Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Class |
|---|---|
| University of Lahore | OTHER |
Not provided
Not provided
Not provided
Not provided
This was a pragmatic, two-arm, and parallel-group, superiority cluster-randomized controlled trial with 1:1 allocation of clusters (schools) to either the Smile Smarts-PK intervention arm or the control arm. The trial settings were lower secondary schools (classes 5-8) in the Punjab, Pakistan. Punjab is the most populous province of Pakistan; it has many public and low-cost private schools that serve lower- and middle-income communities.
Oral diseases are among the most common non-communicable conditions affecting children worldwide and disproportionately burden those in low- and middle-income countries. Robust evidence from pragmatic, theory-informed, school-based cluster-randomized trials in South Asia remains scarce. We evaluated the effectiveness of Smile Smarts-PK, a scalable teacher-delivered oral health intervention embedded within routine lower secondary school systems in Pakistan.
Methods It is a parallel, pragmatic, school-level cluster-randomized controlled trial in 50 lower secondary schools in Pakistan. Schools were randomly assigned (1:1) to either the Smile Smarts-PK intervention or usual school practice. The intervention was teacher-delivered, integrated into routine academic schedules, and informed by the Health Belief Model. Primary outcomes at 12 months were clinical oral health indices: Debris Index-Simplified (DI-S), Calculus Index-Simplified (CI-S), Oral Hygiene Index-Simplified (OHI-S). Secondary outcomes included plaque index, children's oral health knowledge, observed and self-reported oral health behaviours, and maternal knowledge, attitudes, and practices. Analyses were by intention to treat using linear mixed-effects models accounting for clustering at the school level.
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Smile Smarts-PK | Experimental | The intervention group is given the Smile Smarts-PK intervention. It is s a multi-theory, multicomponent oral health promotion intervention grounded in a multi-level theoretical framework integrating the Health Belief Model (HBM) and Social Cognitive Theory (SCT). In addition, the delivery strategy is viewed through an implementation science lens, implementation theory, to strengthen understanding not only of effectiveness but also of reach, adoption, fidelity, and future maintenance. |
|
| Control group | No Intervention | Participants assigned to Arm 2 serve as the control group and do not receive any intervention during the study except for routine school activities |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Smile Smarts | Behavioral | The interactive oral health care lessons provided to participants in Arm 1 would involve activities and discussions aimed at changing behaviors such as tooth brushing frequency, brushing techniques, and the use of interdental aids. The intervention aims to educate and motivate participants to adopt and maintain optimal oral hygiene habits through behavioral change strategies. |
| Measure | Description | Time Frame |
|---|---|---|
| Oral Hygiene Status | The change in the Simplified Oral Hygiene Index (OHI-S) from baseline to 12 months served as the primary endpoint. The OHI-S scores debris and calculus on six index surfaces (scores 0-3 each), with the summed component means creating an overall score ranging from 0 (good hygiene) to 6 (poor hygiene). Scores were categorized as good (0.0-1.2), fair (1.3-3.0), or poor (3.1-6.0). The primary analysis focused on the change in mean OHI-S score at both the individual and cluster levels | 12 month |
| Measure | Description | Time Frame |
|---|---|---|
| PLAQUE SCORE | The secondary outcome is Plaque score will be measured using the Silness and Löe plaque index. This index scores the thickness of dental plaque at the gingival margin. The scoring range is from 0 to 3, with 0 indicating no plaque and 3 indicating a high amount of plaque accumulation. | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Implementation outcomes | Mixed methods (surveys, interviews, administrative data) to assess how well an intervention is adopted, delivered (fidelity), and sustained | 12 months |
| Equity | Equity was assessed across PROGRESS-Plus-informed dimensions through prespecified interaction analyses and by comparing changes in outcome gaps between more and less advantaged groups. |
Inclusion Criteria:
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| MUHAMMAD ARSHED, PhD | University of Lahore | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| District Sialkot | Sialkot | Punjab Province | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29942102 | Result | Halawany HS, Al Badr A, Al Sadhan S, Al Balkhi M, Al-Maflehi N, Abraham NB, Jacob V, Al Sherif G. Effectiveness of oral health education intervention among female primary school children in Riyadh, Saudi Arabia. Saudi Dent J. 2018 Jul;30(3):190-196. doi: 10.1016/j.sdentj.2018.04.001. Epub 2018 May 4. | |
| 27504414 | Result |
Not provided
| ID | Type | URL | Comment |
|---|---|---|---|
| Informed Consent Form | View IPD |
Not provided
It is a parallel, pragmatic, school-level cluster-randomized controlled trial in 50 lower secondary schools in Pakistan. Schools were randomly assigned (1:1) to either the Smile Smarts-PK intervention or usual school practice.
Not provided
Not provided
In this study, masking, also known as blinding, refers to the practice of concealing the allocation of participants to intervention groups from outcome assessors and investigators involved in data collection and analysis.
Masking helps minimize bias that could occur if those assessing the outcomes are aware of the participants' assigned interventions. In this case, both the outcome assessors and investigators are masked, meaning they are unaware of which participants received the interactive oral care lessons (experimental group) and which participants were in the control group.
|
| Observed toothbrushing performance |
The change in toothbrushing performance from baseline to 12 months was assessed using a validated 12-item checklist. Each item was scored from 0 (poor) to 2 (good), yielding a total score of 0-24, categorized as poor (0-11), fair (12-17), or good (18-24). Analysis focused on changes in mean scores and the proportion of children in each category. |
| 12 months |
| Self-Reported Oral Hygiene Behaviors | Changes in self-reported oral hygiene behaviors from baseline to 12 months were measured using a validated 12-item questionnaire covering brushing frequency and fluoride use. Total scores ranged from 0 to 24, with classifications of poor (0-11), fair (12-17), or good | 12 months |
| Mothers' Knowledge, Attitudes, and Practices (KAP) | The third secondary outcome was the assessment of change in mothers' knowledge, attitudes, and practices (KAP) related to oral hygiene from baseline to 12 months. Data were collected using standardized Likert-scale and multiple-choice items. Response formats, including true/false, Likert scales, and multiple-choice questions, were standardized to allow calculation of summary scores: knowledge (% correct), attitudes (mean Likert score), and practices (categorical frequencies). | 12 months |
| 12 months |
| Acceptability, appropriateness, and feasibility | Acceptability, appropriateness, and feasibility were assessed using the validated 4-item AIM, IAM, and FIM scales (each scored on a 5-point Likert scale from 1=strongly disagree to 5=strongly agree), with higher scores indicating more favourable implementation outcomes. | 12 months |
| Wahengbam PP, Kshetrimayum N, Wahengbam BS, Nandkeoliar T, Lyngdoh D. Assessment of Oral Health Knowledge, Attitude and Self-Care Practice Among Adolescents - A State Wide Cross- Sectional Study in Manipur, North Eastern India. J Clin Diagn Res. 2016 Jun;10(6):ZC65-70. doi: 10.7860/JCDR/2016/20693.8002. Epub 2016 Jun 1. |
| 36755682 | Result | Carvalho AP, Moura MF, Costa FO, Cota LO. Correlations between different plaque indexes and bleeding on probing: A concurrent validity study. J Clin Exp Dent. 2023 Jan 1;15(1):e9-e16. doi: 10.4317/jced.60039. eCollection 2023 Jan. |
| 29319063 | Result | Hilgert LA, Leal SC, Bronkhorst EM, Frencken JE. Long-term Effect of Supervised Toothbrushing on Levels of Plaque and Gingival Bleeding Among Schoolchildren. Oral Health Prev Dent. 2017;15(6):537-542. doi: 10.3290/j.ohpd.a39593. |
| 26897029 | Result | Pine C, Adair P, Robinson L, Burnside G, Moynihan P, Wade W, Kistler J, Curnow M, Henderson M. The BBaRTS Healthy Teeth Behaviour Change Programme for preventing dental caries in primary school children: study protocol for a cluster randomised controlled trial. Trials. 2016 Feb 20;17(1):103. doi: 10.1186/s13063-016-1226-3. |
| 33623340 | Result | Florio FM, Dos Santos Klee L, Brandao Ramos AP, Ambrosano GMB, de Souza Fonseca Silva A. Use of Water by Schoolchildren: Impact of Indirectly Supervised Daily Toothbrushing-A Pilot Study. Int J Clin Pediatr Dent. 2020 Sep-Oct;13(5):513-517. doi: 10.5005/jp-journals-10005-1800. |
| 31495647 | Result | Salama FS, Al-Balkhi BK. Effectiveness of educational intervention of oral health for special needs on knowledge of dental students in Saudi Arabia. Disabil Health J. 2020 Jan;13(1):100789. doi: 10.1016/j.dhjo.2019.03.005. Epub 2019 Mar 19. |
| 33388030 | Result | Swe KK, Soe AK, Aung SH, Soe HZ. Effectiveness of oral health education on 8- to 10-year-old school children in rural areas of the Magway Region, Myanmar. BMC Oral Health. 2021 Jan 2;21(1):2. doi: 10.1186/s12903-020-01368-0. |
| Informed Consent Form | View IPD |
| Informed Consent Form | View IPD |
| ID | Term |
|---|---|
| D003773 | Dental Plaque |
| ID | Term |
|---|---|
| D003741 | Dental Deposits |
| D014076 | Tooth Diseases |
| D009057 | Stomatognathic Diseases |
Not provided
Not provided