Playful Prevention Reconsidered: A Critical Narrative Review of How Game Design Constrains Clinical Content and Behavioural Durability in Paediatric Oral Health Gamification

Mohammed Umar Sharief; T Mahantesha; Suresh B S; Srinivas Naidu; Vijayendra V Kamath; Dhanu G Rao

doi:10.36948/ijfmr.2026.v08i04.84673

Playful Prevention Reconsidered: A Critical Narrative Review of How Game Design Constrains Clinical Content and Behavioural Durability in Paediatric Oral Health Gamification

Author(s)	Dr. Mohammed Umar Sharief, Prof. Dr. T Mahantesha, Prof. Dr. Suresh B S, Dr. Srinivas Naidu, Dr. Vijayendra V Kamath, Prof. Dr. Dhanu G Rao
Country	India
Abstract	Abstract Background: Three recent syntheses have established that gamified oral health education outperforms conventional instruction on short-term measures of knowledge, plaque and gingival health. Attention should therefore shift from whether these tools work to why their clinical coverage is narrow and their effects poorly sustained. Objectives: To advance and test two propositions: first, that the clinical content of gamified paediatric oral health tools is selected by what game mechanics can conveniently express rather than by preventive importance (a design and content inversion); and second, that the behaviour change techniques embedded are almost exclusively behaviour-initiating rather than behaviour-maintaining, making engagement decay a designed-in property rather than an implementation failure. Methods: A critical narrative review was conducted in accordance with the Scale for the Assessment of Narrative Review Articles. Six databases were searched from January 2014 to January 2026, combining the concepts of gamification, paediatric population and oral health. Interventions were coded against a 31-element taxonomy of game design elements and against the Abraham and Michie taxonomy of behaviour change techniques, and the resulting distributions were interrogated against the requirements of evidence-based preventive dentistry. Results: Short-term effectiveness is consistent, with plaque score reductions of up to 63.4 per cent, gingival score reductions of up to 58.7 per cent, and regular engagement of 72.4 per cent against 48.3 per cent for non-gamified equivalents. Content distribution, however, tracks gamifiability rather than clinical importance. Brushing time, which maps directly onto a countdown timer and is therefore expressed by the most prevalent game element (present in 94 per cent of applications), is near-universal, whereas interdental cleaning appears in under 20 per cent of applications, correct dentifrice quantity in two of seventeen, and toothbrush grip and tongue cleaning in none. The distribution of behaviour change techniques shows a parallel asymmetry, with initiating techniques dominant (31 to 42 per cent) and maintaining techniques minimally represented or absent. Conclusions: Gamified paediatric oral health tools are engaging but clinically incomplete, and their engagement decay is predictable from the behaviour change content they contain. Both failures share one cause, namely that mechanics are determining content rather than content determining mechanics. Reversing this inversion, rather than accumulating further short-term efficacy trials, is the substantive task for the field. Keywords: Gamification, Paediatric Dentistry, Oral Health Education, Behaviour Change Techniques, Mobile Health, Evidence-based Dentistry, Serious Games, Intervention Design
Keywords	Gamification, Paediatric Dentistry, Oral Health Education, Behaviour Change Techniques, Mobile Health, Evidence-based Dentistry, Serious Games, Intervention Design
Field	Medical / Pharmacy
Published In	Volume 8, Issue 4, July-August 2026
Published On	2026-07-28
DOI	https://doi.org/10.36948/ijfmr.2026.v08i04.84673

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Playful Prevention Reconsidered: A Critical Narrative Review of How Game Design Constrains Clinical Content and Behavioural Durability in Paediatric Oral Health Gamification

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