Association Between Supervised Brushing and Oral Health Status Among School Children in Slum Communities

Abstract

Background: Dental caries and periodontal disease remain the predominant preventable oral health burdens among children in low-resource settings globally, with urban slum communities in South Asia carrying a disproportionate disease load attributable in part to deficient oral hygiene supervision. Adult-supervised toothbrushing is recognised as a key behavioural determinant of effective plaque removal and fluoride delivery in early childhood, yet its clinical impact and socioeconomic correlates have not been quantitatively examined in a South Asian slum context. Objective: This study aimed to investigate the association between adult-supervised toothbrushing and clinical oral health outcomes — including DMFT, DEFT, OHI-S, and Gingival Index scores — among school-aged children in an urban slum community in Lahore, Pakistan, and to identify socioeconomic predictors of supervision status. Methods: A retrospective cross-sectional analytical study was conducted among 200 school-enrolled children aged 5–15 years. Clinical oral health was assessed using WHO-standardised indices. Brushing supervision status and socioeconomic variables were ascertained through structured interviews. Independent-samples t-tests, chi-square tests, and binary logistic regression were applied using IBM SPSS version 26. Results: Supervised brushing was reported by 35.0% of participants (n=70). Supervised children demonstrated significantly lower DMFT (1.35 ± 0.95 vs 2.25 ± 1.10; p=0.001; d=0.86), DEFT (1.60 ± 1.05 vs 2.45 ± 1.20; p=0.002; d=0.74), OHI-S (1.95 ± 0.65 vs 2.45 ± 0.72; p=0.001; d=0.72), and Gingival Index scores (0.90 ± 0.60 vs 1.20 ± 0.75; p=0.012; d=0.43). Higher parental education (OR=1.85; 95% CI: 1.25–2.73; p=0.002), higher household income (OR=1.57; 95% CI: 1.04–2.36; p=0.030), and younger child age (OR=0.71 per year; 95% CI: 0.55–0.92; p=0.010) were independent predictors of supervision. Conclusion: Adult-supervised brushing was significantly associated with better clinical oral health outcomes across all domains. Socioeconomic inequity in access to supervision underscores the need for school-based supervised brushing programmes and caregiver health literacy interventions to reduce preventable dental disease in Pakistan's urban slum communities.