Impact of different modes of school dental health education on oral health-related knowledge, attitude and practice behaviour: an interventional study

  • P. R. GeethaPriyaEmail author
  • S. Asokan
  • D. Kandaswamy
  • S. Shyam
Original Scientific Article



The study was planned to evaluate the effectiveness of three modes of school dental health education (SDHE) on the oral health-related knowledge, attitude and practice (KAP) behaviour of school children.


An interventional study was carried out among 8–9 year old school children from January 2016 to January 2018. Three hundred and sixty children from three schools in Tiruchengode, Tamil Nadu, India participated in this study. Each school was randomly allotted with a mode (drama, modified snake and ladder game, flashcard) of SDHE, which was delivered for 20 min, every 6 months for 2 years. A validated questionnaire with 18 questions was used to record oral health-related KAP behaviour at baseline and after 2 years.


At the end of 2 years, there was an increase in the percentage of correct response for all the nine knowledge questions, in all the three modes. The mean difference in the cumulative knowledge score between baseline and 2 years was 1.39 ± 2.05 for drama mode, 1.8 ± 1.51 for game mode and 1.7 ± 1.5 for flashcard mode of SDHE. There was a significant difference in three knowledge questions and one attitude practice behaviour question between the three groups at the end of 2 years.


All the three modes were effective in improving the oral health-related KAP behaviour of school children. Game mode made a better impact on the knowledge scores of these children, and it was observed to be more child-friendly and entertaining.


Dental health education School health Knowledge attitude practice Modes of health education 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Protocol was approved by the Institutional Ethical Committee (IEC-NI/14/DEC/44/80) of Sri Ramachandra University, Chennai, TamilNadu, India.

Informed consent

Informed consent was obtained from all the children (and their parents) included in the study.


  1. Ahire M, Dani N, Muttha R. Dental health education through the brushing ROBOTUTOR: a new learning experience. J Indian Soc Periodontol. 2012;16(3):417–20.CrossRefGoogle Scholar
  2. Al-Jundi SH, Hammad M, Alwaeli H. The efficacy of a school-based caries preventive program: a 4-year study. Int J Dent Hyg. 2006;4(1):30–4.CrossRefGoogle Scholar
  3. Al-Omiri MK, Al-Wahadni AM, Saeed KN. Oral health attitudes, knowledge and behaviour among school children in North Jordan. J Dent Educ. 2006;70:179–87.PubMedGoogle Scholar
  4. Blaggana A, Grover V, Anjali AK, Blaggana V, Tanwar R, Kaur H, Haneet RK. Oral health knowledge, attitudes and practice behaviour among secondary school children in Chandigarh. J Clin Diagn Res. 2016;10(10):ZC01–6.PubMedPubMedCentralGoogle Scholar
  5. Burt BA. Trends in caries prevalence in North American children. Int Dent J. 1994;44:403–13.PubMedGoogle Scholar
  6. Downer MC. The improving oral health of United Kingdom adults and prospects for future. Br Dent J. 1991;23:154–8.CrossRefGoogle Scholar
  7. Esfahanizadeh N. Dental health education programme for 6-year-olds: a cluster randomized controlled trial. Eur J Paediatr Dent. 2011;12(3):167–70.CrossRefGoogle Scholar
  8. Gambhir RS, Sohi KR, Nanda T, et al. Impact of school based oral health education programmes in India: a systematic review. J Clin Diagn Res. 2013;7(12):3107–10.PubMedPubMedCentralGoogle Scholar
  9. Goel P, Sehgal M, Mittal R. Evaluating the effectiveness of school-based dental health education program among children of different socioeconomic groups. J Indian Soc Pedod Prev Dent. 2005;23:131–3.CrossRefGoogle Scholar
  10. Haleem A, Siddiqui MI, Khan AA. School based strategies for oral health education of adolescents—a cluster randomized controlled trial. BMC Oral Health. 2012;54(12):1–12.Google Scholar
  11. Hartono SW, Lambri SE, van Palestein Helderman WH. Effectiveness of primary school-based oral health education in West Java, Indonesia. Int Dent J. 2002;2(3):137–43.CrossRefGoogle Scholar
  12. Hebbal M, Ankola AV, Vadavi D, Patel K. Evaluation of knowledge and plaque scores in school children before and after health education. Dent Res J. 2011;8:189–96.CrossRefGoogle Scholar
  13. Holst D, Schuller A, Grytten J. Future treatment needs in children, adults, and the elderly. Community Dent Oral Epidemiol. 1997;25:113–8.CrossRefGoogle Scholar
  14. John BJ, Asokan S, Shankar S. Evaluation of different health education interventions among preschoolers: a randomized controlled pilot trial. J Indian Soc Pedod Prev Dent. 2013;31(2):96–9.CrossRefGoogle Scholar
  15. John BJ, Asokan S, Geethapriya PR, Shanmugaavel AK. Dental caries and the associated factors influencing it in tribal, suburban and urban school children of Tamil Nadu, India: a cross sectional study. J Public Health Res. 2015;4(361):23–8.Google Scholar
  16. Kazemian R, Ghasem H, Movahhed T, Kazemian A. Health education in primary school textbooks in Iran in school year 2010–2011. J Dent (Tehran). 2014;11(5):536–44.Google Scholar
  17. Kumar Y, Asokan S, John B, Gopalan T. Effect of conventional and game-based teaching on oral health status of children: a randomized controlled trial. Int J Clin Pediatr Dent. 2015;8(2):123–6.CrossRefGoogle Scholar
  18. Lloyd RP. Seriously considering play: designing interactive learning environments based on the blending of microworlds, simulations and games. Educ Technol Res Dev. 1996;44(2):43–58.CrossRefGoogle Scholar
  19. Maheswari UN, Asokan S, Asokan S, Kumaran ST. Effect of conventional vs game-based oral health education on children’s oral health-related knowledge and oral hygiene status—a prospective study. Oral Health Prev Dent. 2014;12(4):331–6.PubMedGoogle Scholar
  20. Marthaler T, O’Mullane DM, Vbric V. The prevalence of dental caries in Europe 1990–1995. Caries Res. 1996;39:237–55.CrossRefGoogle Scholar
  21. Naidu J, Nandlal B. Evaluation of the effectiveness of a primary preventive dental health education programme implemented through school teachers for primary school children in Mysore city. J Int Soc Prev Community Dent. 2017;7(2):82–9.CrossRefGoogle Scholar
  22. Padmini DB, Thangaraj S, Ranganath TS, Ambiger N. A cross sectional study to assess the oral health knowledge, attitude and practice among school children in rural field practice area of Bangalore Medical College and Research Institute, Bengaluru. Int J Community Med Public Health. 2018;5(12):5385–91.CrossRefGoogle Scholar
  23. Pathania V, Sachdev V, Kirtaniya BC, Jaj HS. Oral health related knowledge attitude and practices amongst school children in Himachal Pradesh, India. Glob J Med Res J Dent Otolaryngol. 2015;15(1):1–5.Google Scholar
  24. Pereira WD. Knowledge, attitude and practice on oral hygiene measures among students in rural areas: Kanchipuram. Pharma Innov J. 2017;6(9):382–5.Google Scholar
  25. Shenoy RP, Sequeira PS. Effectiveness of a school dental education program in improving oral health knowledge and oral hygiene practices and status of 12 to 13 year old school children. Indian J Dent Res. 2010;21(2):253–9.CrossRefGoogle Scholar
  26. Smyth E, Caamano F, Fernandez-Riveiro P. Oral health knowledge, attitudes and practice in 12-year-old school children. Med Oral Path Oral Cir Buccal. 2007;12(8):614–20.Google Scholar
  27. Tai B, Jiang H, Du M-Q, et al. Assessing the effectiveness of a school-based oral health promotion programme in Yichang City, China. Community Dent Oral Epidemiol. 2009;37:391–8.CrossRefGoogle Scholar
  28. Tewari A, Gauba K, Goyal A. Evaluation of KAP of oral hygiene measures following oral health education through existing health and educational infrastructure. J Indian Soc Pedod Prev Dent. 1992;10(1):7–17.PubMedGoogle Scholar
  29. Tolvanen M, Lahti S, Poutanen L, et al. Changes in children’s oral health-related behaviour, knowledge and attitudes during a 3.4 year randomized clinical trial and oral health-promotion program. Eur J Oral Sci. 2009;117(4):390–7.CrossRefGoogle Scholar
  30. Vishwanathaiah S. Knowledge, attitudes and oral health practices of school children in Davangere. Int J Clin Pediatr Dent. 2016;9(2):172–6.CrossRefGoogle Scholar
  31. Wasylko Y, Stickley T. Theatre and pedagogy: using drama in mental health nurse education. Nurse Educ Today. 2003;23:443–8.CrossRefGoogle Scholar
  32. WHO. Promoting health through schools: the World Health Organisation’s Global School Heath Initiative. Geneva: WHO; 1996.Google Scholar
  33. Zanin L, Meneghim MC, Assaf AV, et al. Evaluation of an educational program for children with high risk of caries. J Clin Pediatr Dent. 2007;31(4):246–50.CrossRefGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2019

Authors and Affiliations

  1. 1.Department of Pedodontics and Preventive DentistryKSR Institute of Dental Science and ResearchTiruchengodeIndia
  2. 2.Faculty of Dental SciencesSri Ramachandra UniversityPorurIndia
  3. 3.Department of Public Health DentistryMeenakshi Ammal Dental College and HospitalChennaiIndia

Personalised recommendations