Ekstrand 2000

Methods	Study design: quasi‐randomised trial Conducted in: Solntsevky, Russia Unit of randomisation: not applicable Unit of analysis: individual Setting: kindergartens in Solntsevky, a district in Moscow with high caries prevalence, Russia Funded by: not disclosed Duration: 2.5 years
Participants	Inclusion criteria: Inclusion criteria for children in groups B and C were that first/second permanent molars had begun to erupt or were just about to do so. Groups B and C were screened to find the 100 in the earliest stage of eruption of permanent first and second molars Exclusion criteria: not reported Age at baseline: group A: 3‐year‐olds, group B: 6‐year‐olds, group C: 11‐year‐olds N (controls baseline): group A: 0, group B: 50, group C: 50 N (controls follow‐up): group A: 45, group B: 50,group C: 49 N (intervention baselines): group B: 50, group C: 50 N (intervention follow‐up): group A: 45,group B: 50,group C: 49 Recruitment: through kindergarten Gender: Percentage of girls and boys was about 50% in each group A, B and C
Interventions	Interventions Group A: Education was given to the parents in two 45‐minute lectures. Parents received information about caries, reducing sweets between mealtimes and brushing teeth twice per day. The second lecture was given to reinforce parents' knowledge of methods to prevent caries Group B: Programme was based on intensive patient and parent education, training and toothbrushing, professional tooth cleaning and local application of 2% sodium fluoride and sealants ‐ all given according to individual requirements. Two 45‐minute lectures with the same information as in group A were given. Information about plaque removal was given, and parents were asked to supervise brushing in the morning and to brush their child’s teeth at night using fluoridated toothpaste Group C: Preventive programme was organised at the polyclinic, with two 45‐minute lectures given to children. Emphasis on eruption period of second permanent molar Control: Children attending control groups B and C followed the dental service provided by the local public dental health service. This meant that none of the children were covered by any caries‐preventive programme, but like all other children in the district, they were screened by dentists when they reached the ages of 6 and 11 years. Suggestions for treatment were given according to restorative treatment needs Duration of intervention: 2.5 years
Outcomes	Caries status and gingival status, caries status in primary dentition, caries status in permanent dentition, course of occlusal caries on permanent first molars, course of occlusal caries on permanent second molars
Implementation related factors	Theoretical basis: policy Resources for implementation: education sessions, parent training, toothbrushes, toothpaste (fluoridated and sodium fluoridated) Who delivered the intervention: unclear PROGRESS categories assessed at baseline: not reported PROGRESS categories analysed at outcome: not reported Outcomes related to harms/unintended effects: not reported Intervention included strategies to address diversity or disadvantage: not reported Economic evaluation: not reported
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Most participants were selected with the use of random methods in Groups B and C selecting every second child
Allocation concealment (selection bias)	Unclear risk	Unclear
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Unclear
Selective reporting (reporting bias)	High risk	Published report does not present data on all expected outcomes. Baseline and follow‐up data were not reported for Groups A and C
Other bias	Unclear risk	Unclear
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Unclear
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Unclear