Periodontal health is dependent on patient behaviours. The patient is required to maintain good oral hygiene and to seek treatment when periodontal disease is present. For the clinicians encouraging compliance with and maintenance of effective oral hygiene is a key challenge to periodontal disease management. Evidence exists that psychological interventions based on theories of health-related behaviour achieve better outcomes. The aim of this review was to determine the role that psychological constructs play in adherence to oral hygiene instruction in patients with periodontal disease.
Searches were conducted in the Cochrane Oral Health groups’ trials register, Medline, Embase and PsychINFO. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), cohort studies or case–control studies were considered. Studies of smoking cessation were excluded. Study bias for intervention trials was assessed using the Cochrane risk of bias tool for cohort and case–control studies the Newcastle-Ottawa Quality Assessment scale was used. Because of the heterogeneity of outcomes, methods and psychological models involved a narrative summary was presented.
- 14 studies reported in 15 papers were included.
- 7 theoretical models of health-related behaviour were included.
- Health Belief model (2 studies) suggest that this Model plays a small role in predicting the oral hygiene-related behaviour of individuals with periodontal disease
- Health locus of control (1 study) – no evidence of any effect.
- Social learning theory (3 studies) – All studies were at high risk of bias and it could not be concluded that the intervention conveys any advantage over an attention control.
- Theory of planned behaviour/extended theory of reasoned action (1 study) – used Structural Equation Modelling to demonstrate that the extended Theory of Reasoned Action model was a strong predictor of gingival outcome scores at 12 months.
- Implementation intentions (1 study) – intervention led to improvements in self-reported flossing frequency, dental plaque and bleeding scores at 4 weeks post-intervention in 73 patients with periodontal disease.
- Cognitive behavioural interventions (2 studies) – approach was effective in leading to improvements in both clinical indices of periodontal status and self- reported behaviour.
- Motivational interviewing (3 studies) – All 3 studies were at low risk of bias . Only one study reported a significant effect of motivational interviewing on plaque levels, but the follow-up was only at 1 month.
The authors concluded:
Perceptions of the benefits of behaviour change and the seriousness of periodontal disease (including the risk of periodontal disease) are related to adherence to oral hygiene instructions in adult periodontal patients. Interventions based on the use of goal setting, self-monitoring and planning are effective in improving oral health-related behaviours as assessed by oral health status.
This helpful review looked at a range of potential models exploring adherence to oral hygiene advice. In all the authors searched for 19 different models in a range wide range of databases finding some evidence to support 7 different models. While including 7 studies they do note that the specification of the interventions was not always clear and there was a tendency to cite the principles rather than the elements of the approach that was being adopted in the study.
Newton JT, Asimakopoulou K. 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. J Clin Periodontol. 2015 Apr;42 Suppl 16:S36-46. doi: 10.1111/jcpe.12356. PubMed PMID: 25639708.