Social story-based oral health promotion for preschool children with special healthcare needs: A 24-month randomized controlled trial

Objectives This study aimed to investigate the efficacy of the social story-based intervention in promoting the oral health status among preschool children with special healthcare needs. Methods The 24-month randomized controlled trial recruited 306 children from centres that provided educational training for 2- to 6-year-old children who had special healthcare needs. The participants received standardized toothbrushing training and oral health education materials. The education materials for children in the test group were validated social stories, while materials for children in the control group were standard leaflets. Those materials were introduced in each training session and used at home by parents. Children's oral health status and oral health-related behaviours were assessed before and after interventions. Data were analysed via generalized estimating equations, negative binomial regression and binary logistic regression. Results There was no significant difference in caries experience among children in both groups after 24 months. However, children in the test group showed better oral hygiene status and better toothbrushing performance, and they were more likely to visit a dentist (OR = 2.00, 95% CI:1.15,3.49) than their peers in the control group. Caries progression was more likely to be observed among children who had low social skills or whose parents were not working full-time. Children from high-income families showed better oral hygiene status than their peers (Estimate = -0.11, 95%CI: -0.20,-0.01). Conclusion Social stories could be used to improve oral health-related behaviours among young children with SHCN. The efficacy of the intervention might be associated with children's adaptive skills and family socio-demographic status.