• NASREEN HAMARASH HAMONARI Lecturer, Dept of dentistry, Kurdistan Higher Council of Medical Specialties, Erbil, Kurdistan Region, Iraq
  • QAYSER SAHIB HABEEB Professor, Dept of Family and Community Medicine, Duhok College of Medicine, University of Duhok
Keywords: Gingival index, Health education, , Periodontal health, Plaque index, Primary school students



Background: Data from numerous epidemiological studies revealed that the prevalence and severity of periodontal disease is wide spread in children and adolescents, with approximately 50% to 100% of 12-years-old children having the signs of gum inflammation.

Aim: This study was designed to assess the role of health education program in improving periodontal health status among primary school students in Duhok governorate.

Participants and methods: The study investigated students 11-15 years old selected from 12 schools out of (892) primary public schools in Duhok governorate. For better socio demographic representation, the schools were purposely categorized into three equal groups representing rural, suburban and urban sectors. Four schools were randomly selected from each of the three sub-counties, two schools were randomly assigned for health education programs with the other two schools regarded as controls. All students of the first 6th grade class from the selected schools were enrolled. Thus a total of 615 students were assigned to intervention and controls (304 and 311 students respectively). A questionnaire was used to obtain information on age, gender, medical diseases and drug history. Utilizing a variety of learning and teaching methods a specially constructed health education program was administered to the intervention group by the researcher. The program included lectures, discussions, practical experiments, group work, problem-solving exercises, debates and role-play with appropriate stimulating visual aids and posters, accompanied by distribution of brushes and paste to the students. This was followed by clinical dental examination for each student. The effects of health education have been evaluated by using two outcome variables namely; Plaque index and gingival index.

Results: The results revealed high scores of plaque and gingival indices at the baseline pre- intervention assessment among the participants. These scores have been reduced significantly at post intervention assessment in the intervention group compared to the controls p ≤ 0.05. This improvement in the intervention group was maintained at follow up assessment six weeks after the intervention.

 Females in the intervention and the control groups exhibited lower mean plaque and gingival scores than males. Both gingival and plaque scores in this study were consistently higher in rural than in urban communities p ≤ 0.05 (Significant).


Download data is not yet available.


1. Petersen PE and Ogawa H. Strengthening the prevention of periodontal disease: The WHO approach. J Periodontol .2005; 76: 2187-2193.
2. World Health Organization. The Status of School Health. Report of the School Health Working Group and the WHO Expert Committee on Comprehensive School Health Education and Promotion. Geneva: WHO, 1996.
3. World Health Organization. Global Oral Health Data Bank. Geneva: WHO, 2001.
4. World Health Organization .The world oral health report. Geneva, 2003, World Health Organization (WHO/NMH/NPH/ORH/03.2), 2003
5. Löe H. Oral hygiene in the prevention of caries and periodontal disease. Int Dent J.2000; 50: 129-1.
6. U.S Department of Health and Human Ser;vices. Oral Health in America: A Report of the Surgeon General. Rockville, Maryland, 2000.
7. Murray JJ, Nunn JH, Steele JG. Prevention of oral disease. 4th ed. Oxford: Oxford University press. 2003; pp: 7-34, 77-95, 123-144, 241-258.
8. Al-Beiruti N. Oral health behaviour among a sample of school teachers, physicians and nurses in the Syrian Arab Republic, East Meditt Health J.1997;3:258-262
9. Baelum V, Fejerskov 0, Monji F. Periodontal diseases in adult kenyans. J Clin Periodontal.1988; 15(7):455-2.
10. Al-Sayyab M, Al-Alousi W, and Al-Dujaili D. Periodontal treatment needs among 15 years old Iraqi school children in the city of Baghdad, 1991.
11. Khamrco TY, Abdal AK, Salman KA. Dental health status in - Kasa Fakra and Shamsiat Village. J College of Dentistry.2000; 7:5-18.
12. Makani LA. Oral hygiene and gingival health among adolescents and adult population(15-44)years in Sharkhan village, Al-Rafidain Dental J.2001;1(1):1-7
13. Al-Mufti NA (1996): Prevalence of gingivitis in adolescent and its relation to socioeconomic status in Baghdad.AI-Buhooth Al-TachaniyaJ. 1996;9(32): 16-27
14. Al-Naimi RJ. Oral health status and treatment needs in 13-15 year old students in Mosul city Iraq. M. Sc. Thesis, University of Mosul, 1998.
15. Khamrco TY. A comparative study of dental health status between urban and rural school students in Nineveh, Iraq. Al-Rafidain Dent J.2001; 1(1): 7-15.
16. Åstrøm AN and Samdal O. Time trends in oral health behaviours among Norwegian adolescents. Acta Odontol Scand. 2001;59:193- 200
17. Mutar TA. Evaluation of WHO dental health education program for primary schools in Dyala Governorate-Iraq. M.Sc. Thesis, University of Baghdad, 1998.
18. Khamrco TY. Assessment of periodontal disease using the CPITN index in a rural population in Ninevah, Iraq. East Meditt Health J.1999; 5(3): 549-555.
19. Makani LA, Al-Dabbagh SA, Khamrco TY. Evaluation of three methods of dental health education in changing dental knowledge, attitude, behaviour and improving gingival health. J College of Dentistry.1999; 5:45-54
20. Silness J and Löe H. Periodontal Disease in Pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand.1964; 22:1, 121-135.
21. Löe H and Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand.1963; 21:533-551.
22. Vanobbergen J, Martens L, Lesaffre E, Declerck D. Parental occupational status related to dental caries experiences in 7-year-old in Flanders (Belgium). Community Dent Health.2001; 18: 256-262.
23. Albandar JM. Global risk factors and risk indicators for periodontal diseases. Periodontol 2000.2002; 29: 177-206.
24. Makani LA. Evaluation of trials of dental health education in improving gingival health. M.Sc. Thesis, University of Mosul, 1998.
25. Ali DN. Oral health status and treatment needs among 12 years old school children in urban and rural areas of Baghdad, Iraq. M.Sc. Thesis, 2001, University of Baghdad, College of Dentistry.
26. Albandar JM and Tinoco EM (2002). Global epidemiology of periodontal diseases in children and young persons. Periodontol 2000.2002; 29: 153-176.
27. Corbet EF, Zee KY, Lo ECM (2002). Periodontal diseases in Asia and Oceania. Periodontol 2000. 2002; 29: 122-152.
28. WHO Oral Health Country/Area Profile. Geneva, World Health Organization, 2005.
29. Yazdani R. Dental health and school-based health education among 15-year-olds in Tehran, Iran, University of Helsinki Finland, 15 May, 2009.
30. Kay E and Locker D.Is dental health education effective? A systematic review of current evidence. Community Dent Oral Epidemiol.1996; 24: 231-235.
31. Sri Wendari AH, Lambri SE, van Palenstein Helderman WH. Effectiveness of primary school-based oral health education in West Java, Indonesia. Int Dent J.2002; 52: 137-143.
32. Biesbrock AR, Walters PA, Bartizek RD. Initial impact of a national dental education program on the oral health and dental knowledge of children. J Contemp Dent Pract.2003; 2: 1-10
33. Petersen PE, Peng B, Tai B, Bian Z, and Fan M. Effect of a school-based oral health education program in Wuhan city, People's Republic of China. Int Dent J.2004 54: 33-41.
34. Kay E and Locker D. A systematic review of the effectiveness of health promotion aimed at improving oral health. Community Dent Health. 1998; 15: 132-144.
35. Hausen H. Oral health promotion reduces plaque and gingival bleeding in the short term. Evid Based Dent.2005; 6: 31.
36. Baranowski T, Allen D, Masse C, and Wilson M. Does participation in an intervention affect responses on self-care questionnaires? Health Educ Res.2006; 21(1): 98-109.
37. Al-Azawi LAB. Oral health status and treatment needs among Iraqi five-years old kindergarten children and fifteen -years old students(A national Survey) Ph.D. Thesis, University of Baghdad, College of Dentistry,2000.
38. Ashraf-Sadat Sanei and Alireza Nikbakht-Nasrabadi. Periodontal health status and treatment needs in Iranian adolescent population.2005; 8 (4): 290-294.
39. Macêdo TCN, Costa MCN, Gomes-Filho IS, Vianna MIP, and Santos CT. Factors related to periodontal disease in a rural population. Braz Oral Res.2006; 20(3):257-62.
40. Department of Health and Environmental Control. South Carolina takes action: the burden of oral disease, 2007.
How to Cite