Effect of educational strategy combined with ART on oral health-related quality of life: a controlled clinical trial

SOUSA, Karina Guedes de; GAVIÃO, Maria Beatriz Duarte; CASTELO, Paula Midori; HUAMANI, Juana Rosmeri Salas; FREITAS, Camila Nobre de; MIALHE, Fábio Luiz; BARBOSA, Taís de Souza

doi:10.1590/1807-3107bor-2021.vol35.0136

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Original Research, Social/Community Dentistry • Braz. oral. res. 35 • 2021 • https://doi.org/10.1590/1807-3107bor-2021.vol35.0136 linkcopy

Effect of educational strategy combined with ART on oral health-related quality of life: a controlled clinical trial

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Abstract

This study aimed to assess whether complementing atraumatic restorative treatment (ART) with oral health educational strategies (OHES) improves the perception of oral health-related quality of life (OHRQoL) and clinical oral outcomes. A controlled clinical trial included 93 six- to eight-year-old students from five public schools of Piracicaba, Saltinho, and Charqueada municipalities (State of São Paulo, Brazil) divided into 3 groups (31 children each) which received: OHES (caries-free), ART (dental caries), and ART plus OHES (dental caries). OHRQoL (CPQ8-10-ISF:16), dental caries, biofilm control, and gingivitis were assessed before and 1 month after interventions by one calibrated examiner. OHES consisted of an educational interactive activity performed once a week for four weeks. Data were analyzed using mixed model ANOVA, Chi-square, and Sign tests. After 1 month of follow-up, improvement in gingivitis status, OHRQoL total score, and Functional Limitations, Emotional Well-Being and Social Well-Being domains scores were found in all groups (p < 0.05). The improvement in biofilm control was observed only in the OHES group (p < 0.001; power = 0.98), while a decrease in Oral Symptoms scores was observed only in ART+OHES group (p <0.001; power = 0.99) and a significant change in the perception of oral health was observed in the two groups that received ART (p < 0.05). In conclusion, improvement in overall OHRQoL and oral status was observed in all children, although the effect of including health educational strategies in the treatment plan was determinant for the perception of an improved oral health after restorative treatment.

Child; Dental Caries; Health Education; Oral Hygiene

Follow-up time	OS	FL	EWB	SWB

	Mean (SD)
Baseline
OHES	2.4 (1.5)	1.0 (1.2)	0.9 (1.7)	0.8 (1.2)	5.1 (4.2)
OHES+ART	2.9 ^A (1.6)	1.7 (1.8)	2.2 (2.6)	1.7 (2.0)	8.5 (6.6)
ART	2.7 (1.8)	1.8 (2.0)	1.7 (1.9)	1.0 (1.3)	7.1 (5.6)
1-month after intervention (OHES and/or ART)
OHES	1.9 (1.4)	1.0 (1.6)	0.5 (1.2)	0.6 (1.6)	4.1 (4.8)
OHES+ART	1.6 ^B (1.2)	1.2 (1.6)	1.0 (1.5)	0.7 (1.0)	4.4 (4.2)
ART	2.3 (2.0)	1.1 (1.9)	1.0 (2.0)	0.9 (1.5)	5.3 (6.2)
Results of the Two-way Mixed Model ANOVA	F (p-value)
Time effect	20139 (< 0.001)	4092 (0.046)	11669 (< 0.001)	5273 (0.024)	14804 (< 0.001)
Time*group interaction effect	3663 (0.030)	1108 (0.335)	1155 (0.320)	2393 (0.097)	2308 (0.105)

Variable	“How much do your teeth or mouth bothers you in your everyday life?”		“Compared to the first time you answered the questionnaire, you think that the health of your mouth and teeth…”
OHES (n = 31)	Baseline		One month after OHES
	Not at all	17 (55)	Improved	16 (52)
	A little	13 (42)	Stayed the same	13 (42)
	A lot	1 (3)	Worsened	2 (6)
OHES + ART (n = 31)	Baseline		One month after OHES + ART
	Not at all	10 (32)	Improved	24 (77)
	A little	13 (42)	Stayed the same	7 (23)
	A lot	8 (26)	Worsened	0 (0)
ART (n = 31)	Baseline		One month after ART
	Not at all	17 (55)	Improved	26 (84)
	A little	9 (29)	Stayed the same	5 (16)
	A lot	5 (16)	Worsened	0 (0)
	p-value*	0.0774	p-value*	0.0172

“When you think about your teeth or mouth, would you say that they are…”

OHES (n = 31)	Baseline	One month after OHES	p-value*
Excellent	18 (58)	22 (71)	1.000
Average	12 (39)	6 (19)
Poor	1 (3)	3 (10)

OHES+ART (n = 31)	Baseline	One month after OHES+ART

Excellent	15 (48)	26 (84)	0.019
Average	12 (39)	4 (13)
Poor	4 (13)	1 (3)

ART (n = 31)	Baseline	One month after ART

Excellent	15 (47)	22 (71)	0.057
Average	14 (45)	9 (29)
Poor	2 (6)	0 (0)

Follow-up time	Group	Biofilm score	Gingivitis score

		Mean (SD)
Baseline	OHES	1.8 ^A (1.7)	1.1 (1.5)
	OHES+ART	1.1 (1.5)	0.7 (1.4)
	ART	1.0 (1.6)	0.7 (1.4)
1-month after intervention (OHES and/or ART)	OHES	0.6 ^B (1.1)	0.2 (0.8)
	OHES+ART	0.5 (1.0)	0.3 (0.2)
	ART	0.9 (1.4)	0.6 (1.2)
Results of the two-way mixed model ANOVA		F (p-value)
Time effect		13961 (< 0.001)	14878 (< 0.001)
Time*group interaction effect		3752 (0.027)	2128 (0.125)

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Sociedade Brasileira de Pesquisa Odontológica - SBPqO Av. Prof. Lineu Prestes, 2227, 05508-000 São Paulo SP - Brazil, Tel. (55 11) 3044-2393/(55 11) 9-7557-1244 - São Paulo - SP - Brazil
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[TFN1] OS: oral symptoms; FL: functional limitations; EWB: emotional well-being; SWB: social well-being; SD: standard deviation; OHES: oral health educational strategy group; OHES+ART: oral health educational strategy and atraumatic restorative treatment group; ART: atraumatic restorative treatment group; OHRQoL: oral health-related quality of life. A ≠ B (p < 0.001; one-way ANOVA repeated measures/simple main effect). Numbers in bold are significant p-values.