Behaviour change intervention for toothbrushing (lesson and text messages) to prevent dental caries in secondary school pupils: The BRIGHT randomized control trial

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Community dentistry and oral epidemiology Pub Date : 2024-01-08 DOI:10.1111/cdoe.12940

Nicola Innes, Caroline Fairhurst, Katie Whiteside, Hannah Ainsworth, Debbie Sykes, Sarab El Yousfi, Emma Turner, Ivor G. Chestnutt, Anju Keetharuth, Simon Dixon, Peter F. Day, Nassar Seifo, Fiona Gilchrist, Katie Hicks, Ian Kellar, Waraf Al-Yaseen, Mariana Araujo, Donna Dey, Catherine Hewitt, Sue Pavitt, Mark Robertson, David Torgerson, Zoe Marshman

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Abstract

Objectives

This multicentre, assessor-blinded, two-arm cluster randomized trial evaluated the clinical and cost-effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in UK secondary schools.

Methods

Pupils aged 11–13 years with their own mobile telephone attending secondary schools with above average free school meals eligibility were randomized (at year-group level) to receive a lesson and twice-daily text messages or to usual care. Year-groups (n = 84) from 42 schools including 4680 pupils (intervention, n = 2262; control, n = 2418) were randomized.

Results

In 2383 participants with valid data at baseline and 2.5 years, the primary outcome of presence of at least one treated or untreated carious lesion (D_4-6 MFT [Decayed, Missing and Filled Teeth] in permanent teeth using International Caries Detection and Assessment System) was 44.6% in the intervention group and 43.0% in control (odds ratio [OR] 1.04, 95% CI 0.85–1.26, p = .72). There were no statistically significant differences in secondary outcomes of presence of at least one treated or untreated carious lesion (D_1-6 MFT), number of D_4-6 MFT and D_1-6 MFT, plaque and bleeding scores or health-related- (Child Health Utility 9D) or oral health-related- quality of life (CARIES-QC). However, twice-daily toothbrushing, reported by 77.6% of pupils at baseline, increased at 6 months (intervention, 86.9%; control, 83.0%; OR 1.30, 95% CI 1.03–1.63, p = .03), but returned to no difference at 2.5 years (intervention, 81.0%; control, 79.9%; OR 1.05, 95% CI 0.84–1.30, p = .69). Estimated incremental costs and quality-adjusted life-years (QALYs) of the intervention, relative to control, were £1.02 (95% CI −1.29 to 3.23) and −0.003 (95% CI −0.009 to 0.002), respectively, with a 7% chance of being cost-effective (£20 000/QALY gained threshold).

Conclusion

There was no evidence of statistically significant difference for caries prevalence at 2.5-years. The intervention's positive 6-month toothbrushing behaviour change did not translate into caries reduction. (ISRCTN 12139369). COVID-19 pandemic adversly affected follow-up.

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改变中学生刷牙行为的干预措施（课程和短信）以预防龋齿：BRIGHT 随机对照试验。

目的：这是一项多中心、评估者盲法、双臂群组随机试验：这项多中心、评估者盲法、双臂分组随机试验评估了在英国中学推广刷牙预防龋齿的行为改变干预措施的临床和成本效益：年龄在11-13岁、拥有自己的移动电话、就读于免费学校膳食资格高于平均水平的中学的学生被随机分配（以年级组为单位），接受一堂课和每天两次的短信，或接受常规护理。来自 42 所学校的年级组（n = 84）共 4680 名学生（干预组，n = 2262；对照组，n = 2418）被随机分组：在 2383 名基线和 2.5 年有效数据的参与者中，干预组和对照组的主要结果分别为 44.6%和 43.0%（几率比 [OR] 1.04，95% CI 0.85-1.26，p = .72），即干预组和对照组的主要结果分别为干预组和对照组的主要结果（干预组和对照组的主要结果分别为干预组和对照组的主要结果），即干预组和对照组的主要结果分别为干预组和对照组的主要结果（干预组和对照组的主要结果分别为干预组和对照组的主要结果）。在至少存在一个已治疗或未治疗龋损（D1-6 MFT）、D4-6 MFT 和 D1-6 MFT 的数量、牙菌斑和出血评分或与健康相关的生活质量（儿童健康效用 9D）或与口腔健康相关的生活质量（CARIES-QC）等次要结果方面，差异无统计学意义。然而，77.6% 的学生在基线时报告称每天刷牙两次，但在 6 个月时这一比例有所上升（干预组，86.9%；对照组，83.0%；OR 1.30，95% CI 1.03-1.63，p = .03），但在 2.5 年时恢复到无差异（干预组，81.0%；对照组，79.9%；OR 1.05，95% CI 0.84-1.30，p = .69）。相对于对照组，干预的估计增量成本和质量调整生命年（QALYs）分别为 1.02 英镑（95% CI -1.29 至 3.23）和-0.003（95% CI -0.009 至 0.002），具有成本效益的几率为 7%（20 000 英镑/QALY gained threshold）：结论：没有证据表明 2.5 年的龋齿患病率在统计学上有显著差异。干预措施对 6 个月刷牙行为的积极改变并没有转化为龋齿的减少。(ISRCTN 12139369)。COVID-19大流行对随访产生了不利影响。

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来源期刊

Community dentistry and oral epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

4.40

自引率

8.70%

发文量

审稿时长

6 months

期刊介绍： The aim of Community Dentistry and Oral Epidemiology is to serve as a forum for scientifically based information in community dentistry, with the intention of continually expanding the knowledge base in the field. The scope is therefore broad, ranging from original studies in epidemiology, behavioral sciences related to dentistry, and health services research through to methodological reports in program planning, implementation and evaluation. Reports dealing with people of all age groups are welcome. The journal encourages manuscripts which present methodologically detailed scientific research findings from original data collection or analysis of existing databases. Preference is given to new findings. Confirmations of previous findings can be of value, but the journal seeks to avoid needless repetition. It also encourages thoughtful, provocative commentaries on subjects ranging from research methods to public policies. Purely descriptive reports are not encouraged, nor are behavioral science reports with only marginal application to dentistry. The journal is published bimonthly.