but not in randomized clinical trials. SignificanceThe anti-caries effect of fluoride releasing materials is still not based on clinical evidence, and, in addition, it can be overwhelmed by fluoride delivered from dentifrices.

Effects of chlorhexidine varnish on caries during orthodontic treatment: a systematic review and meta-analysis.

This study aimed to perform a systematic review and meta-analysis to evaluate the effectiveness of chlorhexidine varnish on the reduction of caries incidence during fixed orthodontic treatment. The literature searches involved The Cochrane Library, Medline, Scopus, OpenSigle databases and manual searches. The search on OpenSigle did not produce any additional articles. Clinical studies conducted in patients with orthodontic fixed appliances that used professional application of chlorhexidine varnish were included. The effect-size was calculated and a meta-analysis was performed. From 182 abstracts, a total of six articles fulfilled the inclusion criteria. After reading the full articles, one was excluded because of lack of a control group. Three articles were used for continuous data analysis, and two articles were used for the dichotomous data analysis. The pooled meta-analysis with continuous data demonstrated chlorhexidine varnish effectiveness on caries reduction (p = 0.003), with a mean difference and confidence interval of -1.49 [-2.47, -0.51]. On the basis of the pooled meta-analysis of continuous data, we were able to conclude that professional application of chlorhexidine varnish is effective in caries incidence reduction during fixed orthodontic treatment.

Relationship Between Social and Behavioural Factors and Caries Experience in Schoolchildren in Italy.

The aims of this study were to: 1) determine the oral health status of Campanian (Italy) 5- and 12-year-old schoolchildren; 2) establish an oral health baseline prior to introducing promotion and prevention strategies and appropriate healthcare for specific groups; 3) provide the starting point for monitoring changes over time according to the World Health Organization 2020 global goals for oral health. A cross-sectional observational study was performed on schoolchildren from public schools. 828 children were clinically evaluated, recording DMFT, dmft and SiC (Significant Caries Index). A questionnaire investigating demographic and oral health behaviour was completed by parents. 56.6% of the 5-year-old children were caries free (deciduous dentition) and the mean dmft value was 1.44 ± 2.13. In 12-year-old children, caries prevalence was 35.8%. The mean DMFT value was 1.17 ± 1.96, while the SiC was 3.42 ± 1.97. There were significant relationships between dmft/DMFT (caries experience) and family income level (p < 0.001), mother's educational level (p < 0.001) and history of recent dental visits (p < 0.01). Information drawn from this study can be helpful to describe future and specific dental prevention programmes in order to reduce caries incidence and promote better oral health in the Campania region of Italy.

School-based oral health-education program using experiential learning or traditional lecturing in adolescents: a clinical trial

The aim of this project was to compare the effectiveness of experiential learning (EL) and traditional lecturing (TL) school-based oral health education on the oral health knowledge, attitude, habits, oral hygiene, gingival health and caries incidence of 13-year-old Greek children. Eighty-seven children for the EL group and 80 for the TL group were selected from two areas of Greece. Information on oral health knowledge, attitude and behaviours were obtained using a questionnaire. Dental plaque was recorded using a modified hygiene index, gingivitis was assessed using the simplified gingival index and dental caries was measured by recording the number of Decayed, Missing and Filled teeth (DMFT) using the British Association for the Study of Community Dentistry (BASCD) criteria. All children were examined by two calibrated dentists, using a World Health Organisation (WHO) periodontal probe and artificial light. Questionnaires were delivered and clinical examinations were performed at baseline and at 6 and 18months post-intervention. The EL oral health educational programme was implemented by teachers using the programme's manual. Oral health knowledge had improved significantly (P<0.001) in both groups at 6 and 18months post-intervention. Oral health behaviour (P<0.001) and attitude (P<0.05) had improved significantly at 6months, and oral hygiene and gingival health had improved significantly at both 6 (P<0.001) and 18 (P<0.05) months for the EL group. Lower caries incidence was recorded for the EL group, 18months post-intervention (P<0.05). School-based oral health EL for adolescents was found to be more effective than TL in improving oral health attitude and behaviour at 6months, in improving oral hygiene and gingival health at both 6 and 18months and in reducing caries incidence 18months post-intervention.