Abstract
Objective To determine whether oral health promotion brought about any improvement in oral health. Oral health was not limited to clinical measures of knowledge, attitudes and behaviour; the validity of measures to assess these outcomes was also assessed.
Data sources Studies were identified from Medline, E.Med, Cancerlit, Dissertation Abstracts Outline, government documents listings, Current research in Britain, Health service abstracts, reference lists of retrieved articles, personal files of topic experts as well as a hand search of 96 relevant journals. Articles were published in English or with English abstracts between 1980–1995.
Study selection Three types of study design were included: randomised controlled trials, quasi-experimental studies and single group studies. Studies were excluded if no measure of outcome was reported (i.e. descriptive studies).
Data abstraction Each paper identified was classified by study design, target population, setting, outcome measure and follow-up period. A list of 21 items was used to assess quality. Quantitative and qualitative data synthesis was carried out where appropriate.
Main results 192 papers were retrieved: 28 descriptive or theoretical, 1 case study, 36 randomised controlled trials, 80 quasi-experimental and 33 single group studies.
Interventions aimed at reducing caries (7 RCTs) Most studies involved use of some form of fluoride application therefore making it difficult to measure any educational effect.
Interventions aimed at improving oral hygiene (23 RCTs) Not all measured plaque levels in same way. Mean effect in those studies using plaque index was a 0.316 reduction (95% CI 0.063–0.695). As confidence interval crosses zero this means that oral hygiene is not reliably improved by interventions identified in studies.
Interventions aimed at improving gingival health (5 RCTs) Many different indices used to record gingival health. Evidence suggests that if plaque levels are reduced some improvement in gingival health can be expected.
Interventions aimed at improving knowledge, attitudes, beliefs and behaviours (7 RCTs). Due to different ad hoc knowledge scales used it is difficult to compare studies. Studies suggest simple provision of information improves knowledge, and that few differences in behaviour could be attributed to knowledge.
Interventions aimed at altering sugar intake(1 RCT) This study showed a clear increase in recommendations for sugar-free preparations from pharmacists.
Conclusions and recommendations Despite hundreds of studies involving thousands of individuals, we know remarkable little about how best to promote oral health. Sustained use of fluoride reduces caries and good oral hygiene promotes gum health and appears to be related self-esteem. Daily thorough brushing with fluoride toothpaste is an oral health behaviour and is an achievable goal. Manipulation of sugar consumption or other means of promoting oral health has not be proven to be effective. The review also recommended a series of actions for purchasers, policy makers and research.
Kay E J, Locker D. Effectiveness of Oral Health Promotion: a review. Health Education Authority 1997
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Address: E J Kay, Oral Health Development Department, University of Manchester, Manchester M15 6FH, UK
Funding: Commissioned by the Health Education Authority, which is funded by the Department of Health.
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Effectiveness of oral health promotion in changing behaviour is not proven. Evid Based Dent 1, 13 (1998). https://doi.org/10.1038/sj.ebd.6490007
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DOI: https://doi.org/10.1038/sj.ebd.6490007