Patient-reported experiences and outcomes following two different approaches for non-surgical periodontal treatment: a randomized field study

Necessity of Collaborative Health Care for Patients with Stage III and IV Periodontitis: Qualitative Study

AIM

To understand the barriers and facilitators faced by clinicians in the treatment of periodontitis and to explore the barriers and facilitators to periodontal care encountered by patients when navigating the health care system.

MATERIALS AND METHODS

Semistructured in-depth interviews were conducted with clinicians (n = 22) and patients (n = 18) selected through purposive sampling. Audio recordings were transcribed, coded, and analyzed thematically to identify key issues.

RESULTS

Four main themes were identified by clinicians: 1) psychological barriers and dissatisfaction caused by uncertain treatment outcomes when managing periodontitis; 2) professional barriers caused by referral processes and decisions about shared care; 3) barriers caused by patients' undervaluing specialist care; and 4) participatory care, standardized referral processes, and aligning treatment expectations in primary and tertiary care-facilitated management. Three main themes were identified for patients: 1) first contact with general dentists facilitated patients' perceptions about good dental care; 2) recognizing the emotional and social impact of periodontitis promoted health seeking and engagement in dental care; and 3) problems with navigating and understanding the health care system negatively affected patients' journeys. Both groups highlighted the importance of primary care services in playing a key role in managing periodontitis and raising public awareness of periodontitis.

CONCLUSION

Close collaboration between primary and tertiary levels of health care is required to ensure an efficient referral process and continuity of care. Prioritizing empathetic approaches and raising awareness of periodontitis at clinical and policy levels is needed to address the structural and interpersonal barriers in care delivery.Knowledge Transfer Statement:Primary care services play a key role in treating patients with periodontitis. Closer collaboration is required to ensure a seamless transition of care between specialists and general dental practitioners. Patients need to be engaged and play a participatory role when planning for care integration at a health care system level. Greater public health education is needed to improve awareness of the etiology and treatment of periodontitis.

Impact of non-surgical periodontal therapy on self-perceived halitosis, and the senses of smell and taste: a prospective clinical study

BACKGROUND

Periodontal diseases could cause halitosis and may impair taste and smell. While non-surgical periodontal therapy is known to reduce halitosis, its effects on taste and smell are less studied. This study aims to investigate the factors influencing self-perceived halitosis, taste, and smell, as well as the changes in these perceptions after periodontal therapy.

METHODS

A total of 183 participants were divided into three groups: 61 patients with periodontitis, 61 with gingivitis, and 61 who were gingivally healthy. Periodontal parameters and self-perceived halitosis, taste, and smell were evaluated at baseline and four weeks after non-surgical periodontal treatment using a visual analog scale (VAS). Robust regression analysis was used to assess independent variables influencing baseline VAS ratings.

RESULTS

The periodontitis group had the lowest taste perception and the highest self-perceived halitosis scores (p < 0.05). Taste perception was negatively associated with ≥ 4 mm pockets (p = 0.002). A positive relationship was also observed between the plaque index and self-perceived halitosis (p = 0.030). Post-treatment, taste perception improved significantly in all groups (p < 0.05), in parallel with improvements in periodontal parameters. Additionally, self-perceived halitosis showed a significant decrease (p < 0.05). The improvement in smell perception was statistically significant in the gingivally healthy and periodontitis groups (p < 0.05).

CONCLUSIONS

Periodontal disease may contribute to the development of chemosensory disorders. While the main goal of periodontal treatment is disease management, it can also improve taste and smell function. Oral hygiene practices play an essential role in the development of these improvements. However, further research is needed on the subject.

TRIAL REGISTRATION

The study was registered as "Investigation of Halitosis, Taste, and Smell in Terms of Periodontal Condition Stated by Patients and Periodontal Diagnosis by Dentists, and Then Evaluation of Change Before and After Treatment" with the registration number NCT06063460 (13/09/2023) at https://www.

CLINICALTRIALS

gov Protocol Registration and Results System.

CLINICAL TRIAL REGISTRATION

This clinical trial was registered prior to participant recruitment on ClinicalTrials.gov (NCT06063460,13.09.2023).

Effectiveness of Ultrasonic and Manual Instrumentation in Nonsurgical Periodontal Therapy: Are Additional Therapies More Effective? A Systematic Review

Nonsurgical periodontal therapy aims to remove supragingival and subgingival biofilm to restore periodontal health. This systematic review aims to assess the clinical effectiveness of manual and/or ultrasonic instruments and to determine whether other therapies can improve periodontal clinical outcomes. Case-control, cross-sectional and cohort studies and clinical trials of patients undergoing nonsurgical periodontal therapy with ultrasonic and/or manual instruments (and any adjunctive therapies, such as glycine, erythritol, ozone, laser and glycine) from 2013 to 2023 were analyzed using Pub-med/MEDLINE, Scopus and Google Scholar. To assess the risk of bias in this review, blinding, randomization, allocation concealment, outcome data and outcome recording were assessed. No differences between treatments were found; all methods, including manual and ultrasound, were helpful in improving clinical parameters (primary outcome). Although the results were mixed, adjunctive therapies seemed to be helpful in the treatment of periodontal disease. The results of this systematic review are consistent with the previous scientific literature and have shown that both manual and ultrasonic instruments are effective in nonsurgical periodontal therapy. This review could not show how complementary therapies could further improve nonsurgical periodontal therapy. For future research, it would be good to standardize the sample with regard to the degree and stage of periodontal disease and to evaluate the risks and benefits of the instruments (manual and ultrasonic scalers).

Adolescents' self-reported experiences following a person-centred, theory-based educational intervention versus conventional education for improved oral hygiene: Analysis of secondary outcomes of a randomized field study

AIM

To analyse adolescents' self-reported experiences and behavioural outcomes of a person-centred, theory-based intervention in comparison with conventional information/instruction for improved oral hygiene.

MATERIALS AND METHODS

Data were derived from a prospective, multi-centred, two-arm, quasi-randomized field study focusing on the effectiveness of educational interventions for improved oral hygiene. Dental hygienists working within the Public Dental Service, Västra Götaland, Sweden, provided treatments, and adolescents with poor oral hygiene conditions were eligible for participation. The person-centred test intervention was based on social cognitive constructs, and motivational interviewing was used as an approach in communication. The control intervention included conventional information/instructions. Clinical examinations were performed, and questionnaires were distributed at baseline and at 6 months. Three-hundred and twelve patients were enrolled, and data from 276 patients, following treatment per protocol, were analysed.

RESULTS

The test group was more satisfied with the education about gingivitis (very good: 61% vs. 37%) and communication during therapy (very good: 69% vs. 50%) and reported to a larger extent that they were much more careful regarding their oral hygiene after the treatment (30% vs. 15%) and had higher confidence about keeping up healthy gingival conditions, in comparison with the control group (all p < .01).

CONCLUSIONS

The person-centred, theory-based intervention was superior in terms of adolescents' experiences of education and communication during therapy and self-reported oral hygiene behavioural outcomes at 6 months, in comparison with conventional information/instruction.

Outcomes of periodontal therapy: Strengthening the relevance of research to patients. A co-created review

Periodontitis is a long-term condition affecting up to half of the population globally and causing significant impacts on life quality. Successful management depends on taking life-long ownership of the condition by those affected. There is a wealth of research to inform on management options. However, most of the research has been designed by professional experts with outcomes to gauge benefits and harms based on parameters that inform on the disease process but which might not be informative to support decision-making in people with lived experience (PWLE) of periodontal ill-health (including both patients and carers). The importance of relevant outcomes is highlighted in the concept of the "expert patient" which aims to strengthen the capacity of PWLE to make health-care choices that are important for them, elements of which are likely to be already familiar to many clinicians delivering periodontal health care. Therefore, the voice and collaboration of PWLE in research are recognised as crucial to developing high quality, relevant evidence especially for long-term conditions. In this paper, we review what is known about the relevance of treatment outcomes to PWLE. We also examine the degree to which PWLE have been involved in identifying outcomes that are important to them as well as the diversity and therefore representativeness of PWLE recruited for studies. We consider why having more relevant outcomes could enhance the expertise of PWLE in managing their periodontitis. We then conclude with key learnings from our review which we hope will encourage more rapid development of these initiatives in periodontology for the benefit of global health and wellbeing.

A randomized multi-centre study on the effectiveness of non-surgical periodontal therapy in general practice

AIM

To evaluate the effectiveness of two non-surgical treatment protocols for periodontitis patients in general dental practice.

MATERIALS AND METHODS

Ninety-five dental hygienists (59 dental clinics) were randomly assigned to one of two treatment protocols: (i) establishment of adequate self-performed oral hygiene prior to a single session of ultrasonic instrumentation (guided periodontal infection control [GPIC]) or (ii) conventional non-surgical therapy (CNST) including patient education and scaling and root planing integrated in multiple sessions. Residual pockets at 3 months were retreated in both groups. The primary outcome was pocket closure (probing pocket depth ≤ 4 mm) at 6 months. Multilevel models were utilized.

RESULTS

Based on data from 615 patients, no significant differences with regard to clinical outcomes were observed between treatment protocols. Treatment-related costs (i.e., chair time, number of sessions) were significantly lower for GPIC than CNST. Smoking and age significantly affected treatment outcomes.

CONCLUSIONS

No significant differences between the two approaches were observed in regard to clinical outcomes. GPIC was more time-effective. Patient education should include information on the detrimental effects of smoking.

CLINICALTRIALS

gov (NCT02168621).