Behavioral oral health interventions improve knowledge and hygiene but not calculus in children
This meta-analysis synthesized evidence from 44 quasi-experimental studies, primarily using pretest/posttest designs often without control groups, evaluating behavior-based oral health interventions in children. The population, specific settings, and follow-up duration were not reported. The analysis examined multiple outcomes, with standardized mean differences (SMD) as the primary effect measure.
The interventions were associated with significant, large improvements in oral health knowledge (SMD=1.98, 95% CI: 1.54-2.42) and self-reported behaviors (SMD=1.52, 95% CI: 0.87-2.17). Clinically, significant improvements were seen in plaque index (SMD=-1.34, 95% CI: -1.72 to -0.96), gingival index (SMD=-1.39, 95% CI: -2.12 to -0.65), oral hygiene index-simplified (SMD=-1.18, 95% CI: -1.65 to -0.71), and debris index (SMD=-1.38, 95% CI: -1.97 to -0.80). However, no significant improvement was found for the calculus index (SMD=-0.15, 95% CI: -0.50 to 0.21). Safety and tolerability data were not reported.
Key limitations include the quasi-experimental nature of the included studies, which often lacked control groups, limiting causal inference. The certainty of evidence is tempered by this design. In practice, these findings support the potential role of behavior-based educational interventions in improving children's oral hygiene knowledge and reducing plaque and gingival indices as part of early prevention programs. However, the lack of effect on calculus suggests these interventions should be viewed as adjuncts to, not replacements for, professional dental care that addresses calculus accumulation.
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