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The evidence concerning the impacts of MMCs using television, radio, newspaper and other electronic and print media shows that these can have significant effects upon major public health risk factors, including tobacco use, sedentary behaviour, sexual health practices, sun protection behaviours, cancer screening, and road safety behaviours [ 13 , 14 , 15 ].

Further, there is encouraging, albeit limited, evidence that MMCs can contribute to the development of public health policies, as reported in relation to clear air legislation and tobacco sales regulations [ 16 ].

For oral health, MMCs can be used to target preventive health behaviours, improve screening or encourage the use of dental services.

They may also be applied in advocacy efforts to raise public awareness and support for policy initiatives to improve oral health, such as water fluoridisation and subsidisation of dental services for priority population groups. It is notable, however, that there has been limited attention to MMCs in previous reviews of the evidence concerning oral health promotion strategies.

The purpose of this scoping review is to describe the objectives, design and evaluation methods of oral health MMCs, and to report current evidence of their effectiveness, strengths and limitations.

This scoping review was registered at the Research Registry ID: reviewregistry To be included, articles were required to be published in English between January and December The literature searching strategy is shown in Additional file 1 : Figs.

S1 and 2. This process yielded 28 abstracts Fig. Papers were assessed against the inclusion criteria and the reference lists were checked for additional studies not identified via the systematic search. During this process, a further 10 papers were identified, located and assessed for inclusion.

Of the 38 full articles assessed, 20 articles did not meet the review inclusion criteria, leaving 18 published papers in the final review. The FLOWPROOF framework for the appraisal of mass media campaigns was used to analyse the extracted information [ 18 ], as it encompasses the best practice elements of campaign development, delivery and evaluation.

The components of the FLOWPROOF framework are shown in the adjacent Box 1. The 18 articles included in this review described 11 campaigns. Table 1 presents the data extracted from these article for each of these campaigns. Of these, eight were at the national or large regional level, and three were at the city or smaller regional level.

The vast majority of the evaluations [10 out of 11] reported formative needs assessment data as the rationale for the campaigns conducted.

In most instances this was evidence of the prevalence of poor dental health e. In two evaluations [ 23 , 32 ] the lack of impact of previous oral health promotion strategies upon behaviours and indicators of oral health were cited as the basis for the campaigns.

All of the campaigns stated clear objectives, with four addressing periodontal awareness and knowledge [ 19 , 23 , 30 , 35 ], six targeting self-care dental preventive behaviours tooth brushing, toothpaste use, flossing, reducing sugar intake, use of infant drinking cups [ 22 , 23 , 25 , 27 , 29 , 32 ], and two promoting use of dental health services [ 21 , 35 ].

One campaign was undertaken to persuade adults in a regional community to vote in favour of water fluoridation [ 34 ]. Most of the MMCs did not have well defined target audiences. In two campaigns it was noted that campaign messages were directed to a whole population [ 25 , 32 ], while five campaigns targeted adults [ 19 , 23 , 30 , 34 , 35 ], and two targeted children [ 22 , 29 ].

While none of the campaign evaluations presented a comprehensive logic model, three cited a theory or model of change as the basis for their campaign design [ 19 , 23 , 27 ]. Consequently, each included strategies to engage intermediaries e. All except two [ 32 , 35 ] of the MMCs used paid advertising to reach target audiences via the mass media.

There was only one oral health campaign that was implemented over multiple waves [ 25 ], involving a different theme every year for over two decades. In addition to mass media, in four campaigns information and resources were provided to dental professionals to boost on-the-ground support for the oral health messages through use of these materials in their interactions with the target groups [ 21 , 23 , 27 , 30 ].

In another campaign in Finland, local dental societies offered free dental consultations to coincide with the campaign [ 21 ]. Little information was available in any of the evaluations concerning finance, personnel and other resources required to deliver the MMCs and associated activities.

Process evaluation was reported in eight campaigns [ 19 , 22 , 23 , 25 , 27 , 29 , 30 , 35 ]. While it was common for elements of campaign delivery e. The methods used to evaluate campaign reach were stated in three studies [ 23 , 25 , 27 ]. Campaign exposure was the most common form of process evaluation, which was reported in six campaigns [ 19 , 22 , 23 , 29 , 30 , 35 ].

In all cases, this was measured by asking questions within follow-up surveys to elicit campaign message recall. The evaluation of the infant feeding campaign in the Netherlands was the only instance where there was examination of contextual factors which affected the implementation process.

This was undertaken by follow-up interviews with the public health and childcare intermediaries [ 27 ]. In terms of the evaluation of campaign impacts, two of the studies used a quasi-experimental, controlled pre- and post-test design [ 29 , 32 ]. In the oral hygiene campaign in Ireland, children were followed up after 8 weeks at control and intervention sites [ 29 ], while in the toothbrushing campaign undertaken in Finland there was follow-up of parents and children after both 1 year and 3.

Five of the studies assessed campaign impacts using a pre- and post-test design [ 21 , 23 , 27 , 30 , 35 ]. In two of these, cohorts underwent assessment at baseline and follow-up, which was after 3 months in one study [ 35 ] and 6 months in the other [ 30 ].

Two studies recruited independent samples at the pre-and post-test measurement points, with one of these undertaking follow-up after 1 year [ 21 ] and the other at multiple time-points 1, 2 and 3 years [ 23 ]. In one study, follow-up was conducted after 18 months and included a cohort measured at baseline as well as newly recruited participants [ 27 ].

A post-test only design was used for impact evaluation in four of the studies [ 19 , 22 , 25 , 34 ]. The evaluation of the long-term national campaign in China was notable because follow-up was conducted in every year of the campaign over 20 years [ 25 ].

In other studies follow-up was carried out immediately after the campaign [ 34 ], or 2 months later [ 19 ], while in one study follow-up was conducted at both of these timepoints [ 22 ].

None of the campaigns included an economic evaluation to assess cost—benefit, cost effectiveness, or return on investment from the oral health MMCs.

The highest levels of awareness were reported in the study that collected measures from relatively small, quota samples of adults and children [ 22 ]. Impacts upon oral health knowledge were reported in eight studies, with measures that examined understanding of risk factors and symptoms of poor oral health e.

Four uncontrolled studies showed significant improvements in measures of oral health knowledge, including those investigating change after 6 months [ 30 ], 18 months [ 27 ] and 3 years [ 25 ].

In three further studies there was investigation of whether those reporting campaign exposure at follow-up had higher levels of oral health knowledge than the unexposed. Each of these reported a significant association between campaign exposure and oral health knowledge, with follow-ups between 2 and 3 months in all cases [ 19 , 29 , 35 ].

Only two studies investigated changes in oral health attitudes. In the quasi-experimental campaign evaluation undertaken in regional Finland there was no improvement found in attitudes towards oral health among parents or children in the intervention town after 3.

In the other study, support for water fluoridation was found to have a prevalence of Eight studies reported impacts of campaigns upon oral health behaviours, which included toothbrushing, use of fluoride toothpaste, dental flossing, consumption of sugary foods and drinks, smoking, use of infant feeding bottles, and use of dental service.

Two of the controlled quasi-experimental studies found improvements in oral health behaviours among children who were exposed to campaign interventions. Follow-up after 3. The studies using pre-and post-test designs reported improvements in selected behavioural outcomes: in the campaign addressing nursing caries in the Netherlands there was a reduction in infant bottle feeding after 18 months, but not higher adherence to recommendations for switching from bottles to drinking cups [ 27 ]; follow-up at 12 and 24 months in the national oral health campaign in Finland found an increase in visits to dentists, but not in attendance for general dental examinations [ 30 ]; and, in the campaign in Norway which promoted the use of interdental aids there was found to be an increase in levels of flossing between the immediate post-campaign and 12 month follow-ups, but no improvements were reported in other outcomes [ 23 ].

In the serial post-test surveys conducted following the annual campaigns in China there was a marked improvement in twice daily toothbrushing and use of recommended toothbrushes and fluoride toothpaste, over a three year period, but little change in the prevalence of dental visits [ 25 ].

In the other two studies that assessed impact using post-test designs, one did not find differences in preventive dental visits between those who recalled and did not recall the campaign [ 19 ], while the other reported improvements in oral health behaviours among children who recalled the campaign but did not compare these with outcomes in the non-recallers [ 22 ].

This is the first synthesis of peer-reviewed studies concerning the delivery and impact of oral health MMCs implemented over a year period. Although reviews have been conducted of health education programs for oral health [ 6 , 9 , 10 ] there has not been a structured assessment of those using mass-reach media channels.

There was wide variation in the evaluation and reporting of these interventions, which may reflect a limited adoption of the planning frameworks and models used in MMCs conducted for other health-risk behaviours [ 15 , 16 , 18 , 37 ], as well as the under-developed status of research and practice in this area.

Notwithstanding these limitations, the findings indicate potential for oral health campaigns to achieve good levels of population engagement, and to influence knowledge and behaviours across diverse oral health topics.

All of the studies included in this review used traditional media channels. Television was the most frequently adopted mass-reach strategy, and some MMCs used combinations of radio, print, billboards and bus-side advertisements, supported by public relations strategies. The fact that none of the campaigns were conducted within the past decade may account for the absence of online and social media methods of delivery, which are now widely used communication channels within public health campaigns given their potential reach and relatively low cost [ 16 ].

Only one of the included studies reported a systematic method of recording the delivery of campaign components, and none appeared to adopt commonly used metrics of mass media reach e.

The messages delivered in campaigns aligned with the recommendations of leading dental health agencies, including the adoption of oral hygiene behaviours e. One campaign was distinguished by its focus on advocating for public support of water fluoridation, rather than a personal behaviour.

The breadth of issues addressed across the MMCs highlights the scope for public health interventions in this field, as well as the opportunity to focus on well-defined behaviours, which is a factor that is likely to improve campaign effectiveness [ 40 ]. However, only two of the studies reported preliminary formative evaluation to guide the development of messages and design of media content and resources, which is recognised as a standard element of good practice in MMCs [ 37 , 41 ].

There was also an apparent lack of use of best practice logic models that propose a roadmap linking campaign activities to message exposure, knowledge development, attitude formation, intentions and behaviours [ 37 ].

In several oral health MMCs, health opinion leaders e. It would benefit future oral public health endeavours to harness wider community influencers and social networks [ 16 ].

It has been posited that social marketing initiatives can comprise strategies across five domains: altering the environment; regulation and enforcement; provision of services; education; and the communication of information for attitude change.

Some of the MMCs reviewed here attended to the provision of services to support behaviour change, and others incorporated education initiatives in the intervention mix [ 42 ].

Building upon this, and applying a social ecological analysis of the determinants of oral health, other important targets of change may include public policies that affect costs of sugar sweetened beverages, access to dental services, incentives for primary care practitioners to promote oral health behaviours, and partnerships with agencies and groups that have engagement with priority population groups e.

A social marketing approach that incorporates actions at these multiple levels will not only increase enablers for behaviour change, but may also achieve more sustained delivery and impact than is possible through MMCs alone.

Building support among policy makers is needed to increase public investment in mass reach oral health promotion campaigns, and researchers can assist by providing evidence concerning the cost effectiveness of different intervention methods and the potential co-benefits that these will have for the prevention of other chronic conditions e.

None of the MMCs examined in this review provided evidence of cost effectiveness in relation to behaviour change or dental services utilisation, and only one gave details about the cost of intervention components.

It should be noted that this has been identified as a common limitation of the evaluation of MMCs across multiple areas of public health [ 13 ]. Given the established relationships between oral disease and major conditions like cardiovascular disease and diabetes [ 5 , 43 , 44 ], and the risk factors that oral disease shares with these conditions e.

There is also an opportunity to communicate these linkages between oral health and NCDs in MMCs; this review did not find any examples where this had been attempted. Limitations of this review included the exclusion of studies not reported in English, as well as those which were published in the grey non peer-reviewed literature.

Further, given that the impact measures and follow-up time points in the studies varied considerably, and that four of the 11 campaign evaluations used a post-test design, it was not possible to estimate campaign effect sizes.

It is recommended that future campaigns follow best practice campaign guidelines, including identification of priority population segments, development of program logic models to guide implementation and evaluation, formative pre-testing of messages, use of a mix of strategies that include mobilisation of professional and community influencers, and provision of resources and services to support behaviour change.

Building an evidence base to inform policy-makers and campaign managers will require comprehensive evaluation of oral health MMCs at the process and impact levels. While there is a substantial body of evidence concerning the impact of narrow reach oral health education strategies in clinical and school settings, this review has found far fewer studies reporting on population-wide oral health MMCs.

As is the case with a number of public health programs, these mid-stream interventions can utilise an expansive range of electronic and digital communication channels to extend the reach of oral health promotion efforts.

However, there remains a need to better understand the impact that MMCs can have upon oral health knowledge, attitudes and behaviours, and the use of preventive dental services.

Dental and Ophthalmic Services Division. Choosing better oral health: an oral health plan for England. London, United Kingdom: Department of Health; National Advisory Council on Dental Health. Report of the National Advisory Council on Dental Health.

Australian Institute of Health and Welfare. Australian Burden of Disease Study: Impact and causes of illness and death in Australia Canberra: Australian Institute of Health and Welfare; GBD Oral Disorders Collaborators, Bernabe E, Marcenes W, Hernandez CR, Bailey J, Abreu LG, Global, regional, and national levels and trends in burden of oral conditions from to a systematic analysis for the global burden of disease study.

J Dent Res. Petersen PE. The World Oral Health Report continuous improvement of oral health in the 21st century—the approach of the WHO Global Oral Health Programme.

Community Dent Oral Epidemiol. Article Google Scholar. Menegaz AM, Silva AE, Cascaes AM. Educational interventions in health services and oral health: systematic review.

Rev Saúde Pública; ; Kay E, Vascott D, Hocking A, Nield H, Dorr C, Barrett H. A review of approaches for dental practice teams for promoting oral health. Toniazzo MP, Nodari D, Muniz FW, Weidlich P. Effect of mHealth in improving oral hygiene: a systematic review with meta-analysis.

In spite of excellent oral health care, oral diseases are prevalent. This suggests that improving healthcare services merely will not address the issue, oral health promotion is mandatory.

Hence, health policymakers should be made aware of these evidences and directs themselves to restructure the policy framework. Health promotion policy acknowledges complimentary measures such as legislation, fiscal measures, taxation and organizational change altogether.

These are best example of a coordinated effort towards creating supportive environments and strengthening community action. Ottawa Charter implementation for health promotion through establishing concrete and effective community actions in setting priorities, making decisions, planning strategies leads to achieve better health.

They are the best possible existing human and material resources of community and for community. Oral health promotion through sensitive health policies and actions which already exist in some parts of world can address the global burden of oral diseases, essentially to improve oral health and quality of life.

Identifying a significant health issue on the basis of prevalence, incidence, severity, cost, or impact on quality of life is preliminary step to design prevention programs.

Incorporating public, practitioners and policymakers into strategic development of oral disease prevention and health promotion intervention is necessary.

They should be liable to create a healthy setting, limit risk factors, inform target groups, generate knowledge and thus improve behaviors. This section includes a discussion of knowledge and practices of the public and healthcare providers regarding the oral health promotion.

Oral health education has been considered as one of the fundamentals in oral health promotion [ 5 , 6 ]. High caries risk, change in dentition, ability to change bad habits and facilities to learn make oral health promotion for children a priority.

The importance of oral health education programs in schools is significantly reported predominantly in the form of positive learning and behavior in children [ 5 — 11 ]. The oral health promotion programs should primarily focus on this age group who become easy victims of excessive consumption of sweets, sugary beverages, tobacco and alcohol.

Commonly, their main association is with home, school and community organizations. These three along with oral health professionals can form an effective alliance to control risks to oral diseases and form oral health promotion programs for young people [ 12 ].

Dental erosion due to excessive carbonated beverages consumption is on rise, which was earlier noticed only among the late adulthood. Enamel defects due to malnourishments, dental trauma due to negligence and safety barriers are some of the increasing evidences in children.

Eventually and unknowingly, early start of tobacco consumption manifolds risks of oral precancerous lesions and cancer in life ahead [ 8 , 10 , 13 ].

Personal and social education aimed at developing life skills—Pupils and students can be accessed during their formative years, from childhood to adolescence. Schools can provide a supportive environment for promoting oral health.

Access to safe water, for example, may allow for general and oral hygiene programs. Also, provision of mouth guards—accessible and affordable sports protection, a safe physical environment and school policy on bullying and violence between students reduce the risk of dental trauma.

The burden of oral disease in children is significant. Most established oral diseases are irreversible, will last for a lifetime and have an impact on quality of life and general health.

School policies on control of risk behaviors, such as intake of sugary foods and drinks, tobacco use and alcohol consumption. Schools can provide a platform for the provision of oral health care, that is, preventive and curative services [ 14 — 18 ].

The need to set up oral health promotion programs in schools is evident, and it can easily be integrated into general health promotion, school curricula and activities. One of the proposed examples has been shown in Figure 1 [ 13 ].

Using the structures and systems already in place as a competent setting for the installation of vital facilities such as safe water and sanitation can instigate oral health promotion in schools. While oral health issue is specifically addressed, it can be admixed in general health promotion strategy.

It is well illustrated in following examples of school health policies as shown in Table 1 [ 13 ]. A protocol for dealing with bullying and violent behavior, as well as interpersonal conflicts. Training for parents about good oral health and encouragement for them to take part in health promotion activities at school.

Healthy foods must be made available in the school canteen, tuck shop, kiosks and vending machines. Role of teachers in oral health surveillance, screening and basic treatment, for example, ART.

On an average, students attending private schools belong to more advantaged backgrounds than their counterparts in public schools. For example, urban schools tend to have greater resources than those in rural. Also, students in private schools had higher levels of positive behavior than those in public schools, and these results were statistically significant for most countries [ 19 ].

Consequently, children from upper and high middle socioeconomic status prefer private schools, while children with low socioeconomic strata attend public schools [ 20 ].

Students gain more attention when the student to teacher ratio is higher. Bruneforth et al. The children who do not have adult supervision after school are more vulnerable to indulge them into health hazarding habits like smoking, drugs and substance abuse and behavioral problems.

Smoking and chewing tobacco are systematically associated with socioeconomic markers [ 20 ]. However, it has not led to change in behavior [ 22 , 23 ]. Providing healthy food in schools can meet the nutritional requirement of students and also guide the parents to deal with healthy diet chart for their children.

In UK, campaigns like the ones conducted by famous chef, Jamie Oliver, are one example of actions in this area. In India, Mid Day Meal Scheme in school started in from a single city, Madras now Chennai and now spread to all States. This suggests significant contributions of gender, age and religion belief to the eating habit.

Therefore, Schools should introduce healthy food policy and activity after consulting with school authority, nutrition expert and parents so as to maintain good eating habits among students [ 25 ]. Tobacco consumption either in smoke form or smokeless form has deleterious effect general and oral health.

Tobacco abuse is the leading preventable cause of death and disease so far. Long list of diseases caused by tobacco abuse includes different cancers — lung cancer, oral cancer, cardiovascular disease, stroke and chronic lung disease.

Prevention is the prime key factors, and at initial stage, most of the adverse effects of tobacco are reversible.

This fact can be used to motivate tobacco using people to curb the use of tobacco [ 26 ]. India is the second largest consumer and producer of tobacco. The program includes objectives as:. Effective primordial and primary level prevention strategies are planned under the National Tobacco Control Program NTCP.

Training of trainers, that is, health and social workers, NGOs, school teachers and enforcement officers. Indian government implemented Cigarette and Other Tobacco Products Act COTPA; addressing tobacco use in public places, tobacco advertising and sale and packaging regulations since with comprehensive action in following the Framework Convention of Tobacco Control FCTC.

Section 4: Prohibition of smoking in public places. Section 5: Prohibition of direct and indirect advertisement, promotion and sponsorship of cigarette and other tobacco products.

Section 7: Mandatory depiction of statutory warnings including pictorial warnings on tobacco packs. Section 7 5 : Display of tar and nicotine contents on tobacco packs [ 27 ]. The achievements of this national program are examples of apt implementation.

The GATS data indicate that Fluoride is an essential mineral for human health. It widely exists in natural water and in foods such as tea, fish and beer. The twentieth century documented association among reduced level of dental caries with communal fluoridated water consumption.

Soon, fluoride has become an effective preventive measure for dental caries. Easy incorporation into toothpaste has improved oral health in some parts of world, particularly in developing countries [ 26 ]. However, the other part of world suffers from excessive fluoride in natural environment.

There is no treatment for severe cases of skeletal fluorosis, only efforts can be made towards reducing the disability which has occurred. However, the disease is easily preventable if diagnosed early and steps are taken to prevent intake of excess fluorosis through provision of safe drinking water, promote nutrition and avoid foods with high fluoride content.

Fluorosis is worldwide in distribution and endemic at least in 25 countries. It has been reported from fluoride belts: one that stretches from Syria through Jordan, Egypt, Libya, Algeria, Sudan and Kenya, and another that stretches from Turkey through Iraq, Iran, Afghanistan, India, northern Thailand and China.

There are similar belts in the Americas and Japan. In India, fluorosis is mainly due to excessive fluoride in water except in parts of Gujarat and Uttar Pradesh where industrial fluorosis is also seen. High levels of Fluoride were reported in districts of 20 States of India after bifurcation of Andhra Pradesh in The population at risk as per population in habitations with high fluoride is Rajasthan, Gujarat and Andhra Pradesh are worst affected states.

Punjab, Haryana, Madhya Pradesh and Maharashtra are moderately affected states, while Tamil Nadu, West Bengal, Uttar Pradesh, Bihar and Assam are mildly affected states. Dental fluorosis : It is categorized into mild, moderate and severe dental fluorosis depending on the extent of staining and pitting on the teeth.

The teeth could be chalky white and may have white, yellow, brown or black spots or streaks on the enamel surface. Discoloration is away from the gums and bilaterally symmetrical. Skeletal fluorosis : The early symptoms of skeletal fluorosis include stiffness and pain in the joints.

In severe cases, the bone structure may change and ligaments may calcify, with resulting impairment of muscles and pain. Constriction of vertebral canal and intervertebral foramen exerts pressure on nerves, blood vessels leading to paralysis and pain.

Neurological manifestation: Nervousness and depression, tingling sensation in fingers and toes, excessive thirst and tendency to urinate. Muscular manifestations: Muscle weakness and stiffness, pain in the muscle and loss of muscle power, inability to carry out normal routine activities.

Abortions, still births and children with birth defects are common in endemic areas. Low hemoglobin levels: Fluoride accumulates on the erythrocyte red blood cells membrane, which in turn looses calcium content.

The membrane which is deficient in calcium content is pliable and is thrown into folds. The shape of erythrocytes is changed. Such RBCs are called echinocytes and found in circulation. This would lead to low hemoglobin levels in patients chronically ill due to fluoride toxicity.

Calcification of ligaments and blood vessel: Forms unique feature of the disease helps in differential diagnosis.

With an aim to prevent and control fluorosis cases, Government of India initiated the National Program for Prevention and Control of Fluorosis NPPCF as a new health initiative in — To collect, assess and use the baseline survey data of fluorosis of Ministry of Drinking Water Supply for starting the project.

Surveillance of fluorosis in the community and school children. Capacity building at different level of healthcare delivery system for early detection, management and rehabilitation of fluorosis cases.

b Create awareness and skills among the medical as well as paramedical health workers to detect the disease in the community.

c Provision of safe drinking water, water harvesting rain water and other measures in collaboration with Public Health Engineering Department.

Management Efforts are aimed to reduce the fluorosis induced disability and to improve quality of life of affected patients. Treatment of deformity includes physiotherapy, corrective plasters and orthoses appropriate appliances. Trained health sector manpower in Government set up for measuring fluoride in urine and water.

Improve information base for the community and all concerned in the program districts [ 29 ]. Likewise, fluoride is double edge sword, that is, its deficiency and excess both affect the oral health. Hence, science based on effectiveness, safety and benefits should be implemented at different needs at different part of the world.

WHO aim at building healthy populations involving all communities by combating every possible illness. Promoting healthy lifestyles and reducing risk factors to oral health that arise from environmental, economic, social and behavioral causes.

Framing policies in oral health, based on integration of oral health into national and community health programs, and promoting oral health as an effective dimension for development policy of society [ 7 ].

Program goals are broad statements on the overall purpose of a program. Program objectives are more specific statements of desired endpoints of program. Specific —they should describe an observable action, behavior or achievement. Measurable —they are systems, methods or procedures to track to record the action upon which objective is focused.

Achievable —the objective is realistic, based on current environment and resources. Relevant —the objective is important to the program and is under the control of program.

Time based —there are clearly defined deadlines for achieving the objective [ 3 ]. Designing an oral health promotion program: step by step can be studied as shown in Figure 2 [ 1 ]:. Best practices in oral health promotion and prevention can take various forms, be it education, health promotion, integrating oral health promotion into general health promotion programs, policy changes which promote better oral health, the provision of care services, or programs specifically designed at addressing oral health inequalities.

It is interesting to learn how oral health promotion and practices are implemented in through various interventions applying the Ottawa Charter guidelines. Establishing healthy policies is integral in improving oral health. Based on the needs, evidences and situation analysis, National Government, health ministry, local governments, organizations, communities, schools, primary healthcare settings and local stakeholders forms or reforms the healthy policy.

Health promotion advocates hold key responsibility to convey appropriate health needs of the population. Supporting early childhood centers and school boards in developing healthy food and nutrition policies. Working on policy options that eliminate the advertising of harmful food and beverages to children.

Making the healthy choice easy choice is the aim of health promotion. This can be achieved by creating supportive social, physical, biological and cultural environments.

A high blood sugar level is associated with increased risk of gum disease. Dental sealants are thin coatings that when painted on the chewing surfaces of the back teeth molars can prevent cavities for many years. Removing the dental plaque between teeth helps prevent decay.

During pregnancy, you may be more prone to gum disease and cavities. Skip directly to site content Skip directly to page options Skip directly to A-Z link. National Center for Chronic Disease Prevention and Health Promotion NCCDPHP.

Section Navigation. Facebook Twitter LinkedIn Syndicate. Oral health promotion is any combination of oral health education and legal, fiscal, economic, environmental, organizational and technical interventions designed to facilitate the achievement of oral health and the prevention of disease.

Oral health promotion directs multi-sectoral actions to the determinants of health in order to ensure that the environment is conducive to health. A key concern is the achievement of equity in health. Methods are community involvement, multi-sectoral working, empowerment, advocacy and mediation.

This was undertaken by follow-up interviews with the public health and childcare intermediaries [ 27 ]. In terms of the evaluation of campaign impacts, two of the studies used a quasi-experimental, controlled pre- and post-test design [ 29 , 32 ].

In the oral hygiene campaign in Ireland, children were followed up after 8 weeks at control and intervention sites [ 29 ], while in the toothbrushing campaign undertaken in Finland there was follow-up of parents and children after both 1 year and 3. Five of the studies assessed campaign impacts using a pre- and post-test design [ 21 , 23 , 27 , 30 , 35 ].

In two of these, cohorts underwent assessment at baseline and follow-up, which was after 3 months in one study [ 35 ] and 6 months in the other [ 30 ]. Two studies recruited independent samples at the pre-and post-test measurement points, with one of these undertaking follow-up after 1 year [ 21 ] and the other at multiple time-points 1, 2 and 3 years [ 23 ].

In one study, follow-up was conducted after 18 months and included a cohort measured at baseline as well as newly recruited participants [ 27 ].

A post-test only design was used for impact evaluation in four of the studies [ 19 , 22 , 25 , 34 ]. The evaluation of the long-term national campaign in China was notable because follow-up was conducted in every year of the campaign over 20 years [ 25 ]. In other studies follow-up was carried out immediately after the campaign [ 34 ], or 2 months later [ 19 ], while in one study follow-up was conducted at both of these timepoints [ 22 ].

None of the campaigns included an economic evaluation to assess cost—benefit, cost effectiveness, or return on investment from the oral health MMCs. The highest levels of awareness were reported in the study that collected measures from relatively small, quota samples of adults and children [ 22 ].

Impacts upon oral health knowledge were reported in eight studies, with measures that examined understanding of risk factors and symptoms of poor oral health e. Four uncontrolled studies showed significant improvements in measures of oral health knowledge, including those investigating change after 6 months [ 30 ], 18 months [ 27 ] and 3 years [ 25 ].

In three further studies there was investigation of whether those reporting campaign exposure at follow-up had higher levels of oral health knowledge than the unexposed. Each of these reported a significant association between campaign exposure and oral health knowledge, with follow-ups between 2 and 3 months in all cases [ 19 , 29 , 35 ].

Only two studies investigated changes in oral health attitudes. In the quasi-experimental campaign evaluation undertaken in regional Finland there was no improvement found in attitudes towards oral health among parents or children in the intervention town after 3.

In the other study, support for water fluoridation was found to have a prevalence of Eight studies reported impacts of campaigns upon oral health behaviours, which included toothbrushing, use of fluoride toothpaste, dental flossing, consumption of sugary foods and drinks, smoking, use of infant feeding bottles, and use of dental service.

Two of the controlled quasi-experimental studies found improvements in oral health behaviours among children who were exposed to campaign interventions. Follow-up after 3. The studies using pre-and post-test designs reported improvements in selected behavioural outcomes: in the campaign addressing nursing caries in the Netherlands there was a reduction in infant bottle feeding after 18 months, but not higher adherence to recommendations for switching from bottles to drinking cups [ 27 ]; follow-up at 12 and 24 months in the national oral health campaign in Finland found an increase in visits to dentists, but not in attendance for general dental examinations [ 30 ]; and, in the campaign in Norway which promoted the use of interdental aids there was found to be an increase in levels of flossing between the immediate post-campaign and 12 month follow-ups, but no improvements were reported in other outcomes [ 23 ].

In the serial post-test surveys conducted following the annual campaigns in China there was a marked improvement in twice daily toothbrushing and use of recommended toothbrushes and fluoride toothpaste, over a three year period, but little change in the prevalence of dental visits [ 25 ].

In the other two studies that assessed impact using post-test designs, one did not find differences in preventive dental visits between those who recalled and did not recall the campaign [ 19 ], while the other reported improvements in oral health behaviours among children who recalled the campaign but did not compare these with outcomes in the non-recallers [ 22 ].

This is the first synthesis of peer-reviewed studies concerning the delivery and impact of oral health MMCs implemented over a year period. Although reviews have been conducted of health education programs for oral health [ 6 , 9 , 10 ] there has not been a structured assessment of those using mass-reach media channels.

There was wide variation in the evaluation and reporting of these interventions, which may reflect a limited adoption of the planning frameworks and models used in MMCs conducted for other health-risk behaviours [ 15 , 16 , 18 , 37 ], as well as the under-developed status of research and practice in this area.

Notwithstanding these limitations, the findings indicate potential for oral health campaigns to achieve good levels of population engagement, and to influence knowledge and behaviours across diverse oral health topics. All of the studies included in this review used traditional media channels. Television was the most frequently adopted mass-reach strategy, and some MMCs used combinations of radio, print, billboards and bus-side advertisements, supported by public relations strategies.

The fact that none of the campaigns were conducted within the past decade may account for the absence of online and social media methods of delivery, which are now widely used communication channels within public health campaigns given their potential reach and relatively low cost [ 16 ].

Only one of the included studies reported a systematic method of recording the delivery of campaign components, and none appeared to adopt commonly used metrics of mass media reach e.

The messages delivered in campaigns aligned with the recommendations of leading dental health agencies, including the adoption of oral hygiene behaviours e. One campaign was distinguished by its focus on advocating for public support of water fluoridation, rather than a personal behaviour.

The breadth of issues addressed across the MMCs highlights the scope for public health interventions in this field, as well as the opportunity to focus on well-defined behaviours, which is a factor that is likely to improve campaign effectiveness [ 40 ].

However, only two of the studies reported preliminary formative evaluation to guide the development of messages and design of media content and resources, which is recognised as a standard element of good practice in MMCs [ 37 , 41 ].

There was also an apparent lack of use of best practice logic models that propose a roadmap linking campaign activities to message exposure, knowledge development, attitude formation, intentions and behaviours [ 37 ]. In several oral health MMCs, health opinion leaders e. It would benefit future oral public health endeavours to harness wider community influencers and social networks [ 16 ].

It has been posited that social marketing initiatives can comprise strategies across five domains: altering the environment; regulation and enforcement; provision of services; education; and the communication of information for attitude change.

Some of the MMCs reviewed here attended to the provision of services to support behaviour change, and others incorporated education initiatives in the intervention mix [ 42 ].

Building upon this, and applying a social ecological analysis of the determinants of oral health, other important targets of change may include public policies that affect costs of sugar sweetened beverages, access to dental services, incentives for primary care practitioners to promote oral health behaviours, and partnerships with agencies and groups that have engagement with priority population groups e.

A social marketing approach that incorporates actions at these multiple levels will not only increase enablers for behaviour change, but may also achieve more sustained delivery and impact than is possible through MMCs alone.

Building support among policy makers is needed to increase public investment in mass reach oral health promotion campaigns, and researchers can assist by providing evidence concerning the cost effectiveness of different intervention methods and the potential co-benefits that these will have for the prevention of other chronic conditions e.

None of the MMCs examined in this review provided evidence of cost effectiveness in relation to behaviour change or dental services utilisation, and only one gave details about the cost of intervention components.

It should be noted that this has been identified as a common limitation of the evaluation of MMCs across multiple areas of public health [ 13 ]. Given the established relationships between oral disease and major conditions like cardiovascular disease and diabetes [ 5 , 43 , 44 ], and the risk factors that oral disease shares with these conditions e.

There is also an opportunity to communicate these linkages between oral health and NCDs in MMCs; this review did not find any examples where this had been attempted. Limitations of this review included the exclusion of studies not reported in English, as well as those which were published in the grey non peer-reviewed literature.

Further, given that the impact measures and follow-up time points in the studies varied considerably, and that four of the 11 campaign evaluations used a post-test design, it was not possible to estimate campaign effect sizes. It is recommended that future campaigns follow best practice campaign guidelines, including identification of priority population segments, development of program logic models to guide implementation and evaluation, formative pre-testing of messages, use of a mix of strategies that include mobilisation of professional and community influencers, and provision of resources and services to support behaviour change.

Building an evidence base to inform policy-makers and campaign managers will require comprehensive evaluation of oral health MMCs at the process and impact levels. While there is a substantial body of evidence concerning the impact of narrow reach oral health education strategies in clinical and school settings, this review has found far fewer studies reporting on population-wide oral health MMCs.

As is the case with a number of public health programs, these mid-stream interventions can utilise an expansive range of electronic and digital communication channels to extend the reach of oral health promotion efforts. However, there remains a need to better understand the impact that MMCs can have upon oral health knowledge, attitudes and behaviours, and the use of preventive dental services.

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