Psychological interventions to improve oral health

This meta-analysis claims to be the first evaluating mindfulness-based interventions in primary care.

There are a number of psychological theories that guide behavioural change, health belief model, the theory of planned behavior, the self-regulatory model, and social learning theory. As a result psychological interventions may have a positive impact on oral diseases.

The aim of this review was to study the efficacy of psychological interventions in comparison with education and/or information in adults and adolescents with poor oral health, defined as dental caries, periodontal disease, and peri-implantitis.


Searches were carried out in the Medline. PsycINFO, Embase, the Cochrane Library, the Health Technology Assessment (HTA) databases of the NHS Centre for Reviews and Dissemination, the Swedish Council on Health Technology Assessment (SBU), the Norwegian Knowledge Centre for the Health Services, and the Danish Health and Medicines Authority databases. Randomised controlled trials of psychological and/or behavioral models and theories, in comparison with traditional oral health education/information published since 1990 and published in in English, Danish, Norwegian, or Swedish were considered.

Two reviewers independently selected studies initially with 3 reviewers agreeing final selection. Study quality was assessed using the SBU RCT checklist with quality of evidence for each outcome being rated using the GRADE system. The primary outcomes were dental caries, periodontitis, gingivitis, and peri-implantitis. Secondary outcomes were dental plaque, oral health-related behavior, health-related quality of life, health beliefs and attitudes, self-perceived oral health, and complications/risks.


  • 11 papers reporting on 9 RCTs were included.
  • The number of patients ranged from 33 to 167.
  • 3 studies used motivational interviewing (MI), based on self-regulatory theory
  • 4 studies used components of MI
  • The client empowerment model, the explanatory model, the human needs conceptual model and the behavioral cognitive method were used in single studies.
  • Meta-analysis showed no statistically significant differences in gingivitis or plaque presence. Meta-analysis on MI compared with education/information found no statistically significant differences in gingivitis presence.
  • Meta-analysis-on psychological interventions versus education/information regarding the plaque index-showed a small but statistically significant difference.
  • There were also statistically significant differences reported in favor of psychological interventions in oral health behavior and self-efficacy in toothbrushing. However, the clinical relevance of these differences is difficult to estimate.


The authors concluded

This systematic review shows that psychological interventions do not result in a statistically significant difference concerning gingivitis and plaque presence. However, a small significant reduction in plaque, measured by plaque index, was found when compared with traditional oral health education in adults. The certainty of the evidence was low.


A 2007 Cochrane review had looked at psychological interventions to improve adherence to oral hygiene instructions in adults and included 4 RCTs and suggested that there was tentative evidence that psychological interventions may improve oral health although, the evidence was of low quality. That Cochrane review has now been withdrawn and a revised protocol published (O’Malley et al), with publication anticipated in 2017.

Since 2007 a number of reviews of motivational interviewing have been published which have suggested that this approach may be beneficial in improving oral health. However, as is the case with the current review the overall quality of the available evidence is low.

The authors’ note that only in 1 study was the psychological intervention delivered by a psychologist and the included studies were only undertaken in adults. Therefore there is a need for higher quality better reported studies to be undertaken that includes adolescents as well as adults. The use of agreed common outcome measures would also assist the assessment of effectiveness of the intervention.


Primary paper

Werner H, Hakeberg M, Dahlström L, Eriksson M, Sjögren P, Strandell A, Svanberg T, Svensson L, Wide Boman U. Psychological Interventions for Poor Oral Health: A Systematic Review. J Dent Res. 2016 Jan 29. pii: 0022034516628506. [Epub ahead of print] Review. PubMed PMID: 26826109.

Other references

Dental Elf – 17th Aug 2015 – Motivational interviewing for paediatric oral health

Dental Elf – 5th May 2014 – The use of motivational interviewing to improve oral health has potential but needs more research

Dental Elf – 4th July 2013 – Review suggests that motivational interviewing may have potential for improving oral health

Renz A, Ide M, Newton T, Robinson PG, Smith D. Psychological interventions to improve adherence to oral hygiene instructions in adults with periodontal diseases. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD005097. Review. PubMed PMID: 17443571.

O’Malley L, Adair P, Bonetti DL, Preshaw PM, Jervøe-Storm PM. Psychological interventions to improve adherence to oral hygiene instructions in adults with periodontal diseases. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD005097. DOI: 10.1002/14651858.CD005097.pub3.



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