Changing the behavior of patients with periodontitis

Effectiveness of internet-based nursing interventions for the treatment of patients with periodontitis

BACKGROUND

Periodontitis, one of the most common oral diseases, is a chronic inflammatory condition occur in response to bacterial plaque biofilms. Plaque control and oral hygiene instructions are the most widely used and effective nonsurgical treatment for periodontitis, which is based on a partnership between patient and clinician and requires a life-long commitment. The objective of this study was to analyze the effectiveness of internet-based nursing interventions for the treatment of patients with periodontitis. The findings from this study may help to enhance the therapeutic outcomes for patients with periodontitis.

METHODS

A total of 80 patients with periodontitis treated in Zhejiang Province Stomatology hospital from December 2021 to January 2023 were randomly selected and divided into control group and intervention group with 40 cases each. The control group was given routine oral health guidance and the intervention group received internet based nursing intervention. The periodontal pocket depth, percentage of periodontal pocket depth (PD) ≥ 4 mm, bleeding on probing (BOP)%, and self-efficacy scale for oral health care (SESS) were assessed and compared at four time points: initial visit, 6-8-weeks follow-up, 3-months follow-up, and 6-months follow-up.

RESULTS

There was no significant difference between the two groups in terms of age, gender, initial visit PD, initial visit PD ≥ 4 mm (%), initial visit BOP (%), and initial visit SESS (P > 0.05). The intervention group showed a significantly decreased percentage of PD ≥ 4 mm at 6-8 weeks and 6-months follow-up compared to the control group (P < 0.05). The PD, BOP%, and SESS scores of the intervention group were significantly better than those of the control group at 6-months follow-up (P < 0.05). There was no statistically significant difference in patient satisfaction between the two groups.

CONCLUSIONS

This study confirmed that the internet-based nursing intervention in conjunction with periodontal treatment was able to improve the periodontal pocket depth, gingival bleeding and the level of self-efficacy of patients, suggesting that it is necessary to carry out the extended oral hygiene instructions via internet-based platforms for the patients in clinical practice.

The effectiveness of motivational interviewing on the oral health of leukemic children and oral health care knowledge, attitude and practice of their mothers: a hospital-based intervention

BACKGROUND

Some studies suggest a higher effectiveness of motivational interviewing compared to common oral health instruction in healthy individuals. As regards to higher prevalence of dental diseases like early childhood caries, oral mucositis, and gingivitis are reported for leukemic children, the present study aims to compare the effectiveness of educating mothers through MI with the common instruction (CI) for the oral health of children with leukemia under six years old.

METHOD

This quasi-experimental study was designed in Tehran University of Medical Sciences, School of Dentistry and conducted on 61 mothers with leukemic children under age six hospitalized in Mahak Hospital and Rehabilitation Complex which is a Pediatric Cancer Research and Hospital Center, in 2021. Mother and child pairs were allocated to MI or CI (using pamphlets) groups. Data was collected using a questionnaire of mothers' knowledge, attitude, motivation, and practice concerning oral health care in leukemic children. The children underwent clinical examination to assess plaque index before and three months after the intervention. The data were analyzed using SPSS version 25 (IBM, Armonk, NY, USA) by ANCOVA test.

RESULTS

The preschoolers mean ages were 4.23 ± 1.41 and 4.32 ± 1.33 (ranged from 2 to 6 years old) in the MI and CI group, respectively. There were 16 girls (53.3%) and 14 boys (46.7%) in the MI group, and 15 girls (48.4%) and 16 boys (51.6%) in the CI group. Significant differences were observed in the amount of plaque index between the MI group and the CI group (0.20 ± 0.04, p-value < 0.001). A significant increase was observed in the mean of changes in scores of knowledge, attitude, motivation, mother's practice concerning child's oral health, mother's practice concerning personal oral health in the MI group (p-value < 0.001).

CONCLUSIONS

Considering that instruction using MI showed to be effective in improving oral health adherence in mothers and reducing plaque in children with Leukemia, it may be recommended as a promising method to promote the oral health of such susceptible children in places that they are constantly present for treatment.

TRIAL REGISTRATION

The study was registered in the Iranian Registry of Clinical Trials (IRCT) on 11.03.2021 (code: IRCT20131102015238N5).

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.

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.

Poor oral hygiene and dental caries predict high mortality rate in hemodialysis: a 3-year cohort study

The aim of this study was to investigate the impact of oral hygiene, periodontal diseases, and dental caries on all-cause mortality in hemodialysis. This prospective cohort study included 266 patients with end-stage renal disease who were undergoing hemodialysis. Medical interviews, blood biochemical tests, and comprehensive dental examinations including periodontal pocket examination on all teeth and dental plaque accumulation by debris index-simplified (DI-S), were performed. Survival rates were assessed at a 3-year follow-up. Overall, 207 patients were included in the longitudinal analysis, and 38 subjects died during the follow-up period. Cox proportional hazards analysis of the multivariate model demonstrated that the highest tertile of DI-S had a significantly higher risk of all-cause mortality than the lowest two tertiles after adjustment for age, sex, smoking habit, body mass index, diabetes, prior cardiovascular disease, hemodialysis vintage, high sensitivity C-reactive protein, albumin, and number of remaining teeth (hazard ratio, 3.04; 95% confidence interval, 1.50–6.17; p = 0.002). Moreover, the number of decayed teeth significantly increased the hazard ratio to 1.21 (95% confidence interval, 1.06.1.37; p = 0.003). This study suggests that accumulated dental plaque and untreated decay, but not periodontal disease, may be independently associated with all-cause mortality in patients undergoing hemodialysis.

Behavioral Sciences in the Promotion of Oral Health

The importance and value of behavioral sciences in dentistry have long been recognized, and their contribution to dental education, research, clinical practice, and oral health policy has been significant over the past half century. Over time behavioral sciences have expanded our understanding of oral health beyond "disease" to a broader biopsychosocial concept of oral health. This in turn has led dentistry away from a focus of "treatment" to oral health "care," notably in the new millennium. Key oral health behaviors have been identified for more than half a century: the importance of diet, oral hygiene, dental services, and other factors. Various behavioral models and theories have been proposed, particularly since the 1970s, providing useful frameworks with sound psychological basis to help understand the paths of oral health behaviors. These models draw on theories of self-efficacy, motivation, counseling, and "behavior change." Since the 1980s, there has been a greater understanding that these behaviors often share a common pathway with the etiology of other diseases (common risk factors). Furthermore, the relationship between individual factors and the broader environmental factors has been increasingly emphasized since the 1990s, leading to a united call for action in addressing oral health inequalities. Within the past decade, there are useful examples of models, frameworks, and techniques of behavior change with respect to oral health, involving planning, prompting, encouraging, goal setting, and/or motivating. In particular, there is a growing interest and use of motivational interviewing. Likewise, behavioral therapies, such as cognitive behavioral therapy, are increasingly being employed in dental practice in the management of dental anxiety, pain, and psychosomatic dental and oral problems, with promising results. Recommendations are outlined for future directions for behavioral sciences in the promotion of oral health.

The Psychological Models of Health-related Behavior in Understanding Sugars Intake in Adults: A Review

Free sugars intake plays a major role in dental caries formation and other general health issues such as obesity. Therefore, interventions, which assist individuals or populations in the control of their free sugars intake, are of central importance in caries prevention strategies. There is good evidence that behavioral interventions benefit from a foundation in conceptual theories of behavior change founded on empirical data. In this review, we discuss the future application of seven theories, including six common psychological theories in predicting and developing interventions to reduce free sugars intake related to dental caries among adults. For each model, we summarize its key features and the data derived from its application in general and oral health settings and make recommendations for future research. We searched Medline, PsycINFO, Global Health, PubMed, and Embase databases to identify items dealing with dental caries, adults, sugars intake, and six psychological theories. These included the Transtheoretical Model of Change, Theory of Planned Behavior, Social Cognitive Theory, Information-Motivation-Behavioral Skills model, PRIME Theory, and Behavior Change Wheel theories. We searched literature published in the last 10 years, and priority was given to systematic reviews and randomized control trials. Although there is extensive literature on the application of the six psychological theories, there is a gap in knowledge about their effectiveness in reducing free sugars intake related to dental caries among adults. There is a need for better-designed trials of interventions based on the clear operationalization of psychological constructs to reduce sugars intake among the adult population.

Exploring the Relationship between Maternal Health Literacy, Parenting Self-Efficacy, and Early Parenting Practices among Low-Income Mothers with Infants

OBJECTIVE

To explore the association of maternal health literacy (MHL), parenting self-efficacy and early parenting practices among low-income mothers with infants.

DESIGN

A cross-sectional, descriptive correlational design.

PARTICIPANTS

Low-income mothers (N=186) with infants.

METHODS

Face-to-face interviews were conducted using English and Spanish versions of questionnaires by trained bilingual research assistants. The Newest Vital Sign (NVS) screening tool was used to measure MHL.

RESULTS

Nearly three-quarters (72%) of mothers were rated as having low MHL. In the bivariate analysis, MHL was positively correlated with education, household income, language, social support, parenting self-efficacy, and early parenting practices, but negatively correlated with number of children. The study findings demonstrate that parenting self-efficacy had a mediating effect on MHL and early parenting practices among mothers with infants.

CONCLUSION

Results suggest that future research is needed to advance MHL in low-income mothers and to inform potential HL interventions for this target population.

Exploring changes in oral hygiene behaviour in patients with diabetes and periodontal disease: A feasibility study

Objective

Exploring the feasibility to understand changes in oral hygiene behaviour using the Health Action Process Approach (HAPA) model applied to qualitative research interviews in patients with diabetes and periodontitis undergoing standard periodontitis treatment.

Methods

Patients with type 1/2 diabetes and chronic periodontitis (n = 8) received standard non‐surgical periodontal treatment accompanied with personalized oral hygiene instructions by a dental hygienist. Clinical indices (% bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), % of sites with PD ≥ 5 mm, periodontal epithelial surface area (PESA) and periodontal inflammatory surface area (PISA) were recorded pre‐ and post‐treatment. At 3 months post‐treatment, patients were interviewed using a topic guide relating to oral health. A behaviour change framework was constructed from elements of the HAPA model and used directly to map interview data to evaluate oral hygiene behaviour in these patients.

Results

Data from this feasibility study suggest a clinical improvement in periodontal status, albeit only monitored for 3 months. Application of the HAPA model highlighted the behavioural change pathway that diabetes patients undertake before, during and after periodontal treatment. The data suggest that patients move through all elements of the motivation phase and all elements of the volition phase except for the recovery self‐efficacy element.

Conclusion

The novel approach of applying the HAPA model to qualitative research data allowed for the collection of richer data compared to quantitative analysis only. Findings suggest that, in general, patients with periodontitis and diabetes successfully manage to incorporate new oral hygiene behaviours into their daily routine.

The effect of dental health education on pregnant women's adherence with toothbrushing and flossing - A randomized control trial

OBJECTIVES

In a three-arm randomized control trial, this study compared the efficacy of dental health education (DHE) with or without a planning intervention on adherence to oral health-related behaviours.

METHODS

Women (N=154) in their second trimester of pregnancy attending three maternal healthcare clinics in Kuwait completed an assessment of social cognitions and oral health behaviours before a debris and gingival assessment (Plaque Index [PI], Gingival Index [GI]) was undertaken; this was repeated at 1 month. In addition to treatment as usual (TAU), which was a demonstration of OH practices, intervention participants received one of two interventions: (i) DHE, which targeted social cognitions; or (ii) DHE and planning (DHE&P), which targeted social cognitions and intentions to undertake oral health behaviours. The TAU group was given a standard oral hygiene leaflet.

RESULTS

At Time one (T1) 154 women were eligible and randomly allocated to the three groups, respectively: treatment as usual (TAU)=53; DHE=53; DHE and planning=48. At Time two (T2), the number of women in each group completing the intervention (N=90) was, respectively, as follows TAU=28; DHE=30; DHE&P=32. There were no demographic differences between the groups at baseline. The mean age of women was 27.80±SD 5.40; 43% (n=38) had a high school level education. A mixed factor ANOVA analysis demonstrated that all women improved their PI (F=94.343 df=1 P=.001) and GI (F=73.138 df=1 P=.001) scores. There were no differences in self-reported oral hygiene and PI and GI by intervention group. The social cognition models (SCM) constructs changed over time in all women (N=90) except barriers to attendance (F=1.067 df=1 P=.305). There were no statistically significant differences in SCM constructs by intervention group at T2. All women reported increasing the frequency of toothbrushing and flossing.

CONCLUSIONS

The provision of information using a simple leaflet improved the adherence of Kuwaiti pregnant with toothbrushing and flossing advice, while the addition of DHE targeting social cognitions and planning conferred no additional benefits.

Oral Health Knowledge, Attitudes, and Perceptions of Pregnant Kuwaiti Women

Good oral hygiene is known to prevent maternal gingivitis, but little is known about Kuwaiti pregnant women’s understanding and beliefs about maintaining and improving oral health during pregnancy. This qualitative study investigated perceptions, beliefs, and attitudes about oral health among Kuwaiti pregnant women and explored beliefs about maintaining and improving oral health during pregnancy. In-depth one-to-one interviews were conducted with a purposive sample of 19 Kuwaiti pregnant women across 7 government primary health care centers in Kuwait. A topic guide framed the questions, which explored pregnancy, oral health, oral health and pregnancy, oral health knowledge, and oral health behaviors. All interviews were digitally recorded, transcribed verbatim, and analyzed by thematic analysis. The key themes emerging from the data related to low oral health knowledge, unhelpful cultural beliefs concerning oral health during pregnancy, and lack of awareness about the effect of pregnancy on oral health. Pregnant women lacked motivation to seek dental care even when they considered dental treatment safe during pregnancy. Dentists’ purported incorrect beliefs about providing dental treatment to pregnant women and the women’s lack of motivation were identified as barriers to accessing oral health care and seeking oral health knowledge. Pregnant women in this study had not received the necessary oral health information to undertake appropriate oral health behaviors. Cultural beliefs and practices about oral health were identified that need to be tackled to improve and maintain positive oral health behaviors during pregnancy. Behavioral interventions must acknowledge the cultural sensitivity around beliefs during pregnancy and, as a first step, focus on correcting oral health knowledge among Kuwaiti pregnant women.

Knowledge Transfer Statement: The results of this qualitative study can be used by oral health care workers and researchers to plan and design more targeted dental health education interventions with pregnant women. The information in this study might be helpful to public health decision makers to make more appropriate decisions about implementing dental health education with pregnant women.

Managing oral hygiene as a risk factor for periodontal disease: a systematic review of psychological approaches to behaviour change for improved plaque control in periodontal management

BACKGROUND

Plaque control in patients with periodontal disease is critically dependent upon self-care through specific oral hygiene-related behaviours.

OBJECTIVES

To determine the relationship between adherence to oral hygiene instructions in adult periodontal patients and psychological constructs. To determine the effect of interventions based on psychological constructs on oral health-related behaviour in adult periodontal patients.

DATA SOURCES

The Cochrane Oral Health Group's Trials Register, MEDLINE, EMBASE and PsycINFO.

STUDY APPRAISAL AND SYNTHESIS METHODS

Studies were grouped according to the study design, and appraised using an appropriate methodology, either the Newcastle-Ottawa assessment for observational studies, or the Cochrane criteria for trials.

RESULTS

Fifteen reports of studies were identified.

LIMITATIONS

There was a low risk of bias identified for the observational studies. Older trials suffered from high risk of bias, but more recent trials had low risk of bias. However, the specification of the psychological intervention was generally poor.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

The use of goal setting, self-monitoring and planning are effective interventions for improving oral hygiene-related behaviour in patients with periodontal disease. Understanding the benefits of behaviour change and the seriousness of periodontal disease are important predictors of the likelihood of behaviour change.

Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta-analysis

CONTEXT

The effect of periodontal therapy on diabetes outcomes has not been established.

OBJECTIVE

This update examines the effect of periodontal treatment on diabetes outcomes.

DATA SOURCES

Literature since October 2009 using MEDLINE.

STUDY ELIGIBILITY CRITERIA

Published RCTs including periodontal therapy for diabetic subjects, a metabolic outcome, an untreated control group, and follow-up of 3 months.

DATA EXTRACTION

Pre-defined data fields, including study quality indicators were used.

DATA SYNTHESIS

A search revealed 56 publications of which 9 met inclusion criteria. Mean change of HbA1c from baseline was compared across treatment groups. Pooled analysis was based on random effects models.

RESULTS

A meta-analysis indicated a mean treatment effect of -0.36% HbA1c (CI -0.54, -0.19) compared to no treatment after periodontal therapy (p < 0.0001). Heterogeneity tests revealed only minimal evidence of publication bias (I(2 ) = 9%).

LIMITATIONS

Small sample size and high risk of bias remain problematic for studies of this type. Periodontal therapy varied considerably.

CONCLUSION

The modest reduction in HbA1c observed as a result of periodontal therapy in subjects with type 2 diabetes is consistent with previous systematic reviews. Despite this finding, there is limited confidence in the conclusion due to a lack of multi-centre trials of sufficient sample size are lacking.

Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta-analysis

CONTEXT

The effect of periodontal therapy on diabetes outcomes has not been established.

OBJECTIVE

This update examines the effect of periodontal treatment on diabetes outcomes.

DATA SOURCES

Literature since October 2009 using MEDLINE.

STUDY ELIGIBILITY CRITERIA

Published RCTs including periodontal therapy for diabetic subjects, a metabolic outcome, an untreated control group, and follow-up of 3 months.

DATA EXTRACTION

Pre-defined data fields, including study quality indicators were used.

DATA SYNTHESIS

A search revealed 56 publications of which 9 met inclusion criteria. Mean change of HbA1c from baseline was compared across treatment groups. Pooled analysis was based on random effects models.

RESULTS

A meta-analysis indicated a mean treatment effect of _0.36% HbA1c (CI _0.54, _0.19) compared to no treatment after periodontal therapy (p < 0.0001). Heterogeneity tests revealed only minimal evidence of publication bias (I2 = 9%).

LIMITATIONS

Small sample size and high risk of bias remain problematic for studies of this type. Periodontal therapy varied considerably.

CONCLUSION

The modest reduction in HbA1c observed as a result of periodontal therapy in subjects with type 2 diabetes is consistent with previous systematic reviews. Despite this finding, there is limited confidence in the conclusion due to a lack of multi-centre trials of sufficient sample size are lacking.

Patients' perception of own efforts versus clinically observed outcomes of non-surgical periodontal therapy in a Norwegian population: an observational study

BACKGROUND

Most periodontal intervention studies have focused on biomedical qualities like change in pocket depth and clinical attachment levels. Very few studies have described patient response in terms of how patients' general lives are affected by disease, treatment, and communication with therapy providers. Thus the aim of the present study was to investigate patient response to systematic periodontal information, motivation and treatment strategy (primary aim) by comparing the patients' perception of own efforts and results with those clinically registered in a trans-sectional, observational study (secondary aim).

METHODS

One year after treatment of 184 patients, 152 completed a questionnaire covering aspects of received oral health information and instruction, expectations, communication with the therapeutic team, behavioral change, self-perceived outcomes and satisfaction.

RESULTS

More than 90% of the patients were satisfied with the interaction with the specialist team. 98% were satisfied with the information and instruction they had been given. 84% said that the information had been necessary to make them change their behavior towards better oral hygiene. Pain and discomfort, as well as bleeding were reduced substantially from before to after treatment, and 28 patients reported to have stopped smoking. In all questions regarding well-being there were statistically significant changes towards positive impact following therapy.

CONCLUSIONS

Periodontal treatment, including customized information and education on the etiology and pathogenesis, prevention and treatment as well as maintenance of periodontal diseases resulted in a high degree of short- and long term compliance, and very good patient centered outcomes, which again had a positive impact on the patients' satisfaction. The patient centered outcomes correlated mostly with the compared clinical endpoints.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01318928.

The contributions of behaviour change science towards dental public health practice: a new paradigm

Conventional behavioural models, such as social cognition models, to improve oral health have been proposed for a long time but have failed to consistently explain reliable amounts of variability in human behaviours relevant to oral health. This paper introduces current work from the behavioural sciences aiming to better understand the process through which behaviour change may take place. Given the shortcomings seen so far in attempts to explain behaviour through traditional models it is proposed that a new approach is adopted. This commentary outlines this new approach, grounded in current work by mainstream behaviour change experts. We propose that attempts to use unreliable theoretical models to explain and predict oral health behaviour should now be replaced by work following this new paradigm.

Periodontology: past, present, perspectives

Periodontitis is an infectious disease that affects the tooth-supporting tissues and exhibits a wide range of clinical, microbiological and immunological manifestations. The disease is associated with and is probably caused by a multifaceted dynamic interaction of specific infectious agents, host immune responses, harmful environmental exposure and genetic susceptibility factors. This volume of Periodontology 2000 covers key subdisciplines of periodontology, ranging from etiopathogeny to therapy, with emphasis on diagnosis, classification, epidemiology, risk factors, microbiology, immunology, systemic complications, anti-infective therapy, reparative treatment, self-care and affordability issues. Learned and unlearned concepts of periodontitis over the past 50 years have shaped our current understanding of the etiology of the disease and of clinical practice.

Longitudinal supportive periodontal therapy for severe chronic periodontitis with furcation involvement: a 12-year follow-up report

We report a case involving a 12-year follow-up after treatment for chronic periodontitis with furcation involvement. A 54-year-old woman presented with the chief complaint of hypersensitivity. Clinical examination at the first visit revealed 15% of sites with a probing depth ≥4 mm and 35% of sites with bleeding on probing. Initial periodontal therapy was implemented based on a clinical diagnosis of severe chronic periodontitis. Surgical periodontal therapy was subsequently performed at selected sites. For #44, regenerative periodontal therapy using enamel matrix derivative (Emdogain(®)) was selected. For #16, which exhibited a 2- to 3-wall vertical bony defect and class III (mesio-distal) furcation involvement, bone graft was scheduled. Other sites with residual periodontal pockets were treated by open flap debridement. For #37, with a gutter-shaped root, odontoplasty was performed. After reevaluation, the patient was placed on supportive periodontal therapy (SPT). During 12 years of SPT, the periodontal condition remained uneventful in most of the teeth. However, bone resorption was observed in the distal aspect of #37, making the prognosis poor. This indicates the need to continuously monitor risk factors, including inflammation and traumatic occlusion, during SPT. Although some problems still remain, severe periodontitis with furcation involvement was successfully maintained longitudinally with an adequate level of patient compliance and careful SPT.

Low-cost periodontal therapy

Periodontitis is a complex infectious disease that affects low-income individuals disproportionately. Periodontitis is associated with specific bacterial species and herpesviruses, and successful prevention and treatment of the disease is contingent upon effective control of these pathogens. This article presents an efficacious, highly safe, minimally invasive, practical and low-cost periodontal therapy that involves professional and patient-administered mechanical therapy and antimicrobial agents. The major components are scaling for calculus removal, periodontal pocket irrigation with potent antiseptics, and treatment with systemic antibiotics for advanced disease. Povidone-iodine and sodium hypochlorite have all the characteristics for becoming the first-choice antiseptics in the management of periodontal diseases. Both agents show excellent antibacterial and antiviral properties, are readily available throughout the world, have been safely used in periodontal therapy for decades, offer significant benefits for individuals with very limited financial resources, and are well accepted by most dental professionals and patients. Four per cent chlorhexidine applied with a toothbrush to the most posterior part to the tongue dorsum can markedly reduce or eliminate halitosis in most individuals. Systemic antibiotics are used to treat periodontopathic bacteria that are not readily reached by topical therapy, such as pathogens within gingival tissue, within furcation defects, at the base of periodontal pockets, and on the tongue, tonsils and buccal mucosae. Valuable antibiotic therapies are amoxicillin-metronidazole (250 mg of amoxicillin and 250 mg of metronidazole, three times daily for 8 days) for young and middle-aged patients, and ciprofloxacin-metronidazole (500 mg of each, twice daily for 8 days) for elderly patients and for patients in developing countries who frequently harbor enteric rods subgingivally. Scaling to remove dental calculus and the prudent use of inexpensive antimicrobial agents can significantly retard or arrest progressive periodontitis in the great majority of patients.

Effect of a school-based oral health-education program on Iranian children: results from a group randomized trial

Parents and school staff play important roles in promoting children's oral health. Our study goals were to investigate whether an intervention targeting parents and school staff can improve the oral-health behavior and oral-health status of schoolchildren. Three-hundred and ninety-two schoolchildren in six schools in Tehran participated in a group randomized trial from September 2010 to March 2011. Schools were randomly allocated into three groups: comprehensive, student, and control. Intervention in the comprehensive group consisted of strategies to encourage children, their parents, and school staff to increase the frequency of toothbrushing and flossing. In the student group, the intervention targeted only children. The control group received no intervention. The primary outcome was change in oral-health behaviors (brushing and flossing), while the secondary outcomes were changes in oral hygiene and Community Periodontal indices and in Health Belief Model components. Multilevel modeling was employed for data analyses. Students who were in the comprehensive intervention group brushed and flossed significantly more frequently compared with those in the student intervention group. Although students' gingival health improved significantly in the comprehensive intervention group, such significant improvement was not seen in the student group. In conclusion, promising results are seen when the oral-health education targets both school and home settings.

Relationships between eating habits and periodontal condition in university students

BACKGROUND

Being overweight is a risk factor for periodontitis. Unhealthy eating habits, which can induce overweight, may be involved in the development of periodontitis in young people. The present study aims to examine the relationships among overweight, eating habits, and the periodontal condition in Japanese university students.

METHODS

We conducted a cross-sectional study of 801 university students (413 males and 388 females; age range: 18 to 25 years). Patients were classified as underweight (body mass index [BMI] <18.5 kg/m(2)), normal weight (BMI of 18.5 to 22.9 kg/m²), and overweight (BMI ≥ 23 kg/m²). Students completed a questionnaire including items related to eating habits and underwent oral health examinations. Patients with a community periodontal index (CPI) of 0 to 2 were considered controls, and patients with a CPI >2 were considered to have periodontitis.

RESULTS

The prevalence of underweight, normal weight, and overweight patients was 21%, 62%, and 17%, respectively. In overweight patients, the periodontitis risk was increased by the frequent consumption of fatty foods (adjusted odds ratio: 2.3; 95% confidence interval: 1.1 to 5.2; P <0.05) and reduced by the frequent consumption of vegetables (adjusted odds ratio: 0.2; 95% confidence interval: 0.1 to 0.7; P <0.01). In underweight and normal-weight groups, eating habits did not differ significantly according to the presence of periodontitis.

CONCLUSIONS

In overweight students, the frequent consumption of fatty foods and infrequent consumption of vegetables were associated with an increased risk of periodontitis. In underweight and normal-weight students, eating habits had little effect on the periodontal condition.

The relationship of oral health literacy and self-efficacy with oral health status and dental neglect

OBJECTIVES

We examined the associations of oral health literacy (OHL) with oral health status (OHS) and dental neglect (DN), and we explored whether self-efficacy mediated or modified these associations.

METHODS

We used interview data collected from 1280 female clients of the Special Supplemental Nutrition Program for Women, Infants and Children from 2007 to 2009 as part of the Carolina Oral Health Literacy Project. We measured OHL with a validated word recognition test (REALD-30), and we measured OHS with the self-reported National Health and Nutrition Examination Survey item. Analyses used descriptive, bivariate, and multivariate methods.

RESULTS

Less than one third of participants rated their OHS as very good or excellent. Higher OHL was associated with better OHS (for a 10-unit REALD increase: multivariate prevalence ratio = 1.29; 95% confidence interval = 1.08, 1.54). OHL was not correlated with DN, but self-efficacy showed a strong negative correlation with DN. Self-efficacy remained significantly associated with DN in a fully adjusted model that included OHL.

CONCLUSIONS

Increased OHL was associated with better OHS but not with DN. Self-efficacy was a strong correlate of DN and may mediate the effects of literacy on OHS.

Self-efficacy and oral hygiene beliefs about toothbrushing in dental patients: a model-guided study

Building on previous research on psychosocial variables associated with oral hygiene behavior, this study examined the ability of Health Belief Model variables (perceived benefits, barriers, susceptibility, severity) and self-efficacy beliefs about toothbrushing to inform prevalence of dental caries and toothbrushing frequency. To accomplish this goal, a sample of 125 dental patients completed self-report questionnaires and provided data on demographic and behavioral factors. A path analysis model with manifest variables was tested. Oral hygiene beliefs emerged as a multidimensional construct. Results suggested that stronger self-efficacy beliefs (β = .81) and greater perceived severity of oral diseases (β = .18) were related to increased toothbrushing frequency, which in turn was associated with better oral health status, as indicated by the total number of decayed, missing, and filled teeth due to dental caries (β = -.39). Possible strategies for improving oral health are discussed.

A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy

BACKGROUND

Current reporting of intervention content in published research articles and protocols is generally poor, with great diversity of terminology, resulting in low replicability. This study aimed to extend the scope and improve the reliability of a 26-item taxonomy of behaviour change techniques developed by Abraham and Michie [Abraham, C. and Michie, S. (2008). A taxonomy of behaviour change techniques used in interventions. Health Psychology, 27(3), 379-387.] in order to optimise the reporting and scientific study of behaviour change interventions.

METHODS

Three UK study centres collaborated in applying this existing taxonomy to two systematic reviews of interventions to increase physical activity and healthy eating. The taxonomy was refined in iterative steps of (1) coding intervention descriptions, and assessing inter-rater reliability, (2) identifying gaps and problems across study centres and (3) refining the labels and definitions based on consensus discussions.

RESULTS

Labels and definitions were improved for all techniques, conceptual overlap between categories was resolved, some categories were split and 14 techniques were added, resulting in a 40-item taxonomy. Inter-rater reliability, assessed on 50 published intervention descriptions, was good (kappa = 0.79).

CONCLUSIONS

This taxonomy can be used to improve the specification of interventions in published reports, thus improving replication, implementation and evidence syntheses. This will strengthen the scientific study of behaviour change and intervention development.

Global Oral Health Inequalities

Periodontal diseases constitute one of the major global oral health burdens, and periodontitis remains a major cause of tooth loss in adults worldwide. The World Health Organization recently reported that severe periodontitis exists in 5-20% of adult populations, and most children and adolescents exhibit signs of gingivitis. Likely reasons to account for these prevalent diseases include genetic, epigenetic, and environmental risk factors, as well as individual and socio-economic determinants. Currently, there are fundamental gaps in knowledge of such fundamental issues as the mechanisms of initiation and progression of periodontal diseases, which are undefined; inability to identify high-risk forms of gingivitis that progress to periodontitis; lack of evidence on how to prevent the diseases effectively; inability to detect disease activity and predict treatment efficacy; and limited information on the effects of integration of periodontal health as a part of the health care program designed to promote general health and prevent chronic diseases. In the present report, 12 basic, translational, and applied research areas have been proposed to address the issue of global periodontal health inequality. We believe that the oral health burden caused by periodontal diseases could be relieved significantly in the near future through an effective global collaboration.