The Effects of Virtual Human-Based Oral Health Education on Oral Health Literacy and Oral Health-Related Knowledge, Attitudes, and Practices Among Adolescents: A Pilot Cluster-Randomized Controlled Trial

Adolescence is an important period for developing oral health literacy (OHL) and oral health-related knowledge, attitudes, and practices (KAP). Artificial intelligence-based virtual human oral education (AI-VOHE) has been proposed as a tool for school-based oral health education (OHE); however, evidence regarding its educational outcomes among adolescents remains limited. This pilot study compared short-term changes in OHL and self-reported oral health-related KAP between AI-VOHE and conventional face-to-face oral health education (FOHE). A pilot cluster-randomized pre-test–post-test intervention design was employed in two middle schools. Participants received either AI-VOHE or FOHE, and outcomes were assessed immediately before and after two educational sessions using a structured self-administered questionnaire. A total of 268 adolescents were included in the analyses. Linear mixed-effects models were used to evaluate the effects of time, group, and the group-by-time interaction. Both groups showed significant short-term improvements in OHL and self-reported oral health-related KAP following the intervention (all p < 0.05). However, no significant group-by-time interaction effects were observed for any outcome (all p > 0.05), indicating comparable short-term effectiveness between AI-VOHE and FOHE. These findings suggest that AI-VOHE showed short-term improvements in adolescents’ OHL and self-reported oral health-related KAP comparable to those achieved with FOHE. Given the pilot nature of the study, the limited number of schools, and the absence of long-term follow-up, the findings should be interpreted cautiously. Further adequately powered cluster-randomized trials are warranted.