Behavioural interventions that have the potential to improve self-care in adults with periodontitis: a systematic review

Clinical Performance of the Bioperio® Protocol to Manage Periodontitis

Objectives: The aim of this study was to describe the structure and assess the efficacy of a patient-centered framework for managing periodontitis, utilizing the Bioperio® protocol, a standardized treatment approach incorporating both clinical and extra-clinical phases. Methods: Patients diagnosed with periodontitis were included in this multicenter, single-arm, clinical observational study with a 3-month follow-up. All patients were treated following the Bioperio® protocol, involving professional supra-gingival scaling, oral hygiene instructions, and scaling and root planing following a full-mouth approach. In Stage III/IV periodontitis cases, enamel matrix derivatives (EMD) were applied in periodontal pockets > 5 mm. Monthly recalls were performed until the 3-month follow-up. Results: In total, 663 patients were enrolled, with 76.4% being diagnosed with Stage II/III periodontitis. At 3 months, all clinical periodontal parameters improved regardless of the initial stage of periodontitis, achieving pocket closure in 75.4% of cases and patient resolution in 91.3% of the sample. Stages I/II showed significantly improved outcomes compared to Stage IV. The adjunct of EMDproved beneficial, especially in stage III patients, increasing pocket closure by 15% and doubling the odds of patient resolution. No adverse effects of the treatment protocol were observed throughout the study. Conclusions: The Bioperio® protocol appears to be a safe and effective therapeutic approach for the management of patients affected by periodontitis. Combining a stepwise approach for clinical phases with tailored oral hygiene instructions and motivational sessions offers a comprehensive strategy that may enhance outcomes for patients with periodontitis.

Motivational interviewing at home: A community trial to improve oral health literacy and reduce morbidity in disadvantaged Chilean families

BACKGROUND

Limited evidence exists regarding the effects of home-based interventions on oral health outcomes in preschool-aged children or caregivers despite the success of such interventions in other child and pregnancy health outcomes. The aim of this community trial was to assess the impact after 12 months of a home-delivered motivational interviewing (MI) intervention on oral health outcomes in disadvantaged Chilean families.

METHODS

This trial was conducted with a community single-blinded design, including preschoolers (aged 2-4 years) and their caregivers from 2 disadvantaged communities who received either the MI intervention or standard oral health interventions at kindergartens. The MI intervention comprised from 4 through 6 tailored home visits by MI-trained dental hygienists. Data on socioeconomic-demographic factors, caries (International Caries Detection and Assessment System [ICDAS]), oral hygiene, and caregivers' oral health literacy (OHL) (assessed with Oral Health Literacy Instrument and Rapid Estimate of Adult Literacy in Dentistry, 30 items) were collected at baseline and 12-month follow-up.

RESULTS

Two hundred fifty-two dyads completed baseline measurements, and 212 completed the follow-up (control, n = 104; intervention, n = 108). Weak associations were found between clinical-sociodemographic factors and OHL at baseline (correlations, < 0.3) and follow-up. Analysis of covariance revealed a reduction in caries incidence for lesions with ICDAS scores above 0 (P = .03) but not for ICDAS scores above 2 (P = .47). No reduction in oral hygiene was observed (P = .74). Oral Health Literacy Instrument scores showed no improvement (P = .10), and Rapid Estimate of Adult Literacy in Dentistry, 30 items scores showed a marginal increase (P = .03).

CONCLUSIONS

Home-delivered MI intervention had a marginal impact on preschoolers' caries incidence and caregivers' OHL but no effect on preschoolers' oral hygiene, with the primary impact observed at the level of caries ICDAS scores above 0.

PRACTICAL IMPLICATIONS

Home-delivered MI interventions by dental hygienists marginally reduce caries incidence in preschoolers from disadvantaged populations. This trial was registered at the Australian and New Zealand Clinical Trials Registry. The registration number is ACTRN12615000450516.

A psychological intervention for caries active young adults, a randomized controlled trial

Objective

The aim of the present study was to evaluate the effect of a brief version of the behavioral intervention Acceptance and Commitment Therapy (ACT) on reducing gingivitis and plaque levels after 18 weeks.

Materials and methods

One hundred thirty‐five caries‐active young adults (18–25 years of age), recruited from two public dental clinics, participated in this parallel group randomized control trial (RCT). Participants in the intervention (n = 67) received two ACT sessions in combination with standard information on oral health, and participants allocated to the control group (n = 68) received standard information only. Gingivitis and plaque levels were recorded at baseline and at the 9‐ and 18‐week follow‐ups. The effect of the intervention versus standard information alone was analyzed by intention‐to‐treat and per protocol, applying the General Linear Model (GLM). Exploratory analyses for the intervention and control groups were conducted to evaluate the effect of gender and smoking habits on the gingivitis and plaque outcome. The CONSORT guidelines for RCT were followed.

Results

A significant decrease in gingivitis and plaque levels was observed over time, irrespective of treatment allocation. However, the ACT intervention was not significantly more effective at reducing gingivitis and plaque scores than standard information alone, even though the intervention participants had maintained their improvement to a greater extent. The exploratory analysis revealed that females improved their gingivitis and plaque levels significantly more than the males in the intervention group (p = 0.025 for gingivitis and p = 0.013 for plaque).

Conclusion

A brief ACT intervention was not proven to be more effective than standard information alone at improving oral health in a sample of young adults with poor oral health. However, ACT seems to have a positive effect on oral health among females. (TRN ISRCTN15009620).

Randomised controlled trial demonstrating the impact of behaviour change intervention provided by dental professionals to improve gingival health

AIMS

To determine impact of oral hygiene behaviour change intervention compared to the prevailing standard of oral hygiene advice provided in general dental practice, on bleeding on probing (BOP) in gingivitis patients, over 3-months. The effect of providing power-brushes was also evaluated.

MATERIALS AND METHODS

NHS dental practices were cluster-randomised to intervention or control (2:1). Dentists at intervention sites received behaviour modification training. Participants were stratified to high (≥20% BOP) or low (<20% BOP) presence of gingivitis and a subset assigned a power-brush. BOP and plaque scores were assessed at baseline and 3-months.

RESULTS

A total of 538 participants (369:169; intervention: control) completed the study. BOP reduced in both gingivitis groups with significantly greater reduction in intervention compared to control group (BOP:38% vs 19%, p = 0.0236); Borderline significance favouring the intervention was demonstrated for the low gingivitis group (BOP:37% vs 15%, p = 0.0523). A highly significant reduction in BOP (intervention vs control) was demonstrated for volunteers who swapped from manual to power-brush (44% vs 37%, p = 0.0039). Plaque score improved more in control than intervention group (Plaque:37% vs 44%, p = 0.00215).

CONCLUSIONS

Behaviour change techniques were readily mastered by the dental professional researchers. The introduction of an oral hygiene behaviour change intervention significantly reduced gingivitis in volunteer patients compared to control at 3 months. Swapping to a power-brush significantly favoured BOP reduction compared to manual brush continuation although plaque reduction did not follow expectation in comparison to BOP scores. Behaviour change techniques should routinely be considered in patient care.

CLINICAL SIGNIFICANCE

Plaque-induced gingivitis is highly prevalent in the UK despite being preventable with good oral hygiene. Its continuum, periodontitis, negative impacts quality of life. This study suggests oral hygiene behavioural interventions (GPS) significantly reduce gingivitis and that GPS introduction will improve oral health and may improve quality of life.

Promoting behavioural changes to improve oral hygiene in patients with periodontal diseases: A systematic review

AIM

This systematic review investigates the impact of specific interventions aiming at promoting behavioural changes to improve oral hygiene (OH) in patients with periodontal diseases.

METHODS

A literature search was performed on different databases up to March 2019. Randomized and non-randomized controlled trials evaluating the effects of behavioural interventions on plaque and bleeding scores in patients with gingivitis or periodontitis were considered. Pooled data analysis was conducted by estimating standardized mean difference between groups.

RESULTS

Of 288 articles screened, 14 were included as follows: 4 studies evaluated the effect of motivational interviewing (MI) associated with OH instructions, 7 the impact of oral health educational programmes based on cognitive behavioural therapies, and 3 the use of self-inspections/videotapes. Studies were heterogeneous and reported contrasting results. Meta-analyses for psychological interventions showed no significant group difference for both plaque and bleeding scores. No effect was observed in studies applying self-inspection/videotapes.

CONCLUSIONS

Within the limitations of the current evidence, OH may be reinforced in patients with periodontal diseases by psychological interventions based on cognitive constructs and MI principles provided by oral health professionals. However, no conclusion can be drawn on their specific clinical efficacy as measured by reduction of plaque and bleeding scores over time.

Periodontal status, perceived stress, diabetes mellitus and oral hygiene care on quality of life: a structural equation modelling analysis

BACKGROUND

To determine if periodontal risk assessment (PRA), the number of missing teeth, diabetes mellitus (DM), perceived stress and interproximal cleaning are associated with oral health-related quality of life (OHRQoL), using Andersen's behavioral modelling (ABM).

MATERIAL AND METHODS

Data derived from 472 adults derived from a representative population of the Study of Periodontal Health in Almada-Seixal (SoPHiAS) was used. Socioeconomic status, perceived stress scale (PSS-10), oral health behaviors and oral health impact profile (OHIP-14) were collected through questionnaire. Periodontal conditions were assessed with a full-mouth periodontal examination. PRA was computed through behavioral and clinical information. Variables were grouped into Predisposing Factors, Enabling, Need, Oral Health Behaviors and Perceived Health Outcome latent variables. Confirmatory factor analysis, structural ABM and model fitness were conducted.

RESULTS

ABM applied to OHIP-14 showed acceptable model fit (χ2 = 2.75, CFI = 0.92, TLI = 0.90, RMSEA = 0.05, CI 90% [0.04-0.07]). The average of OHRQoL was 9.5 ± 11.3. Patient with periodontitis and with a high number of missing teeth experienced worse OHRQoL. Uncontrolled DM participants had more periodontal treatment necessity and poorer OHRQoL. Characteristic like aging and lower levels of education were directly associated with better OHRQoL, but in indirect path the OHRQoL was diminishes. Good oral hygiene and preventative measures were associated to lower periodontal treatment necessity. Lower periodontal treatment necessity was associated to higher OHRQoL. Age, tooth loss and interproximal cleaning were the most associated items to Predisposing, Need and Oral Health Behaviors, respectively.

CONCLUSION

ABM confirmed age, number of missing teeth, DM, interproximal cleaning and perceived stress as associated factors for OHRQoL. Uncontrolled DM was associated to higher Need and poorer OHRQoL. Good oral hygiene habits promote a healthy periodontium and, consequently, increases OHRQoL.

Characteristics of dental patients determining their compliance level in dentistry: relevance for predictive, preventive, and personalized medicine

This article centers on the relationship between psychological specifics of dental patients and their adherence to treatment. It describes clinical and personality specifics of periodontal patients and presents personality characteristics of patients with positive and negative dynamics of the therapy, as well as patients without periodontal diseases. The study findings highlight the importance of building confidential relationships with the patient and the need for a client-oriented approach to developing treatment plans and strategies for different types of dental patients. In the future, based on the study results, we find it necessary to elaborate more specific criteria for assessing personality characteristics of patients which determine their ability to comply with the doctor's recommendations. The dentist should not expect the success of their work without applying individual psychological approach to each particular patient. This knowledge means to help in further prognosis of the prescribed treatment and also can make the treatment more personalized and prevent non-compliance complications.