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Objectives: To evaluate the oral cleanliness of schoolchildren in the District of Sunsari, Nepal.

Design and Method: Multi-stage random sampling oral epidemiological survey conducted by trained examiners using the Simplified Oral Hygiene Index (OHI-S). Settings: Surveys were conducted in private and government urban, rural town and rural village schools in 15 Illakas of Sunsari District, Eastern Nepal. Subjects: A total 600 12-13 year old and 600 15 year old schoolchildren were examined between April and September, 2001. Outcome measures: The level of debris and calculus were estimated and scored. The average age-group debris and calculus index scores were combined to obtain the simplified oral hygiene index (OHI-S). Results: In both age groups, the mean debris, calculus and OHI-S for the index teeth and the mean scores were higher in schoolchildren of government schools than in private boarding schools and the differences in means OHI-S were statistically significant (P< 0.005). 12-13 year old males and females have comparable mean OHI-S (1.24 and 1.17) and this was not statistically significant. However, the mean OHI-S was higher in males (1.29) compared to females (1.11) in the 15 year old age group and this was statistically significant (P<0.005). The OHI-S for urban 12-13 years schoolchildren was 0.98 compared to 1.34 for schoolchildren of rural towns and 1.44 for 15 year old age group; urban schoolchildren had a mean OHI-S score of 1.00 compared to 1.37 for rural towns and 1.43 for rural villages. The variance in the mean OHI-S scores was statistically significant (P<0.005). Conclusion: The overall level of cleanliness in the schools had better oral hygiene than their counterparts in government schools. Females were cleaner the males. Children of urban schools had the lowest scores followed by schoolchildren from rural towns and then rural villages. When the mean OHI-S scores were compared with the DMFT scores, there was an inverse relationship between oral cleanliness and dental caries. Frequency of sugar consumption and the availability and affordability of fluoridated toothpaste may be more important factors in the development of dental caries than oral cleanliness.