Can Dental Screening of Preschoolers, With or Without Parental Education, Improve Children's Oral Health? Results of a Longitudinal Study

RESEARCH AND DEVELOPMENT TADQIQOT VA TARAQQIYOT ISSN: 3030 – 3281 Volume II, Issue 11 (2025) © 2025, the Author(s). Published by IMFAKTOR. This is an open access article under the CC BY license http://creativecommons.org/licenses/by/4.0/ 3 Can Dental Screening of Preschoolers, With or Without Parental Education, Improve Children’s Oral Health? Results of a Longitudinal Study Mekhriniso KAMALOVA¹ 1DSc., Professor, Department of Surgical Dentistry, Abu Ali ibn Sina Bukhara State Medical Institute, Uzbekistan. https://doi.org/10.5281/zenodo.17625253 ANNOTATION The study aimed to assess the effectiveness of two preventive programs involving dental screening of preschool children, with or without parental education on oral health. The research was conducted in six randomly selected kindergartens in the Bukhara region of Uzbekistan, involving 478 children aged 3-6 years. In three kindergartens (Group SC), only dental screening was performed; in the remaining three (Group SE), screening was supplemented with parental education. After eight months, all children underwent a follow-up dental examination. Baseline results showed high caries prevalence in both groups (dmft: 3.86 ± 0.11 in SC; 4.02 ± 0.12 in SE, p > 0.05). At followup, new caries lesions appeared in both groups, but caries increment was significantly lower in Group SE (1.08 ± 0.05) compared to Group SC (1.58 ± 0.07; p < 0.05). The filling rate was also higher in Group SE. Dental screening alone had limited impact on improving children’s oral health. Adding parental education produced better outcomes; however, in both groups the proportion of untreated teeth remained high. Keywords: preschool children, dental screening, parental education, oral health, caries prevalence, caries incidence, preventive programs, dental care, Uzbekistan. Может ли стоматологический скрининг дошкольников, с обучением родителей или без него, улучшить состояние полости рта у детей? Результаты лонгитюдного исследования АННОТАЦИЯ Исследование было направлено на оценку эффективности двух профилактических программ, включающих стоматологический скрининг дошкольников, с обучением родителей вопросам гигиены полости рта или без него. Исследование проводилось в шести случайным образом отобранных дошкольных учреждениях Бухарской области Узбекистана и охватило 478 детей в возрасте 3-6 лет. В трёх детских садах (группа SC) проводился только стоматологический скрининг; в трёх других (группа SE) скрининг дополнялся обучением родителей. Через восемь месяцев всем детям было проведено повторное стоматологическое обследование. Первичное обследование показало высокую распространённость кариеса в обеих группах (dmft: 3,86 ± 0,11 в группе SC; 4,02 ± 0,12 в группе SE; p > 0.05). При повторном обследовании новые очаги кариеса были выявлены в обеих группах, однако прирост кариеса оказался значительно ниже в группе SE (1,08 ± 0,05) по сравнению с группой SC (1,58 ± 0,07; p < 0,05). Также показатель пломбирования был выше в группе SE. Один лишь стоматологический скрининг оказывал ограниченное влияние на улучшение состояния полости рта у детей. Добавление обучения родителей обеспечивало более высокую эффективность; однако в обеих группах доля нелечёных зубов оставалась высокой. Ключевые слова: дошкольники, стоматологический скрининг, обучение родителей, состояние полости рта, распространённость кариеса, заболеваемость кариесом, профилактические программы, стоматологическая помощь, Узбекистан. Maktabgacha yoshdagi bolalarda stomatologik skrining, ota-onalarni o‘qitish bilan yoki o‘qitmasdan, bolalarning og‘zaki sog‘lig‘ini yaxshilashi mumkinmi? Uzoq muddatli tadqiqot natijalari ANNOTATSIYA Tadqiqotning maqsadi maktabgacha yoshdagi bolalarda og‘zaki sog‘liq bo‘yicha ota-onalarni o‘qitish bilan yoki o‘qitmasdan o‘tkazilgan stomatologik skriningni o‘z ichiga olgan ikki profilaktik dasturning samaradorligini baholashdan iborat edi. Tadqiqot O‘zbekistonning Buxoro viloyatida tasodifiy tanlangan olti maktabgacha ta’lim muassasasida o‘tkazilib, 3-6 yoshdagi 478 nafar bolani qamrab oldi. Uchta bog‘chada (SC guruhi) faqat stomatologik skrining o‘tkazildi; qolgan uchta bog‘chada (SE guruhi) esa skrining otaonalarni qo‘shimcha o‘qitish bilan birga olib borildi. Sakkiz oy o‘tgach, barcha bolalarda qayta stomatologik tekshiruv o‘tkazildi. RESEARCH AND DEVELOPMENT | VOLUME II | ISSUE 11 | 2025 \ 4 Oral diseases, particularly early childhood caries (ECC), are highly prevalent among children worldwide [1,2]. Untreated dental caries in primary teeth rank tenth among all human diseases in terms of burden on healthcare systems [3]. Globally, an estimated 400–600 million children suffer from untreated caries in primary teeth [4]. Dental caries may lead to tooth loss, inflammation, sepsis, and impairment of speech and mastication; it also negatively affects children’s self-esteem and the quality of life of both children and their families [5,6]. Children with severe caries in primary dentition are at a higher risk of developing caries in permanent teeth [7]. A low filling rate has been reported among children aged 3-5 years [8]. Thus, caries prevention and access to dental care constitute key priorities in pediatric dentistry [9]. Numerous dental educational programs have been developed for pregnant women, parents of toddlers, young children, kindergarteners, preschoolers, and schoolchildren [10-13]. These programs typically emphasize children’s oral hygiene, the use of fluoride toothpaste, reduced consumption of carbohydrates, and regular dental examinations [14]. However, the effectiveness of oral health education programs remains inconsistent across studies [15,16]. Kindergarten children represent a specific population group that can be examined by dentists on a regular basis. It has been suggested that mandatory dental screening may help improve children’s oral health [17]. Nevertheless, evidence regarding the effectiveness of dental screening in children remains inconsistent [18,19]. The aim of this study was to evaluate the outcomes of two preventive programs that included dental screening of preschool children, with or without parental education on oral health. Materials and Methods Approval of the preventive programs. The preventive programs were approved by the local authorities of the Bukhara region and the Ministry of Health of the Republic of Uzbekistan. Selection of Participants The study was conducted in six kindergartens that were randomly selected from three districts: Bukhara city (2 kindergartens), Alatsky district (2 kindergartens), and Karakulsky district (2 kindergartens). Approximately 80 children attended each kindergarten. Children aged 3–6 years were recruited after their parents provided written informed consent. Inclusion criteria: − age 3-6 years; − regular kindergarten attendance; − availability of signed parental informed consent. Exclusion criteria: − age below 3 years or above 6 years; − irregular kindergarten attendance; − absence of parental informed consent; − refusal to continue participation. In three kindergartens (one per district), only dental screening was performed (238 children, Group SC). In the remaining three kindergartens (one per district), dental screening was supplemented with parental oral health education (240 children, Group SE). Dental Screening The baseline and follow-up dental examinations were conducted in the kindergartens by one experienced and qualified general dentist. Only visual examination was performed. Infectious safety procedures were strictly followed, including the use of disposable gloves, medical masks, disinfectant solutions, and other standard protective measures by the dentist and dental assistant. The dental screening algorithm included: − external examination; − assessment of the maxillofacial region; − detection of malocclusions; Boshlang‘ich tekshiruvda har ikki guruhda kariesning yuqori tarqalganligi aniqlandi (dmft: SC guruhida 3,86 ± 0,11; SE guruhida 4,02 ± 0,12; p > 0,05). Qayta tekshiruvda har ikkala guruhda yangi karies o‘choqlari aniqlangan bo‘lsa-da, kariesning ko‘payish ko‘rsatkichi SE guruhida sezilarli darajada past bo‘ldi (1,08 ± 0,05), SC guruhiga nisbatan (1,58 ± 0,07; p < 0,05). Shuningdek, plombalash ko‘rsatkichi SE guruhida yuqoriroq edi. Faqat stomatologik skrining bolalarning og‘zaki sog‘lig‘ini yaxshilashda cheklangan ta’sir ko‘rsatdi. Ota-onalarni o‘qitish bilan qo‘shimcha kuchaytirilgan dastur esa yaxshiroq natijalar berdi; biroq har ikki guruhda ham davolanmagan tishlar ulushi yuqori bo‘lib qoldi. Kalit so‘zlar: maktabgacha yoshdagi bolalar, stomatologik skrining, ota-onalarni o‘qitish, og‘zaki sog‘liq, kariesning tarqalishi, kariesning uchrashi, profilaktik dasturlar, stomatologik yordam, O‘zbekiston. TADQIQOT VA TARAQQIYOT | II-JILD | 11-SON | 2025 \ 5 − examination of the oral mucosa and periodontal tissues; − diagnosis of dental caries and non-carious dental pathologies. Findings were recorded in each child’s medical card. Based on the screening results, referral letters were prepared for all parents. These personalized letters contained information about the preventive and treatment needs of each child and included the address of the nearest dental clinic. Referral letters were distributed to parents through kindergarten staff. Educational Program on Oral Health for Parents Parents of the children in Group SE were invited to attend special lectures organized in the same kindergartens. These lectures focused on improving children’s oral health through regular oral hygiene, the use of fluoride toothpaste, limiting carbohydrate intake, and visiting the dentist not only for treatment but also for preventive examinations. The benefits of fluoride varnish applications and fissure sealants were also explained. Referral letters were distributed to parents after the lectures. Assessment of Program Outcomes Eight months after the initial screening, a second dental examination was conducted in the same kindergartens for the same children. Comparison of the results from the first and second examinations served as the basis for evaluating the effectiveness of the preventive programs. The mean caries increment was used as the main indicator of caries prevention. The filling rate (proportion of ft in dmft) served as a measure of parental compliance with the referral recommendations to visit a dental office for treatment. Statistical Analysis Statistical analysis was performed using Microsoft Excel 2019. Proportions (%), mean values (dmft and caries increments), and standard errors (M ± m) were calculated. The chi-square test was used to assess differences between groups, with statistical significance set at p < 0.05. Results The initial dental examination revealed a high prevalence of dental caries in primary teeth, which increased with age and reached 100% among 6-year-old children. The dmft index also increased consistently from age 3 to age 6 in both study groups. The mean dmft values were 3.86 ± 0.11 in Group SC and 4.02 ± 0.12 in Group SE. Differences in caries prevalence and dmft indices between the two groups at all ages were not statistically significant (p > 0.05) (Table 1). Table 1. Caries prevalence and dmft values in children at the first dental screening Age, years Caries prevalence dmft-index group SC group SE group SC group SE % % M±m M±m 3 59.5 58.4 1.84±0.12 1.88±0.12 4 91.2 89.7 3.39±0.18 3.19±0.17 5 98.1 97.5 4.09±0.22 4.36±0.23 6 100 100 6.12±0.37 6.66±0.39 An average 87.2 86.4 3.86±0.11 4.02±0.12 In both groups, the majority of affected primary teeth were decayed (dt). The proportion of dt ranged from 76-78% of the dmft index among 6-year-olds to 86-91% among 3-4-year-olds. On average, dt accounted for 86.1% of the dmft in Group SC and 84.7% in Group SE (p > 0.05) (Table 2). Table 2. Proportions of dt, mt, and ft components in the dmft index at the first dental examination Age, years Group SC Group SE Percentage (%) from dmft Percentage (%) from dmft dt mt ft dt /ds mt/ms fts 3 91.2 5.1 3.6 86.4 8.2 5.3 4 88.2 1.2 10.6 92.8 0.6 6.6 5 86.3 3.8 9.9 83.1 0.9 16.1 6 78.6 2.9 18.5 76.6 6.2 17.1 An average 86.1 3.2 10.6 84.7 3.9 11.3 RESEARCH AND DEVELOPMENT | VOLUME II | ISSUE 11 | 2025 \ 6 The proportion of filled teeth (ft) was low among the 3-year-old children (5.1% in group SC and 8.2% in group SE, p > 0.05) and increased by the age of six to 18.5% and 17.1%, respectively (p > 0.05). The proportion of prematurely extracted primary teeth (mt) ranged from 1.2% to 5.1% in group SC and from 0.6% to 8.2% in group SE, averaging less than 4% in both groups. At the second dental examination, new carious lesions were detected in children across all age groups, occurring more frequently in group SC than in group SE, with mean values of 1.58 ± 0.07 and 1.08 ± 0.05, respectively (p < 0.001). In both groups, the lowest caries increment was observed among the 3-year-olds, while the highest was recorded in the 6-year-olds (Table 3). Table 3. Caries increments among children in both groups after eight months Group New carious lesions in the children aged: 3 years 4 years 5 years 6 years An average M±m M±m M±m M±m M±m SC 0.92±0.03 1.11±0.03 1.30±0.03 3.00±0.08 1.58±0.07 SE 0.55±0.03 0.76±0.04 0.83±0.04 2.17±0.11 1.08±0.05 p <0.001 <0.001 <0.001 <0.001 <0.001 The proportion of decayed teeth (dt) ranged from 59.6% among 6-year-old children to 83.4% among 3-year-olds in group SC, and from 50.9% to 72.9% in group SE, respectively (Table 4). Table 4. Proportions of decayed (dt), missing (mt), and filled (ft) teeth in the dmft index in both groups at the second dental examination Age, years Group SC Group SE Percentage (%) from dmft Percentage (%) from dmft dt mt ft dt mt ft 3 83.4 3.9 12.7 72.9 9.8 17.3 4 77.6* 3.7 18.7* 62.2* 3.6 34.2* 5 70.5* 6.4 23.1* 52.6* 5.3 42.1* 6 59.6 13.2 27.2 50.9 9.4 39.7 An average 70.2* 7.9 21.9* 53.8* 10.6 35.6* *The differences between the groups are statistically significant (p < 0.05–0.001). The proportion of filled teeth (ft) ranged from 12.7% among 3-year-olds to 27.2% among 6-year-olds in group SC (average: 70.2%), and from 17.3% to 39.7% in group SE (average: 53.8%). The proportion of prematurely extracted primary teeth also varied, averaging 7.9% in group SC and 10.6% in group SE (p > 0.05). Discussion The results of this study revealed a high prevalence of dental caries among 3-6-year-old children in the Bukhara region of the Republic of Uzbekistan, reaching 100% among 6-year-olds. These findings are consistent with reports from other authors describing over 90% prevalence of early childhood caries (ECC) in several regions of Southeast Asia and Russia [20, 21]. However, in our study population, the mean dmft score ranged from 3.86 to 4.02, whereas in countries with comparable ECC prevalence, the dmft scores were substantially higher – between 8.4 and 9.1 [22, 23]. In most developed countries, both the prevalence of caries in primary teeth and the mean dmft values are significantly lower [24, 25]. These observations indicate a pressing need for effective caries-preventive programs for children in the study region.\ Globally, the majority of carious primary teeth over 90% remain untreated in most children [26]. In our study, the proportion of decayed teeth in the dmft index ranged from 76.6% to 92.8% at the first dental examination. Among 6-year-olds, the dt ratio was lower than in the younger age groups, which may be attributed to a cumulative effect over time. High ECC prevalence and low rates of dental fillings are key reasons to introduce preventive programs for children [27]. Nevertheless, the implementation of such programs remains insufficient in many countries [28]. In our study, the first intervention (Program 1) was a dental screening initiative conducted in three kindergartens. Children were examined by a dentist, and parents received recommendations on caries prevention and dental treatment for their children. Despite being provided with referral letters to dental clinics, parental compliance was low. Consequently, most children did not receive the necessary preventive or restorative dental care. TADQIQOT VA TARAQQIYOT | II-JILD | 11-SON | 2025 \ 7 At the second dental examination (after eight months), new carious lesions were detected in all children, and the majority of primary teeth remained untreated, although the overall proportion of decayed teeth (dt) decreased on average from 86.1% to 70.2%. These findings are consistent with the results of Baker et al., who reported low parental engagement in implementing health-protective practices for their children [29]. Similarly, Arora et al. found that school dental screening programs did not improve children’s attendance at dental clinics for treatment or preventive procedures [30], a conclusion also supported by other researchers [31]. The second intervention (Program 2) was implemented in another three kindergartens and included, in addition to dental screening, educational lectures for parents on caries prevention in children. The outcomes of this program were more favorable than those of dental screening alone. Eight months after implementation, mean caries increments were 1.4-1.7 times lower, and the proportion of filled teeth (ft) was 1.4-1.8 times higher compared with the group that received only dental screening. These results underscore the importance of parental education as part of oral health promotion programs. Similar conclusions were reached by many other researchers who demonstrated the positive effects of parental education on children’s oral health outcomes [32, 33]. In contrast, some authors emphasized the challenges in implementing preventive strategies and noted that parental oral health education often yields only moderate improvements [34, 35]. Despite the better outcomes observed with dental screening combined with parental education compared to screening alone, the results of both interventions remain suboptimal. Caries increment was still high, particularly among 5–6-year-olds. The proportion of untreated teeth exceeded that of filled teeth, especially among 3-year-olds (6.6 times higher after screening alone and 4.2 times higher after screening combined with parental education). These findings justify the need for more comprehensive and active caries-prevention programs for preschool children, incorporating evidence-based measures such as fluoride use, fissure sealants, and other proven interventions [36, 37]. Conclusion The study demonstrated a very high prevalence of early childhood caries among 3-6-year-old children in the Bukhara region, with caries affecting nearly all participants and reaching 100% among 6-year-olds. Although a slight improvement in oral health indicators was observed after the implementation of preventive programs, both interventions showed that the overall effect of dental screening alone was limited. The inclusion of parental education significantly enhanced outcomes-leading to lower caries increments and higher proportions of filled teeth-yet these results remained insufficient to achieve satisfactory oral health levels. The persistence of new carious lesions, particularly among 5-6-year-olds, and the predominance of untreated teeth over filled ones, especially in 3-year-olds, point to systemic gaps in preventive care and parental engagement. These findings emphasize that dental screening must be complemented by sustained parental education, community-based prevention, and evidence-based public health measures such as fluoride application, fissure sealants, and improved access to pediatric dental services. Strengthening these components could substantially improve oral health outcomes for preschool children in Uzbekistan and similar settings. RESEARCH AND DEVELOPMENT | VOLUME II | ISSUE 11 | 2025 \ 8 References 1. Mathur VP, Dhillon JK. Dental caries: a disease which needs attention. Indian J Pediatr. 2018;85(3):202–206. doi:10.1007/s12098-017-2381-6 2. Chen KJ, Gao SS, Duangthip D, Lo ECM, Chu CH. Prevalence of early childhood caries among 5year-old children: a systematic review. 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Evidence-based clinical practice guideline for the use of pit-andfissure sealants: a report of the American Dental Association and the American Academy of Pediatric Dentistry. J Am Dent Assoc. 2016;147(8):672–682.e12. doi:10.1016/j.adaj.2016.06.001 RESEARCH AND DEVELOPMENT | VOLUME II | ISSUE 11 | 2025 \ 10 Scientific Review Article: Can Dental Screening of Preschoolers, With or Without Parental Education, Improve Children’s Oral Health? Results of a Longitudinal Study Author: Mekhriniso Kamalova, DSc, Professor, Department of Surgical Dentistry, Abu Ali ibn Sina Bukhara State Medical Institute, Uzbekistan The presented research is a highly relevant and timely scientific work devoted to one of the most important public health challenges – the prevention of early childhood caries (ECC) among preschool children. The topic is of great social and medical significance for Uzbekistan, where the prevalence of dental caries in children remains extremely high, while preventive programs are still in the stage of development and institutionalization. The study stands out for its well-structured design, clear objectives, and significant practical value for improving oral health at the community level. It provides important baseline data that can serve as a foundation for broader preventive strategies and health policy decisions in the field of pediatric dentistry. The author has successfully combined a rigorous scientific approach with practical implementation. The research was conducted in six kindergartens across three districts of the Bukhara region and included 478 children aged 3–6 years, which provides a strong empirical basis for statistical analysis. The division of participants into two groups – one receiving only dental screening and another where screening was supplemented with parental education – allowed for an objective and evidence-based comparison of the outcomes of two distinct preventive models. The methodology is clearly described and follows international research standards. Ethical approval, informed parental consent, and compliance with infection control procedures ensure the reliability and integrity of the study. The choice of the dmft index and caries increment as the main evaluation indicators fully corresponds to WHO recommendations and allows for meaningful comparisons with international data. The results are presented with exceptional clarity and analytical depth. The study revealed an alarmingly high prevalence of dental caries, reaching 100% among six-year-olds, which underscores the urgency of implementing structured preventive interventions. Despite this, the study also demonstrates that even shortterm educational interventions targeting parents can yield measurable benefits. In the kindergartens where parents participated in oral health lectures, the caries increment was significantly lower, and the proportion of filled teeth was substantially higher compared to the group where only screening was conducted. These outcomes convincingly illustrate that prevention is most effective when dental examinations are complemented by active parental engagement and educational efforts aimed at improving home-based oral hygiene practices. The discussion section reflects a high level of scientific reasoning and contextual awareness. The author skillfully situates the findings within both global and national frameworks, comparing them with results from other regions and countries. While the prevalence of ECC in Uzbekistan is consistent with global patterns observed in developing regions, the relatively lower mean dmft values suggest opportunities for successful intervention through structured and evidence-based preventive programs. The author’s analysis also highlights the importance of integrating oral health promotion into broader public health and early childhood education systems. This is in full alignment with international priorities, such as the WHO Global Oral Health Action Plan and the FDI Vision 2030 framework, both emphasizing prevention, health literacy, and accessibility of pediatric dental care. An additional strength of the study is its practical orientation. The implementation of the program in collaboration with local authorities and the Ministry of Health demonstrates that the proposed interventions are feasible within existing administrative and institutional structures. The emphasis on the role of parents, teachers, and local communities in improving children’s oral health behavior reflects a modern, intersectoral approach to preventive healthcare. Moreover, the study’s findings could serve as a foundation for developing national guidelines on oral health education for parents and educators, as well as for introducing preventive modules into preschool health curricula. TADQIQOT VA TARAQQIYOT | II-JILD | 11-SON | 2025 \ 11 From a scientific standpoint, the study is methodologically sound, ethically conducted, and statistically reliable. The author demonstrates excellent knowledge of contemporary literature, logical coherence in argumentation, and high academic standards in data interpretation. From a practical perspective, the work offers actionable insights that can guide the design of more comprehensive preventive programs for young children. The manuscript is written in a clear and precise style, with well-organized sections and informative tables, making it suitable for publication in peer-reviewed journals in the fields of dentistry, public health, or child development. In conclusion, this research represents an important and commendable contribution to the field of pediatric dentistry and preventive medicine in Uzbekistan. It successfully combines international scientific rigor with national health priorities and provides realistic, evidence-based recommendations for improving oral health among preschool-aged children. The study not only highlights existing challenges but also offers concrete, achievable pathways for progress through education, prevention, and early intervention. The article can be confidently recommended for publication in national and international scientific journals, and it deserves recognition for its high scientific and practical value. The author’s work will undoubtedly be of great interest to researchers, dental practitioners, and public health policymakers committed to advancing children’s health and well-being. Disclaimer © This scientific review has been prepared by the editorial board of the “RESEARCH & DEVELOPMENT” journal and is intended solely for use within the journal’s internal expert evaluation process and editorial activities. This review is protected by copyright law, and its content may not be distributed, reproduced, or used for commercial purposes without the prior permission of the editorial board. The review has been prepared to assess the scientific quality, content, and methodological aspects of the author’s (authors’) work. It does not represent the personal opinion of the author(s) nor should it be interpreted as the official position of the journal. 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