Comparing the Effect of the Online Oral Health Education to the Conventional Method on the Knowledge and Practice of Personal Oral Hygiene in a Group of Primary School Children in Egypt. A Randomized Controlled Trial
Phase: NA
Conditions: Knowledge, Attitude to Health, Practice
Sponsor: Ain Shams University

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Comparing the effect of the online oral health education to the 
conventional method on the knowledge and practice of personal oral 
hygiene in a group of primary school children in Egypt. 
 A randomized controlled trial 
 
Thesis Protocol  
Submitted to the Department of Paediatric Dentistry and Dental Public 
Health Faculty of Dentistry, Ain Shams University 
 
 
 
 
NCT number: NCT05570500 
 
Date of document: November 21st, 2020 
 
 
 
 
 
 
 
 
 
 

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1. Background: 
 
         Caries is one of the greatest challenges facing the health system in Egypt, and as 
of the past few years studies have shown that Egyptian children have many dental 
problems, including: untreated dental caries, forms of periodontal diseases and even 
irregular tooth brushing habits. The latter being mainly due to the ignorance of 
children of understanding the correct technique of tooth brushing, which may have 
been due to the lack of dental awareness that these children receive, either by dental 
professionals who should offer this service regularly [1] or due to poor parental 
awareness of the factors that affect the oral health status of their children  [2]. 
Oral health (OH) education has proven to play a significant role in improving the 
knowledge, attitude and behaviour of children [3]. Implementing Oral health 
education in schools tend to improve the children’s OH-related quality of life 
because engaging children at younger age regarding their habits, practices or 
knowledge tends to stay with them till adolescence then to adulthood [4]. 
         In the year 2019 the Covid crisis has globally struck, being recognised by the 
WHO as a pandemic on March 11th, 2020 [5] the world was set in motion for various 
changes in the daily life of every man, woman and child. Covid 19, as defined by the 
WHO, is an infectious disease that spreads through droplets of saliva or discharge 
from the nose when the infected person sneezes or coughs, and thus the best way to 
avoid being infected by this disease is through some precautions that include social 
distancing of at least 1-2 meters between each person [6]. In Egypt, 75% of school 
children are usually very crowded in classrooms, which sometimes might reach 40 
students per classroom or even more in certain schools [7]. Such numbers pose a great 
challenge to fulfilling the Covid precautions set by the WHO.  
         Luckily, we are in an era of technological advancement and the need for the 
electronic communication has risen to its peak. Recently, Egyptian ministry of 
education had applied the online education system as a must have in all schools and 
even released an online governmental portal which provides E-learning service, 
which in turn, would allow the students to remain at home while receiving their 
education [8]. Oral health education, which is considered as a part of the health 
promoting schools according to the WHO [9], has been known to be effective at 

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direct contact between the educator and the recipients [10], and many modifications 
in the way of delivering knowledge to children has been improved to include games, 
drama scenes and flash cards [11]. The challenge nowadays is that with the Covid 
outbreak the need for more distancing and less direct contact between people has 
increased, and the conventional methods of health education might deem unfit 
towards the global direction to control the Covid outbreak.  
          The online methods of delivering oral health education has been shown to be 
effective using Motivational Interviewing (MI) [12]. MI, defined by Miller & 
Rollnick (2002) as a technique based on evidence, centred on the individual, and 
individually-tailored. This technique is meant to prepare the participant for change 
by motivating and promoting the participant’s solutions to the inconsistency of 
decisions towards self-improvement [13]. Few studies have engaged young 
adolescents through MI [14], yet with young children the MI results are still under 
investigation [15]. With the Covid outbreak still on the loose, oral health educators 
must follow the guidelines presented by the WHO to prevent its spreading all the 
while providing oral health education service to school children. Hence finding ways 
to implement the oral health education into the online education system is 
challenging yet an important step to address young children in these hard times, in 
order to help them understand how to take care of their oral hygiene while keeping 
them, their families and their environment safe from harm. 
 
 
 
 
 
 
 
 
 

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2. Research question:  is the online method of delivering oral health knowledge to primary 
school children is as effective as the conventional methods regarding their knowledge and 
practice towards personal oral hygiene?  
 
Framing the research question - PICOTS:  
P (participants): Primary school children of ages 7-9 years old in Egypt. 
I (intervention): Online oral health education. 
C (comparator): Conventional oral health education. 
O (primary outcome): Improving the oral hygiene knowledge and practice in primary school 
children. 
T (Time of follow up): Every 3 months interval for one academic year. 
S (Study settings): 2 schools will be chosen (Al Rehab city and Al-Sherook city). The rationale 
behind choosing those two schools is to increase the sample size. Classrooms of grade two and 
grade three stages inside each school will be divided blindly into two groups; one receives the 
online oral health education while the other receives the conventional oral health education. Both 
schools had received simplified conventional oral health education service two years ago. The 
participants were of 5-6 years of age by then. 
 
3. Aim:  
The aim of this study is to compare the results of the comparison between the online oral 
health education and conventional oral health education methods in terms of their 
effectiveness towards improving the knowledge and practice of oral hygiene in primary 
school children in Egypt.  
Objectives: 
➢ Primary objective :  
▪ To compare the online oral health education to the conventional oral health 
education regarding : 
1. Oral health knowledge of primary school children of 7-9 years old. 
2. Assessing oral hygiene measures practice in primary school children of 7-9 
years old. 
 
➢ Secondary  objective : 
Is to evaluate the efficacy of a new oral health education method to deliver health 
information to target population   
 
 

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Study hypothesis: 
▪ Null hypothesis: 
No difference between the effectiveness of online oral health education and conventional 
oral health education methods on oral health knowledge and oral hygiene practice of 
primary school children 
4. Methods: 
 
▪ Study design: Randomized controlled trial (RCT) 
▪ Study settings:  2 schools will be chosen (Al Rehab city and Al-Sherook city). The 
rationale behind choosing those two schools is to increase the sample size. 
Classrooms of grade three and grade four stages inside each school will be divided 
blindly into two groups; one receives the online oral health education while the other 
receives the conventional oral health education. Both schools had received simplified 
conventional oral health education service two years ago. The participants were of 5-
6 years of age by then. 
▪ Study population: Grade three and grade four Egyptian students aged 7-9 years old 
situated in 2 different schools related to Futures Educational Systems in Egypt. 
 
 
 
 
 
 
Sampling:  
Type of sample:  
A convenient sample will be recruited to participate in the study. 
 
Recruitment:  
Recruitment will start in September 2022 through sending the children’s parents papers of 
consent via their channel books during the school day. 
 
 
 
Inclusion criteria 
Exclusion criteria 
• 
2nd and 3rd grade Egyptian students. 
• 
Average of age 7-9 years old.  
• 
Currently residing in Egypt. 
• 
Both male and female students. 
• 
Those who do not consent to participate 
in the study.  
• 
Those who cannot speak English or 
Arabic. 
• 
Non-Egyptians. 

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Sample size calculation:  
Sample size estimation was based on testing the change in KAP before and after each 
educational intervention. The predicted sample size was found to be 265 children for each 
intervention, by assuming an α level of 0.05, β level of 0.1 (power = 90%), allocation ratio of 
1:1, to detect an effect size d of 0.2. After adding a 20% increase to adjust for dropout, the final 
sample size was 318 children for each intervention (total sample size = 636 children). Sample 
size calculation was performed using G*Power software version 3.1.9.4 for MS Windows, Franz 
Faul, Kiel University, Germany. 
Study procedures:  
1) A literature review was conducted using electronic search engines like PubMed and 
Google scholar to identify studies assessing the effect of online and conventional oral 
health education on improving the oral health knowledge and practice in school 
children regarding their oral hygiene. 
2) After reviewing many articles, a questionnaire was selected to assess the above 
outcomes. The questionnaire was chosen according to availability and effectiveness, 
and it was modified by simplifying and deselecting some of the questions that aren’t 
related to the age group to better suit the age group of question.  
3) A piloting session will be done on two separate classes, one from each educational 
stage to assess the modified questionnaire in terms of ease of understanding and 
comprehension to the participants. Those two classes will not be included in the final 
results of the study. 
4) The questionnaire will be distributed before conducting the oral health education 
sessions (both online and conventional) to assess the pre-session knowledge and 
practice of the participants. 
5) All questionnaires are self-administered but a well-trained interviewer will be 
available offering assistance in understanding the questionnaires if needed.  
6) 3rd and 4th grade classrooms in each school will be randomly and evenly allocated to 
the interventions included in the study using computer-generated randomization 
application.  
7) The researcher will be blinded of the classrooms of each school during the 
randomization process. 
8) The researcher will be blinded of the names of the participants or their personal data 
during and after the questionnaire session. 
9) After the questionnaire is finished, the researcher will then begin his educational 
lesson using electronic aids like a projector inside the classrooms or using Microsoft 
teams during the online session. 
10) Another questionnaire will be distributed after the educational lesson for both session 
types to assess the post-session knowledge and practice in the participants. 
11) A comparison will be carried out for the results of each question in both 
questionnaires and for the final results of both questionnaires to determine the 
statistical significance of both results. 
12) These statistical results will be done by a separate statistician outside the study field 
and blinded from all the procedures. 

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Ethical consideration: 
All participants’ parents will be briefed about the nature of the study and an informed consent 
form will be delivered to them both in Arabic and English languages for their approval to include 
their children’s data in the study. This informed consent will be available and approved by the 
Ethical Committee of Faculty of Dentistry, Ain Shams University. There will also be an assent 
from each child to freely accept or decline joining the study prior to the questionnaire. Parents 
and/or children will be given the complete freedom to complete or quit the study whenever they 
want. Also, they will be assured of the confidentiality of their personal information and 
anonymity. The participants who won’t participate in the study or are excluded will receive the 
oral health education in both methods (online and conventional) nonetheless as it is ethically not 
appropriate for one person to receive the health education service while the other doesn’t in the 
same working / studying space.  
5. Data management:  
Data for each classroom will be collected through laptops (Google forms) or printed 
questionnaires, according to the nature of the session delivered.  Results will be monitored and 
inserted into an excel sheet.  
 
 
6. Statistical analysis: 
 
Statistical analysis will be done by a professional statistician after the gathering of all data is 
complete. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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7. Timeline:  
 
 
Oct. 
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Nov 
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Dec 
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Jan 
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Feb 
21 
March 
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April 
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May 
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June 
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July 
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Aug 
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Sep 
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Oct 
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Nov 
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Literature 
review 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Protocol 
writing  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Submission 
to 
Ethics 
Committee 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Data 
collection 
and 
data 
entry 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Statistical 
analysis 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Writing 
manuscript  
and editing 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Submission 
for 
Publication 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
8. Funding of the study: 
Until the time of the submission of the proposal no Funds were available. 
 
 
 
 
 
 
 
 
 

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https://doi.org/10.21608/edj.2020.25196.1058 
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AtBy8zOdgnZqtCPK3gaAoUhEALw_wcB 
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