Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis

Akera, Peter; Kennedy, Sean E.; Lingam, Raghu; Obwolo, Mark J.; Schutte, Aletta E.; Richmond, Robyn

doi:10.1186/s12903-022-02291-2

Table 4 Summary of findings

From: Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis

Certainty assessment							No. of patients		Effect		Certainty	Importance
No. of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Experiment	Control	Relative (95% CI)	Absolute (95% CI)	Certainty	Importance
Dental caries measured by DMFT scores
7	4 Randomised trials 2 Quasi experiments 1 Non-randomized trial	Serious^a	Not serious	Serious^b	Serious^c	None	4392	2374	–	SMD − 0.33 (− 0.56, − 0.10)	⨁◯◯◯ Very low	IMPORTANT
Dental caries measured by net increment in DMFT scores
5	3 Randomised trials 2 non-randomized trial	Serious^a	Not serious	Serious^b	Serious^d	None	3091	2401	–	SMD − 0.34 (− 0.69, 0.02)	⨁◯◯◯ Very low	IMPORTANT
Dental caries measured by DMFS scores
5	3 Randomised trials 1 quasi experiment 1 cohort study	Serious^e	Not serious	Serious^b	Serious^f	None	2110	1396	–	SMD − 0.26 (− 0.70, 0.18)	⨁◯◯◯ Very low	IMPORTANT
Dental caries measured by net increment in DMFS scores
3	2 Randomised trials 1 Cohort study	Serious^e	Not serious	Serious^b	Serious^g	None	2066	1689	–	SMD − 1.09 (− 1.91, 0.27)	⨁◯◯◯ Very low	IMPORTANT
Dental caries prevalence measured by dmft or DMFT/S score greater than one
4	1 Randomised trial 1 Quasi experiment 2 cohort studie	Serious^a	Not serious	Serious^b	Serious	None	871/2049 (42.5%)	553/919 (60.2%)	RR 0.70 (0.53, 0.94)	–	⨁◯◯◯ Very low	IMPORTANT
Oral hygiene measured by plaque scores
7	All randomised trials	Serious^a	Not serious	Serious^b	Seriousⁱ	None	1971	1368	–	SMD − 0.32 (− 0.46, − 0.18)	⨁◯◯◯ Very low	IMPORTANT
Oral hygiene measured by gingival scores
3	All randomised trials	Serious^a	Not serious	Serious^b	Serious	None	1094	479	–	SMD 0.12 (− 0.32, 0.55)	⨁◯◯◯ Very low	IMPORTANT

The bold provides information on certainty of assessement, number of pateints, effect, certainty and importance
CI confidence interval, RR risk ratio, SMD standardized mean difference
^aStudies show limitations for allocation concealment, blinding of participants, those delivering treatment and outcome assessors, and intention to treat analysis
^bInterventions delivered differently in different settings
^cFive of seven studies did not have the required sample (200) in each group to provide optimal information size (OIS)
^dTwo out of five studies did not have the required sample (200) in each group to provide optimal information size (OIS)
^eStudies show limitations with allocation concealment; blinding of participants, those delivering treatment and outcome assessors; intention to treat analysis and control confounding
^fFour out of five studies did not have the required sample (200) in each group to provide optimal information size (OIS)
^gOne out of three studies did not have the required sample (200) in each group to provide optimal information size (OIS)
^hThree out of four studies did not have the required sample (200) in each group to provide optimal information size (OIS)
ⁱSix out of seven studies did not have the required sample (200) in each group to provide optimal information size (OIS)
^jAll three studies did not have the required sample (200) in each group to provide optimal information size (OIS)

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