Insufficient evidence for the efficacy of primary school-based behavioural interventions for reducing caries


This new Cochrane review looked at school-based interventions aimed at changing behaviour related to toothbrushing habits and the frequency of consumption of cariogenic food and drink in children between the ages of 4 and 12 years.

The Cochrane Oral Health Group’s Trials Register, and Cochrane Central Register of Controlled Trials (CENTRAL) ,Medline, Embase, CINAHL, PsycINFO, Current Controlled Trials, ,Web of Science and  Dissertations and Theses via Proquest databases were searched. In addition a number of relevant journals that had not already been searched as part of the Collaboration’s handsearching programme were hand searched.   There were no language or date restrictions.

 Randomised or cluster randomised controlled trials (RCTs) were included. Included studies had to include behavioural interventions addressing both toothbrushing and consumption of cariogenic foods or drinks and have a primary school as a focus for delivery of the intervention.  The primary outcomes were changes in caries or plaque levels.

  • Four studies involving a total of 2302 children were included. One study was at unclear risk of bias and three were at high risk of bias.
  • Only one small with an unclear risk of bias study reported on caries. This found a prevented fraction of 0.65 (95% confidence interval (CI) 0.12 to 1.18) in the intervention group. However, as this is a single study, this should be interpreted with caution.
  • Three studies found less plaque in children receiving the programme but they were not combined in a meta-analysis owing to substantial heterogeneity considered to be due to differences in study design and in the details of the interventions.
  • Secondary outcome measures from one study reported that the intervention had a positive impact upon children’s oral health knowledge.

The authors concluded

Currently, there is insufficient evidence for the efficacy of primary school-based behavioural interventions for reducing caries. There is limited evidence for the effectiveness of these interventions on plaque outcomes and on children’s oral health knowledge acquisition. None of the included interventions were reported as being based on or derived from behavioural theory. There is a need for further high quality research to utilise theory in the design and evaluation of interventions for changing oral health related behaviours in children and their parents.


School-based toothbrushing programmes are a commonly used oral health improvement measure  and many are linked with behavioural interventions but as it would seem from the paucity of available evidence rarely robustly evaluated. Several of the studies that met the initial inclusion criteria were also excluded as they did not include any food or drink components within the intervention.

An earlier Cochrane review by Harris et al (2012) found some evidence to support one-to-one dietary interventions in the dental setting . However, these were more successful for fruit/vegetable and alcohol consumption that dietary sugars.


Cooper AM, O’Malley LA, Elison SN, Armstrong R, Burnside G, Adair P, Dugdill L, Pine C. Primary school-based behavioural interventions for preventing caries. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD009378. DOI: 10.1002/14651858.CD009378.pub2.

Harris R, Gamboa A, Dailey Y, Ashcroft A. One-to-one dietary interventions undertaken in a dental setting to change dietary behaviour. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD006540. DOI: 10.1002/14651858.CD006540.pub2.

Dental Elf   16th Mar 2012  – Evidence for dietary advice aiming to change sugar consumption is poor

Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+