10.59987/ads/2014.3.87-90
Aim. The purpose of the study Project was to test the effectiveness of a multimedia game designed in order to attract the attention of primary school children to oral health basic concepts and use the instrument to assess students’ knowledge.
Materials and methods. An originally designed multimedia game on oral health was administered in the computer class rooms, before (T0) and after (T1) an educational stage, to third (8-9 years) and fifth graders (10-11 years) of primary schools in urban and rural areas of two provinces of medium-small cities in Center Italy (Terni and Latina). Considered variables were: age, gender, school time schedule (only antemeridian, extended schedule). The statistical test used was the nonparametric Wilcox on signed-rank test.
Results. Response rate was 90.6% (due to absence on the due date). 1,300 students were involved. Overall, the average of the correct answers was 40.7% before oral health lessons and 59.2% after. An improving trend of correct answers was recorded from T0 to T1, significantly (p&lt; 0.05) among: fifth graders (+ 17.5%), extended school time schedulers (+18.1%) and females (+18.9%). The results, however, show poor global oral health knowledge, being total percentage of correct answers below 60%.
Conclusions. The results stress the importance of the school environment as access to health promotion for all socio-economic classes. The multimedia educational approach has proved a valuable and updated tool to attract the attention of digital native children.
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L. Ottolenghi 
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Annali di stomatologia
primary school
A multimedia oral health promoting project in primary schools in central Italy
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Original Article
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2022-08-12
2014-09-01
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Ann Stomatol (Roma)
L. Ottolenghi 
2014
10.59987/ads/2014.3.87-90
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primary school
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A multimedia oral health promoting project in primary schools in central Italy
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                                                                                                    Original article



    A multimedia oral health promoting project in
    primary schools in central Italy




                                                                                                      i
                                                                                                    al
                                                                                                 on
    Iole Vozza, DDS, PhD                                       media educational approach has proved a valu-
    Fabrizio Guerra, MD, DDS                                   able and updated tool to attract the attention of
    Massimiliano Marchionne, BSDH                              digital native children.
    Ercole Bove, MD, DDS
    Denise Corridore, DDS                                      Key words: oral health, health promoting school,




                                                                                         zi
    Livia Ottolenghi, DDS                                      primary school.




                                                                            na
    Department of Oral and Maxillo Facial Sciences, “Sapien-   Introduction
    za” University of Rome, Italy
                                                               As children spend a considerable proportion of their
                                                               lives in education, schools can play a significant role
                                                               in promoting their oral health. Schools reach over 1




                                                                 er
    Corresponding author:
    Iole Vozza                                                 billion children worldwide and are recognized as use-
    Department of Oral and Maxillo Facial Sciences,            ful settings for health promotion (1). Oral health mes-
    “Sapienza” University of Rome                              sages can be reinforced during the school years,
    Via Caserta 6


                                                         t     which are the most influential stages of children’s
    00161 Rome, Italy
    E-mail: iole.vozza@uniroma1.it
                                                      In       lives. Health promoting schools (HPS) is increasingly
                                                               adopted as an approach to guide supportive practices
                                                               in promoting the development of healthy behaviors in
                                                               the early years. Health promotion was codified by Ot-
    Summary                                                    tawa Charter for Health Promotion in the First Inter-
                                                ni
                                                               national Conference on Health Promotion, on 1986.
    Aim. The purpose of the study Project was to test          The European Network of Health-Promoting Schools
    the effectiveness of a multimedia game designed            (ENHPS) started in 1992, followed by the establish-
                                     io

    in order to attract the attention of primary school        ment of the WHO Global School Health Initiative in
    children to oral health basic concepts and use the         1995 (2). The Ottawa Charter for Health promotion
    instrument to assess students’ knowledge.                  was thereby transformed into practice. Encouraging
    Materials and methods. An originally designed              children to adopt healthy lifestyle habits is a central
                           iz



    multimedia game on oral health was administered            objective, and health promotion at a community level,
    in the computer class rooms, before (T0) and after         particularly through health promoting schools, may be
    (T1) an educational stage, to third (8-9 years) and        an effective strategy. Thus, a Health Promoting
           Ed




    fifth graders (10-11 years) of primary schools in          School should aim to:
    urban and rural areas of two provinces of medi-            • Promote lifestyles conducive to good health
    um-small cities in Center Italy (Terni and Latina).        • Provide an environment supporting healthy
    Considered variables were: age, gender, school                  lifestyles
    time schedule (only antemeridian, extended                 • Give students and staff the ability to take action
    schedule). The statistical test used was the non-               for a healthier community and healthier living con-
IC




    parametric Wilcox on signed-rank test.                          ditions (3).
    Results. Response rate was 90.6% (due to ab-               The influence of childhood experiences on health sta-
    sence on the due date). 1,300 students were in-            tus through HPS is well documented and implement-
    volved. Overall, the average of the correct an-            ed worldwide (4-6). Different studies in Italy focused
C




    swers was 40.7% before oral health lessons and             the importance of oral health promotion at school (7,
    59.2% after. An improving trend of correct an-             8); the Italian Ministry of Health published a volume
    swers was recorded from T0 to T1, significantly (p         about “Promotion and protection of health in children
    < 0.05) among: fifth graders (+ 17.5%), extended           and adolescents: criteria of clinical, technological and
©




    school time schedulers (+18.1%) and females                structural appropriateness” in 2012 to promote oral
    (+18.9%). The results, however, show poor global           health among children and adolescents (9) following
    oral health knowledge, being total percentage of           the criteria of the Regional Office for Europe of the
    correct answers below 60%.                                 World Health Organization developed in the volume
    Conclusions. The results stress the importance of          entitled “Gaining health” (10). Oral health education
    the school environment as access to health pro-            can be taught as a specific subject or as part of
    motion for all socio-economic classes. The multi-          health promotion integrated approaches with active

    Annali di Stomatologia 2014; V (3): 87-90                                                                       87
    I. Vozza et al.


    participation aiming to sustainable changes in health-              focused on toothbrush and its use. Once completed
    related behavior. The purpose of this study was to                  the questions the multimedia program processed the
    test the effectiveness of a multimedia game designed                answers and the monitor displayed a picture of a
    in order to attract the attention of primary school chil-           cartoon character who lost a couple of teeth for
    dren to oral health basic concepts and use the instru-              each wrong answer. The first pair of teeth on the left




                                                                                                                  i
    ment to assess students’ knowledge.                                 of the image was associated to the first question




                                                                                                                al
    Multimedia approach has been chosen in order to en-                 and so forth in a sequential manner (Fig. 1). The
    counter digital natives’ interests and learning strategies.         collected data were then statistically analyzed. Con-
                                                                        sidered variables were: age, gender, school time




                                                                                                             on
                                                                        schedule (antemeridian, extended). The statistical
    Materials and methods                                               test used was the non-parametric Wilcox on signed-
                                                                        rank test.
    Third (8-9 years) and fifth graders (10-11 years) of
    elementary schools in two provinces of medium-




                                                                                                       zi
    small cities in Center Italy have been involved in the              Results
    study. The schools were chosen including urban and
    rural areas of the two provinces. An originally de-                 The study included 1,300 third (8-9 years) and fifth




                                                                                      na
    signed multimedia game on oral health was adminis-                  graders (10-11 years) of 14 elementary schools in
    tered in the computer class rooms, before (T0) and                  two provinces of medium-small cities in Center Italy
    after (T1) an educational stage, to the pupils. The                 (651 students of 6 schools in Terni and 649 students
    test was completely anonymous and there was no                      of 7 schools in Latina). The data are summarized in




                                                                           er
    need of ethical approval. A written informed parental               Table 2. Response rate was 90.6% (due to absence
    consent was collected before the first administra-                  on the administration date). The results are described
    tion. The multimedia game consisted of five ques-                   in Figures 2-4. On 1,300 tested students the average
    tions on issues referring to the Health Promoting                   of the correct answers was 40.7% at T0 and 59.2% at
    Schools program. The study was divided into three


                                                               t        T1. On the whole there was an improving trend of
    separate phases. The first phase consisted in the
    administration of questions and data collection. The
                                                            In          correct answers after the educational phase, signifi-

    second phase was concentrated on oral health
    lessons in the selected schools. The lessons con-
    cerned basic knowledge of dental anatomy, meth-
                                                ni
    ods of brushing and proper nutrition. The third and
    final phase provided for the re-administration of the
    game, and the subsequent data collection, in order
                                    io

    to assess the learning level. The questions are re-
    ported in Table 1. The first question reflected, signif-
    icantly, as well as the knowledge of the role of the
    dentist, the socio-cultural situation of the family and
                             iz



    therefore the knowledge of primary oral prevention
    transmitted to children. The second question was
    about the right technique of brushing and the third
           Ed




    question concerned caries and knowledge of sec-
    ondary prevention. The fourth question inquired
    about the importance of fluoride. The fifth question                Figure 1. Results of the quiz by a cartoon.


    Table 1. Multimedia questions about oral health.
IC




    Question 1               Question 2                Question 3                  Question 4              Question 5
    How often should         How do you use            What happens if the         What is fluoride?       How often should you
    you visit the dentist?   your toothbrush?          tooth has a cavity?                                 change your toothbrush?
C




    A) Every 2 years         A) Fast horizontal        A) Decay sooner or          A) It protects teeth    A) When bristles ruin
    B) When you need         movements in order        later goes away by itself   from decay              B) When it becomes
    C) Every 6 months        to clean all teeth        B) It’s possible to stop    B) It cleans teeth      black
                             B) Gentle circular and    small cavities and          with the toothbrush     C) Once a year
                             short movements in        save the tooth              C) It freshens breath
©




                             order to clean one        C) Decay always
                             tooth at a time           increases tooth size
                             C) Horizontal and         and you can lose
                             vertical movements        your tooth
                             in order to clean
                             everything quickly


    88                                                                                       Annali di Stomatologia 2014; V (3): 87-90
    A multimedia oral health promoting project in primary schools in central Italy


    cantly (p < 0.05) in: fifth graders (+ 17.5%), extended
    school time schedulers (+18.1%) and females
    (+18.9%). No significant differences were found
    among schools in urban and rural areas of the two
    provinces. The results, however, show poor overall




                                                                                                             i
    oral health knowledge, being total percentage of cor-




                                                                                                           al
    rect answers below 60%. These data are even more
    worrying, given the simplicity of the administered
    questions.




                                                                                                        on
    Table 2. Sample distribution by variables.




                                                                                               zi
                                 Latina         Terni   Total       Figure 4. Improving trend of correct answers from T0 to T1
    Females                      297            311     608         among females.
    Males                        352            340     692




                                                                                 na
    3rd Grade                    298            304     602         Discussion
    5th Grade                    351            347     698
    Antemeridian schedule        77             92      169         Decay and gum disease are among the most diffused
    Extended schedule            572            559     1131        conditions in human populations, affecting over 80%
    Total                        608            692     1300




                                                                      er
                                                                    of school children in some countries (11). Many oral
                                                                    health problems are preventable and their early onset
                                                                    reversible. However, in several countries a consider-
                                                                    able number of children, their parents and teachers



                                                            t       have poor access to oral health care and limited
                                                         In         knowledge of oral health prevention. The problems
                                                                    are exacerbated by the consumption of sugary snacks
                                                                    and carbonated drinks which is high among children
                                                                    and adolescents (12-14). Encouraging children to
                                                                    adopt healthy lifestyle habits, and promoting oral
                                                ni
                                                                    health through Health Promoting Schools, may be an
                                                                    effective strategy. Many studies focused on the effect
                                                                    of oral health promoting schools in different countries
                                     io

                                                                    (15-20). In Italy this is an ongoing process particularly
                                                                    followed through the project “Guadagnare salute” in
                                                                    collaboration with the Ministry of Health (21). Provid-
                                                                    ing education on oral health in schools helps children
                           iz



                                                                    to develop personal skills, provides knowledge about
                                                                    oral health and promotes positive attitudes and
                                                                    healthy behaviors. In this historical context, children
           Ed




    Figure 2. Improving trend of correct answers from T0 to T1
    among fifth graders.                                            show a continued interest to multimedia games. For
                                                                    this reason the quiz administered proved of great in-
                                                                    terest among students arousing curiosity and fun.
                                                                    From the analyzed results of this study it was found
                                                                    that 5 graders, as easily conceivable, showed greater
                                                                    knowledge in the field of oral health compared to 3
IC




                                                                    graders. A significant statistical difference was also
                                                                    found among males and females and among children
                                                                    who attended school with extended schedule time and
                                                                    those who attended antemeridian school time sched-
C




                                                                    ule. The study revealed an improvement of oral health
                                                                    and prevention knowledge although this result can still
                                                                    be considered inadequate, being total percentage of
                                                                    correct answers below 60%. It’s fundamental improv-
©




                                                                    ing knowledge about fluoride and white spot avoiding
                                                                    the onset of carious cavity and subsequent treatment
                                                                    with invasive mechanical aids (22, 23). To build a
                                                                    comprehensive oral health preventive program, three
                                                                    elements are essential that are oral health
    Figure 3. Improving trend of correct answers from T0 to T1      education/instruction, primary and secondary preven-
    among extended school time schedulers.                          tion measures (24). The school plays a crucial role,

    Annali di Stomatologia 2014; V (3): 87-90                                                                              89
    I. Vozza et al.


    raising awareness both for students as parents to sup-                        siding in four North Italian communities. Oral Health Prev Dent.
    port a prevention protocol for oral health. In this study                     2005;3(1):33-8.
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                                                                                  structural appropriateness. 2012. Available from:
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                                                                                                                             i
                                                                                  http://www.quadernidellasalute.it/download/download/16-
    dents, was able to promote parent knowledge and atti-




                                                                                                                           al
                                                                                  luglio-agosto-2012-quaderno.pdf
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