The effect of a behavioural management tool in adults with mild to moderate periodontitis. A single‐blind, randomized controlled trial

Abstract

Objective To compare a behavioural management program (test) to a standard communication approach (control) to reduce plaque, improve clinical outcomes and patient's compliance with oral self‐care. Background Since psychological factors affect oral health–related behaviours, approaches directed at changing behaviours and improving compliance might improve the effect of oral health education. Materials and Methods This was a randomized, single‐blind, parallel‐design trial involving 71 patients with mild to moderate periodontitis. During a run‐in period, all participants began using a power toothbrush. Two sessions of non‐surgical periodontal therapy were performed post‐baseline, along with one of the two oral healthcare communication approaches. Plaque and bleeding scores, probing pocket depth (PPD) and clinical attachment level (CAL) were recorded at the screening visit, baseline visit and at 8 and 14 weeks post‐baseline. Patients were asked to fill in oral self‐care diaries. Experience questionnaires were administered to both clinicians and patients to assess subjective experience of the clinician‐patient interactions during the visits. Results In both groups, a significant reduction in plaque and bleeding scores was observed from baseline to 8 weeks after baseline, which then remained stable at week 14, but no differences between the groups were noted. An improvement in CAL and PPD was recorded at week 8 post‐baseline in the test compared to the control group. No inter‐group differences in the clinician's and subject's experience questionnaires were observed. Conclusion Both approaches significantly promoted periodontal health. However, changing lifestyle requires repeated communication/engagement over time and a behavioural management program based upon two visits did not provide additional benefit compared to a standard approach.

Comparison of the efficacy of periodontal prognostic systems in predicting tooth loss

“…For example, of 14 extracted teeth initially judged to have “good” or “fair” prognosis by McGuire and Nunn (1996), only 1 was extracted for periodontal reasons, while others were lost for fractures ( n = 6), crowding/orthodontic reasons ( n = 5) and caries ( n = 2). Furthermore, relying on tooth data alone in these prognostic systems is not enough to provide optimal patient care, as patient factors are also very important, and a questionable tooth in the mouth of a “good prognosis” and very motivated patient (Donos et al, 2021) can have a better prognosis than in the mouth of a non‐compliant patient with other risk factors (Eickholz et al, 2008; Morelli et al, 2017). Other studies have also tried to combine patient factors such as smoking and bruxism with tooth factors (Martinez‐Canut & Llobell, 2018) or to use the staging and grading classification in order to predict tooth loss (Ravidà et al, 2019).…”

Motivational interviewing for preventing oral morbidities in adults: Systematic review and meta‐analysis

“…Only one study reported the participation of a Ph.D. student in Psychology trained in MI and a clinical psychologist 24 who examined fidelity with recording audios, performance rating and feedback. In the case of Donos et al, 15 the same clinician gave both interventions previously receiving specific training and taking care to minimize the risk of crossover effect. Moreover, Stenman et al 24 reported the fidelity assessment with MI Treatment Integrity, 25 and Almomani et al 23 also mentioned that they assessed the fidelity, but it was not reported.…”

“…For BOP, the two considered effects are Jönsson et al 22 with a mean change of −4.00 (CI: [−9.78; 1.78]) and Donos et al 15 with a mean change of −10.00 (CI: [−17.78; −2.22]). The summary effect for these two studies was a mean change of −6.13 percentage points (CI: [−10.77; −1.49].…”

“…Only analyses based on the full-mouth measurements are reported, as this allowed including one more study for the Plaque Index outcome. 15 Analyses of only proximal surface measurements are available in the code. As the design of RCTs corresponded to a pretest-posttest-control-design, the mean change was our measure of interest.…”

“…Meta‐analysis was conducted for each outcome of interest, namely Plaque Index (PI), Bleeding on Probing (BoP) and Gingival Index (GI). Only analyses based on the full‐mouth measurements are reported, as this allowed including one more study for the Plaque Index outcome 15 . Analyses of only proximal surface measurements are available in the code.…”