Determinants of Plaque Index Among Children Aged 5-15 Years In A Conventional vs A Religious Schools: A Cross-Sectional DAG Informed Study.

ObjectiveTo compare oral hygiene status through plaque index (PI) and its determinants among children aged 5-15 years in a conventional and religious schools. This comparison was aided by Directed Acyclic Graphs (DAGs) to inform robust confounder adjustment. MethodsThis cross-sectional study in which 938 children were examined through the period of February 2024 to January 2025. Recorded data included demographics, sugary intake and their frequency, oral hygiene practices (dental visits, supervised toothbrushing) and clinical indicators (cavitated and non-cavitated dental lesions, proximal restoration). The outcome variable was PI taken as a continuous variable. Distribution of continuous variables was assessed through histogram and Shapiro-Wilk statistics. Bivariate comparisons utilized Mann-Whitney U (continuous non-normal) and chi-square (categorical) tests. DAGs were derived from literature and specified for minimally sufficient adjustment set criteria for multivariable analysis. Ordinary Least Square (linear regression) models were used to determine associations between outcome and predictor variables. ResultsIn conventional school, higher PI scores were associated with older age, fewer dental visits, and absence of supervised brushing (p<0.001 for all). In religious school, PI scores were associated with age (p<0.001) and sugary intake (p=0.032). All other predictors were non significantly associated. ConclusionsDeterminants of plaque accumulation differ by educational settings. Supervised brushing and preventive dental visits appear important in conventional schools whereas oral hygiene practices and improved dietary assessments should be prioritized in religious schools. Lastly, DAG informed adjustments strengthen the interpretation of cross-sectional associations.