Background
Dental caries is highly prevalent in rural Himachal Pradesh, where seasonal isolation and low oral health literacy limit preventive care. Outreach initiatives may improve engagement and support integration of oral health into public health systems.

Objectives: To assess community engagement in rural caries prevention and identify lessons for integration into public health pathways.

Materials and Methods: A cross-sectional study was conducted in 2023 (baseline) and 2024 (follow-up) in rural villages and schools in the Mandi district. Baseline activities included oral health education, fluoride toothpaste distribution, caries screening (“D/d” component of DMFT/deft index), recording of oral hygiene practices, and urgent care referrals. Follow-up reassessed caries status and oral hygiene practices. Data were collected through clinical exams, questionnaires, focus groups, and interviews. Analyses included chi-square tests, paired t-tests, descriptive statistics, and logistic regression (p ≤ 0.05).

Results: Of 3,041 participants (year 2023), engagement was highest among school-aged children (79.3%) and lowest among adults >65 years (10.1%). Follow-up retention in 2024 was 68% (n = 2,068). Twice-daily brushing rose from 39% to 81.5% (p < 0.001), fluoridated toothpaste use from 65% to 86.7% (p < 0.001), and mean decayed teeth in children decreased from 3.2 ± 1.4 to 2.7 ± 1.2 (p = 0.01). Children (6–12 years) were more likely to adopt twice-daily brushing than adults >65 (OR = 4.2; 95% CI: 3.3–5.3). Female adherence was slightly higher than male adherence (OR = 1.3; 95% CI: 1.1–1.5). School participation strongly predicted sustained engagement (OR = 3.7; 95% CI: 2.9–4.7).

Conclusion: Outreach programs significantly improve oral hygiene behaviors in rural populations. School-based involvement, culturally sensitive strategies, and alignment with public health systems enhance sustainability and provide a replicable model for reducing rural-urban disparities in oral health.