Oral Health Behavior-Cognition-Awareness education is associated with improved short-term knowledge and long-term oral hygiene in head and neck cancer patients undergoing radiotherapy: a two-phase study

The incidence of head and neck cancer (HNC) has increased steadily, and radiotherapy remains a primary treatment modality. However, radiotherapy may induce severe oral complications, including radiation-related caries and osteoradionecrosis of the jaw (ORN). Consequently, comprehensive pre-treatment oral care and patient education are essential. This two-phase study conducted in Guangzhou, China, evaluated the effects of a structured oral health education program on short-term knowledge, behaviors, and long-term oral hygiene outcomes in HNC patients undergoing radiotherapy. In Phase 1, 63 HNC patients were prospectively enrolled and received a standardized, single-session Oral Health Behavior-Cognition-Awareness (OHBCA) education. Questionnaires assessed knowledge, awareness, and behaviors at baseline and 6 weeks post-intervention. In Phase 2, a retrospective cohort analysis was performed, comparing 24 patients from Phase 1 who completed 12-month follow-up (intervention group) with 19 historical controls who received standard care. Oral hygiene behaviors and clinical indices (e.g., Debris Index, Gingival Index) were evaluated at 12 months post-radiotherapy. Given the exploratory nature of the study and the use of a convenience sample, formal sample size calculation was not performed. Statistical analyses included paired and independent samples tests as appropriate. In Phase 1, the OHBCA education led to significant, large-magnitude improvements in oral health knowledge, awareness, and self-reported behaviors (all p < 0.01), including reduced tobacco/alcohol use and enhanced hygiene practices. In Phase 2, at the 12-month follow-up, the intervention group demonstrated significantly better oral hygiene indices (e.g., lower plaque and gingival scores; all p < 0.0001) and more favorable self-care behaviors compared to the historical control group. This exploratory study suggests that a structured pre-radiotherapy oral health education program is associated with significant short-term improvements in patient knowledge and behaviors, as well as superior long-term clinical oral hygiene outcomes. These preliminary, hypothesis-generating findings support the potential value of integrating systematic patient education into the HNC radiotherapy care pathway and underscore the need for validation through prospective randomized controlled trials.