Table 1 Description of studies included in systematic review (n = 9) by study, study design, participants, community engagement, ecological approach, intervention, outcomes and quality assessment rating

Arantes et al, 2010 [37]

Repeat cross-sectional study (nested in prevalence study).

Xavante people of Brazil

Both (results not reported by gender)

≥2 years and 11–15 years

DMFT outcome (11–15 years):

3

STRATEGY(S) n = 3: education; prevention (Fluoride); and clinical. Using principles of participation of the community, promotion of general health, personnel training, utilisation of appropriate technology and fluoride

Outcome: DMFT/DMFS score

↓ in incidence of caries among 11–15 years from 80 to 53% between 1999 and 2007 (nt)

Weak

Moderate

Oe village only - Etenheritipá

Time 1 (1999) = 212 (29)

Mean DMFS score for

Time 2 (2004) = 281 (64)

TARGET(S): IND

11–15-year olds fell from 4.95 in 2004 to 2.39 in 2007

SETTING(S): Community and clinical (clinical implied)

DMFS outcome (11-15 years): Time 1 (2004) = 281 (64)

TIMEFRAME: 8 years

(p < 0.01)

Time 2 (2007) = 372 (66)

Carberry 2004 [38]

Pre-Post design

American Indian Navajo people

Both (results not reported by gender)

3–13 years

Time 1 = 180

0

STRATEGY(S): Fluoride (0.2%) rinsing program (2 rinses per week)

↓ DMFS score to 0.8 for 11 year old children (nt)

Compared with one year previous:

Weak

Time 2 = 251

Moderate

Rural

TARGET(S): IND and INT (family)

↑25% in dental appointments (nt)

SETTING(S): Home and School

Home: 3–4 years of age participated in the ‘Headstart’ program

↓% in dmft of 2nd year ‘Headstart’ children from 16.3 to 7.7% (nt)

School: 5–13 years of age

TIMEFRAME: 1 year

↑'Evidence’ of dental care by 1/3rd: to 67% in school children and to 47% in the ‘HeadStart’ children (nt)

↓% of ‘active decay’ from 63 to 37% (nt)

Rate of sealant applications doubled

↑ in crowns on primary teeth 5 vs 49

↑ in pulpotomy procedures 15 vs 42

Chen, et al, 2011 [39]

Pre-Post design

Truku children in the Chongguang Tribe (Taiwan) Rural (Wenlan Village, Xiulin Township)

m = 34; f = 33

3–15 years

TOTAL: n = 67

2

STRATEGY(S) n = 5: lectures for children and parents; teaching videos for children; teaching children how to brush their teeth correctly; giving out tooth cleaning supplies; and handing out prepared dental care manuals to children

Outcome: Dental care knowledge

Outcome:

Weak

7–15 years = 56

Light

Dental plaque levels

√ ↑ in tooth-cleaning habits; knowledge of caries; knowledge of change of teeth; and periodical examination schedule

(in subset of children n = 16)

√ ↓in dental plaque

TARGET(S): IND (including as member of peer group at school) and INT (family)

SETTING(S): not described (implied either community OR school)

(p < 0.001)

TIMEFRAME: 1 year

√ ↑ in dietary habits

Harrison et al, 2006 [40]

Repeat cross-sectional

Canadian First Nations people Remote

Both (results not reported by gender)

All children on reserve (age not specified)

Time 1 = 34

3

STRATEGY(S) n = 4: daily school ‘brush-ins’; weekly fluoride rinse for children ≥9 years and tri-annual fluoride varnish applications < 9 years; incentives; and anticipatory guidance for parents, classroom health education

Outcome: ‘Time units’ needed to complete dental treatment for children

Weak

Time 2 = 49

Moderate

Reduction in hours required to restore (p ≤ 0.001) or extract (p ≤ 0.01) teeth and to engage in preventative therapy (p ≤ 0.001)

TARGET(S): IND (including as member of peer group at school) and INT (family)

SETTING(S): School and clinic

TIMEFRAME: 3 years

Johnson et al, 2014 [41]

Repeat cross-sectional

Australian Aboriginal and/or Torres Strait Islander people

Both (53% male)

6–15 years

TOTAL: n = 324

0

STRATEGY: Introduction of a reticulated fluoridated water supply

Outcome:

Outcome: caries (primary and permanent dentition)

Fewer teeth had restorations in both surveys

Moderate

10–12 years:

Light

dmft and DMFT

Time 1 = 131 Time 2 = 67 (dmft and caries in primary dentition only)

TARGET(S): Community

√ ↓ mean dmft (missing & filled only) at 10 years

SETTING(S): Environmental

↓ in overall caries prevalence and severity from 2005 to 2012 by 37.3%.

Remote (5 small communities North Queensland)

TIMEFRAME: 7 years

(p < 0.05)

10–15 years:

√ ↓ mean: DMFT at 15 years

Time 1 = 224 Time 2 = 127 (DMFT and caries in permanent dentition only)

Decayed at 15 years

Missing at 14 years

Filled at 10–15 years

(p < 0.05)

McNab et al 2008 [42]

Pre-Post design

Canadian First Nations people

Both (results not reported by gender)

5–16 years

Time 1 = 26 Time 2 = 40

2

STRATEGY(S) n = 4: daily brush-ins; fluoride application; educational presentations; and incentive scheme

Outcome: dmfs/DMFS and dmft/DMFT

Prior to intervention 8% children cavity free

Weak

Moderate

Remote

13 participated in pre and post intervention evaluation

Post intervention 32% cavity free

TARGET(S): IND including as member of peer group at school through the education strategy

√ ↓ dmfs/DMFS

(p < 0.005)

√ ↓ dmft/DMFT

Numbers within age range not stated

SETTING(S): School

(p < 0.05)

TIMEFRAME: 3 years

Olubunmi & Olushola, 2002 [43]

Randomised Controlled Trial

Nigeria

TOTAL: m = 59; f = 61

11–12 years

TOTAL: n = 120

2

STRATEGY(S): Health Education comparing three groups (two intervention and one control)

Outcome: Oral hygiene, debris and calculus scores

Strong

Urban

Intervention = 8 (2 groups of 40)

Light

Grp1: m = 22; f = 18

Intervention 1: 20 min oral health education video of a story acted by well-known local actors Intervention 2: 20 min verbal oral health education

Post intervention all scores lower

Grp 2: m = 19; f = 21

√ differences in mean debris scores between intervention and control groups with lowest score for verbal education

(p < 0.001)

Grp 3: m = 18; f = 22

TARGET(S): IND (peer group at school).

SETTING(S): School

TIMEFRAME: 6 weeks

√ differences in mean calculus scores between intervention and control groups

(p < 0.001)

√ differences in oral hygiene scores between intervention and control groups

(p < 0.001)

Video education showed greater odds of improvement in oral hygiene than verbal education video

Wilder et al 2014 [36]

Pre-Post (cohort) study (nested within a Mixed methods design)

Australian Aboriginal and Torres Strait Islander people

m = 7; f = 10

5–12 years (mean age 7.5 years)

TOTAL: n = 17

4

STRATEGY(S) n = 5. Pilot study of ‘New model’ of care consisting of 5 intervention strategies delivered monthly to children and families in the child’s home. Strategies: partnerships (including community consultations); employment of Aboriginal and/or Torres Strait Islander health workers); ‘cultural aides and equipment’ (timers, charts, toothbrushes); education package; and oral health assessment and dental treatment

Outcome: dmfs

Outcomes: Dental and periodontal indicators

Strong

Numbers within age range not stated.

Moderate

↓ dmfs from 3.7 to 3.5 (nt)

√ ↓ in proportion of unmet restorative needs compared to baseline 71% vs 34.4%

Rural.

(p < 0.05)

√ ↑in average numbers of fissure sealants present in permanent teeth from 0.4 to 1.6

TARGET(S): IND and INT (families).

(p < 0.01)

Gingival Index change: 58.8% no change; 23.5% level 1 improvement; 5.9% level 2 improvement, and less level 1 and 2 dis-improvement

SETTING(S): Home, school and community

TIMEFRAME: 10 months

Plaque Index change: 47.1% no change; 29.4% level 1 improvement; 5.9% level 2 improvement; 17.6% level 1 of dis-improvement

Yang et al, 2009 [44]

Cluster randomised controlled trial

Taiwan (Pingtung County)

TOTAL: m = 68; f = 67.

7th Grade

TOTAL: n = 135 Intervention = 607

0

STRATEGY(S): Intervention group received a specially designed education program covering a range of oral health-related topics delivered using 8 modules (40 min each held once per week)

Outcome: Knowledge and Behaviour

Most (87%) students considered the educational program excellent or good

Moderate

Light

Rural

Intervention: m = 33; f = 34.

√ ↑ oral health knowledge

TARGET(S): IND (as member of peer group at school)

(p < 0.001)

√ ↑ increase in tooth-brushing frequency (p < 0.001)

SETTING(S): School setting

TIMEFRAME: 8 weeks

√ ↓ in tobacco use (p = 001)