Effectiveness of a School-Based Oral-Health Education Programme: A Pre-Post KAP and OHI-S Field Study

Does six weeks of structured oral-health education change what children know, do, and actually have on their teeth? This field study measures exactly that in a government upper-primary school, following the school-component logic of the National Oral Health Programme and the Dental Council of India's Training Manual on Oral Health Promotion for Schools.

The team runs a single-group pre–post interventional study among 120 children of classes 5–7 (ages 10–12). Baseline measurements use a translated, pilot-tested KAP questionnaire (knowledge, attitude, practice) and the Simplified Oral Hygiene Index (OHI-S) recorded by one calibrated examiner. The intervention is a six-week programme of weekly classroom modules and supervised tooth-brushing drills using pea-sized fluoride toothpaste, with daily reinforcement through teacher-run brushing charts. Post-intervention measurement at week 8, and a retention check at week 12, quantify whether knowledge, reported practice and plaque/food-debris scores actually moved.

A second government school is kept as a wait-list comparison — it receives the full programme in the following term, so no school is denied the intervention. All measurements are anonymised with roll codes, reported in aggregate, and no child's clinical findings are shared beyond a generic referral note to parents. The final deliverables are a departmental study report (~40 pages), the SPSS analysis output, a school feedback session, and a viva-ready presentation — a complete, DCI-aligned public-health dentistry study that a jury can interrogate from sample size to p-value.

Government schools deliver oral-health content as an occasional lecture, with no baseline measurement, no structured reinforcement and no evidence of effect. Children in classes 5–7 — the age at which permanent teeth erupt and habits set — frequently brush without supervision or fluoride toothpaste, consume sugar frequently between meals, and have plaque and debris scores that predict caries and gingivitis. Dental teams cannot demonstrate whether their education sessions change anything, because nothing is measured before or after; school administrators have no data to decide whether to institutionalise a programme; and the National Oral Health Programme's school component lacks documented, replicable local implementations. There is a need for a measured, ethically conducted, replicable pre–post study that quantifies the effect of a structured six-week oral-health education programme on knowledge, attitudes, reported practices and clinically scored oral hygiene — and leaves the school with a teacher-run kit to sustain the change.

Abstract

Oral diseases remain among the most common chronic conditions of childhood, and untreated dental caries in permanent teeth is the most common health condition worldwide (WHO). In India, the National Oral Health Programme (NOHP) gives schools a formal role in oral-health promotion, and the Dental Council of India publishes a training manual for school oral-health promotion. Yet classroom health talks are often one-off lectures with no measurement of effect. This study measures the effect of a structured six-week programme on knowledge, attitude, practice and clinically scored oral hygiene in a government school.

Introduction

Children aged 10–12 are at a formative stage: permanent dentition has largely erupted, habits are still plastic, and schools provide an existing delivery channel with attendance, teachers and peer groups. Public-health dentistry teaching emphasises indices (OHI-S, DMFT) and health education, but students rarely run a measured education intervention from consent to analysis. This project fills that gap end to end.

Existing situation and the gap

• School 'awareness talks' are episodic: one lecture, a poster, no baseline, no follow-up.
• Published Indian school studies commonly report cross-sectional prevalence (DMFT/OHI-S surveys) rather than measured behaviour change after a structured programme.
• Teachers lack a simple reinforcement kit they can run after the dental team leaves.
• The gap: a transparent, replicable pre–post study with a retention check, honest about its single-group design, and aligned to NOHP's school component.

The proposed study

1. Design: single-group pre–post with a 12-week retention check; a wait-list comparison school receives the programme in the following term.
2. Participants: 120 children, classes 5–7, from one government upper-primary school (sample sized for a 15-point KAP improvement, 80% power, 5% significance, inflated for ~15% attrition).
3. Instruments: KAP questionnaire (translated, back-translated, pilot-tested, alpha >= 0.7) and OHI-S scored by one calibrated examiner (kappa >= 0.8 against a senior examiner on 10 children).
4. Intervention: six weekly modules — tooth structure and decay, brushing technique with models, supervised daily brushing drills, diet and sugar-frequency diary review, fluoride toothpaste guidance, and a teacher kit for reinforcement.
5. Outcomes: mean KAP score, proportion with 'good' oral hygiene (OHI-S <= 1.2), and brushing-frequency practice, measured at baseline, week 8 and week 12.

Feasibility

The team of two, with departmental supervision, can complete permissions in two weeks, run six classroom sessions in six weeks, and finish measurement and analysis in the remaining six. Costs are limited to consumables, printing and travel. The design's main limitation — no concurrent control — is mitigated by the retention check, the wait-list school, and honest reporting.

In scope

• One intervention government upper-primary school (classes 5–7, ages 10–12, target n = 120) and one wait-list comparison school for contextual baseline only.
• Measurements: KAP questionnaire scores and OHI-S at baseline, week 8 (post) and week 12 (retention).
• Intervention: six weekly classroom modules plus supervised daily brushing drills during school hours, using pea-sized fluoride toothpaste.
• Analysis: paired t-test or Wilcoxon signed-rank on scores, McNemar/chi-square on proportions, SPSS output annexed to the report.

Out of scope

• Restorative treatment or any clinical procedure beyond screening-level examination and referral notes.
• DMFT/dmft caries restoration planning; caries is recorded only if used as a descriptive baseline variable.
• Follow-up beyond week 12, out-of-school behaviour, or family-level interventions.
• Any child's individual results shared beyond the generic referral note to parents; all reporting is aggregate.

Research design: single-group pre–post interventional field study with a retention check and a wait-list comparison school. The study runs 14 weeks with a team of two under departmental supervision.

Sampling: all children of classes 5–7 in the intervention school are invited; those with signed parental consent and child assent form the study group (target 120 after attrition allowance); the comparison school provides a term-start contextual baseline on the same instruments. Analysis plan: normality checked (Shapiro–Wilk); pre–post mean KAP and OHI-S compared with paired t-test or Wilcoxon signed-rank; 'good oral hygiene' proportions compared with McNemar; practice items compared with chi-square; p < 0.05 treated as significant; attrition documented per session. Ethics: institutional ethics committee approval; permissions from the district education office and head teacher; written parental consent plus child assent; anonymised roll codes (no names in datasets); aggregate-only reporting; a generic referral note to parents for children needing dental attention, without labelling any child in front of peers; the wait-list school receives the full programme the following term.

The study is a measurement pipeline: approvals feed the baseline, the intervention sits between two identical measurement passes, and analysis closes the loop with feedback to the school. The flowchart below is the study's spine — it is also the table of contents of the report.

flowchart TD
  A["Approvals: ethics committee,<br/>education office, head teacher,<br/>parent consent + child assent"] --> B["Instrument development:<br/>translation, pilot, alpha >= 0.7,<br/>examiner calibration kappa >= 0.8"]
  B --> C["Baseline: KAP questionnaire<br/>+ OHI-S examination"]
  C --> D["Six-week intervention:<br/>weekly modules + supervised<br/>daily brushing drills"]
  D --> E["Post-test week 8:<br/>same KAP + OHI-S"]
  E --> F["Retention check week 12:<br/>KAP + OHI-S"]
  F --> G["Analysis in SPSS:<br/>paired t / Wilcoxon,<br/>McNemar, chi-square"]
  G --> H["Report + school feedback session<br/>+ teacher kit handover"]
  W["Wait-list school:<br/>contextual baseline only,<br/>programme next term"] -.-> G

Within the intervention block, every week follows the same micro-structure so delivery stays consistent across the team:

flowchart LR
  A["Recall last week:<br/>brushing charts"] --> B["New module:<br/>demo on models"]
  B --> C["Supervised brushing:<br/>pea-sized fluoride paste"]
  C --> D["Activity: diary, quiz<br/>or poster"]
  D --> E["Teacher handover:<br/>daily chart tick"]

Every arrow in the first diagram carries its document — approvals register, calibration log, dataset version, session log — so the viva question 'how do you know this happened?' always has a named artefact behind it.

• Extend to a full two-arm cluster design with more schools and a concurrent control, reporting DMFT alongside OHI-S.
• Add a 6-month follow-up to measure sustained practice and teacher-kit survival without dental-team visits.
• Test the teacher kit alone (no dental-team sessions) as a low-cost delivery model for the department's extension activities.
• Adapt the programme for Anganwadi centres and caregivers of younger children under the ICDS platform.