龋齿的存在会影响儿童的日常生活,特别是那些生活在贫困地区的人。在整个英国,有成功的针对幼儿的干预措施,这些措施都是基于用含氟牙膏刷牙。然而,缺乏证据表明中学生的口腔健康改善计划,以减少龋齿及其后遗症。
■确定促进刷牙以预防中学生龋齿的行为改变干预措施的临床和成本效益。
■多中心,校本,评估者盲化,双臂集群随机对照试验,内部试点和嵌入式健康经济和过程评估。
■苏格兰的中学,英格兰和威尔士有资格获得免费学校餐的学生比例高于平均水平。随机化发生在学校内(年组水平),使用按学校分层的区组随机化。
■招募时年龄在11-13岁的学生,他们有自己的手机。
■基于行为改变理论的两部分干预:(1)教师提供的50分钟课程,和(2)每天两次短信给学生\'关于刷牙的手机,与常规教育相比。
■主要结果:使用DICDAS4-6MFT(腐烂,缺失和填充的牙齿)在任何恒牙中,在2.5年的瞳孔水平测量。次要结果包括:DICDAS4-6MFT的数量;DICDAS1-6MFT的存在和数量;牙菌斑;出血;每天两次刷牙;与健康相关的生活质量(儿童健康效用9D);与口腔健康相关的生活质量(儿童龋齿影响和经历问卷)。
■四千六百八十名学生(干预,n=2262;控制,n=2418)来自42所学校的随机分组。对2383名小学生(50.9%;干预1153,51.0%;对照组1230,50.9%)进行了基线和2.5年有效数据的初步分析,发现干预组中有44.6%的学生和对照组中的43.0%的学生至少有一个恒牙。没有差异的证据(比值比1.04,95%置信区间0.85至1.26,p=0.72),除了6个月时每天两次刷牙(比值比1.30,95%置信区间1.03至1.63,p=0.03)和2.5年时牙龈出血评分(边界线)(几何平均差异0.92,95%置信区间0.85至1.00,p=0.05)外,次要结局没有统计学上的显着差异。干预具有较高的增量平均成本(£1.02,95%置信区间-1.29至3.23)和较低的增量平均质量调整生命年(-0.003,95%置信区间-0.009至0.002)。在2.5年内,干预措施具有成本效益的可能性为7%。然而,在两个小组中,试点学校和学生比例较高的学校有资格享受免费学校餐,成本效益的可能性分别为84%和60%,分别,尽管他们的增量成本和质量调整生命年仍然很小,没有统计学意义。过程评估显示,干预措施总体上是可以接受的,尽管短信的实施被证明具有挑战性。COVID-19大流行阻碍了数据收集。高缺失率的经济数据意味着应谨慎解释调查结果。
■参与干预和6个月刷牙行为变化的证据是积极的,但没有转化为龋齿的减少。未来的工作应包括与中学生合作,了解口腔健康行为的决定因素,包括刷牙和糖消耗,特别是根据免费校餐资格。
■本试验注册为ISRCTN12139369。
■该奖项由美国国家卫生与护理研究所(NIHR)卫生技术评估计划(NIHR奖参考:15/166/08)资助,并在《卫生技术评估》中全文发布。28号52.有关更多奖项信息,请参阅NIHR资助和奖励网站。
蛀牙对儿童和年轻人的日常生活有影响,特别是那些生活在贫困地区的人。对于年幼的孩子,用含氟牙膏改善刷牙的方案有助于防止蛀牙。刷牙提醒4良好的口腔健康试验(BRIGHT)调查了基于中学的刷牙计划是否有效。我们开发了一个新程序,其中包括一堂课和每天两次发送到学生手机的短信。总的来说,4680名学生,年龄11-13岁,来自英国42所中学的学生参加了试验。在每个学校,随机选择一年组接收该方案,而另一年组没有收到。对所有学生进行了2.5年的随访,以查看是否有任何蛀牙水平的差异,刷牙的频率,斑块或生活质量。我们还考虑了该计划的物有所值以及学生和学校工作人员的意见。我们追踪了2383名学生,发现蛀牙没有差异,斑块或生活质量。我们发现,有该计划的人比没有该计划的人更有可能在6个月后每天刷牙两次。该方案总体上并不物有所值。然而,与不符合资格的学生相比,该计划似乎在防止有资格获得免费学校餐的学生蛀牙方面更有好处。在有更多学生有资格享受免费校餐的学校中,该节目物有所值的机会增加了。学生和学校工作人员普遍喜欢该方案。一些学生发现短信有用,尽管其他人说他们很烦人。该计划在短期内帮助学生更频繁地刷牙,但这并没有减少蛀牙。需要进一步的研究来了解如何防止中学生蛀牙。
UNASSIGNED: The presence of dental caries impacts on children\'s daily lives, particularly among those living in deprived areas. There are successful interventions across the United Kingdom for young children based on toothbrushing with fluoride toothpaste. However, evidence is lacking for oral health improvement programmes in secondary-school pupils to reduce dental caries and its sequelae.
UNASSIGNED: To determine the clinical and cost effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in secondary-school pupils.
UNASSIGNED: A multicentre, school-based, assessor-blinded, two-arm cluster randomised controlled trial with an internal pilot and embedded health economic and process evaluations.
UNASSIGNED: Secondary schools in Scotland, England and Wales with above-average proportion of pupils eligible for free school meals. Randomisation occurred within schools (year-group level), using block randomisation stratified by school.
UNASSIGNED: Pupils aged 11-13 years at recruitment, who have their own mobile telephone.
UNASSIGNED: Two-component intervention based on behaviour change theory: (1) 50-minute lesson delivered by teachers, and (2) twice-daily text messages to pupils\' mobile phones about toothbrushing, compared with routine education.
UNASSIGNED: Primary outcome: presence of at least one treated or untreated carious lesion using DICDAS4-6MFT (Decayed, Missing and Filled Teeth) in any permanent tooth, measured at pupil level at 2.5 years. Secondary outcomes included: number of DICDAS4-6MFT; presence and number of DICDAS1-6MFT; plaque; bleeding; twice-daily toothbrushing; health-related quality of life (Child Health Utility 9D); and oral health-related quality of life (Caries Impacts and Experiences Questionnaire for Children).
UNASSIGNED: Four thousand six hundred and eighty pupils (intervention, n = 2262; control, n = 2418) from 42 schools were randomised. The primary analysis on 2383 pupils (50.9%; intervention 1153, 51.0%; control 1230, 50.9%) with valid data at baseline and 2.5 years found 44.6% in the intervention group and 43.0% in control had obvious decay experience in at least one permanent tooth. There was no evidence of a difference (odds ratio 1.04, 95% confidence interval 0.85 to 1.26, p = 0.72) and no statistically significant differences in secondary outcomes except for twice-daily toothbrushing at 6 months (odds ratio 1.30, 95% confidence interval 1.03 to 1.63, p = 0.03) and gingival bleeding score (borderline) at 2.5 years (geometric mean difference 0.92, 95% confidence interval 0.85 to 1.00, p = 0.05). The intervention had higher incremental mean costs (£1.02, 95% confidence interval -1.29 to 3.23) and lower incremental mean quality-adjusted life-years (-0.003, 95% confidence interval -0.009 to 0.002). The probability of the intervention being cost-effective was 7% at 2.5 years. However, in two subgroups, pilot trial schools and schools with higher proportions of pupils eligible for free school meals, there was an 84% and 60% chance of cost effectiveness, respectively, although their incremental costs and quality-adjusted life-years remained small and not statistically significant. The process evaluation revealed that the intervention was generally acceptable, although the implementation of text messages proved challenging. The COVID-19 pandemic hampered data collection. High rates of missing economic data mean findings should be interpreted with caution.
UNASSIGNED: Engagement with the intervention and evidence of 6-month change in toothbrushing behaviour was positive but did not translate into a reduction of caries. Future work should include work with secondary-school pupils to develop an understanding of the determinants of oral health behaviours, including toothbrushing and sugar consumption, particularly according to free school meal eligibility.
UNASSIGNED: This trial is registered as ISRCTN12139369.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/166/08) and is published in full in Health Technology Assessment; Vol. 28, No. 52. See the NIHR Funding and Awards website for further award information.
Tooth decay has an impact on children and young people’s daily lives, particularly those living in deprived areas. For young children, programmes to improve toothbrushing with fluoride toothpaste help prevent tooth decay. The Brushing RemInder 4 Good oral HealTh trial (BRIGHT) investigated whether a secondary-school-based toothbrushing programme would work. We developed a new programme which included a lesson and twice-daily text messages sent to pupils’ phones. In total, 4680 pupils, aged 11–13 years, from 42 secondary schools in the United Kingdom took part in the trial. At each school, one year group was randomly selected to receive the programme, while the other year group did not receive it. All pupils were followed up for 2.5 years to see whether there were any differences in levels of tooth decay, frequency of toothbrushing, plaque or quality of life. We also considered the programme’s value for money and the views of pupils and school staff. We followed up 2383 pupils and found no difference in tooth decay, plaque or quality of life. We found those who had the programme were more likely to brush their teeth twice daily after 6 months than those who did not. The programme was not good value for money overall. However, the programme appeared to be of more benefit at preventing tooth decay in pupils eligible for free school meals compared to those not eligible. In the schools with more pupils eligible for free school meals, the chance of the programme representing good value for money increased. The programme was generally liked by the pupils and school staff. Some pupils found the text messages useful, although others said they were annoying. The programme helped pupils brush their teeth more frequently in the short term, but this did not lead to less tooth decay. Further research is needed to understand how to prevent tooth decay in secondary-school pupils.