Improving cerebral palsy children’s oral hygiene: an 18-month school-based oral health promotion program in Bangkok, Thailand

INTRODUCTION: Children with cerebral palsy (CP) have relatively poor oral health. Oral health behavioral programs previously reported were limited to oral health education. This study aimed to develop a community participatory oral health promotion program for CP children and to evaluate their oral hygiene over 18 months. MATERIALS AND METHODS: A longitudinal school-based intervention study was conducted at a Thai public school using a one-group quasi-experimental design and involving 23 CP children (mean age 12). The program included community study, policy advocacy, staff training, goal setting, curriculum development, dormitory arrangements, and sponsorship. Oral hygiene was assessed via dental plaque examinations at baseline and five follow-ups (1 week, 2 weeks, 3 months, 9 months, and 18 months). Data on age, sex, residency, and CP severity were collected. Oral hygiene was categorized as good, fair, poor. Statistical analyses included Wilcoxon signed-rank test, McNemar’s exact tests, and Mann-Whitney U tests (p < 0.05). RESULTS: Seven oral health activities were implemented. At the end of the program, mean plaque scores significantly decreased by 44% (Cohen’s d = 1.36). At baseline, no children had good oral hygiene. At 9- and 18-month follow-ups, 26% of children demonstrated good oral hygiene. Older children showed greater improvements (p = 0.038 for 1-week, p = 0.014 for 2-week follow-ups), while those with severe disabilities improved notably at the first (p = 0.022) and last follow-ups (p = 0.037). CONCLUSION: Over an 18-month program, CP children effectively improved their oral hygiene. Our study explicitly highlights the success of the community participatory approach as a model for future interventions.