The Potato Teeth Project:
A comparison of classroom and garden-based educational interventions for oral hygiene in primary school pupils
Southlands Methodist Trust
This project involves a series of garden-themed activities for primary school pupils, designed as intervention packages to support their health and wellbeing. These interventions aim to reinforce correct oral hygiene techniques, as well as educate pupils on healthier alternatives to sugary foods to reduce their risk of tooth decay.
The 'Potato Teeth Project' builds on the Principal Investigator's recently funded project, 'Sugarless Green' (2021) and Gardening and Gums (2021). The former was a single-arm, quantitative oral health education pilot study, targeting primary school pupils at Key Stage 2 (ages 7-11), and funded by Research England. Due to UK lockdown conditions, 'Sugarless Green' was piloted in classrooms only. Whereas, Gardening and Gums was a community based project which invited parents and children from the local Alton Estate and surroundings in the Roehampton region and wider Wandsworth Borough. While 'Sugarless Green' focused on relating oral care and the impacts of sugar to young children, 'Gardening and Gums' extended this lesson to consider healthy gum care. Parents from the local community were invited to participate to learn about gum care, the detection of early gum disease and the higher likeliness of gum disease impacting people from black and minority ethnic (BME) backgrounds.
This third arm of the project (Potato Teeth) will be modelled on the activities of 'Sugarless Green’ but will implement the project indoors as well as outdoors in a garden to understand the relative benefits between the two settings. Participants will be recruited from primary schools in the London Borough of Wandsworth, local to the University of Roehampton (UoR).
Video Summary: Why an oral care intervention using gardening techniques?
What makes the 'Potato Teeth Project' different?
The 'Potato Teeth Project' will be set up in a mixed-methods design. The quantitative element will be quasi-experimental, with two 'treatments', each corresponding to the intervention in-classroom or on-campus activities. A fully randomised approach is unfeasible due to restrictions with social distancing measures and maintaining pupil class bubbles. It is expected that a single Key Stage 2 class will be recruited as a control group, with one class each for in-classroom activities and on-campus activities (all classes being from different schools).
Each class is expected to comprise at most 30 pupils, given an average class size of 28 in the local schools near UoR. The study will adopt a pre-post observational design for each of the control and 'treatment' classes, with the results measured being pupils':
i. changes in knowledge gained about oral hygiene (cognitive), and
ii. changes in frequency of healthy food choices (behavioural).
The first will be determined based on pupils' scores on a series on multiple-choice questions provided in the activity booklet. The second will be determined based on their records in a 'snack log', which they will maintain over one week before and after the intervention activities.
This project extends the work done on 'Sugarless Green' as the latter was only a single treatment and the former has a multiple treatments design. Furthermore, 'Sugarless Green' was a purely quantitative study. For in-classroom activities, modelled on 'Sugarless Green', it Is expected that the contrast between the garden matter (fruit, vegetables, and soil) and the demonstrated interactions with 'artificial' sugar, would reinforce pupils' recognition as something foreign to the environment as well as to their bodies.
Whereas, on-campus activities extends this with a Froebelian approach to learning, in the manner of providing the activities in a 'fun', outdoor setting, where pupils can be more exploratory and creative in the ways they use their senses to learn about the problems with sugar and oral hygiene. The uniqueness of the multiple treatments design also means that a more sophisticated approach to measuring the effect size of each intervention must be taken, in order to reduce the effect of sample selection bias.
This will be achieved by using information about pupils' current oral health habits in a 'propensity score matching' technique to associate subgroups of pupils in the control class with similar subgroups in the intervention classes. The qualitative element of the project will examine the feedback provided by participating pupils on their experience to supplement the quantitative analysis and create a more rounded view of costs and benefits of the interventions.
Participating Schools & Project Activities
The project team would like to extend special thanks to the participating primary schools in the local Roehampton vicinity. Below are photo summaries of pupils participating in the activities:
Intervention Group 1 On-Campus - Roehampton Church School
Year 4 pupils visited the university campus to access the Growhampton Garden plots where they worked with our trained university student facilitators to do the one-hour intervention programme. Pupils were largely engaged in the immersive outdoor setting and showed great interest in both the gardening environment in terms of how vegetables were grown and discovering facts like the green tops of carrots can be eaten.
Intervention Group 2 In-Classroom - Sacred Heart Catholic Primary School
University of Roehampton Student Facilitators visited Year 4 students in their classrooms with resources harvested and packaged from the garden plots, for instance small bags of soil with potted carrots and carved potato teeth moulds for flossing. The pupils were excited by the activity of working with soil and sticky golden syrup on their desks while learning about oral hygiene.
Control Group 3 Non-Intervention - Granard Primary School
Year 4 pupils participated as our control group, which means they completed two rounds of activity booklets about oral care (approximately 6 to 8 weeks apart) and did not participate in the intervention. However, to thank the pupils and to contribute to their learning about oral care we provided them with start-up dental kits to brush and floss their teeth at home.
What are the next steps?
The immediate next steps pending the publication of the impact of the intervention will be seeking (i) collaborative opportunities to work with dentists and teachers in training to finesse the intervention programme into one that cna be scaled up across the UK to schools. Publications and findings from this research are currently under analysis and will be made available via this site/page. If you are interested in becoming involved in any future collaborations please contact us here.