The present study assessed the roles of schools in supporting positive oral health behavior among adolescents in selected secondary schools in a metropolis in Nigeria. Our findings showed that the only oral health promotion activity in the schools was oral health education. The finding highlights gross deficiencies of the schools in promoting oral health among adolescents. It also contrasts other findings where supervised school brushing, preventive services and treatment services among other activities are components of the school oral health program [24–26]. It is also noteworthy that less than 30% of the schools had benefitted from such programs and about 20% of the students had participated in such programs. This contrast findings from countries like Kuwait [25] and developed countries where school oral health has gained prominence and covered many schools in the districts and the country at large [26]. Teachers were the main educators of oral health in the schools with dentists coming next. This is not surprising as teachers are expected to pass across health information in schools more so, they are the ones in close contact with the students throughout the school period. This was similarly documented in a previous report [26].
Dentists as educators in schools supports previous studies on the role of public health dentists in school oral health education [21]. There are few public health dentists in the country [27] and hence limited coverage of the schools. Training of more public health dentists is one solution to the present problem but it would take a long time and enormous resources to have the right number required for the school population. The training of personnel to complement oral health promotion in schools is, therefore, worthwhile and teachers can fit this role.
None of the schools had oral health promotional materials in place for the students to learn from or serve as a reminder on daily basis. Consistency is important in instilling knowledge for positive attitude and behavior change [14]. In addition, written communication has also been found helpful in behavior change [28]. Therefore, the need for oral health promotional materials such as posters among others in schools in the country is pertinent. Importantly, provision of the materials will have to be looked into for prospects and success of oral health promotion interventions. Furthermore, production of oral health education materials on a large scale for all schools to improve awareness should be considered. In addition, it will contribute to educative opportunities in which good oral health behavior can be developed and sustained, thus encouraging to the students. All the tuck shops in the schools had fruits and cariogenic food on their shelves. Although the availability of fruits is a positive effort, this is countered by the continuous supply of cariogenic food. Appropriate intervention to this effect may go a long way in restricting its sale and thus limiting the negative influence that its availability may have on the students’ behavior.
This is further buttressed by the fact that the majority of the students did not want restriction of sales of cariogenic food in the school’s tuck shops. In fact, students from schools that had conducted oral health education program were more likely to disagree with the restriction of sales of cariogenic diet in the school’s tuck shop. This is a pointer to inadequate motivation despite oral health education program conducted in their schools. Absence of promotional materials may have contributed to this. In addition, the students may fear that the school may enforce restriction of sales of cariogenic food if students are committed to a restriction. School policy on restriction of sale of cariogenic food will also go a long way in providing supportive environment for oral health promotion in the schools. Policy as facilitating factor for sustainable school oral health program has been documented [26]. In addition, those who had participated in the school oral health program were more likely to have consulted a dentist. This can be alluded to the motivation of students to seek dental care from messages learnt during the oral health education programs. This is encouraging as the school oral health education program can be an avenue to encourage students to utilize dental services.
A higher proportion of students that that had participated in oral health education in schools were motivated to participate in subsequent school oral health program. Availability of oral health promoting opportunities in schools such as school dental club and school dental clinic among others will go a long way in impacting the students’ behavior positively and a higher likelihood of being motivated for a positive behavior change. However, in the schools that were studied, only a few had exposed their students to oral health education, there were inadequate oral health promotional activities and lack of oral health promotional materials.
The study has a major limitation: that it was conducted among public school students only. This may affect generalizability of findings to private schools in the country. However, this was done as school oral health programs will be initiated in public schools as their attendees suffer more often from preventable oral diseases of significant concern in LMICs.
In conclusion, the schools surveyed played very little or no role to support positive oral health behavior of adolescents. There were no oral health promotional materials in the schools. Students who had been exposed to oral health education in school were better motivated about their oral health.