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Nursing: Untreated Dental Caries in Students

Research Problem/Purpose

The reviewed study was written by Haque et al. (2016) and published in the following year in BMC Oral Health. The purpose of the article was to evaluate the effect of a school-based oral health education in preventing untreated dental caries and increasing knowledge and promoting change in attitudes and practices among adolescents in Bangladesh (Haque et al., 2016). The article focuses on the problem of untreated dental caries in students.

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In the context of nursing, education of students about the basics of oral hygiene is seen as the solution. Therefore, the authors prove that the issue can be solved in the context of nursing, specifically, by using patient education techniques. The researchers placed the study problem in the context of existing nursing knowledge by stating that although educational interventions have proven to be very cost-effective.

Review of the Literature

The article does not have a dedicated literature review section. The review of literature addresses the overall oral health situation in Bangladesh and establishes school settings as some of the best potential locations for conducting educational oral health interventions (Haque et al., 2016). In addition, primary and secondary sources were used to establish measures to be used throughout the research, especially untreated dental caries, notions and beliefs about oral health, attitudes towards oral health, and traditional OH practices (Haque et al., 2016).

The majority of the studies used in the review of literature is dated between years 2000-2010, which could be explained by the fact that definitions and causes of oral health problems are largely well-studied and do not require up-to-date sources to establish them. In addition, the time necessary for conducting research, analyzing the available data, synthesizing it, and presenting a finished article for publishing often exceeds several years. All of the core sources could be considered recent and trustworthy.

Theoretical Framework

The article does not explicitly state the theoretical framework of its study. However, the goal of educational interventions is to empower patients to help themselves and improve the quality of self-care. As such, it is likely that the authors have used Orem’s Self-Help theory in order to inform the nursing intervention (Alligood, 2017). The assumptions this theory suggests include the general desire of the patient to become fully autonomous and the will to improve one’s own health through learning.

To the authors’ credit, they incorporate not only nursing theoretical frameworks but also theories from other disciplines such as education into the analysis. For example, Kolb’s Learning Cycle is integrated into the paper. Combined with Orem’s Self-Care Theory that could be used in the scope of this intervention, Kolb’s experiential learning theory provides a framework for the actual processes within the proposed study.


The research question is clearly stated in the article and consists of the following notions: “determine the impact of school based OHE program in (1) preventing the prevalence of untreated dental caries and (2) increasing knowledge, attitude, and practices regarding oral hygiene among 6–8 grade school students in Bangladesh” (Haque et al., 2016, p. 2).

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The hypotheses are not explicitly stated, but it is implied that an educational intervention would reduce the prevalence of caries and improve the overall views of the people targeted by the study towards oral and dental health. The defined variables include the number of decayed, missing, and filled permanent teeth (dependent), as well as various variables revolving around oral health knowledge, traditions, and attitudes (independent). Both types of variables are measurable, concrete, and clearly defined by to the reader in the dedicated subsections.


The study follows a quantitative type of design, with deductive reasoning used throughout the article. The researchers used a standard framework, with theoretical background implemented to generate implicit hypotheses and observations leading to either confirmation or rejection of the original thesis of the paper (Tappen, 2015). The sampling population for this research included 944 students from three local schools in Bangladesh (Haque et al., 2016). The study used a simple random probability sampling method, with candidates chosen to participate determined by random numbers.

The intervention was conducted in a school setting, whereas the evaluation took place in a dedicated dental clinic. Dependent variables were measured by using a visual survey of caries-affected teeth and areas before the study as well as after the 6-month intervention (Haque et al., 2016). Independent variables, such as knowledge, attitudes, and traditions, were measured using a specialized questionnaire. The validity and reliability of measuring tools were supported by their wide use in similar studies. The study protocol was observed by the Bangladesh ethical committee in order to ensure that the rights and preferences of the participants were observed and followed. This type of study typically requires consent from the child’s parents or guardians (Haque et al., 2016).

Data Analysis

The primary data analysis method for this study was the McNemar’s Chi-Square method. It was used twice, before and after the intervention, in order to determine the changes in oral health based on the outlined variables. Multiple logistic regression analyses were used to determine how impacted variables affected the sample as a whole (Haque et al., 2016). One of the critical findings of this research was the overall reduction of untreated caries by 42.5% by the end of the study (Haque et al., 2016). The prevalence of caries (dependent variable) was determined through a physical examination of the children’s teeth. These findings were characterized by the changes in oral habits, dietary patterns, and parental participation of children.

Summary/Conclusions, Implications, and Recommendations

The authors identified five major limitations to their studies. According to the article, the intervention was not a full health promotion scenario, which is why the effectiveness is inherently limited to what is learned and supervised at school. In addition, the self-reported nature of independent variables provides a degree of bias when assessing its effectiveness (Haque et al., 2016). Overreporting is a standard weakness of a survey-type research.

Apart from the strengths and weaknesses mentioned by the authors, one should also outline the limitations and advantages of the research design. The application of the quantitative method, specifically, the chi-test, has helped the authors to gain an excessive amount of data and locate the correlation between the key variables. However, the method in question also restricted the opportunities to define the nature of the lack of education about the essentials of oral hygiene, which is a major weakness.

This study would not be useful in determining the scale-up costs of an intervention, nor would it allow for standardization of interventions, as this one was fitted based on the available time and resources. Lastly, national and regional specifics may have played a role in affecting the results of the study (Haque et al., 2016). The The article proved to be very useful for my personal nursing practice and for nursing in general as a profession, as it demonstrates a succinct and focused endeavor of improving healthcare outcomes in a vulnerable population group.

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Alligood, M. R. (2017). Nursing theorists and their work (9th ed.). New York, NY: Elsevier Health Sciences.

Haque, S. E., Rahman, M., Itsuko, K., Mutahara, M., Kayako, S., Tsutsumi, A.,… Mostofa, M. G. (2016). Effect of a school-based oral health education in preventing untreated dental caries and increasing knowledge, attitude, and practices among adolescents in Bangladesh. BMC Oral Health, 16(44), 1-10.

Tappen, R. M. (2015). Advanced nursing research: From theory to practice. New York, NY: Jones & Bartlett Publishers.

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