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Background  The early recognition of technology together with great ability to use computers and smart systems have promoted researchers to investigate the possibilities of utilizing technology for improving health care in children. The aim of this study was to compare between the traditional educational leaflets and E-applications in improving oral health knowledge, oral hygiene and gingival health in schoolchildren of Damascus city, Syria.    Methods  A clustered randomized controlled trial at two public primary schools was performed. About 220 schoolchildren aged 10–11 years were included in this study and grouped into two clusters. Children in Leaflet cluster received oral health education through leaflets, while children in E-learning cluster received oral health education through an E-learning program. A questionnaire was designed to register information related to oral health knowledge and to record Plaque and Gingival indices. Questionnaire administration and clinical assessment were undertaken at baseline, 6 and at 12 weeks of oral health education. Data was analysed using one way repeated measures ANOVA, post hoc Bonferroni test and independent samples t-test.    Results  Leaflet cluster (107 participants) had statistically significant better oral health knowledge than E-learning cluster (104 participants) at 6 weeks ( P  < 0.05) and at 12 weeks ( P  < 0.05) (Leaflet cluster:100 participants, E-learning cluster:100 participants). The mean knowledge gain compared to baseline was higher in Leaflet cluster than in E-learning cluster. A significant reduction in the PI means at 6 weeks and 12 weeks was observed in both clusters ( P  < 0.05) when compared to baseline. Children in Leaflet cluster had significantly less plaque than those in E-learning cluster at 6 weeks ( P  < 0.05) and at 12 weeks ( P  < 0.05). Similarly, a significant reduction in the GI means at 6 weeks and 12 weeks was observed in both clusters when compared to baseline ( P  < 0.05). Children in Leaflet cluster had statistically significant better gingival health than E-learning cluster at 6 weeks ( P  < 0.05) and 12 weeks ( P  < 0.05).    Conclusions  Traditional educational leaflets are an effective tool in the improvement of both oral health knowledge as well as clinical indices of oral hygiene and care among Syrian children. Leaflets can be used in school-based oral health education for a positive outcome.    Trial registration  Australian New Zealand Clinical Trials Registry ( ACTRN12618000395235 ), Date registered: 16/03/2018, retrospectively registered.    Electronic supplementary material  The online version of this article (10.1186/s12903-018-0540-4) contains supplementary material, which is available to authorized users.

E-learning or educational leaflet: does it make a difference in oral health promotion? A clustered randomized trial