Can a behaviour change toothbrushing intervention prevent dental caries in 11-13-year-olds?

Area of Science:

• Public Health
• Dental Public Health
• Behavioral Science

Background:

• Adolescent oral health remains a public health concern.
• Effective interventions are needed to improve toothbrushing habits and reduce caries prevalence in schools.
• The Brushing RemInder 4 Good oral HealTh (BRIGHT) trial investigated a novel intervention combining education and text message reminders.

Purpose of the Study:

• To assess the clinical and cost-effectiveness of a school-based intervention on toothbrushing behavior and caries rates.
• To compare the impact of an educational session and SMS reminders against standard dental health education.

Main Methods:

• A multi-centre randomized controlled trial involving 4680 pupils aged 11-13 in state-funded secondary schools.
• Intervention group received a 50-minute education session and twice-daily toothbrushing reminders via text messages.
• Control group received the normal education curriculum and no SMS; outcomes assessed over 2.5 years.

Main Results:

• While short-term adherence to brushing twice daily improved, this was not sustained at 2.5 years.
• No statistically significant difference in the prevalence of caries (D4-6MFT) was observed between intervention and control groups.
• The intervention showed a 7% chance of being cost-effective, with no significant differences in Quality-Adjusted Life Years (QALYs) or costs.

Conclusions:

• The BRIGHT intervention did not lead to a statistically significant reduction in caries prevalence after 2.5 years.
• Behavioral change strategies involving education and text message reminders may not be sufficient to impact long-term oral health outcomes in adolescents.
• Further research is needed to identify more effective interventions for improving adolescent oral hygiene and preventing dental caries.