Oral cleanliness and gingival health following oral hygiene instruction by self-educational programs

Behavioral Interventions on Periodontitis Patients to Improve Oral Hygiene: A Systematic Review

This systematic review aimed to investigate the impact of different psychological models, strategies, and methods to improve plaque control and/or gingival inflammation in patients with periodontal diseases. Methods: The PubMed/MEDLINE, Cochrane Library, and Embase online databases were explored to identify relevant studies published before October 2022. Articles investigating the effects of different psychological approaches and intervention strategies on periodontitis patients’ oral hygiene (OH) behavioral change were screened. Results: 5460 articles were identified, and 21 fulfilled the inclusion criteria. In total, 2 studies tested audio-visual modalities, and the remaining 19 publications involved six psychological models of health-related behavioral interventions, including Social Cognitive Theory, the Theory of Planned Behavior, the Health Action Process Approach, Leventhal’s self-regulatory theory, Motivational Interviewing, and Cognitive Behavioral Therapy. A meta-analysis of the results was not carried out due to the high heterogeneity among the interventions. Conclusions: Considering the limitations of the available studies, psychological interventions based on social cognitive models that combine some of the techniques of this model (goal setting, planning, self-monitoring, and feedback) may improve OH in periodontitis patients, having a positive impact on periodontal clinical outcomes. Delivering cognitive behavioral therapy in combination with motivational interviewing may result in an improvement in OH as evaluated by decreasing plaque and bleeding scores.

Are oral hygiene instructions with aid of plaque-disclosing methods effective in improving self-performed dental plaque control? A systematic review of randomized controlled trials

OBJECTIVES

To systematically evaluate the literature on whether plaque-disclosing (PD) methods, applied by dental professionals (FQ1) or at-home (FQ2), combined with verbal oral hygiene instructions and brushing demonstration (standard OHI) lead to improvements in self-performed dental plaque control in comparison to standard OHI alone.

MATERIALS AND METHODS

Seven databases were searched by two independent reviewers according to pre-specified eligibility criteria up to September 2020. No restrictions regarding language, date and type of report were imposed. The Cochrane Collaboration's Risk of Bias tool (RoB 2.0) was used for quality appraisal. Multiple comparisons referring to a single study were included if the articles evaluated different PD agents. Narrative synthesis using evidence tables were performed.

RESULTS

Seven eligible studies were retrieved, including data of 430 individuals (159 wearers of orthodontic appliances). The studies exhibited considerable heterogeneity regarding outcome assessments and follow-up. Eleven (eight corresponding to FQ1 and three to FQ2) out of 13 relevant comparisons found no significant difference between techniques for dental plaque outcomes and three (two corresponding to FQ1 and one to FQ2) out of five comparisons indicated a positive effect of standard OHI with aid of PD methods on gingival inflammation scores. With respect specifically to orthodontic patients, three out of four comparisons indicated significant improvements on gingival inflammation scores for individuals instructed with PD methods.

CONCLUSION

Clinicians should consider PD agents as adjunct to standard OHI in orthodontic patients. For those without appliances, PD methods can be used as an alternative.

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.

Clinical relevance of dexterity in oral hygiene

Introduction Dental plaque is a major aetiological factor in the development of periodontal disease; thus, it is essential to remove dental plaque to maintain good oral health. We used a simple method to visually evaluate a patient's dexterity to assess their oral care efficiency. The aim of this study was to evaluate dexterity and the effect it has on plaque control. Materials and methods A total of 80 patients, aged between 18 and 60 years, participated in this study. Participants were asked to pick up peas using chopsticks, and transfer them from one box (box A) to an empty box (box B), within one minute. The numbers of peas in box B were then counted. The plaque index score was recorded before and after standardised oral hygiene instructions (OHI) were given to each participant. Age, sex, dominant hand, and the result of the dexterity test were compared. Results Dexterity was the only significant predictor of improvement in oral hygiene after the OHI. All other variables were included in the model but none were reliable predictors. Conclusion Dexterity might be a good predictor of improvement in oral hygiene. We conclude that dexterity should be assessed in order to provide tailored instructions to each individual.

Dentistry and population approaches for preventing dental diseases

Dental professionals are expected to engage in oral disease prevention, but their tools limit the approach to chair side activities based on the common notion that the major dental diseases, dental caries, gingivitis and periodontitis, are behavioural diseases shaped by individual lifestyles. However, lifestyles also have causes and individual behaviours reflect cultural norms, expectations and opportunities that are socio-economically determined and structurally maintained. Importantly, the effects of the societal and socio-economic determinants reach way above their influences as individual attributes, and effective approaches to the prevention and control of oral diseases are aligned with this causal chain. Unfortunately, the ethos and philosophy of dentistry is focused to a downstream, patient-centred, curative and rehabilitative approach to oral diseases. Whilst such services are needed to care for those who have already suffered the consequences of oral diseases, they do not influence population oral health. A more balanced distribution of efforts and resources along the whole range of intervention points from the downstream curative to the upstream structural healthy policy approaches is required if appropriate, evidence-based, effective, cost-effective, sustainable, equitable, universal, comprehensive and ethical delivery of health care, including oral health care, is the goal. The implementation of healthy policies and sound approaches to population oral health will require substantial commitment and political will on the part of the public and their elected officials.

A three-year prospective study of adult subjects with gingivitis II: microbiological parameters

AIM

To investigate whether the clinical benefits obtained with a periodontal prevention programme in subjects with periodontal health or minimal disease were accompanied by beneficial changes in the subgingival microbiota.

MATERIAL AND METHODS

One hundred and twenty-four subjects completed the study. Subjects were clinically and microbiologically monitored at baseline, 1, 2 and 3 years. Subgingival plaque samples were taken from the mesiobuccal aspect of every tooth and were analysed for the levels of 40 bacterial species using checkerboard DNA-DNA hybridization (total samples=13,477). The mean counts of each of the 40 test species were calculated for each subject at each time point. Significance of differences over time was sought using the Friedman test. p values were adjusted for multiple comparisons.

RESULTS

All clinical parameters, at the microbiologically sampled sites, improved over time. The clinical changes were accompanied by statistically significant decreases in the mean counts of 35 of the 40 test species. Major reductions occurred by year 2 for Actinomyces, Capnocytophaga, Campylobacter, Fusobacterium and Prevotella species. At year 3, there was a modest re-growth of the majority of the species.

CONCLUSIONS

The clinical improvements obtained through preventive measures were accompanied by a shift to a more host-compatible subgingival microbiota.

Comparison of Interdental Cleaning Methods: A Randomized Controlled Trial

BACKGROUND

Although interdental cleaning is an integral component of home plaque control for periodontally involved patients, limited data exist on the periodontal benefits of commonly used interdental cleaning methods before definitive root surface debridement is undertaken. Therefore, the aim of this study was to compare the effects of a customized interdental brushing technique and a customized flossing technique on clinical periodontal outcomes prior to root surface debridement in chronic periodontitis cases.

METHODS

This was a single-blind, randomized controlled clinical trial. Seventy-seven patients with chronic periodontitis were measured for plaque, relative interdental papillae level, Eastman interdental bleeding index, probing depths, and bleeding on probing at interdental sites and underwent a 10-minute hand scaling to remove easily accessible calculus deposits. Before group allocation, patients were advised on toothbrushing and instructed in two customized methods of interdental cleaning involving dental floss and precurved interdental brushes. Materials were supplied after random allocation. Participants were recalled at 6 and 12 weeks for clinical measurements, reinforcement of instructions, and fresh materials.

RESULTS

There were significant reductions from baseline for all indices in both groups (P <0.01). At 6 weeks, the interdental brush group improved more than the floss group in every parameter (P <0.05). By 12 weeks, the changes in plaque, papillae level, and probing depths were significantly greater in the interdental brush group than the floss group (P <0.01).

CONCLUSION

This trial demonstrated that patients were able to improve clinical periodontal outcomes by interdental cleaning, particularly with interdental brushes, even before thorough root surface debridement was undertaken.

A randomised controlled trial to explore attitudes to routine scale and polish and compare manual versus ultrasonic scaling in the general dental service in Scotland [ISRCTN99609795]

Background

To investigate, within general dental practice, patients' and vocational dental practitioners' (VDP) attitudes towards the benefits and costs of a simple scale and polish and to compare the experience of using manual versus ultrasonic instruments to scale teeth.

Methods

28 VDPs and 420 patients participated. Patients were randomly allocated to either group. Patients' and VDPs' attitudes towards, and experience of, the scale and polish were elicited by means of self-administered questionnaires.

Results

The majority of patients (99%) believed a scale and polish was beneficial. VDPs considered ultrasonic treatment to be appropriate on significantly more occasions than they did for manual scale and polish (P < 0.001). Patient discomfort: with ultrasonic scaling 69.2% felt 'a little uncomfortable' or worse compared with 60% of those undergoing manual treatment (P = 0.072). VDPs considered treatment charges were appropriate for 77% of patients.

Conclusion

Routine scaling and polishing is considered beneficial by both patients and vocational trainees. The majority of patients, regardless of treatment method, experience some degree of discomfort when undergoing a scale and polish. VDPs showed a preference for the ultrasonic treatment method.

The result of periodontal treatment in relationship to various background factors

The aim of the present study was to investigate whether various background factors of patients play a role for the result of periodontal treatment and whether their attitudes towards prevention change during treatment. The study was carried out as a retrospective analysis using data obtained during periodontal treatment of 143 patients. The result of the treatment was assessed by the recording of presence or absence of gingival bleeding by probing prior to treatment and after 3, 6 and 12 months. The background factors were assessed by letting the patients answer a questionnaire about their dental history, tooth cleaning habits and knowledge about their own dental health situation. Moreover, they responded to statements regarding their attitudes to and general knowledge about prevention of dental diseases. 89 of the patients were asked again 3 months later to respond to these statements. After treatment, 3 groups were formed on the basis of the 12-month gingival score: a successful treatment group (S) comprising 79 patients with a gingival bleeding score of 20% or less, a non-successful treatment group (N) comprising 49 patients with more than 20% tooth surfaces showing bleeding and a drop-out group (D) of 15 patients who did not appear for the 12-month examination. No statistically significant difference was found in the various background factors of patients with a successful or a non-successful treatment result. However, dropping out showed a significant relationship to unfavorable dental beliefs and young age (P less than 0.005). Following treatment, the patients responded more favorably to statements about oral hygiene as a preventive means.

Use of gingival bleeding for reinforcement of oral home care behavior

The present study examined the use of gingival bleeding as a reinforcement mechanism for interproximal home care with the toothpick. After initial assessments of plaque and gingival bleeding, 36 subjects were given a professional toothcleaning and instructed to maintain oral hygiene by toothbrushing alone for 3 months. After 3 months of brushing only, subjects were re-examined and given another professional toothcleaning. Having been matched for age and percentage of sites bleeding on probing, as determined at the initial examination, they were than randomly attached to one of three groups. One group, the control, continued to clean their teeth with only a toothbrush, while the other two groups used the toothbrush supplemented with the toothpick for interproximal subgingival cleaning. Both toothpick groups received identical instruction in toothpick technique, but one group was taught to use bleeding as an interpretive device for health. Three months later, clinical assessments indicated significantly less gingival bleeding for both toothpick groups as compared with the control (whose gingival health worsened). Although there was no significant difference between the final scores of the toothpick groups, only the group that used gingival bleeding as a sign of disease showed a significant improvement in gingival health (P less than 0.003), and also had a fivefold higher rate of return of self-report compliance cards. These results suggest that the use of gingival bleeding as a reinforcement mechanism should be considered as a strategy in oral home care instruction to promote compliance with recommended behavior.

Oral hygiene instruction in general dental practice by means of self-teaching manuals

The present study evaluates the applicability of delivering oral hygiene instruction to patients in general dental practice by means of self-educational programs. Patients (55) seeking dental treatment in 3 general dental practices in Denmark were divided at random into a conventional professional instruction group (C) in which each individual received personal instruction by the dentist and a self-instruction group (S), in which the patients were given self-educational programs. In order to evaluate the effect of the 2 types of instruction, the presence or absence of dento-gingival plaque and gingival bleeding by probing was recorded prior to the instruction and after 3 and 6 months. The patient of the self-instruction group (S) answered a questionnaire about the treatment 1 week after they had received the self-instruction program. An identical improvement in oral hygiene and gingival health was recorded in both treatment groups after 3 and 6 months. This finding indicates, that the self-educational programs were as effective in changing the oral hygiene habits of the patients as was personal oral hygiene instruction by dental personnel. The answers of the patients to the post-treatment questionnaire reflected a favorable attitude towards the use of self-educational programs.