Systematic Review: Comparing Oral Health Interventions in Schools

This systematic review compares two oral health interventions aimed at improving dental health among school children in Saudi Arabia and Israel. The report analyzes two research papers: one focusing on an oral health education program for female primary school students in Riyadh, utilizing ...Read More

Running head: SYSTEMATIC REVIEW
SYSTEMATIC REVIEW COMPARING TWO HEALTH RELATED INTERVENTION
Name of the Student
Name of the university
Author’s note

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Review of two health improvement interventions
Project title: Identifying the effectiveness of the oral health interventions among the primary
school students in Saudi Arabia and Israel
Brief rationale for the topic chosen
Oral health is associated to general health and the diseases related to oral cavity are one
of the most important public health issue in Saudi Arabia and Israel (Al-Ansari 2014).Dental
caries is one of the most common and preventable disease occurring among the children (Quadri
et al. 2018). Oral diseases in children affect their quality of life both at home and at school. Pain,
bad breath, gum bleeding, dental cavities diminish the quality of life of these children by
affecting their psychosocial aspects (Mulu et al. 2014). Other consequences of oral health
problem among the school gong children are infection causing abscess and cellulitis, poor
appetite, disturbed sleep, emergency visits and hospitalizations, loss of school days with limited
activities , reduction in the ability to concentrate and learn , need for tooth extractions,
premature loss of the primary molar teeth predisposing to malocclusion (Colak et al. 2013).
Other long term effects include the continuation of the poor oral health even in the adulthood
posing higher risks of carious lesions in other healthy teeth and the permanent dentition. Dental
caries in children in Saudi Arabia ranges from high to medium as stated in the world Oral health
report (Quadri et al. 2018).. The main cause of the dental caries are lack of knowledge among the
children, indifference of the parents towards the oral health of the children due to lack of
knowledge, excessive consumption of the sugary and sticky food and inadequate utilization of
the dental care services (Mulu et al. 2014). Risk factors like age, dietary habits, age, sex, socio-
economic status and the oral hygiene status are linked with the increased prevalence of the oral
health services. Association between dental caries and the socio-economic status among the

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school going students of both Saudi Arabia and Israel have been well documented in many of the
studies. Oral health problems has been found to be common among the children who lives in
poverty or in poor economic condition, or those who belong to the racial and the ethnic
minorities, or those who are born to single mothers or those having low economic status (Colak
et al. 2013). Farooqi et al. (2015) have stated that a large proportion of the children from the
urban areas are suffering from dental carries. Authors have presumed that the use of chewing
stick or miswak is the only oral practice in the rural regions (Halawany 2012). Mulu et al. (2014)
have stated that there is an association between the family structure, twice daily tooth brushing,
use of the fluorinated toothpastes and caries and oral hygiene status among the school going
children in Israel.
Review of the articles
In relation to the high prevalence of the dental carries among the school going children of
Riyadh and Israel, two papers have been chosen for the review.
Halawany et al. (2018) in the paper had aimed to determine the effectiveness of the oral
health intervention program on the increasing the knowledge and the self-reported actions among
the 6-8 female primary school children of Riyadh. The levels of knowledge of the school
students are evaluated with the help of a self-administered pictorial questionnaire, that has been
exclusively articulated for this age group. The questionnaire was disseminated before and after
the implementation of the OHE program for measuring the progression in the knowledge. 20
female students from each of the three classes of a government run school in Riyadh is chosen
for the study. The oral health intervention program mainly consisted of an animation video for
four minutes, a lecture presentation and four educational corners. The interventions focused on

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the three messages (brushing of teeth twice in a day, healthy diet and regular dental visits twice
in a year).
The rationale for choosing this paper is because of the current year of publication and it
provided a vivid information about the cost effective school based education interventions that
resulted in an improvement in the knowledge about the oral health behavior among the school
students. It was found that there had been an increase in the overall knowledge score which is
parallel to a Brazilian study that has been conducted with similar school children (Halawany et
al. 2018). The education interventions were in compliance with the communication behavior
change model, one of the oldest model of the health behavior that refers to the beliefs concerning
the perceived susceptibility, severity, benefits and barriers. The questionnaire has been set as per
the perceived knowledge of each of the children. This theory has been found to be appropriate as
children can learn by effective communication and interventions has been carried out by
communicating effectively with the children (Farooqi et al. 2015). The main limitation of this
paper is that it focused only on the female school children and hence the self-reported data might
not be suitable for the entire population. Furthermore, another factor that could have affected the
result is the cross sectional design, the absence of any control group without any intervention
and the short time period between the pre- and the post test for identifying any substantial that
might have occurred.
Another paper by Anaise and Zilkah (1976) focused on the effectiveness of the dental
health education program providing dental health information and suggestions about oral
cleanliness to the school going children in Israel. Both individual and group instructions have
been provided to the students. Tooth brushing instruction and education about the tooth pastes
has been given. The patient hygiene performance method was used for the evaluation of the

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performance of each of the child. Instructions about the main aspects of the periodontal disease
and tooth brushing techniques like rolling stroke (Anaise and Zilkah 1976). The result of the
study had demonstrated that both group interactions and individual interactions has helped in
improving the tooth brushing skills among the students.
One of the strength of this paper is that there are very few papers related to the evaluation
of the dental health education programs or papers demonstrating the perception of the school-
goers about the dental health. A limitation of this paper is the small sample size that cannot be
generalized to the entire population. The future implication for this research is that more dental
health educational programs should be conducted in schools to increase the awareness on oral
health. It has been found that effective health education has brought about changes in knowledge,
induced and have clarified the values bringing a shift in the attitudes and the beliefs (Quadri et al.
2018). These evidences thus provides the rationale for future oral health promotion programs.
The difference between the two papers is that the age group of the target participants are
different. The paper by Halawaney et al.(2014) had examined the effectiveness of the oral health
interventions among the female school children only and the age group chosen is within the
narrow range that cannot be generalized to the entire population. On the other hand the other
paper deals with the target group 11-14 years old, where one can nullify the cause of not being
able to take care of their oral health on their own. Again the paper by Halawany is based on the
self-reported oral behavior, which increases the possibility of response bias unlike the paper by
Anaise and Zilkah (1976).

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References
Al-Ansari, A. A. 2014. Prevalence, severity, and secular trends of dental caries among various
Saudi populations: A literature review. Saudi Journal of Medicine and Medical Sciences, 2(3),
pp.142.
Anaise, J.Z. and Zilkah, E., 1976. Effectiveness of a dental education program on oral
cleanliness of schoolchildren in Israel. Community dentistry and oral epidemiology, 4(5),
pp.186-189.
Colak, H., Dülgergil, C. T., Dalli, M., and Hamidi, M. M. 2013. Early childhood caries update: A
review of causes, diagnoses, and treatments. Journal of natural science, biology, and
medicine, 4(1), 29-38.
Farooqi, F. A., Khabeer, A., Moheet, I. A., Khan, S. Q., Farooq, I., and ArRejaie, A. S. 2015.
Prevalence of dental caries in primary and permanent teeth and its relation with tooth brushing
habits among schoolchildren in Eastern Saudi Arabia. Saudi medical journal, 36(6), pp.737-42.
Halawany, H.S., 2012. A review on miswak (Salvadora persica) and its effect on various aspects
of oral health. The Saudi Dental Journal, 24(2), pp.63-69.
Halawany, H.S., Al Badr, A., Al Sadhan, S., Al Balkhi, M., Al-Maflehi, N., Abraham, N.B.,
Jacob, V. and Al Sherif, G., 2018. Effectiveness of oral health education intervention among
female primary school children in Riyadh, Saudi Arabia. The Saudi Dental Journal.

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Mulu, W., Demilie, T., Yimer, M., Meshesha, K., and Abera, B. 2014. Dental caries and
associated factors among primary school children in Bahir Dar city: a cross-sectional
study. BMC research notes, 7,pp. 949.
Quadri, M.F.A., Shubayr, M.A., Hattan, A.H., Wafi, S.A. and Jafer, A.H., 2018. Oral Hygiene
Practices among Saudi Arabian Children and Its Relation to Their Dental Caries
Status. International journal of dentistry, 2018.