Behavioral Interventions on Periodontitis Patients to Improve Oral Hygiene: A Systematic Review
Abstract
:1. Introduction
2. Methods
2.1. Search Strategy
2.2. Inclusion and Exclusion Criteria
2.3. Eligibility Criteria
- Participants: Adult patients aged 18 or over with periodontitis, excluding patients who only had gingivitis, patients with comorbidities affecting periodontal status (e.g., diabetes mellitus), or patients with orthodontic appliances.
- Interventions: OH instructional strategies and behavioral or educational interventions provided by oral health professionals and/or psychologists/counselors to increase adherence to OH advice.
- Comparison: No OH instructions (OHI) or regular OHI provided by oral health specialists.
- Outcome measures: Any established index for measuring the amount of plaque and inflammation (bleeding before and after the intervention).
- Study design: RCTs, NRCTs, cohort studies, and case-control studies with a follow-up of at least 1 month.
2.4. Data Collection
- Periodontal status, age, and sample size;
- Study design;
- Type of intervention;
- Follow-up period;
- Measures of periodontal status;
- Impact of interventions on periodontal status.
2.5. Quality Assessment
2.6. Synthesis of the Results
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.3. Risk of Bias of the Included Studies
3.4. Impact of the Different Strategies Based on Audio-Visual Tools for OHI
3.5. Impact of the Psychological Models of Health-Related Behavior
4. Discussion
5. Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
OH | oral hygiene |
BoP | bleeding on probing |
SPT | supportive periodontal therapy |
SCMs | social cognition models |
CBT | cognitive behavioral therapy |
MI | motivational interviewing |
PICOS | patient, intervention, control, outcome, and study design |
RCTs | randomized controlled clinical trials |
NRCTs | non-randomized controlled clinical trials |
CI | confidence intervals |
OR | odds ratio |
NR | not reported |
T | test |
C | control |
OHI | oral hygiene instructions |
PPD | probing pocket depth |
PD | pocket depth |
PI | plaque index |
PS | plaque score |
FMPS | full mouth plaque score |
GI | gingival index |
GB | gingival bleeding |
BI | bleeding index |
BOMP | bleeding on marginal probing |
CAL | clinical attachment level |
CSCCM | client self-care commitment model |
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Reference | Periodontal Status Age (Year) Sample Size | Study Design | Intervention | Follow-Up | Outcome Assessed | Impact on Plaque Score {Mean (SD)} or {Percentage %} | Impact on Bleeding Score {Mean (SD)} or {Percentage %} |
---|---|---|---|---|---|---|---|
AUDIO-VISUAL POWERPOINT | |||||||
Williams et al. 2018 [65] | Mild to moderate periodontitis (PD < 6 mm) 21–80 years n = 58 T group n = 30 C group n = 28 | RCT | Same OHI delivered: Test: Computer-teaching format (8 min audio-visual PowerPoint presentation containing 12 slides). Control: Self-care instructor (8 min). | Baseline (T0) 4 weeks (T1) | 6 tooth surfaces: PS (O’Leary) BI (Silness and Loe) BoP% | TEST Baseline: 68 ± 10.7 At 4 weeks: 79.8 ± 11.4 CONTROL Baseline: 65.8 ± 7.1 At 4 weeks: 76.5 ± 11.9 | TEST Baseline: 0.28 ± 0.1 42% ± 15.3 At 4 weeks: 0.23 ± 0.09 32.2% ± 20.9 CONTROL Baseline: 0.26 ± 0.1 37.8% ± 15.2 At 4 weeks: 0.17 ± 0.1 30.6% ± 10.7 |
VIDEOTAPE | |||||||
Glavind et al., 1986 [81] | Few periodontal pockets > 5 mm 32–63 years n = 24 T group n = 12 C group n = 12 | NRCT | Both groups: OHI. Test: Reinforcement of the OHI by videotape (12 min) at the 3-week follow-up. | Baseline (T0) 2 weeks (T1) 3 weeks (T2) 8 weeks (T3) | 4 tooth surfaces: PI%: (presence/ absence) BI%: (presence/ absence) | TEST Baseline: 62% (16.8) At 2 weeks: 59% (16.7) At 3 weeks: 29% (19.5) At 8 weeks: 28% (16.3) CONTROL Baseline: 58% (16.2) At 2 weeks: 52% (18.4) At 3 weeks: 23% (19.0) At 8 weeks: 22% (12.5) | TEST Baseline: 51% (19.8) At 8 weeks: 29% (17.0) CONTROL Baseline: 45% (14.8) At 8 weeks: 24% (14.8) |
Reference | Strategy | Results |
---|---|---|
Williams et al., 2018 [65] | OHI given in a computer-assisted format (PowerPoint presentation). | No statistically significant difference between the groups. PLAQUE: Significant differences between older and younger participants (<50 years old) trained on the computer. Younger sample was significantly better using the computer format. |
Glavind et al., 1986 [81] | Reinforcement of the OHI by showing a television tape. | No statistically significant difference between the groups. |
Reference | Periodontal Status Age (Year) Sample Size | Study Design | Intervention | Follow-Up | Outcome Assessed | Impact on Plaque Score {Mean (SD)} or {Percentage %} | Impact on Bleeding Score {Mean (SD)} or {Percentage %} |
---|---|---|---|---|---|---|---|
SOCIAL COGNITIVE THEORY | |||||||
Little et al., 1997 [66] | Mild to moderate periodontal disease (at least 6 sites PD 4–7 mm) 50–70 years n = 107 T group: n = 54 C group: n = 53 | RCT | Test: 5 weekly, 90-min sessions: skill training, self-monitoring, and feedback Control: Usual periodontal maintenance care | Baseline (T0) 4 months (T1) | 4 tooth surfaces: PI (O’Leary) GI BoP (%) PPD CAL | TEST Baseline: 82% At 4 months: 76% CONTROL Baseline: 80% At 4 months: 80% | TEST Baseline: 24% At 4 months: 15% CONTROL Baseline: 26% At 4 months: 21% |
Weinstein et al., 1996 [67] | Periodontitis patients 32–50 years n = 20 Control group 1: n = 5 Control group 2: n = 5 Test group 1: n = 5 Test group 2: n = 5 | RCT | Control 1: Bass technique Control 2: Bass technique + 2× weekly verbal feedback Test 1: Bass technique + 2× weekly verbal feedback + positive reinforcement Test 2: Bass technique + 2× weekly verbal feedback + positive reinforcement + Self-monitoring | Baseline (T0) 1 month (T1) 2 months (T2) | FMPS (O’Leary) | CONTROL 1 Baseline: 0.397 (0.165) At 1 month: 0.390 (0.175) At 2 months: 0.384 (0.159) CONTROL 2 Baseline: 0.395 (0.086) At 1 month: 0.271 (0.096) At 2 months: 0.323 (0.079) TEST 1 Baseline: 0.353 (0.187) At 1 month: 0.205 (0.091) At 2 months: 0.228 (0.075) TEST 2 Baseline: 0.376 (0.058) At 1 month: 0.121 (0.017) At 2 months: 0.148 (0.034) | NR |
Baab et al., 1986 [68] | Periodontitis patients who had completed active periodontal treatment 30–76 years, n = 31 T group n = 15 C group n = 16 | RCT | Both groups: OHI. Test: oral self-inspection manual | Baseline (T0) 2 weeks (T1) 1.5 months (T2) 3 months (T3) 6 months (T4) | 6 tooth surfaces: Plaque% (O’Leary) Gingival bleeding% | Outcomes of measurements are not described numerically | Outcomes of measurements are not described numerically |
Glavind et al., 1981 [82] | Few periodontal pockets > 5 mm 25–64 years, n = 37 Group 1 n = 12 Group 2 n = 13 Group 3 n = 12 | NRCT | Group 1: Written self-instructional manual of OH Group 2: Individualized OHI Group 3: Minimal OHI | Baseline (T0) 1 week (T1) 2 weeks (T2) 6 weeks (T3) 3 months (T4) 6 months (T5) | 4 tooth surfaces: PI%: (presence/ absence) BI%: (presence/ absence) | GROUP 1 Baseline: 66.2 (19.7) At 1 week: 44.1 (17.2) At 2 weeks: 22.3 (18.7) At 6 weeks: 21.5 (20.4) At 3 months: 17.2 (14.2) At 6 months: 20.4 (15.9) GROUP 2 Baseline: 61.4 (19.3) At 1 week: 43.8 (20.3) At 2 weeks: 27.5 (20.9) At 6 weeks: 23.3 (19.1) At 3 months: 25.1 (21.3) At 6 months: 22.1 (19.2) GROUP 3 Baseline: 66.1 (16.7) At 1 week: 48.1 (16.6) At 2 weeks: 25.6 (16.8) At 6 weeks: 26.4 (20.7) At 3 months: 19.6 (12.0) At 6 months: 19.7 (15.9) | GROUP 1 Baseline: 39.5 (24.4) At 6 weeks: 14.1 (15.7) At 3 months: 18.0 (16.3) At 6 months: 13.1 (14.8) GROUP 2 Baseline: 39.6 (26.9) At 6 weeks: 15.2 (17.6) At 3 months: 18.0 (15.2) At 6 months: 13.1 (10.6) GROUP 3 Baseline: 39.6 (20.9) At 6 weeks: 15.0 (13.6) At 3 months: 14.5 (14.9) At 6 months: 15.9 (12.9) |
Glavind et al., 1983 [83] | Few periodontal pockets > 5 mm 22–67 years, n = 63 Group B: brushing test n = 17 Group O: open scoring n = 14 Group M: minimal feedback n = 17 Group C: control n = 15 | NRCT | Group B: Written self-instructional manual of OH + feedback + “tooth brushing test”. Group O: Written self-instructional manual of OH + feedback Group M: Written self-instructional manual of OH Group C: Minimal OHI | Baseline (T0) 1 week (T1) 2 weeks (T2) 6 weeks (T3) 3 months (T4) 7 months (T5) 13 months (T6) | 4 tooth surfaces: PI%: (presence/ absence) BI%: (presence/ absence) | GROUP B Baseline: 60.9 (19.6) At 1 week: 35.6 (11.9) At 2 weeks: 23.1 (14.8) At 6 weeks: 28.5 (16.3) At 3 months: 26.5 (18.0) At 7 months: 37.5 (14.5) At 13 months: 35.7 (16.4) GROUP O Baseline: 62.8 (17.2) At 1 week: 37.2 (17.5) At 2 weeks: 27.1 (20.3) At 6 weeks: 27.1 (14.7) At 3 months: 22.4 (18.8) At 7 months: 31.8 (16.6) At 13 months: 30.4 (19.3) GROUP M Baseline: 61.9 (18.3) At 1 week: 36.4 (20.6) At 3 months: 34.4 (21.3) At 7 months: 33.3 (21.0) At 13 months: 29.9 (13.9) GROUP C Baseline: 62.0 (16.8) At 1 week: 34.5 (12.7) At 3 months: 35.3 (12.6) At 7 months: 34.3 (15.6) At 13 months: 37.0 (15.7) | GROUP B Baseline: 49.0 (21.9) At 6 weeks: 29.5 (16.9) At 3 months: 17.2 (14.8) At 7 months: 24.3 (13.5) At 13 months: 24.0 (17.6) GROUP O Baseline: 54.5 (18.3) At 6 weeks: 28.6 (17.3) At 3 months: 13.9 (12.4) At 7 months: 20.9 (15.5) At 13 months: 19.6 (16.4) GROUP M Baseline: 50.3 (16.7) At 6 weeks: 29.8 (14.5) At 3 months: 13.6 (12.1) At 7 months: 22.0 (20.2) At 13 months: 19.9 (13.8) GROUP C Baseline: 53.6 (23.5) At 6 weeks: 30.1 (14.6) At 3 months: 18.8 (11.7) At 7 months: 22.5 (14.4) At 13 months: 34.8 (15.9) |
Glavind et al., 1984 [84] | Few periodontal pockets > 5 mm 22–67 years, n = 74 Group 1 n = 23 Group 2 n = 27 Group 3 n = 24 | NRCT | Group 1: Self-examination prior to OHI Group 2: OHI Group 3: Delayed OHI (at 6 weeks) | Baseline (T0) 1 week (T1) 2 weeks (T2) 6 weeks (T3) 7 weeks (T4) 3 months (T5) 7 months (T6) | 4 tooth surfaces: PI%: (presence/ absence) BI%: (presence/ absence) | GROUP 1 Baseline: 61.8 (15.7) At 2 weeks: 40.7 (17.4) At 6 weeks: 38.3 (21.0) At 3 months: 31.5 (21.3) At 7 months: 23.7 (16.8) GROUP 2 Baseline 59.4 (17.0) At 2 weeks: 44.3 (17.3) At 6 weeks: 34.3 (16.7) At 3 months: 30.1 (17.2) At 7 months: 23.5 (14.9) GROUP 3 Baseline: 60.3 (16.8) At 6 weeks: 52.0 (17.7) At 7 weeks: 24.5 (13.9) At 3 months: 27.1 (20.3) At 7 months: 19.7 (16.8) | GROUP 1 Baseline: 55.4 (14.4) At 6 weeks: 33.3 (18.5) At 3 months: 17.3 (11.4) At 7 months: 20.4 (11.8) GROUP 2 Baseline: 52.6 (19.2) At 6 weeks: 31.4 (16.8) At 3 months: 19.2 (14.4) At 7 months: 21.9 (13.9) GROUP 3 Baseline: 56.3 (21.2) At 6 weeks: 45.7 (18.9) At 3 months: 21.4 (18.4) At 7 months: 18.0 (17.1) |
RISK COMMUNICATION, GOAL SETTING, PLANNING, AND SELF-MONITORING | |||||||
Asimakopoulou et al., 2019 [79] | Periodontitis patients Mean age: 60.61 (11.24) n = 97 T group 1 (RISK) n = 32 T group 2 (GPS) n = 33 C group (TAU) n = 32 | RCT | All groups: OHI T Group 1: 5–10′ explanation of their individualized risk T Group 2: 5–10′ explanation of their individualized risk + setting goals, self-monitoring, and planning | Baseline (T0) 1 month (T1) 3 months (T2) | 4 tooth surfaces: PI% (presence/ absence) 6 tooth surfaces: BoP% (presence/ absence) PPD | TEST 1 (RISK) Baseline: 21.59% (15.49) At 1 month: 12.21% (9.33) At 3 months: 9.87% (7.93) TEST 2 (GPS) Baseline: 16.23% (10.54) At 1 month: 10.91% (9.90) At 3 months: 9.65% (8.06) CONTROL (TAU) Baseline: 13.97% (10.30) At 1 month: 10.87% (7.22) At 3 months: 10.60% (7.66) | TEST 1 (RISK) Baseline: 13.89% (14.88) At 1 month: 5.44% (6.40) At 3 months: 6.72% (7.03) TEST 2 (GPS) Baseline: 9.94% (7.33) At 1 month: 6.11% (7.80) At 3 months: 4.42% (4.23) CONTROL (TAU) Baseline: 8.62% (6.13) At 1 month: 4.37% (3.64) At 3 months: 4.17% (5.51) |
THEORY OF REASONED ACTION | |||||||
Jönsson et al., 2012 [85] | Moderate to advanced periodontitis and PI > 0.3 Mean age: T = 52.4 (8.4) C = 50.1 (10.3) n = 113 T group n = 57 C group n = 56 | Data from RCT (Jönsson et al., 2009, 2010) | Questionnaire: Theory of Reasoned Action | Baseline (T0) 3 months (T1) 12 months (T2) | NR | NR | NR |
TEXT MESSAGES AND HEALTH ACTION PROCESS APPROACH | |||||||
Araújo et al., 2020 [80] | Periodontal pockets > 3 mm ≥18 years, n = 142 C group (FF) n = 43 T group 1 (NFH) n = 38 T group 2 (TM + NFH) n = 61 | RCT | All groups: HAPA Questionnaire Patient motivation, discussion about treatment needs, goal setting, and individualized OHI (60′) C group: Finger Floss (FF) T group 1: Novel Floss Holder (NFH) T group 2: Novel Floss Holder + Text Messages (TM + NFH) | Baseline (T0) 4 months (T1) | Bleeding on Marginal Probing index (BOMP) | NR | TEST 1 (NFH) Baseline: 1.14 At 4 months: 0.81 TEST 2 (TM + NFH) Baseline: 1.19 At 4 months: 0.62 CONTROL (FF) Baseline: 1.15 At 4 months: 0.82 |
LEVENTHAL’S SELF-REGULATORY THEORY | |||||||
Philippot et al., 2005 [74] | Periodontitis patients 20–68 years, n = 30 T group: n = 15 C group: n = 15 | RCT | Both groups: Information and training of self-care T group: Leventhal’s theory Daily records of improvements in periodontal symptoms | Baseline (T0) 1 month (T1) | PI (Silness and Löe) | TEST Baseline: Global 1.63 (0.43) Lingual 1.87 (0.49) Buccal 1.13 (0.55) Proximal 1.83 (0.41) At 1 month: Global 0.24 (0.19) Lingual 0.22 (0.28) Buccal 0.08 (0.08) Proximal 0.43 (0.24) CONTROL Baseline: Global 1.88 (0.41) Lingual 2.03 (0.41) Buccal 1.41 (0.64) Proximal 2.19 (0.40) At 1 month: Global 0.88 (0.38) Lingual 0.84 (0.48) Buccal 0.45 (0.43) Proximal 1.34 (0.55) | NR |
MOTIVATIONAL INTERVIEWING GUIDED BY LEVENTHAL’S SELF-REGULATORY THEORY | |||||||
Godard et al., 2011 [73] | Moderate-to- severe chronic periodontitis Mean age: T = 51.6 (16.6) C = 48.3 (16.5) n = 51 T group n = 27 C group n = 24 | RCT | All groups: OHI T group: Single session of MI guided by Leventhal’s theory (15–20′), by 2 experienced periodontists | Baseline (T0) 1 month (T1) | 3 tooth surfaces: PI (O’Leary) | TEST Baseline: Lingual 35% (0.23) Buccal 58% (0.28) Proximal 65% (0.22) At 1 month: Lingual 18% (0.20) Buccal 29% (0.29) Proximal 45% (0.30) CONTROL Baseline: Lingual 37% (0.23) Buccal 59% (0.19) Proximal 68% (0.23) At 1 month: Lingual 27% (0.16) Buccal 43% (0.22) Proximal 73% (0.27) | NR |
MOTIVATIONAL INTERVIEWING | |||||||
Stenman et al., 2012 [69] | Moderate chronic periodontitis Mean age: T = 51.9 (8.9) C = 48.9 (12.1) n = 39 T group: n = 19 C group: n = 20 | RCT | All groups: OHI T group: Single session of 20–90′ MI by a psychologist | Baseline (T0) 2 weeks (T1) 4 weeks (T2) 12 weeks (T3) 26 weeks (T4) | 6 tooth surfaces: PI (O’Leary) Marginal gingival bleeding (MBI) (%) | TEST Baseline: 50.2% (21.5) At 3 months: 27.1% (15.2) At 6 months: 25.2% (15.4) CONTROL Baseline: 43.1% (19.2) At 3 months: 19% (13.3) At 6 months: 18.6% (13.2) | TEST Baseline: 36.6% (17.1) At 3 months: 21% (12.5) At 6 months: 18.8% (10.9) CONTROL Baseline: 33% (12.4) At 3 months: 16.2% (13.4) At 6 months: 18.4% (14.1) |
Stenman et al., 2018 [70] | Moderate chronic periodontitis Mean age: T = 58.3 (10.2) C = 54.2 (10.1) n = 26 T group: n = 13 C group: n = 13 | RCT | All groups: OHI T group: Single session of 20–90′ MI by a psychologist | Baseline (T0) 6 months (T1) 3 years (T2) | 6 tooth surfaces: PI (O’Leary) Marginal gingival bleeding (MBI) (%) | TEST Baseline: 49.6% (23.7) At 6 months: 25.26% (15.3) At 3 years: 42.1% (30.6) CONTROL Baseline: 38.4% (15.3) At 6 months: 15.7% (10.4) At 3 years: 41.9% (30.3) | TEST Baseline: 37.8% (19.7) At 6 months: 17.1% (8.6) At 3 years: 14.7% (9.2) CONTROL Baseline: 32.1% (12.3) At 6 months: 16.3% (8.9) At 3 years: 15.4% (17.6) |
Brand et al., 2013 [71] | Patients in periodontal maintenance for at least one year and with a BOP ≥ 40% or at least two teeth with interproximal PD ≥ 5 mm Mean age: 61.9 (11.0) n = 56 T group: n = 29 C group: n = 27 | RCT | All groups: Individualized OHI T group: Single brief session of MI (15–20′) by a trained and experienced counselor in MI | Baseline (T0) 6 weeks (T1) 3 months (T2) | 6 tooth surfaces: PI (Quigley–Hein) (Ramfjord teeth) BoP (%) PPD | TEST Baseline: 2.4 (0.6) At 6 weeks: 1.9 (0.6) At 3 months: 2.1 (0.7) CONTROL Baseline: 2.6 (0.5) At 6 weeks: 2.2 (0.4) At 3 months: 2.3 (0.7) | TEST Baseline: 50% (18) At 6 weeks: 31% (14) At 3 months: 33% (15) CONTROL Baseline: 55% (18) At 6 weeks: 40% (19) At 3 months: 36% (20) |
Woelber et al., 2016 [72] | CPITN ≥ 3 of at least two sextants Mean age: 59.27 (11.40) n = 172 T group: n = 73 C group: n = 99 | RCT | All groups: OHI T group: 4–5 sessions of MI delivered by dental students trained in MI | Baseline (T0) 6 months (T1) | PI (Silness and Löe) GI (Löe and Silness) BoP (%) PPD CAL | TEST Baseline: 0.56 (0.3) At 6 months: 0.72 (0.32) CONTROL Baseline: 0.43 (0.30) At 6 months: 0.54 (0.32) | TEST Baseline: 51.87% (23.18) At 6 months: 46.65% (25.07) CONTROL Baseline: 53.65% (23.86) At 6 months: 51.82% (27.32) |
COGNITIVE BEHAVIOURAL THERAPY | |||||||
Alcouffe et al., 1988 [75] | Periodontitis patients with no sites of active periodontitis, who did not respond adequately to hygiene instructions (PI > 50%) 29–72 years, n = 26 T group: n = 13 C group: n = 13 | RCT | All groups: 4 teaching sessions of OH T group: Interviewed by a psychologist (50–90′): perception of periodontal disease, notions of recovery, prevention, and personal hygiene measures | Baseline (T0) Every 3 months for 2 years | PI (O’Leary) | TEST Baseline: 68.08 (12.06) At 3 months: 55.31 (13.36) At 6 months: 49.0 (22.58) At 1 year: 50. 64 (20.69) At 2 years: 48.7 (22.32) CONTROL Baseline: 69.38 (10.91) At 3 months: 68.77 (12.21) At 6 months: 67.58 (15.97) At 1 year: 66.55 (18.32) At 2 years: 65.80 (20.60) | NR |
Jönsson et al., 2006 [76] | Periodontitis patients with insufficient compliance and progress of their periodontal disease Mean age: T = 54.8 (11.7) C = 58.1 (9.9) n = 35 T group n = 19 C group n = 16 | RCT | T group: 4 sessions of Client Self-care Commitment Model (CSCCM) by an experienced dental hygienist C group: 3 sessions of conventional OHI | Baseline (T0) 3 months (T1) | 6 tooth surfaces: PI (Silness and Löe) GI (Löe and Silness) BoP% (4 tooth surfaces) PPD | TEST Baseline: 0.59 (0.17) At 3 months: 0.25 (0.11) CONTROL Baseline: 0.59 (0.29) At 3 months: 0.33 (0.11) | TEST Baseline: 46.8% (13.8) At 3 months: 18.7% (8.3) CONTROL Baseline: 39% (16.0) At 3 months: 16.3% (5.7) |
COGNITIVE BEHAVIOURAL THERAPY + MOTIVATIONAL INTERVIEWING | |||||||
Jönsson et al., 2009 [77] | Moderate to advanced periodontitis and PI > 0.3 Mean age: T = 52.4 (8.4) C = 50.1 (10.3) n = 113 T group n = 57 C group n = 56 | RCT | T group: 5–9 visits of individually tailored oral health educational program based on CBT, using MI, delivered by trained dental hygienist C group: 4–8 visits of OHI One visit lasts 45 to 60 min | Baseline (T0) 3 months (T1) 12 months (T2) | 6 tooth surfaces: PI (Silness and Löe) GI (Löe and Silness) BoP% PPD | TEST Baseline: 0.74 (0.34) At 3 months: 0.17 (0.11) At 12 months: 0.14 (0.13) CONTROL Baseline: 0.73 (0.31) At 3 months: 0.32 (0.22) At 12 months: 0.31 (0.16) | TEST Baseline: 0.92 (0.28) At 3 months: 0.27 (0.14) At 12 months: 0.21 (0.16) CONTROL Baseline: 0.92 (0.23) At 3 months: 0.52 (0.20) At 12 months: 0.50 (0.17) |
Jönsson et al., 2010 [78] | Moderate to advanced periodontitis and PI > 0.3 Mean age: T = 52.4 (8.4) C = 50.1 (10.3) n = 113 T group n = 57 C group n = 56 | RCT | T group: 5–9 visits of individually tailored oral health educational program based on CBT, using MI, delivered by trained dental hygienist C group: 4–8 visits of OHI One visit lasts 45 to 60 min | Baseline (T0) 3 months (T1) 12 months (T2) | 6 tooth surfaces: PI (Silness and Löe, expressed as % plaque scores ≥ 1) BoP% PPD | TEST Baseline: 59% (18) At 3 months: 17% (10) At 12 months: 14% (12) CONTROL Baseline: 57% (17) At 3 months: 28% (17) At 12 months: 28% (13) | TEST Baseline: 70% (20) At 3 months: 24% (12) At 12 months: 19% (13) CONTROL Baseline: 75% (18) At 3 months: 33% (15) At 12 months: 29% (14) |
Reference | Strategy | Results |
---|---|---|
Little et al., 1997 [66] | 5 weekly, 90-min sessions including skill training, self-monitoring, and feedback. | Test group: Significantly increased their skills and frequency of tooth brushing and flossing. Significant reduction in PI and BoP. Significant relative improvement in PD reduction in PD 3–6 mm. |
Weinstein et al., 1996 [67] | 2× weekly verbal feedback, positive social reinforcement, and self-monitoring. | Significant motivation of periodontal patients to conduct the OH routine. |
Baab et al., 1986 [68] | Oral hygiene self-inspection manual. | No statistically significant difference between the groups. |
Glavind et al., 1981 [82] | Written self-instructional manual of OH and individual OHI. | No statistically significant difference between the groups. |
Glavind et al., 1983 [83] | Written self-instructional manual of OH, feedback, and “tooth brushing test”. | At 3 months: the “tooth brushing test” and feedback significantly improved plaque scores compared to the other groups. At 13 months: the control group showed a significantly higher gingival bleeding score than the others. |
Glavind et al., 1984 [84] | Self-examination prior to OHI and delayed OHI. | At 6 weeks, the delayed OHI group showed significantly higher plaque and bleeding scores compared to the other groups. At 3 months, no statistically significant difference between the groups was observed. |
Asimakopoulou et al., 2019 [79] | 5–10′ explanation of the individualized risk, setting goals, self-monitoring, and planning. | Individualized risk assessment, setting goals, self-monitoring, and planning showed a statistically significant reduction in the percentage of plaque at 1 month and 3 months. Significant improvement in interdental cleaning frequency. |
Jönsson et al., 2012 [85] | Questionnaire: Theory of Reasoned Action. | Self-efficacy, gender, and cognitive behavioral intervention were important predictors of OH behavioral change. |
Araújo et al., 2020 [80] | Questionnaire (HAPA). Patient motivation, desired outcomes, treatment needs, goal setting, individualized OHI, and text messages. | The use of text messages significantly improved the clinical measures of BOMP. |
Philippot et al., 2005 [74] | Leventhal’s theory. Daily records of the improvement in periodontal symptoms. | At the 1-month follow-up, the experimental group showed smaller scores on all indices as compared with the control group. |
Godard et al., 2011 [73] | Single session of MI guided by Leventhal’s theory (15–20′) by two experienced periodontists introduced to the practice of MI. | The test group showed statistically significant improvement compared to the control group. |
Stenman et al., 2012 [69] And Stenman et al., 2018 [70] | Single session of MI (20–90′) by a psychologist with extensive experience in MI. | No statistically significant difference between the groups. |
Brand et al., 2013 [71] | Single brief session of MI (15–20′) by a trained and experienced counselor in MI. | No statistically significant difference between the groups. |
Woelber et al., 2016 [72] | 4–5 sessions of MI delivered by dental students trained in MI. | No statistically significant difference between the groups in all the clinical parameters. The test group showed significantly higher interdental cleaning self-efficacy than the control group. |
Alcouffe et al., 1988 [75] | Interviewed by a psychologist (50–90′): assessment of their perception of periodontal disease, recovery, prevention, and personal hygiene measures. | Test group: the majority of the patients improved their PI to below 50% after 1 year. Control group: the majority of patients remained stable or worsened. |
Jönsson et al., 2006 [76] | 4 sessions of Client Self-care Commitment Model (CSCCM) by an experienced dental hygienist | Test group at 3 months: Statistically significant improvement in PI compared to the control group. Statistically significant increase in the use of interdental cleaning. No statistically significant difference in the reduction in PD > 4 mm between the groups. |
Jönsson et al., 2009 [77] | 5–9 visits of individually tailored oral health educational program based on CBT, using MI, delivered by a trained dental hygienist. | Statistically significant improvement in PI and GI in the test group between both baseline and 3-month follow-up and baseline and 12-month follow-up compared to the control group. Test group reported a higher frequency of daily inter-dental cleaning. |
Jönsson et al., 2010 [78] | 5–9 visits of individually tailored oral health educational program based on CBT, using MI, delivered by a trained dental hygienist. | Statistically significant improvement in PI and GI in the test group between both baseline and 3-month follow-up and baseline and 12-month follow-up compared to the control group. No group difference for “pocket closure” and reduction in periodontal pocket depth. More individuals in the test group reached a level of treatment success. |
D1 | D2 | D3 | D4 | D5 | Overall Bias | |
---|---|---|---|---|---|---|
Williams et al. [65] | HIGH | LOW | LOW | LOW | SOME CONCERN | HIGH |
Little et al. [66] | SOME CONCERN | LOW | LOW | HIGH | HIGH | HIGH |
Weinstein et al. [67] | HIGH | HIGH | HIGH | HIGH | SOME CONCERN | HIGH |
Baab et al. [68] | SOME CONCERN | HIGH | LOW | HIGH | HIGH | HIGH |
Stenman et al. [69] | SOME CONCERN | LOW | LOW | LOW | SOME CONCERN | SOME CONCERN |
Stenman et al. [70] | HIGH | SOME CONCERN | LOW | LOW | SOME CONCERN | HIGH |
Brand et al. [71] | LOW | LOW | LOW | LOW | SOME CONCERN | SOME CONCERN |
Woelber et al. [72] | HIGH | HIGH | HIGH | SOME CONCERN | HIGH | HIGH |
Godard et al. [73] | LOW | LOW | LOW | HIGH | SOME CONCERN | HIGH |
Philippot et al. [74] | SOME CONCERN | HIGH | HIGH | HIGH | SOME CONCERN | HIGH |
Alcouffe et al. [75] | HIGH | HIGH | HIGH | HIGH | HIGH | HIGH |
Jönsson et al. [76] | HIGH | SOME CONCERN | LOW | LOW | LOW | HIGH |
Jönsson et al. [77] | LOW | LOW | LOW | LOW | SOME CONCERN | SOME CONCERN |
Jönsson et al. [78] | LOW | LOW | LOW | LOW | SOME CONCERN | SOME CONCERN |
Asimakopoulou et al. [79] | HIGH | SOME CONCERN | LOW | HIGH | LOW | HIGH |
Araújo et al. [80] | HIGH | HIGH | HIGH | LOW | SOME CONCERN | HIGH |
Glavind et al. [82] | Glavind et al. [83] | Glavind et al. [84] | Glavind et al. [81] | Jönsson et al. [85] | |
---|---|---|---|---|---|
Newcastle–Ottawa Assessment criteria: | |||||
Representativeness of the exposed cohort | * | * | * | * | * |
Selection of non-exposed cohort | * | * | * | * | * |
Ascertainment of exposure | * | ||||
Demonstration that the outcome of interest was not present at start of study | * | * | * | * | * |
Comparability of cohorts | * | ||||
Assessment of outcome | * | * | * | * | * |
Was follow-up sufficient | * | * | * | * | |
Adequacy of follow up | * | * | * | * | * |
TOTAL | 6 | 6 | 6 | 5 | 8 |
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Vilar Doceda, M.; Petit, C.; Huck, O. Behavioral Interventions on Periodontitis Patients to Improve Oral Hygiene: A Systematic Review. J. Clin. Med. 2023, 12, 2276. https://doi.org/10.3390/jcm12062276
Vilar Doceda M, Petit C, Huck O. Behavioral Interventions on Periodontitis Patients to Improve Oral Hygiene: A Systematic Review. Journal of Clinical Medicine. 2023; 12(6):2276. https://doi.org/10.3390/jcm12062276
Chicago/Turabian StyleVilar Doceda, Maria, Catherine Petit, and Olivier Huck. 2023. "Behavioral Interventions on Periodontitis Patients to Improve Oral Hygiene: A Systematic Review" Journal of Clinical Medicine 12, no. 6: 2276. https://doi.org/10.3390/jcm12062276