Effectiveness of oral health promotion programmes

Smile agus Sláinte, Ireland’s national oral health policy, aims to transform Ireland’s oral healthcare system by making services more accessible and focusing on prevention rather than just treatment. Oral health promotion supports this shift from acute intervention to preventive care.

This overview of reviews presents evidence to inform the Department of Health on what types of oral health promotion programmes should be provided. It answers the question: What is the evidence regarding the effectiveness of population-based oral health promotion programmes to prevent oral disease and improve oral health?

We found evidence for three population groups: maternal and early childhood (7 reviews), children and adolescents (12 reviews), and older adults (3 reviews). None of the included reviews examined oral health promotion in the general adult population, despite adulthood being a critical period for oral health maintenance.

The highest-quality evidence suggested that diet and feeding practice advice may slightly reduce the risk of dental caries and the number of decayed, missing, and filled primary tooth surfaces in early childhood. There were also findings that oral health education significantly improved mothers’ oral-health-related behaviours when cleaning their children’s teeth, and that it led to reduced biofilm, dental caries, and periodontitis among mothers themselves; however, we had less confidence in these findings. There was no clear pattern of effectiveness for oral health education that was based on behaviour change motivational interviewing.

The highest-quality evidence among the children and adolescent population suggested that oral health education and training interventions incorporating demonstrations, instruction, and action planning may have positive effects on oral hygiene status. Modes of education included leaflets/flashcards/books, smartphone-based/e-learning, and different lecturing approaches. Other findings suggested significant improvements in plaque and gingival scores; however, we had less confidence in these findings.

In relation to oral health education interventions for children and adolescents that were based on general behaviour change theory, improvement was noted for various oral health status indicators. Other findings from oral health education and skills acquisition interventions incorporating hands-on practice and techniques also demonstrated improved oral health indicators at short- and long-term follow-up. Our confidence in both findings was low.

While our confidence in the oral health behaviour outcomes among children and adolescents was low, there was some evidence that peer-led interventions were more promising than interventions delivered by dental professionals or teachers. When oral health interventions combined both training and skills acquisition delivered by dental professionals to children and adolescents, some improvements (e.g. in plaque scores) or mixed effects on other oral health indicators were noted. Again, our confidence in these findings was low.
All three of the included reviews that assessed older adult populations evaluated combined oral health education interventions that incorporated training and skills acquisition delivered to older adults and/or caregivers. Findings were conflicting, with contradictory findings from different time periods and different trial populations. The two more recent, but low-quality, systematic reviews reported significant improvements in dental and denture hygiene, while the earlier, higher-quality review found no difference for the intervention group compared with usual or routine care.

Overall, the findings suggest that oral health promotion interventions may have a positive effect on oral health outcomes across the life-course; however, good-quality evidence is scarce, and the measures used in order to evaluate the effect of the interventions are diverse. Our confidence in findings for individual outcomes ranges from very low to moderate across all population groups and outcomes, with no outcomes supported by high-certainty evidence.

Many interventions demonstrated only short-term effects; sustained improvement tended to benefit from ongoing reinforcement or reminders.

The substantial diversity in intervention types, outcome measures, and methodological limitations makes it difficult to draw firm conclusions about which approaches are most effective.