Document Type : original article


1 Students Research Committee, Arak University of Medical Sciences

2 Departments of Health Education and Health Promotion, School of Health,Arak University of Medical Sciences

3 Professor of Health Education and Health Promotion, School of Health, Arak University of Medical Medical Sciences, Arak, Iran.

4 Epidemiology Department of Epidemiology, Arak University of Medical Medical Sciences


Background: Dental caries are one of the children’s most common chronic diseases. This study aims to examine the influence of school-based online education on oral hygiene behaviors during COVID-19.
Methods: This quasi-experimental study was conducted on 120 students in the 5th and 6th grades of primary school in Shazand, Iran, from February 2022 to April 2022. The participants were selected by cluster sampling method and divided into two groups; control (n=60) and experimental (n=60). The data collection instrument checked the participants’ demographic information, constructions of the theory of planned behavior (TPB), and oral health behaviors before and after the intervention. The experimental group participated in four online educational sessions (each session was 1 hour) in SHAD software. Descriptive statistics, Chi-square test, and Analysis of Covariance (ANCOVA) were used to analyze the data via SPSS version 23.
Results: The mean ±standard deviation (SD) of the students’ age was 11.50 ± 0.50. Before the intervention, there was no significant relationship between the oral hygiene behavior of the two groups and the TPB constructions (p>0.05). A month after the intervention, the mean scores of the oral hygiene behavior, attitude, subjective norm, perceived behavioral control, and intention significantly increased in the experimental group (p<0.001). After the intervention, both twice brushing a day and once a day flossing significantly increased in the experimental group; from 28.2 % to 73.3 % and from 50 % to 75 %, respectively (p<0.001).
Conclusion: Rendering the results of this study, online educational intervention based on the theory of planned behavior promotes the oral health behaviors of primary school students.


  1. Knorst JK, Brondani B, Tomazoni F, Vargas AW, Cósta MD, da Silva Godois L, Mendes FM, Ardenghi DM, Ardenghi TM. COVID-19 pandemic reduces the negative perception of oral health-related quality of life in adolescents. Quality of Life Research. 2021; 30:1685-91.
  2. Achmad H, Hasbi HS. Gingival Health and Oral Hygiene Measures among Junior High School Children during the Covid-19 Pandemic: A Systematic Review. Annals of the Romanian Society for Cell Biology. 2021:4783-99.
  3. Brondani B, Knorst JK, Tomazoni F, Cósta MD, Vargas AW, Noronha TG, Mendes FM, Ardenghi TM. Effect of the COVID‐19 pandemic on behavioral and psychosocial factors related to oral health in adolescents: A cohort study. International journal of pediatric dentistry. 2021; 31(4):539-46.
  4. Mohammadi Zeidi I, Yekaninejad M, Akaberi A. Effectiveness of motivational interviewing (MI) of oral self-care behaviors among high school students in Qazvin. Journal of North Khorasan University of Medical Sciences. 2013; 5(1):127-37.
  5. Falahinia N, Razeghi S, Shamshiri AR, Firoozi M, Mohebbi SZ. The effectiveness of motivational interviewing on the oral health of leukemic children and oral health care knowledge, attitude and practice of their mothers: a hospital-based intervention. BMC Pediatrics. 2023; 23(1):261.
  6. Nejadsadeghi E, Loeloe MS, Rabiei SMR, Bakhshesh L. Factors Affecting Oral Health Self-Care Behaviors in Seventh Grade Students in Behbahan City: An Application of the Health Belief Model. International Journal of Pediatrics. 2022; 10(4):15835-41.
  7. Jafari A, MakvandGholipour M, KhoramiyanTousi S. The effect of a health promotion program on permanent dental health in elementary students. Iranian Journal of Pediatric Dentistry. 2019; 14(2):79-88.
  8. Soltani R, Sharifirad G, Mahaki B, Ali Eslami A. The Effect of Oral Health Educational Intervention Program among Mothers of Children aged 1-6, Based on the Theory of Planned Behavior. Journal of dentistry (Shiraz, Iran). 2020; 21(4):292-9.
  9. Karami K, Shakerinejad G, Kabiry B. Effect of education based on health belief model on students' oral health behavior change. J Ilam Univ Med Sci. 2014; 21(7):134-41.
  10. Kamiab N, Kamalabadi YM, Fathollahi MS. DMFT of the First Permanent Molars, dmft and Related Factors among All First-Grade Primary School Students in Rafsanjan Urban Area. Journal of Dentistry. 2021; 22(2):109.
  11. Shamsaei F, Ashtarani E, Meschi M, Ashtarani F. The Effect of Oral Health Education through Role Playing on Health Behavior of Educable Mentally Disabled Male Students in Hamadan. JOURNAL OF NURSING EDUCATION (JNE), [online]. 2018; 7(1):27.
  12. Beigi MR, Gholami M, Jafari A. Integration of Oral Health Interventions in the Health Promoting Schools Program in Iran: A Multi-Stakeholder Feasibility Assessment. Frontiers in Dentistry. 2021.
  13. Soltani R, Ali Eslami A, Mahaki B, Alipoor M, Sharifirad G. Do Maternal Oral Health-Related Self-Efficacy and Knowledge Influence Oral Hygiene Behavior of their Children? International Journal of Pediatrics. 2016; 4(7):2035-42.
  14. Guarnizo-Herreño CC, Wehby GL. Children's dental health, school performance, and psychosocial well-being. The Journal of pediatrics. 2012; 161(6):1153-9.
  15. Yavari M, Morowatisharifabad M, Haghi M, Rezaeipandari H, Hatamzadeh N, Azad E. Study of knowledge, Attitude, Practice and Oral Health Status among High School Students in Yazd. Tolooebehdasht. 2016; 14(6):261-75.
  16. Liu X, Xu J, Li S, Wang X, Liu J, Li X. The prevalence of gingivitis and related risk factors in schoolchildren aged 6-12 years old. BMC oral health. 2022; 22(1):623.
  17. Soltani R, Barzegar M, Ghaffarifar S. Determinants of oral health-related quality of life and its affecting factors in preschool children: Cross-sectional study. Journal of Oral Health and Oral Epidemiology. 2023; 12(1):32-7.
  18. Karamehmedovic E, Bajric E, Virtanen JI. Oral Health Behaviour of Nine-Year-Old Children and Their Parents in Sarajevo. International journal of environmental research and public health. 2021; 18(6).
  19. Babaei N, Belyad S, Moradi A. Evaluation of Oral Hygiene and Related Oral Health Behaviors among Students Studying Science in Meshgin City. Journal of Health. 2019; 10(1):118-28.
  20. Peyman N, Samiee Roudi K. The Effect of Education Based on the Theory of Planned Behavior on Caries Prevention of Permanent Teeth in Fifth Grade Students in Khaf City. Journal of Mashhad Dental School. 2015; 39(2):123-36.
  21. Gotler M, Oren L, Spierer S, Yarom N, Ashkenazi M. The impact of COVID-19 lockdown on maintenance of children's dental health: A questionnaire-based survey. Journal of the American Dental Association (1939). 2022; 153(5):440-9.
  22. Garcés-Elías MC, Beltrán JA, Del Castillo-López CE, Agudelo-Suárez AA, León-Manco RA. Peruvian children toothbrushing during the COVID-19 pandemic. F1000Research. 2022; 11:760.
  23. World Health Organization. WHO expert consultation on public health intervention against early childhood caries: Available at: 255627/1/ WHO-NMH-PND-17.1-eng.pdf
  24. Petersen PE, Peng B, Tai B, Bian Z, Fan M. Effect of a school-based oral health education programme in Wuhan City, People's Republic of China. International dental journal. 2004; 54(1):33-41.
  25. Pakpour AH, Gholami M, Gellert P, Yekaninejad MS, Dombrowski SU, Webb TL. The Effects of Two Planning Interventions on the Oral Health Behavior of Iranian Adolescents: A Cluster Randomized Controlled Trial. Annals of behavioral medicine: a publication of the Society of Behavioral Medicine. 2016; 50(3):409-18.
  26. Ajzen I. The theory of planned behavior: Frequently asked questions. Human Behavior and Emerging Technologies. 2020; 2(4):314-24.
  27. Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, Pitkin R, Rennie D, Schulz KF, Simel D, Stroup DF. improving the quality of reporting of randomized controlled trials: the CONSORT statement. Jama. 1996; 276(8):637-9.
  28. Präg P. Subjective socio-economic status predicts self-rated health irrespective of objective family socio-economic background. Scandinavian journal of public health. 2020; 48(7):707-14.
  29. Buunk-Werkhoven YA, Dijkstra A, van der Schans CP. Determinants of oral hygiene behavior: a study based on the theory of planned behavior. Community dentistry and oral epidemiology. 2011; 39(3):250-9.
  30. Shojaei M, Peyman N, Ghavami V. The Effect of Peer Education Based on the Theory of Planned Behavior on the Improvement of Behaviors Related to Oral Health in Primary School Students in Rural Areas of Torbat-e Jam. Military Caring Sciences. 2022; 8(4):399-410.
  31. Scheerman JFM, Hamilton K, Sharif MO, Lindmark U, Pakpour AH. A theory-based intervention delivered by an online social media platform to promote oral health among Iranian adolescents: a cluster randomized controlled trial. Psychology & health. 2020; 35(4):449-66.
  32. Halawany HS, Al Badr A, Al Sadhan S, Al Balkhi M, Al-Maflehi N, Abraham NB, Jacob V, Al Sherif G. Effectiveness of oral health education intervention among female primary school children in Riyadh, Saudi Arabia. The Saudi dental journal. 2018; 30(3):190-6.
  33. Hashemi ZS, Khorsandi M, Shamsi M, Moradzadeh R. Effect combined learning on oral health self-efficacy and self-care behaviors of students: a randomized controlled trial. BMC oral health. 2021; 21(1):342.
  34. ABOUBAKR R, TOUNSI A. Impact of School-based Online Oral Health Education Programme during COVID-19 Pandemic: An Interventional Study in Riyadh, Saudi Arabia. Journal of Clinical & Diagnostic Research. 2022; 16(2).
  35. Dumitrescu AL, Wagle M, Dogaru BC, Manolescu B. Modeling the theory of planned behavior for intention to improve oral health behaviors: the impact of attitudes, knowledge, and current behavior. Journal of oral science. 2011; 53(3):369-77.
  36. Asgari I, Ahmady AE, Broder H, Eslamipour F, Wilson-Genderson M. Assessing the oral health-related quality of life in Iranian adolescents: validity of the Persian version of the Child Oral Health Impact Profile (COHIP). Oral health & preventive dentistry. 2013; 11(2):147-54.
  37. Soltani R, Eslami AA, Akhlaghi N, Sharifirad G, Alipoor M, Mahaki B. Toothbrushing frequency among 4-6-year-old Iranian children and associated maternal attitude and sociobehavioral factors. Dental research journal. 2017; 14(1):50-6.