Oral Health Promotion Among Preschool Children With Special Needs
Condition: Intellectual Disability; Cerebral Palsy; Developmental Disorders; Developmental Delay; Autistic Spectrum Disorders; Down Syndrome; Epilepsy; Developmental Disability; Learning Disorders
MeSH terms: Cerebral Palsy; Down Syndrome; Intellectual Disability; Learning Disabilities; Developmental Disabilities; Autism Spectrum Disorder
Study type: Interventional

Summary: 
      Establishing good oral health-related habit is challenging among younger children, especially
      for preschool children with special needs, as they have physical, mental, sensory,
      behavioural, emotional, and chronic medical conditions that requires health care beyond the
      routines. Existing evidences showed that children with special needs have poorer oral health
      status and more challenging behaviours than their counterparts in main stream schools. Visual
      pedagogy, such as social stories, have been applied to teach a variety of skills or
      behaviours to individuals with special needs. They are short stories demonstrating the target
      skill or behaviour, and then the readers are expected to perform the target skill or
      behaviour following the demonstrations. Giving the evidence that children with special needs
      can understand complex situations and learn new practices by using those stories, we expect
      to apply a package of structured social stories to modify oral health-related behaviours
      (tooth brushing, healthy eating, dental visit), and thereby, improve oral health status among
      preschool children with special needs. Establishment of good oral-health related behaviours
      in early childhood will benefits children in their future life. Additionally, visual
      pedagogy-assisted oral health education is relatively easy and safe to implement. If proven
      effective, social story-based preventive care can be recommended to special children
      globally.
    

Detailed description: 
      Early childhood caries (ECC) is reported to be the most prevalent childhood disease. It is a
      chronic, infectious dental disease affecting children aged between birth and 71 months.
      Untreated ECC can lead to toothache, swelling, abscess, immature loss of primary teeth, and
      thereby, significant impacts on children's physical and emotional status. Nowadays, ECC has
      been recognised as a serious public health problem in developing as well as developed
      countries. Although ECC has a complex aetiology, existing evidence reveals that tooth
      brushing, appropriate eating habits, and regular dental check-ups are effective in preventing
      the development of ECC.

      In this study, oral health education will be reinforced by a series of visual education
      materials (social stories or conventional leaflets), which covering the three topics in ECC
      prevention, namely "tooth brushing", "healthy diets", and "dental visit". Sample size
      calculation is performed by the program G* power 3.1.9.2. The primary outcome is the
      development of new dental caries over the 24-month study period. Clinical oral examinations
      will be performed according to the following criteria: i) Caries experiences were assessed by
      the International Caries Detection and Assessment System(ICDAS); ii) Oral hygiene status by
      Simplified oral hygiene index of Greene and Vermilion (OHI-S); iii) gingival health status by
      Modified Gingival Index of Lobene (MGI). Dental examination will be performed at Special
      Child Care Centres by a paediatric dentist with a disposable mouth-mirror attached to an LED
      light. Tell- Show-Do (TSD) technique will be used to improve children's cooperation level.
      Tooth-brushing performance will be assessed by two observers. After dental examination and
      tooth-brushing assessment, a standard hands-on tooth-brushing training will be provided
      immediately to each child and his/her parent. Oral health instruction will also be
      illustrated to the participants, reinforced by social stories (experiment group) or
      conventional leaflets (control group). Questionnaires regarding children's oral health
      related behaviours and family demographic information will be completed by parents, while
      children's developmental profile will be assessed by staff in Special Child Care Centres.
      Children' oral health status and expected behaviours (tooth brushing, healthy eating habits
      and dental-visit experience) will be assessed at 6-month, 12-month and 24-month intervals.

      All the data will be analysed using IBM SPSS. Continuous valuables such as dmft, dmfs, S-OHI,
      MGI scores between the control and test groups will be analysed by two-sample t test,
      paired-t test, Mann-Whitney Test when appropriate. Chi-square statistics will be used to
      assess the differences in categorical variables between control group and test group, such as
      caries incidence, tooth-brushing frequencies, snacking frequencies, and dental-visit
      frequencies. McNemar's test will be used to analyse whether children's oral-health related
      behaviours will be changed before and after intervention. Regression analyses will be
      conducted to determine potential factors associated with children's oral health status or
      oral-health related behaviours in the model. The significance levels will be set to be P <
      0.05.
    

Intervention name(s): Visual pedagogy (social stories); Conventional leaflets
Intervention type(s): Other; Other
Intervention description(s): Oral health instruction, tooth-brushing training (toothbrushes and fluoridated toothpastes provided); Oral health instruction, tooth-brushing training (toothbrushes and fluoridated toothpastes provided)
Other intervention name(s): Behavioral; Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This study is designed as a 24-month randomised, controlled, blind, parallel clinical trial conducted in Special Child Care Centres, aiming to promote oral health among preschool children with special needs.
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention
Keywords: preschool children; special needs; tooth brushing; social story; visual pedagogy