Effectiveness of an Oral Health Curriculum in Reducing Dental Caries Increment and Improving Oral Hygiene Behavior among Schoolchildren of Ernakulam District in Kerala, India: A Cluster-randomized Trial
Abstract
Background: Oral diseases affect over 3.5 billion people globally, with children in low- and middle-income countries disproportionately impacted. This study aimed to evaluate the effectiveness of an oral health curriculum in reducing dental caries increment and improving oral hygiene behavior among high school students in the Ernakulam district of Kerala, India. Methods: A cluster-randomized, parallel-group trial was conducted in six English-medium high schools in Ernakulam, Kerala, India, involving 1707 students aged 13–15 years. Schools were assigned to receive an oral health curriculum delivered either by a dental professional or a trained schoolteacher. The “Everlasting Smiles” curriculum was implemented over 24 months through six sessions with periodic reinforcement, covering key oral health topics. Outcomes assessed at baseline, 12, and 24 months included the primary outcome (decayed, missing, and filled teeth [DMFT]) and secondary outcomes (oral hygiene index simplified [OHI-S] and oral health-related knowledge, attitude, and behavior scores). Results: Significant improvements in oral health-related knowledge (mean: 8.03–8.76), attitude (2.77–3.23), and behavior (2.38–2.64) scores over 24 months (P < 0.001), postintervention. Dental caries levels decreased, with DMFT reducing from 1.65 to 1.47 (P = 0.011) and DMFS from 2.01 to 1.81 (P = 0.018). Dentist-led interventions consistently showed greater improvements than teacher-led ones. Oral hygiene scores improved substantially, with OHI-S declining from 1.06 to 0.74 (P < 0.001). Conclusions: A structured school-based oral health curriculum significantly reduces dental caries and improves oral hygiene behaviors. Integrating it into schools provides a scalable, cost-effective way to promote lifelong oral health and lasting public health benefits. Trial registration number: Clinical Trial Registry of India (CTRI/2022/09/045410), registered on September 12, 2022.
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BibTeX
@article{das2026effectiveness,
title = {{Effectiveness of an Oral Health Curriculum in Reducing Dental Caries Increment and Improving Oral Hygiene Behavior among Schoolchildren of Ernakulam District in Kerala, India: A Cluster-randomized Trial}},
author = {Hindol Das and Chandrashekar Janakiram and S. Vijay Kumar and Georg Gutjahr and Sandra Chaithanyam Bijukumar and Vineetha Karuveettil and Venkitachalam Ramanarayanan and Parvathy Balachandran and Balagopal Varma},
journal = {Contemporary Clinical Dentistry},
year = {2026},
month = jul,
doi = {10.4103/ccd.ccd_19_26},
url = {https://doi.org/10.4103/ccd.ccd_19_26},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Effectiveness of an Oral Health Curriculum in Reducing Dental Caries Increment and Improving Oral Hygiene Behavior among Schoolchildren of Ernakulam District in Kerala, India: A Cluster-randomized Trial
AU - Hindol Das
AU - Chandrashekar Janakiram
AU - S. Vijay Kumar
AU - Georg Gutjahr
AU - Sandra Chaithanyam Bijukumar
AU - Vineetha Karuveettil
AU - Venkitachalam Ramanarayanan
AU - Parvathy Balachandran
AU - Balagopal Varma
PY - 2026
DA - 2026/07/01
JO - Contemporary Clinical Dentistry
DO - 10.4103/ccd.ccd_19_26
UR - https://doi.org/10.4103/ccd.ccd_19_26
AB - Background: Oral diseases affect over 3.5 billion people globally, with children in low- and middle-income countries disproportionately impacted. This study aimed to evaluate the effectiveness of an oral health curriculum in reducing dental caries increment and improving oral hygiene behavior among high school students in the Ernakulam district of Kerala, India. Methods: A cluster-randomized, parallel-group trial was conducted in six English-medium high schools in Ernakulam, Kerala, India, involving 1707 students aged 13–15 years. Schools were assigned to receive an oral health curriculum delivered either by a dental professional or a trained schoolteacher. The “Everlasting Smiles” curriculum was implemented over 24 months through six sessions with periodic reinforcement, covering key oral health topics. Outcomes assessed at baseline, 12, and 24 months included the primary outcome (decayed, missing, and filled teeth [DMFT]) and secondary outcomes (oral hygiene index simplified [OHI-S] and oral health-related knowledge, attitude, and behavior scores). Results: Significant improvements in oral health-related knowledge (mean: 8.03–8.76), attitude (2.77–3.23), and behavior (2.38–2.64) scores over 24 months (P < 0.001), postintervention. Dental caries levels decreased, with DMFT reducing from 1.65 to 1.47 (P = 0.011) and DMFS from 2.01 to 1.81 (P = 0.018). Dentist-led interventions consistently showed greater improvements than teacher-led ones. Oral hygiene scores improved substantially, with OHI-S declining from 1.06 to 0.74 (P < 0.001). Conclusions: A structured school-based oral health curriculum significantly reduces dental caries and improves oral hygiene behaviors. Integrating it into schools provides a scalable, cost-effective way to promote lifelong oral health and lasting public health benefits. Trial registration number: Clinical Trial Registry of India (CTRI/2022/09/045410), registered on September 12, 2022.
SN - 0976-237X
SN - 0976-2361
ER -