{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T13:59:30Z","timestamp":1790171970178,"version":"4.1.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"Abstract<\/jats:title>\n \n Background:<\/jats:title>\n Oral diseases affect over 3.5 billion people globally, with children in low- and middle-income countries disproportionately impacted. This study aimed to evaluate the effectiveness of an oral health curriculum in reducing dental caries increment and improving oral hygiene behavior among high school students in the Ernakulam district of Kerala, India.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A cluster-randomized, parallel-group trial was conducted in six English-medium high schools in Ernakulam, Kerala, India, involving 1707 students aged 13\u201315 years. Schools were assigned to receive an oral health curriculum delivered either by a dental professional or a trained schoolteacher. The \u201cEverlasting Smiles\u201d curriculum was implemented over 24 months through six sessions with periodic reinforcement, covering key oral health topics. Outcomes assessed at baseline, 12, and 24 months included the primary outcome (decayed, missing, and filled teeth [DMFT]) and secondary outcomes (oral hygiene index simplified [OHI-S] and oral health-related knowledge, attitude, and behavior scores).<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Significant improvements in oral health-related knowledge (mean: 8.03\u20138.76), attitude (2.77\u20133.23), and behavior (2.38\u20132.64) scores over 24 months (\n P<\/jats:italic>\n < 0.001), postintervention. Dental caries levels decreased, with DMFT reducing from 1.65 to 1.47 (\n P<\/jats:italic>\n = 0.011) and DMFS from 2.01 to 1.81 (\n P<\/jats:italic>\n = 0.018). Dentist-led interventions consistently showed greater improvements than teacher-led ones. Oral hygiene scores improved substantially, with OHI-S declining from 1.06 to 0.74 (\n P<\/jats:italic>\n < 0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n A structured school-based oral health curriculum significantly reduces dental caries and improves oral hygiene behaviors. Integrating it into schools provides a scalable, cost-effective way to promote lifelong oral health and lasting public health benefits.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number:<\/jats:title>\n Clinical Trial Registry of India (CTRI\/2022\/09\/045410), registered on September 12, 2022.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ccd.ccd_19_26","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:01:16Z","timestamp":1790078476000},"page":"174-186","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of an Oral Health Curriculum in Reducing Dental Caries Increment and Improving Oral Hygiene Behavior among Schoolchildren of Ernakulam District in Kerala, India: A Cluster-randomized Trial"],"prefix":"10.4103","volume":"17","author":[{"given":"Hindol","family":"Das","sequence":"first","affiliation":[{"name":"Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"},{"name":"Population Oral Health, School of Dentistry, The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandrashekar","family":"Janakiram","sequence":"additional","affiliation":[{"name":"Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Vijay","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Gutjahr","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra Chaithanyam","family":"Bijukumar","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vineetha","family":"Karuveettil","sequence":"additional","affiliation":[{"name":"Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkitachalam","family":"Ramanarayanan","sequence":"additional","affiliation":[{"name":"Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parvathy","family":"Balachandran","sequence":"additional","affiliation":[{"name":"Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Balagopal","family":"Varma","sequence":"additional","affiliation":[{"name":"Department of Pediatric and Preventive Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, 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