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A School-based Community Health Project for Promoting Oral Hygiene Practices &
Preventive Dental Health Behaviours among Children in Northern Saudi Arabia.
Oral health knowledge is an integral part of general health-related behaviours. Oral health
education can be initiated among children at early age through teachers, dentists, community
outreach, school health programs (Almas et al, 2003; Bhat et al., 2010). Oral hygiene practice
and preventive dental behaviour are fundamental components for good health. Mass
awareness among children is vital to spread knowledge of proper dental care and prevention
of dental diseases. Preventive care from early age has proven effective to minimize the risk of
developing tooth decay and periodontal diseases. Schools are especially effective for
promoting preventive health and dental care behaviours among children (Kwan, 2005).
This project attempts to create awareness among primary school children aged 6-12 years on
practices of oral hygiene and promotion of preventive dental behaviours in Northern part of
Saudi Arabia. The primary school teachers will be trained on basic oral hygiene practice and
preventive dental behaviours who will in turn conduct oral health education among children
following the WHO Health Promoting School framework. In addition, this project will
engage local communities into the school health program by developing linkages with health
care organizations, health professionals which will reinforce the learning and provide
opportunity for secondary treatments.
Limited knowledge on hygiene practice, preventive dental behaviour has been identified as a
major problem to maintain good oral health among Saudi population, school-age and preschool children (Farsi et al., 2004; Al-Wazzan 2004; Wyne et al., 2001; Al-Malik et al,
2003). Inadequate hygiene practice and poor preventive dental behaviour are greatly
attributable for wider prevalence of dental carries among school-students (Paul, 2003).
Increase in knowledge and oral hygiene practice is effective to decrease the prevalence of
dental carries and periodontal diseases (Al-Ansari et al., 2003). Furthermore, there is scope to
strengthen school health education across Saudi students following WHO health promoting
school philosophy. This proposal is pertinent with hygiene practice and preventive
community program which aims to create awareness and inculcate positive oral health habits
and attitudes among students.
Firstly, this project will train the selected primary school teachers. There is evidence on
inadequate oral health knowledge among primary school teachers (Khan et al., 2001).
Teachers will receive training on school health education, determinants of oral health, basic
hygiene practices, protective dental behaviours, food choices, oral care etc. which will
address the capacity building component of health promoting school framework.
Traditionally, teachers are thought to be effective in transferring skills among students with
regard to hygiene practice and dental behaviour than dentists. As second step, teachers will
conduct interactive education session on drilling on tooth brush, dental flossing, dental and
oral structure, identifying detrimental food habits etc. which will enable the children to
practice hygiene and promote healthy dental care behaviours in early stage. Lastly, the
project addresses community health issues in general by engaging local health care

organizations, parents, family members of children, other health professionals (dentists,

nutritionists, nurses etc.) who will reinforce knowledge on protective behaviour. Overall, the
project will address the poor knowledge, attitude and practice of primary school-children
towards oral hygiene and dental care to attain good health and to maintain disease free oral
health in later stage.
The overall aim of this project is to instil oral hygiene practices among 6-12 years
children who are attending at primary schools in Northern Saudi Arabia to maintain
good oral health in future. The specific objectives are:

To train selected teachers on basic oral hygiene principles, methods and dental care
practices from primary schools in Northern Saudi Arabia,


To enable the primary school children to maintain oral hygiene practice and promote
preventive dental behaviour by conducting regular oral hygiene practice sessions and
by creating community awareness, and


To develop linkage with local health care organizations for enhanced secondary
prevention within school communities.

Evidence shows that persistent prevalence of dental carries among Saudi population and
people are suffering from toothache and tooth loss from their pre-school ages (Al-Tamini,
1998; Atieh, 2008). Although much research were conducted among school-age children in
the capital city Riyadh, little information exists on oral hygiene practice and preventive dental
behaviour among school-children of Northern part of Saudi Arabia. It is speculated that there
is much need to restructure and strengthen school health education with special emphasis to
hygiene practice and preventive dental behaviour in those parts of the country. This project
will embark on the principles of WHO health promoting schools framework which will in
turn aim to strengthen the oral health education among children in school setting. Besides,
poor oral hygiene practice e.g. 24.5% children brush teeth once a day, 29% received no oral
hygiene instruction in Al-Hassa areas etc. had been previously documented among school
children of northern Saudi Arabia (Amin & Al-Abad 2008; MOH-KSA, 2008). The project
selects 50 primary schools from discrete Northern part of the kingdom among children
concentrating nomadic and semi-nomadic families as special preferences. This project will
promote hygiene practice among school children in early stage in those parts of the country
and will be supportive to achieve overall healthy nation across Saudi Arabia.
A review of available literature shows limited knowledge on oral hygiene practice, preventive
dental behaviour as well as the prevalence of dental carries across Saudi population. In a
recent study on knowledge, practice and awareness on oral hygiene (Abdullah et al., 2010)
among three groups of Saudi population like age 30, 31-45 and > 45 years, has shown poor
knowledge and oral health condition among people aged 31-45 years. Around 25 %
population aged 31-45 years brush once a day while 16.5% aged 30 years brush twice.
Another Oral Health Survey (Al-Banyan et al., 2000) conducted among 272 children of
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A School-based Community Health Project for Promoting Oral Hygiene Practices

& Preventive Dental Health Behaviours among Children in Northern Saudi Arabia

National Guard Employees within 6-12 years age selected from 35 national schools in Riyadh
show high number of dental carries (3.8 3.2). This research concludes by stating high level
of oral disease and poor oral hygiene among school-age children which need to improve.
Another recent research (Atieh, 2008) among 484 Saudi adolescents (14 years) was
conducted to investigate reasons of tooth loss. The prevalence of tooth loss is around 41%
where boys loss more teeth than girls. Both the proportion and mean tooth loss are
significantly associated with sweet consumption, smoking, tooth brushing, dental flossing,
dental visiting pattern and self-rated oral health. This research suggests urgent community
preventive programmes in to address tooth-loss among adolescents. A Knowledge, Attitude
and Behaviour survey (Farsi et al., 2004) among 2586 Saudi students within age group 12-18
years in Jeddah, show differential findings in terms of gender as well as school students from
government and private sector. Use of tooth brush and dental floss is statistically significant
among private students whereas the use of miswak (chew stick) approach statistically
significance among students of government schools. The research also urges health
promotional program among young Saudi students to improve the knowledge, attitude and
behaviour for preventive dental care. A study (Al-Malik et al., 2003) among 987 preschool
children within 2-5 years age selected from 19 nursery schools in Saudi Arabia was
conducted to determine prevalence and severity of dental carries. The research reveals 77%
and 71% preschool children respectively from government and private schools have some
carries experience. The difference in prevalence rates attains statistical significance. This
statistical model summarizes significant relationship with oral hygiene practice and
prevalence meaning carries is more prevalent among those who brush teeth less often and
those who started brush later stage. This research indicates the importance of health
promotion program among children at early stage to maintain good oral practice. Similar
research (Paul, 2003) to assess prevalence of dental carries in relation to oral hygiene practice
among 103 preschool 5-year old children in Al-Kharj, Saudi Arabia only 16.5% was found
carries free. The mean number of dental carries was 8.5 which are high. The research found
that all children who never brushed their teeth had plaque and caries which implicate the
necessity of hygiene promotion program among school-children.
The above literature throws sufficient light to strengthen oral hygiene practice program
among children across Saudi Arabia so that they can learn the health behaviours which will
enable them to enjoy good oral health in later stage of life.
The project adopts below strategies in line with the principles of WHO Global School Health
Initiative and Health Promoting School framework (Kwan, 2005).
Strategy 1: Capacity Building
Capacity building of selected primary school teachers by training on hygiene practices
and strengthening school health program
Like any community health promotion project, capacity building is central component of this
project. A pool of primary school teachers from 50 selected schools will be trained on oral
hygiene practice and preventive dental behaviours following WHO Health Promoting School

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A School-based Community Health Project for Promoting Oral Hygiene Practices

& Preventive Dental Health Behaviours among Children in Northern Saudi Arabia

Strategy 2: Develop Personal Skills by Working Together (teachers, students, parents)

Interactive education session to promote oral hygiene practice, preventive dental
behaviour and monitoring
The project will apply interactive teaching methods rather than traditional class room
education, to orient the students on oral hygiene practices, preventive dental
behaviours and other related issues. The children will learn basic skills to
adopt healthy lifestyles and behaviour in order to reduce the risks of oral
diseases in future.
Strategy 3: Strengthen Community Actions through Network and Partnership
Develop linkages with local health care organisations and engage local communities in
the school health program
Adoption of this strategy will create opportunity to participate local communities, family
members and other health professionals (e.g. dentists, dieticians, nutritionists
etc.) who will reinforce messages and foster hygiene practices among children.
Strategy 4: Monitoring, Evaluation & Research
Regular monitoring, research (baseline and end line) will be conducted among schoolchildren to analyse the knowledge, attitude and behaviours towards hygiene
practice. This will also enable the project to modify the activities as per socioeconomic and cultural context of the school-children.

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A School-based Community Health Project for Promoting Oral Hygiene Practices

& Preventive Dental Health Behaviours among Children in Northern Saudi Arabia

This is a three year project period starting from 2012-2015 in selected primary schools in
northern part of Saudi Arabia. Below table shows key timeline of the project by major
Major Activity & Timeline




Project announcement, meeting, inauguration, and finalization.

Project set up and other administrative tasks (staff, resources, etc.)
School selection in northern part (nomadic & seminomadic
zones), meeting with authorities.
Teachers training need assessments.
Baseline survey among students and teachers on current
Knowledge, Attitude and Behaviour on hygiene practice and
Collection of WHO training curricula, if necessary design further
with local culture and examples etc.
Traning of teachers on WHO HPS framework.
Interactive session to develop learning skills among students as
outlined in the project (drilling on brushing, exercise, model
demonstration, healthy practices, choices, life style factors etc.)
Project mid-term assessment, if need new school selection,
teachers further need, refreshers training etc.
Develop partnership with local dental care, health professionals
etc. to engage community participation in health programs of
End line survey to assess changes in knowledge, attitudes, dental
visits, etc.
Publication, dissemination, design further extension based on
findings in other areas.

The project will be evaluated through base line and end-line surveys approach. At the
beginning, there is baseline survey among the school-children to assess the existing
knowledge, attitude and behaviour and training needs assessments among teachers. The
research findings will help to adapt the training curricula as per the need of children as well
as teachers. Regular monitoring and supervision will be conducted as per fixed monitoring
indicators of HPS framework. An end-line survey will be conducted to measure the

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A School-based Community Health Project for Promoting Oral Hygiene Practices

& Preventive Dental Health Behaviours among Children in Northern Saudi Arabia

effectiveness. Apart these surveys, a short midterm evaluation will be conducted which will
allow reassessment of strategies, modifications in approach, activities.
A mixed method technique will be adopted during evaluation. Children, parents, teachers and
community will be interviewed because; the project aims the community participation for
reinforcement of positive behavioural norms among children.


The project aims to create below benefits among the primary school children of 6-12 years
among communities of nomadic and seminomadic families in Northern Saudi Arabia:

Around 25,000 children with age group 6-12 years will be aware on oral health,
hygiene and preventive health behaviours which will help to develop positive attitude
on dental care from early stage in life.

Children will learn skills on oral hygiene practice and preventive dental behaviours
from early stage of life which will help them to maintain a disease free oral health in
later stage of life.

Around 250 teachers will be trained on oral health, hygiene practice curricula to
strengthen school health education. The school program will also involve community
by engaging parents, teachers and other health professional, health care organizations
which will create a solid base for community health project in school setting.

Early awareness and learning hygiene skills will facilitate decision making on food
choices in their adolescents and adulthood stage.

Lastly, it will help individuals and groups (children, school community, etc.) to move
towards a new approach in public health for oral hygiene practice and protected dental

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A School-based Community Health Project for Promoting Oral Hygiene Practices

& Preventive Dental Health Behaviours among Children in Northern Saudi Arabia

Abdullah, M., Ali, H. Md., & Rahiman, S. 2010, Knowledge, practice and awareness of oral
hygiene among three different age populations of same ethnic group a
community based study. Braz. J. Oral Sci. 9(4): 481-487.
Al-Banyan, R.A., Echeverri, E.A., Narendran, S., & Keene, H.J. 2000, Oral health survey of
5-12 year old children of National Guard employees in Riyadh, Saudi Arabia.
International Journal of Paediatric Dentistry. 10: 39-45.
AI-Malik, M.I., Holt, R.D., & Bedi, R. 2003, Prevalence and Patterns of Caries, Rampant
Caries, and Oral Health in Two- to Five-Year-Old Children in Saudi Arabia.
Journal of Dentistry for Children. 70 (3): 235-242.
Almas, K., Al-Malik., M.T., Al-Shehri, M.A., & Skaug, N. 2003, The knowledge and
practice of oral hygiene methods and attendance pattern among school teachers in
Ryadh, Saudi Arabia. Saudi Medical Journal. 24 (10): 1087-1091.
Al-Tamini, S, & Petersen, PE. 1998, Oral health situation of schoolchildren, mothers and
schoolteachers in Saudi Arabia. Int. Dent. J.48:180186.
Al-Ansari, J., Honkala, E., & Honkala, S. 2003, Oral health knowledge and behaviour among
male health sciences college students in Kuwait. BMC Oral Health. 3(2).
Amin, T.T., & Al-Abad, B.M. 2008, Oral hygiene practices, dental knowledge, dietary habits
and their relation to caries among male primary school children in Al Hassa,
Saudi Arabia. Int. J. Dent. Hygiene. 6: 361370.
Atieh, M.A. 2008, Tooth loss among Saudi adolescents: social and behavioural risk factors.
International Dental Journal. 58: 103-108.
Al-Wazzan, K.A. 2004, Dental caries prevalence in 6-7 year-old schoolchildren in Riyadh
region: A comparative tudy with the 1987 Oral Health Survey of Saudi Arabia
Phase I. Saudi Dental Journal. 16(2): 54-60.
Bhat, P.K., Kumar, A., & Aruna, C.N. 2010, Preventive oral health knowledge, practice and
behaviour of patients attending dental institution in Bangalore, India. J. Int Oral
Health. 2(2): 27-38.
Farsi, J.M.A., Farghaly, M.M., & Farsi, N. 2004, Oral health knowledge, attitude and
behaviour among Saudi school students in Jeddah city. Journal of Dentistry. 32:
Khan, N., Al-Zarea, B., & Al-Mansour, M. 2001, Dental caries, hygiene, fluorosis and oral
health knowledge of primary school teachers of Riyadh, Saudi Arabia. Saudi
Dental Journal. 13(3): 128-132.
Kwan, S.Y.L., Petersen, P.E., Pine, C.M., & Borutta, A. 2005, Health promoting schools: An
opportunity for oral health promotion. Bulletin of the World Health Organization.
83 (9): 677-685.
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A School-based Community Health Project for Promoting Oral Hygiene Practices

& Preventive Dental Health Behaviours among Children in Northern Saudi Arabia

Paul, T.R. 2003, Dental health status and caries pattern of preschool children in Al-Kharj,
Saudi Arabia. Saudi Medical Journal. 24 (12): 1347-1351.
Wyne, A., Darwish, S., Adenubi, J., Battata, S., & Khan, N. 2001, The prevalence and pattern
of nursing caries in Saudi preschool children. International Journal of Paediatric
Dentistry.11: 361364.

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A School-based Community Health Project for Promoting Oral Hygiene Practices

& Preventive Dental Health Behaviours among Children in Northern Saudi Arabia