You are viewing this site in staging mode. Click in this bar to return to normal site.

Psychological interventions to improve adherence to oral hygiene instructions in adults

Background

Gum Disease (periodontitis) is a major public health problem affecting quality of life. More than 45% of UK adults are affected and there are known links to other serious conditions.  Gum disease is preventable and treatable if caught early.

Oral health is critically dependent on behaviour. In order to maintain healthy teeth and gums individuals need to undertake regular effective oral hygiene behaviours. Including tooth brushing with a fluoride toothpaste, interdental cleaning, regular dental attendance and reducing sugar intake. In particular tooth brushing and interdental cleaning are key to avoiding periodontal disease.

There is tentative evidence that psychological approaches to behaviour management can improve oral hygiene related behaviours. Psychologists have identified oral hygiene behaviour as an interesting target for behaviour change given its near universality and the central role of behaviour in maintaining oral health. There are several possible targets for interventions, distinguishing between situations where individuals lack the motivation to change their oral hygiene behaviour (lack of motivation) , and those who are motivated but require support in planning and maintaining behaviour change (lack of volition).

Improvement in a patient’s oral hygiene is often accomplished through the cooperative interaction between the patient and the dental professional. The topic that I chose for my thesis was ‘Psychological interventions to improve adherence to oral hygiene instructions in adults’. The aim of this study was to evaluate an individually tailored Oral Health Psychological Programme (ITOHPP) on periodontal health compared with a Standard Oral Health Educational Programme (SOHP).

Methods:

This study was conducted in two private dental practices in central London. Twenty five participants aged 18-65 years were randomly selected and allocated to an ITOHPP (Experimental Group). A further twenty five participants (aged 18-65 years) were randomly selected and allocated to a SOHP (Control Group).

The Experimental group received an additional 15 minutes ITOHPP based on Cognitive behavioural principles and the individual tailoring for each participants is based on participant’s thoughts, beliefs, capacity, barriers, goals with subsequent guidance towards appropriate and effective oral hygiene habits.

The Health Belief Model (HBM) and Motivational interviewing (MI) were used for the Experimental Group which was suitable for addressing problem behaviours that evoke health concerns – in this case high risk of gingivitis and periodontal disease.

Results:

An ITOHPP approach significantly changed the patient’s behaviour to adherence and compliance in maintaining good oral hygiene, resulting in reduced plaque score and gingival bleeding for patients in the experimental group.

Conclusion:

This study showed evidence that psychological approaches to behaviour management can improve oral hygiene related behaviours. The limitation of the study was the short duration of the trial: the effect of the behavioural change was only assessed during a period of 3-4 months. Ideally, a period of 12 months is required to further investigate the effectiveness of a period of 12 months is required to further investigate the effectiveness of an ITOHPP approach in improving long term oral hygiene behaviours.

 

Tara Taheri, Dental Hygienist

Email: tara.taheri@yahoo.co.uk