The effectiveness of school-based supervised tooth brushing intervention for preventing dental caries: a systematic review and meta-analysis.

BACKGROUND

Dental caries ranks among the most frequent childhood diseases worldwide, significantly impacting oral health and overall well-being. The objective of this systematic review and meta-analysis was to evaluate the efficacy of school-based supervised toothbrushing (STB) intervention in the prevention of dental caries by enhancing oral hygiene.

METHODS

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) sourced from PubMed, Scopus, Web of Science, and other databases up to February 2025. Eligible studies were those that contrasted school-based STB intervention with no-intervention controls, documenting results in DMFT/dmft or DMFS/dmfs indices. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Risk of Bias 2 (RoB2) tool. A random-effects model was used to pool the results, and standardized mean differences (SMDs) were calculated to account for differences in dentition types. Heterogeneity was assessed using the I² statistic and Cochran's Q test.

RESULTS

Five of the eight RCTs that satisfied the inclusion requirements were included in the meta-analysis. A statistically significant reduction was shown in DMFS/dmfs that resulted from STB intervention (SMD = -0.22; 95% CI: -0.42 to -0.01; p = 0.037; I² = 64.6%), indicating a modest preventive effect with moderate heterogeneity. However, there was no significant effect on DMFT/dmft (SMD = 0.05; 95% CI: -0.27 to 0.37; p = 0.754; I² = 86.8%), reflecting high between-study variability.

CONCLUSION

School-based supervised toothbrushing intervention appear to effectively reduce dental caries at tooth surface level, as reflected in the significant reduction in DMFS/dmfs scores. However, their effect on whole-tooth caries, as measured by DMFT/dmft, remains less evident in the short term. These findings support using STB as a practical community-level intervention to promote oral health in children.

TRIAL REGISTRATION: We have registered the protocol on the Open Science Framework (OSF) (Registration DOI: https://doi.org/10.17605/OSF.IO/2JWR9 ).