The aim of this randomized controlled trial is to test the null hypothesis that parent education using an intraoral camera has no effect on children's oral hygiene levels, parental oral health literacy, or plaque accumulation on first permanent molars compared with standard verbal education. 40 children aged 5-7 and their parents will be randomly assigned to two groups. The intervention group will receive real-time visualization of dental conditions and brushing techniques using an intraoral camera, while the control group will receive standard verbal education using a brushing model. Outcomes include children's plaque and gum health and ICDAS caries scores. Secondary outcomes include Occlusal Plaque Index (OPI) on first molars. Assessments will be conducted at baseline and 1-month follow-up. This study tests whether intraoral camera-assisted education leads to better oral hygiene outcomes in children, improves parents' oral health literacy, and reduces plaque accumulation on the first permanent molars compared to standard verbal education.
Dental caries is a common problem in children, and teaching good oral hygiene is important for prevention. Parents play a key role in protecting their children's teeth, especially when the first permanent molars erupt, because these teeth are more sensitive to plaque and caries. In pediatric dentistry, it is known that when parents have better oral health literacy, their children tend to show better oral health outcomes, making parental literacy an important factor. Because of this, education methods that allow parents and children to see the mouth clearly may be more effective. Using an intraoral camera provides real-time visual feedback, so children and parents can directly observe plaque, caries, and brushing mistakes. This may increase motivation, support correct brushing techniques, and improve parents' understanding of oral health. The aim of this study is to determine whether intraoral camera-assisted education can improve children's oral hygiene and increase parents' oral health awareness and literacy more than standard verbal education. Based on this aim, the study tested the following hypotheses: Null Hypothesis (H0a): Intraoral camera-assisted education has no effect on improving children's oral hygiene levels. Alternative Hypothesis (H1a): Intraoral camera-assisted education improves children's oral hygiene levels. Null Hypothesis (H0b): Intraoral camera-assisted education has no effect on improving parental oral health literacy. Alternative Hypothesis (H1b): Intraoral camera-assisted education improves parental oral health literacy. Null Hypothesis (H0c): Intraoral camera-assisted education has no effect on plaque accumulation on first permanent molars. Alternative Hypothesis (H1c): Intraoral camera-assisted education reduces plaque accumulation on first permanent molars. For this purpose, the study is planned as a randomized controlled trial with two groups: an intervention group and a control group. Data will be collected before the education and at the 1-month follow-up after the education to compare changes over time. A two-factor repeated measures ANOVA will be used to evaluate the differences between the groups. A priori power analysis (G\*Power 3.1) showed that at least 34 participants (17 for each group) are needed to detect a medium effect (f = 0.25, α = 0.05, 80% power). To reduce the risk of sample loss, a total of 40 child-parent pairs will be included. These pairs will be randomly assigned to either the intraoral camera-assisted education group or the standard verbal education group. Intervention group: Receives intraoral camera-assisted oral hygiene education. Dental findings such as plaque, caries, and gingival inflammation, as well as brushing techniques, are visualized in real time. Disclosing agents highlight plaque-covered areas, and brushing demonstrations on the child's teeth are individualized using the Modified Stillman and cross-brushing techniques. Parents and children receive visual feedback to reinforce oral hygiene education. Control group: Receives standard verbal oral hygiene education using a brushing model. The Modified Stillman and cross-brushing techniques are demonstrated verbally and on the model, without intraoral camera visualization. Primary outcomes are changes in children's Plaque Index (PI), Gingival Index (GI), ICDAS caries scores, and parents' oral health literacy assessed using the Turkish version of the Oral Health Literacy Assessment Task for Pediatric Dentistry (TOHLAT-P). Secondary outcomes are the Occlusal Plaque Index (OPI) on first molars and the Parent-Child Satisfaction Survey evaluating the intraoral camera-assisted education. Assessments will be conducted at baseline and 1-month follow-up, except for the satisfaction survey, which will be administered only at the 1-month follow-up. The study assesses whether visualized instruction provides additional benefits over verbal education alone in improving objective clinical measures and parental understanding, supporting enhanced preventive care in pediatric dental practice.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
40
Participants receive individualized oral hygiene education using an intraoral camera. Dental findings such as plaque, caries, and gingival inflammation are visualized in real time. Disclosing agents highlight plaque-covered areas, and brushing demonstrations are performed directly on the child's teeth using the Modified Stillman and cross-brushing techniques. Parents and children receive visual feedback to reinforce proper oral hygiene practices.
Participants receive standard verbal oral hygiene education using a brushing model. The Modified Stillman and cross-brushing techniques are demonstrated verbally and on the model. Oral hygiene principles, plaque control, and the importance of regular brushing are explained to both children and parents.
Occlusal surfaces of permanent first molars will be photographed using the EZCAM VATECH intraoral camera to document plaque accumulation. The photographs will be shown only to participants in the camera-assisted education group during oral hygiene instruction. These images will help them see plaque areas and understand correct brushing. The control group will receive only verbal education and will not view the photographs. All images will be stored securely and used only for evaluation in the study.
Parental oral health literacy, knowledge about preventive dental care, and their ability to help their child with oral hygiene will be measured using the Turkish version of the Oral Health Literacy Assessment Task for Pediatric Dentistry (TOHLAT-P). This tool evaluates parents' understanding and use of oral health information. Higher scores indicate better oral health literacy.
A structured questionnaire was given to children and parents in the intraoral camera education group. The aim was to evaluate their satisfaction with the education process. The questionnaire focused on the usability of the intraoral camera and how helpful it was during dental education.
Aydın Adnan Menderes University, Faculty of Dentistry
Aydin, Turkey (Türkiye)
RECRUITINGChildren's Plaque Index (PI)
Plaque levels on the mesial, distal, buccal, and lingual surfaces of all present teeth, excluding partially erupted teeth, were assessed using the Silness and Löe Plaque Index (scores 0-3). Plaque Index and Criteria: 0.Absence of microbial plaque 1. Thin film of microbial plaque along the free gingival margin 2. Moderate accumulation with plaque in the sulcus 3. Large amount of plaque in sulcus or pocket along the free gingival margin
Time frame: Baseline
Children's Plaque Index (PI)
Plaque levels on the mesial, distal, buccal, and lingual surfaces of all present teeth, excluding partially erupted teeth, were assessed using the Silness and Löe Plaque Index (scores 0-3). Plaque Index and Criteria: 0\. Absence of microbial plaque 1. Thin film of microbial plaque along the free gingival margin 2. Moderate accumulation with plaque in the sulcus 3. Large amount of plaque in sulcus or pocket along the free gingival margin
Time frame: 1 month after intervention
Children's Gingival Index (GI)
Gingival status was assessed on the mesial, distal, buccal, and lingual surfaces of all present teeth, excluding partially erupted teeth, using the Löe and Silness Gingival Index (0-3). Gingival Index (GI) and Criteria: 0\. Normal gingiva; no inflammation; no discoloration (erythema); no bleeding. 1. Mild inflammation; slight erythema; minimal superficial alterations; no bleeding. 2. Moderate inflammation; erythema; bleeding on probing. 3. Severe inflammation; severe erythema and swelling; tendency to spontaneous bleeding; possible ulceration.
Time frame: Baseline
Children's Gingival Index (GI)
Gingival status was assessed on the mesial, distal, buccal, and lingual surfaces of all present teeth, excluding partially erupted teeth, using the Löe and Silness Gingival Index (0-3). Gingival Index (GI) and Criteria: 0\. Normal gingiva; no inflammation; no discoloration (erythema); no bleeding. 1. Mild inflammation; slight erythema; minimal superficial alterations; no bleeding. 2. Moderate inflammation; erythema; bleeding on probing. 3. Severe inflammation; severe erythema and swelling; tendency to spontaneous bleeding; possible ulceration.
Time frame: 1 month after intervention
ICDAS Caries Score
Caries status of all present teeth, excluding partially erupted teeth, was recorded using the International Caries Detection and Assessment System (ICDAS). ICDAS Codes (International Caries Detection and Assessment System) 0\. Sound tooth surface 1. First visual change in enamel 2. Distinct visual change in enamel 3. Localized enamel breakdown due to caries with no visible dentin 4. Underlying dark shadow from dentin (with or without enamel breakdown) 5. Distinct cavity with visible dentin 6. Extensive distinct cavity with visible dentin
Time frame: Baseline
ICDAS Caries Score
Caries status of all present teeth, excluding partially erupted teeth, was recorded using the International Caries Detection and Assessment System (ICDAS). ICDAS Codes (International Caries Detection and Assessment System) 0\. Sound tooth surface 1. First visual change in enamel 2. Distinct visual change in enamel 3. Localized enamel breakdown due to caries with no visible dentin 4. Underlying dark shadow from dentin (with or without enamel breakdown) 5. Distinct cavity with visible dentin 6. Extensive distinct cavity with visible dentin
Time frame: 1 month after intervention
Parental Oral Health Literacy (TOHLAT-P)
Parents' oral health literacy, understanding of preventive care, and ability to support children's oral hygiene, assessed by TOHLAT-P. This questionnaire is used to assess parents' oral health knowledge. It measures three types of knowledge (factual, procedural, and conceptual) and includes cognitive process levels (remembering, understanding, and analyzing). The tool also uses literacy and numeracy skills. It has three sections. The maximum score for each section is 12, 26, and 14. The total score range is 0-52. Higher scores indicate higher oral health literacy.
Time frame: Baseline
Parental Oral Health Literacy (TOHLAT-P)
Parents' oral health literacy, understanding of preventive care, and ability to support children's oral hygiene, assessed by TOHLAT-P. This questionnaire is used to assess parents' oral health knowledge. It measures three types of knowledge (factual, procedural, and conceptual) and includes cognitive process levels (remembering, understanding, and analyzing). The tool also uses literacy and numeracy skills. It has three sections. The maximum score for each section is 12, 26, and 14. The total score range is 0-52. Higher scores indicate higher oral health literacy.
Time frame: 1 month after intervention
Occlusal Plaque Index (OPI)
Plaque accumulation on the occlusal surfaces of permanent first molars will be assessed after plaque disclosure using an intraoral camera. The images will be analyzed with ImageJ software (National Institutes of Health, USA) by manually outlining the total occlusal surface area and the plaque-covered areas. All measurements will be performed by the same examiner and repeated at two different time points to reduce measurement error. Intra-examiner reliability will be evaluated using the intraclass correlation coefficient (ICC), and the occlusal plaque index (OPI) will be calculated as the percentage of plaque-covered area relative to the total occlusal surface area using the formula: OPI = (Plaque area / Occlusal surface area) × 100.
Time frame: Baseline
Occlusal Plaque Index (OPI)
Plaque accumulation on the occlusal surfaces of permanent first molars will be assessed after plaque disclosure using an intraoral camera. The images will be analyzed with ImageJ software (National Institutes of Health, USA) by manually outlining the total occlusal surface area and the plaque-covered areas. All measurements will be performed by the same examiner and repeated at two different time points to reduce measurement error. Intra-examiner reliability will be evaluated using the intraclass correlation coefficient (ICC), and the occlusal plaque index (OPI) will be calculated as the percentage of plaque-covered area relative to the total occlusal surface area using the formula: OPI = (Plaque area / Occlusal surface area) × 100.
Time frame: 1 month after intervention
Parent and Child Satisfaction with Intraoral Camera-Assisted Education
In this study, children and parents will complete two short questionnaires to assess their perceptions of the use of an intraoral camera during dental examination. Responses will be recorded using a 5-point Likert-type scale ranging from strongly agree to strongly disagree, with higher scores indicating more positive perceptions of intraoral camera use. Child questionnaire 1. I liked having photographs of my teeth taken with the intraoral camera. 2. I felt comfortable while photographs of my teeth were taken using the intraoral camera. 3. I would tell my friends about having my teeth photographed with an intraoral camera. Parent questionnaire 1. The use of an intraoral camera helped us better understand dental treatment and oral hygiene instructions. 2. The use of an intraoral camera improved our overall dental examination experience. 3. I would recommend the use of an intraoral camera during dental examination to others.
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Time frame: At 1 month after intervention