A Comparative Evaluation of Oral Health Behavior and Plaque Index Between an Innovative Oral Health Literacy Enhancement Program and Traditional Oral Health Education in Adult Orthodontic Patients: A Single-Center, Randomized Controlled Trial

Abstract

Aims: Orthodontic appliances contribute to difficulties in maintaining oral hygiene. This trial aimed to evaluate the effectiveness of a novel oral health literacy (OHL) enhancement program (OHL program) by comparing oral health behavior (OHB) and plaque index (PI) scores between intervention and control groups in orthodontic patients. Materials and Methods: This randomized controlled trial was registered at ClinicalTrials.gov (NCT06666374). Seventy-eight adults undergoing fixed orthodontic treatment were randomly assigned to either the OHL or traditional program. The primary outcomes, OHB and PI, were measured at three time points: pre-intervention, post-intervention, and a 3-week follow-up. OHL was assessed at all intervals as a manipulation check. Data were analyzed using doubly multivariate repeated-measures analysis to evaluate differences in OHB and PI over time and repeated-measures analysis of variance for a mixed design to assess OHL changes. Results: Baseline OHB, PI, and OHL scores were comparable between groups. OHL scores significantly increased over time, with greater improvement in the intervention group (P < 0.01), confirming the program efficacy. The intervention group demonstrated significantly higher OHB and lower PI scores at post-intervention (P < 0.05) and follow-up (P < 0.01). Sustained improvements in OHB and PI were observed in the intervention group across all time points (P < 0.01), whereas the control group showed significant improvements only from pre- to post-intervention (P < 0.01). Conclusions: The OHL program significantly contributed to improved oral hygiene and maintained these improvements throughout follow-up, unlike the control group, which showed only benefits after intervention.