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Raittio E, Lopez R, Baelum V. Contesting the conventional wisdom of periodontal risk assessment. Community Dent Oral Epidemiol 2024; 52:487-498. [PMID: 38243665 DOI: 10.1111/cdoe.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/05/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
Over the years, several reviews of periodontal risk assessment tools have been published. However, major misunderstandings still prevail in repeated attempts to use these tools for prognostic risk prediction. Here we review the principles of risk prediction and discuss the value and the challenges of using prediction models in periodontology. Most periodontal risk prediction models have not been properly developed according to guidance given for the risk prediction model development. This shortcoming has led to several problems, including the creation of arbitrary risk scores. These scores are often labelled as 'high risk' without explicit boundaries or thresholds for the underlying continuous risk estimates of patient-important outcomes. Moreover, it is apparent that prediction models are often misinterpreted as causal models by clinicians and researchers although they cannot be used as such. Additional challenges like the critical assessment of transportability and applicability of these prediction models, as well as their impact on clinical practice and patient outcomes, are not considered in the literature. Nevertheless, these instruments are promoted with claims regarding their ability to deliver more individualized and precise periodontitis treatment and prevention, purportedly resulting in improved patient outcomes. However, people with or without periodontitis deserve proper information about their risk of developing patient-important outcomes such as tooth loss or pain. The primary objective of disseminating such information should not be to emphasize assumed treatment efficacy, hype individualization of care, or promote business interests. Instead, the focus should be on providing individuals with locally validated and regularly updated predictions of specific risks based on readily accessible and valid key predictors (e.g. age and smoking).
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Affiliation(s)
- Eero Raittio
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Rodrigo Lopez
- School of Dentistry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vibeke Baelum
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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Thiemann L, Katzschner M, Hanna G, Kruse AB, Vach K, Ratka-Krüger P, Woelber JP. Oral-hygiene-related self-efficacy in periodontal therapy: A 4-year longitudinal study. J Clin Periodontol 2024. [PMID: 39048326 DOI: 10.1111/jcpe.14043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 06/27/2024] [Accepted: 06/29/2024] [Indexed: 07/27/2024]
Abstract
AIM Oral hygiene-related self-efficacy (OHSE) describes one's confidence to successfully execute oral hygiene behaviour. The aim of this study was to investigate the long-term course of OHSE in patients during initial periodontal therapy (IPT) and supportive periodontal therapy (SPT) and its association with clinical parameters. MATERIALS AND METHODS Patients diagnosed with periodontitis, undergoing either IPT or SPT, were evaluated at two timepoints. Clinical examination included pocket probing depths (PPDs), clinical attachment loss (CAL), bleeding on probing (BOP), plaque index (PI) and gingival index (GI). Patients' OHSE was assessed with a questionnaire. Statistical analyses included t-tests and linear regression models. RESULTS Ninety-eight patients from an initial group of 201 patients were evaluated after 4 years. The overall OHSE score increased significantly in the IPT group (mean 11.65 ± 15.6, p = .001). The increase in the OHSE category 'interdental cleaning' was significantly correlated with a decrease in the number of pockets requiring treatment (Spearman correlation rs = -.2349, p = .022) and periodontal inflamed surface area (PISA) (rs = -.2099, p = .042). CONCLUSIONS Patients under IPT showed a significant increase of OHSE compared to those under SPT. Improved OHSE, particularly in interdental cleaning, appears to be associated with sustained success of periodontal therapy.
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Affiliation(s)
- L Thiemann
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - G Hanna
- Private Practice, Demmin, Germany
| | - A B Kruse
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - K Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - P Ratka-Krüger
- Department of Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J P Woelber
- Policlinic of Operative Dentistry, Periodontology, and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Zhao Y, Shi X, Liu J, Huo R, Xia K, Wang Y, Zhu G, Lu W, Zhang L, Meng Y, Zhao Z. Patients' perceptions matter: Risk communication and psychosocial factors in orthodontics. Am J Orthod Dentofacial Orthop 2024:S0889-5406(24)00246-4. [PMID: 39033445 DOI: 10.1016/j.ajodo.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 06/01/2024] [Accepted: 06/01/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Effective risk communication is essential for achieving patient-centered oral health care, but the limited understanding of patients' subjective perceptions of orthodontic-related risks hinders this process. This study aimed to investigate adults' awareness, concerns, and risk-avoidance behaviors about long-term orthodontic risks, exploring their relationship with psychosocial factors. METHODS We included 498 adult patients (mean age, 27.3 ± 6.8 years; women, 75.5%) during their initial visits to the orthodontic department at a hospital in Chengdu, China. Participants' understanding of orthodontic risks was gauged before and after exposure to the Oral Health Education Comics (OHEC), a specifically designed digital tool. Concurrently, we used logistic regression models to investigate the associations between patients' depression, anxiety, self-esteem, perfectionism, and dentofacial esthetics with risk perceptions. RESULTS Approximately 79.5% of participants initially reported low awareness of orthodontic risks, with most knowledge from online sources. Notably, the percentage of participants with high awareness increased to 64.8% after OHEC. The negative facial soft-tissue change was most concerning for participants: 53.4% showed high concerns, and 28.1% showed high avoidance. Furthermore, linear regression indicated positive associations between depression (β = 0.42 [95% confidence interval {CI}, 0.07-0.77]) and anxiety (β = 0.76 [95% CI, 0.35-1.18]) with orthodontic risk concerns, whereas risk avoidance was positively associated with depression (β = 0.62 [95% CI, 0.27-0.97]), anxiety (β = 1.09 [95% CI, 0.68-1.50]), and perfectionism (β = 0.24 [95% CI, 0.02-0.46]). CONCLUSIONS Findings emphasize the imperative of streamlined risk communication in orthodontics. By incorporating comprehensible tools such as OHEC and integrating psychosocial evaluations, more refined patient-practitioner communication and psychosomatic-based dental care can be achieved.
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Affiliation(s)
- Yifan Zhao
- State Key Laboratory of Oral Diseases, National Center for Stomatology and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xinyi Shi
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China
| | - Junqi Liu
- State Key Laboratory of Oral Diseases, National Center for Stomatology and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Rongrong Huo
- State Key Laboratory of Oral Diseases, National Center for Stomatology and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Kai Xia
- State Key Laboratory of Oral Diseases, National Center for Stomatology and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yifan Wang
- State Key Laboratory of Oral Diseases, National Center for Stomatology and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Guanyin Zhu
- State Key Laboratory of Oral Diseases, National Center for Stomatology and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Wenxin Lu
- State Key Laboratory of Oral Diseases, National Center for Stomatology and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Lan Zhang
- State Key Laboratory of Oral Diseases, National Center for Stomatology and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yajing Meng
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China.
| | - Zhihe Zhao
- State Key Laboratory of Oral Diseases, National Center for Stomatology and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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Farina R, Simonelli A, Guarnelli ME, Secchiati G, Montemezzo G, Scapoli C, Trombelli L. Efficacy of communicating periodontal risk on psychological outcomes and supragingival plaque control in patients undergoing first periodontal consultation: A parallel-arm, randomized trial. J Clin Periodontol 2024. [PMID: 38956317 DOI: 10.1111/jcpe.14032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/31/2024] [Accepted: 06/07/2024] [Indexed: 07/04/2024]
Abstract
AIM To evaluate the efficacy of the PerioRisk prognostic tool in implementing the effect of motivational interviewing (MI) on psychological outcomes and supragingival plaque control. MATERIALS AND METHODS Participants underwent MI immediately after their first periodontal visit. According to a parallel-arm, randomized study design, MI was performed with (RISK group) or without (CTR group) information on PerioRisk level and treatment goals based on PerioRisk output. Psychological outcomes were assessed using the Positive Affect Negative Affect Scale (PANAS) and Protection Motivation Theory (PMT). Plaque index (PI) was re-evaluated after 8-12 weeks. RESULTS Significant improvements in PMT overall score and PI were observed in CTR and RISK groups, without inter-group difference in PANAS and PMT overall scores and PI. A sub-analysis showed that the overall PMT scores recorded immediately after MI in both CTR and RISK groups for subjects with no tooth loss due to periodontitis were higher than those recorded before MI in subjects with tooth loss due to periodontitis. CONCLUSIONS At first periodontal visit, MI (implemented with without PerioRisk) has tangible effects on psychological outcomes and supragingival plaque control and seems to anticipate the awareness that is commonly generated by periodontitis-related tooth loss (ClinicalTrials.gov protocol registration ID: NCT05078411).
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Affiliation(s)
- Roberto Farina
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (AUSL), Ferrara, Italy
| | - Anna Simonelli
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (AUSL), Ferrara, Italy
| | - Maria Elena Guarnelli
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (AUSL), Ferrara, Italy
| | - Giacomo Secchiati
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
| | - Giulia Montemezzo
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (AUSL), Ferrara, Italy
| | - Chiara Scapoli
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
- Section of Biology and Evolution, Department of Life Sciences and Biotechnologies, University of Ferrara, Ferrara, Italy
| | - Leonardo Trombelli
- Research Centre for the Study of Periodontal and Peri-implant Diseases, University of Ferrara, Ferrara, Italy
- Operative Unit of Dentistry, Azienda Unità Sanitaria Locale (AUSL), Ferrara, Italy
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Chow DY, Tay JRH, Nascimento GG. Systematic Review of Prognosis Models in Predicting Tooth Loss in Periodontitis. J Dent Res 2024; 103:596-604. [PMID: 38726948 DOI: 10.1177/00220345241237448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Abstract
This study reviews and appraises the methodological and reporting quality of prediction models for tooth loss in periodontitis patients, including the use of regression and machine learning models. Studies involving prediction modeling for tooth loss in periodontitis patients were screened. A search was performed in MEDLINE via PubMed, Embase, and CENTRAL up to 12 February 2022, with citation chasing. Studies exploring model development or external validation studies for models assessing tooth loss in periodontitis patients for clinical use at any time point, with all prediction horizons in English, were considered. Studies were excluded if models were not developed for use in periodontitis patients, were not developed or validated on any data set, predicted outcomes other than tooth loss, or were prognostic factor studies. The CHARMS checklist was used for data extraction, TRIPOD to assess reporting quality, and PROBAST to assess the risk of bias. In total, 4,661 records were screened, and 45 studies were included. Only 26 studies reported any kind of performance measure. The median C-statistic reported was 0.671 (range, 0.57-0.97). All studies were at a high risk of bias due to inappropriate handling of missing data (96%), inappropriate evaluation of model performance (92%), and lack of accounting for model overfitting in evaluating model performance (68%). Many models predicting tooth loss in periodontitis are available, but studies evaluating these models are at a high risk of bias. Model performance measures are likely to be overly optimistic and might not be replicated in clinical use. While this review is unable to recommend any model for clinical practice, it has collated the existing models and their model performance at external validation and their associated sample sizes, which would be helpful to identify promising models for future external validation studies.
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Affiliation(s)
- D Y Chow
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore
| | - J R H Tay
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore
| | - G G Nascimento
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
- ORH ACP, Duke-NUS Medical School Singapore, Singapore
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Mitani A, Matsuura T, Aino M, Hayashi JI, Nishida E, Hori M, Kikuchi T. Effectiveness of novel oral hygiene instruction avoiding inattentional blindness using an application for unique plaque control record calculation: A randomized clinical trial. J Periodontal Res 2024; 59:458-467. [PMID: 38186286 DOI: 10.1111/jre.13236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE This study was performed to estimate the effectiveness of novel oral hygiene instruction (OHI) focusing on areas with deep periodontal pockets for reduction of periodontal inflammation. BACKGROUND DATA DISCUSSING THE PRESENT STATUS OF THE FIELD Because stained areas on the plaque chart do not always correspond to the areas with deep periodontal pockets, conventional OHI based on O'Leary's plaque control record (PCR) often provides guidance inconsistent with the target area. METHODS This randomized clinical trial involved two groups: (1) OHI based on the PCR limited in deep pocket sites (novel OHI group) and (2) OHI based on O'Leary's PCR (conventional OHI group). The unique PCR (aggressive target for PCR [agPCR]; only counting the plaque-stained areas with PD at ≥4 mm sites) for the novel OHI was calculate by dedicated expression program. The probing depth (PD), bleeding on probing (BOP), and periodontal inflamed surface area (PISA) were obtained at the baseline and 5 to 6 months later. RESULTS The approximation curve with PISA before and after instruction indicated that the PISA converged to a lower value after instruction in the novel OHI group. The approximation curve with the improvement rate of the PISA and agPCR showed a positive correlation in the novel OHI group but no correlation in the conventional OHI group. CONCLUSION Control of inflammation was more effective in the novel OHI group. These results suggest that this novel OHI technique using our developed application could be used as a strategy to improve the effectiveness of brushing instruction.
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Affiliation(s)
- Akio Mitani
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Takato Matsuura
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Makoto Aino
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Jun-Ichiro Hayashi
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Eisaku Nishida
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Miki Hori
- Department of Dental Materials Science, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Takeshi Kikuchi
- Department of Periodontology, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
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Musson D, Buchanan H, Nolan M, Asimakopoulou K. Barriers and facilitators to using an objective risk communication tool during primary care dental consultations: A Theoretical Domains Framework (TDF) informed qualitative study. J Dent 2024; 142:104853. [PMID: 38244908 DOI: 10.1016/j.jdent.2024.104853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVES Objective risk communication tools can supplement clinical judgement and support the understanding of potential health risks. This study used the Theoretical Domains Framework (TDF) to identify barriers and facilitators to implementing a risk communication aid within primary care dental consultations. METHODS Dentists (N = 13), recruited via a dental practice database and through professional contacts were interviewed using a TDF-informed semi-structured interview schedule. Data were analysed inductively and deductively coding the themes using the TDF. RESULTS Eight theoretical domains (environmental context and resources; beliefs about consequences; goals; memory, attention, and decision processes; optimism; reinforcement; social influences and behavioural regulation) and thirteen sub-themes were identified. Insufficient resources and patient factors were commonly encountered barriers and led to increasing pressure to prioritise other tasks. Whilst dentists had a favourable view towards a risk communication aid and acknowledged its benefits, some were sceptical about its ability to facilitate behaviour change. Self-monitoring strategies and colleague support facilitated tool usage. CONCLUSIONS This study identified six barriers and seven facilitators to implementing a risk communication tool within primary care dental settings. Dentists appreciated the value of using a risk communication tool during dental consultations, although some required further support to integrate the tool into practice. CLINICAL SIGNIFICANCE Our findings provide a sound theoretical base for interventions aimed at facilitating patient behaviour change through the use of risk communication in dentistry. Further research should apply behavioural science to support the implementation of the tool in clinical practice.
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Affiliation(s)
- Danielle Musson
- University of Nottingham, School of Medicine, Faculty of Medicine and Health Sciences, Nottingham, United Kingdom.
| | - Heather Buchanan
- University of Nottingham, School of Medicine, Faculty of Medicine and Health Sciences, Nottingham, United Kingdom
| | | | - Koula Asimakopoulou
- Faculty of Dentistry Oral & Craniofacial Sciences, Kings College London, Centre for Host-Microbiome Interactions, London, United Kingdom
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Asimakopoulou K, West N, Davies M, Gupta A, Parkinson C, Scambler S. Why don't dental teams routinely discuss dentine hypersensitivity during consultations? A qualitative study informed by the Theoretical Domains Framework. J Clin Periodontol 2024; 51:118-126. [PMID: 37817400 DOI: 10.1111/jcpe.13885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 10/12/2023]
Abstract
AIM Although dentine hypersensitivity is widespread, can cause substantial pain and impact quality of life, it is not routinely discussed during dental consultations. This qualitative study aimed to develop an understanding of the barriers and facilitators to these discussions. MATERIALS AND METHODS Using the Theoretical Domains Framework to shape the topic guide, N = 7 online focus groups were organized with a total N = 40 participants comprising experienced dentists, dental foundation trainees and dental care professionals. Inductive and deductive thematic analyses of the anonymized, transcribed focus group conversations were undertaken. RESULTS An attitude-behaviour gap was observed in dental teams' accounts. Although they saw it as part of their professional role to routinely discuss sensitivity, and believed that such conversations were 'an easy win', in practice they experienced several behavioural barriers that hindered these conversations from taking place. These included competing priorities, a perceived lack of seriousness and assessment of dentine hypersensitivity and practical issues such as time. CONCLUSIONS Systemic (e.g., lack of time and training, professional culture) and behavioural (e.g., dental teams' belief that conversations should take place only with patients likely to be adherent) barriers to dentine hypersensitivity conversations explain why these conversations do not routinely take place.
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Affiliation(s)
- Koula Asimakopoulou
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Nicola West
- Clinical Trials, Periodontology, Bristol Dental School, Bristol, UK
| | - Maria Davies
- Clinical Trials, Periodontology, Bristol Dental School, Bristol, UK
| | - Anisha Gupta
- Clinical Trials, Periodontology, Bristol Dental School, Bristol, UK
| | | | - Sasha Scambler
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
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Asimakopoulou K, Kitsaras G, Newton JT. Using behaviour change science to deliver oral health practice: A commentary. Community Dent Oral Epidemiol 2023; 51:697-704. [PMID: 35681257 DOI: 10.1111/cdoe.12766] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 05/10/2022] [Accepted: 05/27/2022] [Indexed: 12/01/2022]
Abstract
The aims of this commentary are threefold; firstly, we summarize changes in oral health behaviour change research and practice; secondly, we identify key barriers and challenges proposing practical ways to overcome them; and finally, we showcase key developments on the global and local stage outlining key opportunities for the future of oral health behaviour change. Not applicable. Advancements, including the Capability-Opportunity-Motivation (COM-B), Motivation, Action regulation-Prompts (MAP) and the Goal setting, Planning and Self-Monitoring (GPS) models have showcased a range of evidence-based opportunities to deliver oral health behaviour change. Despite their merits, oral health behaviour change still faces barriers and challenges that limit its scope, applicability and practicability for oral health professionals. Recent developments on the global and local stage have highlighted the important role oral health behaviour change has to play for the future of oral health. We provide practical examples to show how these advancements can be delivered in practice, noting that learnings from other disciplines can help shape the future of oral health behaviour change. A combination of encouraging signs and recent, positive developments have resulted in an unprecedented focus on oral health behaviour change. Through ongoing and future research, meaningful changes to the oral health of the population through applied behavioural science are in sight.
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Affiliation(s)
- Koula Asimakopoulou
- Faculty of Dentistry, Oral & Craniofacial Sciences (FoDOCS), King's College London, London, UK
| | - George Kitsaras
- Dental Health Unit, Division of Dentistry, University of Manchester, Manchester, UK
| | - Jonathon Tim Newton
- Faculty of Dentistry, Oral & Craniofacial Sciences (FoDOCS), King's College London, London, UK
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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:jcm12062276. [PMID: 36983277 PMCID: PMC10058764 DOI: 10.3390/jcm12062276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/11/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
This systematic review aimed to investigate the impact of different psychological models, strategies, and methods to improve plaque control and/or gingival inflammation in patients with periodontal diseases. Methods: The PubMed/MEDLINE, Cochrane Library, and Embase online databases were explored to identify relevant studies published before October 2022. Articles investigating the effects of different psychological approaches and intervention strategies on periodontitis patients’ oral hygiene (OH) behavioral change were screened. Results: 5460 articles were identified, and 21 fulfilled the inclusion criteria. In total, 2 studies tested audio-visual modalities, and the remaining 19 publications involved six psychological models of health-related behavioral interventions, including Social Cognitive Theory, the Theory of Planned Behavior, the Health Action Process Approach, Leventhal’s self-regulatory theory, Motivational Interviewing, and Cognitive Behavioral Therapy. A meta-analysis of the results was not carried out due to the high heterogeneity among the interventions. Conclusions: Considering the limitations of the available studies, psychological interventions based on social cognitive models that combine some of the techniques of this model (goal setting, planning, self-monitoring, and feedback) may improve OH in periodontitis patients, having a positive impact on periodontal clinical outcomes. Delivering cognitive behavioral therapy in combination with motivational interviewing may result in an improvement in OH as evaluated by decreasing plaque and bleeding scores.
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Affiliation(s)
| | - Catherine Petit
- Dental Faculty, University of Strasbourg, 67000 Strasbourg, France
- Pole de Médecine et Chirurgie Bucco-Dentaire, Periodontology, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Olivier Huck
- Dental Faculty, University of Strasbourg, 67000 Strasbourg, France
- Pole de Médecine et Chirurgie Bucco-Dentaire, Periodontology, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
- Correspondence:
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Kitsaras G, Asimakopoulou K, Henshaw M, Borrelli B. Theoretical and methodological approaches in designing, developing, and delivering interventions for oral health behaviour change. Community Dent Oral Epidemiol 2023; 51:91-102. [PMID: 36749671 DOI: 10.1111/cdoe.12817] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 10/21/2022] [Accepted: 11/11/2022] [Indexed: 02/08/2023]
Abstract
Oral health behaviour change interventions are gaining momentum on a global scale. After lagging behind other disciplines, oral health behaviour change is becoming an area of fast and important development. Theories used in medicine and healthcare more generally are now being applied to oral health behaviour change with varying results. Despite the importance of using theories when designing and developing interventions, the variety and variation of theories available to choose from create a series of dilemmas and potential hazards. Some theories, like the COM-B (Capability, Opportunity, Motivation-Behaviour) model, and frameworks, like the Behaviour Change Wheel might represent areas of opportunity for oral health behaviour change interventions with careful consideration vital. Different methodological approaches to intervention development are actively utilized in oral health with a wide host of potential opportunities. The issue of co-designing and co-developing interventions with intended users and stakeholders from the start is an important component for successful and effective interventions, one that oral health behaviour change interventions need to consistently implement. Oral health behaviour change interventions are utilizing technology-based approaches as a major vehicle for intervention delivery and, innovative solutions are implemented across a wide host of oral health behaviour change interventions. With multiple options for designing, developing, and delivering interventions, careful selection of appropriate, user-inclusive, and adaptable approaches is essential. With a lot of available information and evidence from other disciplines, oral health behaviour change interventions need to reflect on lessons learned in other fields whilst also maximizing the potential of the wide variety of theories, frameworks, methodologies, and techniques available at present.
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Affiliation(s)
- George Kitsaras
- Dental Health Unit, University of Manchester, Manchester, UK
| | | | - Michelle Henshaw
- Henry M. Goldman School of Dentistry, Boston University, Boston, Massachusetts, USA
| | - Belinda Borrelli
- Henry M. Goldman School of Dentistry, Boston University, Boston, Massachusetts, USA
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Sharma P, Kristunas C, Chapple IL, Dietrich T. Periodontal health and patient-reported outcomes: A longitudinal analysis of data from non-specialist practice settings. J Clin Periodontol 2023; 50:582-590. [PMID: 36644795 DOI: 10.1111/jcpe.13776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/17/2023]
Abstract
AIM To explore the associations between periodontal health and patient-reported outcomes (PROs), accounting for changes over time, in a large, non-specialist dental practice patient cohort. MATERIALS AND METHODS This longitudinal study used data from 13,162 dentate patients, collected by 162 dentists at routine appointments between May 2013 and April 2020, in 238 non-specialist dental practices across the United Kingdom. Dentists collected data, as part of routine clinical care, on periodontal probing pocket depths, alveolar bone loss, bleeding on probing, as well as a range of covariates. Patients inputted data on outcomes (oral pain/discomfort, dietary restrictions, and dental appearance). Mixed-effects logistic regression analysis was used to investigate the associations between periodontal health and PROs. Models accounted for clustering at the patient and dentist level and were adjusted for time and variables which were thought to confound these associations. RESULTS The odds of all PROs tended to increase with worsening periodontal parameters. For example, the odds of reporting pain in the worst periodontal health category were 1.99 (95% confidence interval: 1.57-2.53) times higher than in the best periodontal health category. CONCLUSIONS This study confirms, using a large longitudinal dataset from a unique non-specialist setting, the associations between poorer periodontal health and poorer PROs.
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Affiliation(s)
- Praveen Sharma
- Periodontal Research Group, School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, Birmingham, UK.,Birmingham Dental Hospital, Birmingham Community Healthcare NHS Foundation Trust, UK
| | - Caroline Kristunas
- Periodontal Research Group, School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Iain L Chapple
- Periodontal Research Group, School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, Birmingham, UK.,Birmingham Dental Hospital, Birmingham Community Healthcare NHS Foundation Trust, UK
| | - Thomas Dietrich
- Periodontal Research Group, School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Birmingham Biomedical Research Centre, Birmingham, UK.,Birmingham Dental Hospital, Birmingham Community Healthcare NHS Foundation Trust, UK
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Matsuda S, Yoshimura H. Impact of oral health management on mental health and psychological disease: a scoping review. J Int Med Res 2023; 51:3000605221147186. [PMID: 36594601 PMCID: PMC9827524 DOI: 10.1177/03000605221147186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The relationship between oral and mental health has been controversial. Few studies have assessed the direct effects of oral health management on mental health and psychological disease. Using evidence from the last 5 years, this scoping review aimed to map and discuss recent progress in understanding this relationship. METHODS Electronic literature searches were performed using PubMed, Web of Science, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature databases. An additional manual search was performed using Google Scholar databases. Studies were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow diagram. RESULTS An eligibility review process identified three randomized controlled trials for inclusion in this review. The oral health interventions and participants' target age, mental health status, and psychological diseases varied across these studies. The only study that reported an improvement included psychosocial support integrated with educational components of oral health as the intervention. The remaining two studies detected no significant impact of oral health interventions on mental health and psychological disease. CONCLUSIONS Evidence of the impact of oral health management on mental health and psychological disease is insufficient in studies published between 2017 and 2021.
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Affiliation(s)
- Shinpei Matsuda
- Shinpei Matsuda, Department of Dentistry
and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine,
Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki,
Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
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Böhme Kristensen C, Ide M, Forbes A, Asimakopoulou K. Psychologically informed oral health interventions in pregnancy and type 2 diabetes: a scoping review protocol. BMJ Open 2022; 12:e062591. [PMID: 36123100 PMCID: PMC9486353 DOI: 10.1136/bmjopen-2022-062591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Periodontal health is becoming a recognised component in managing gestational diabetes. Gestational diabetes is characterised as raised blood glucose levels first discovered in pregnancy and managed similarly to type 2 diabetes. Currently, the standard intervention for gestational diabetes in the UK entails dietary modifications and physical activity interventions. However, considering the literature discussed in this review, it is argued that oral health advice and support should also become an integrated part of gestational diabetes management. OBJECTIVE The objective of this scoping review is to map out psychologically informed oral health interventions in pregnancy and type 2 diabetes. This will inform the development of a new behavioural intervention to promote oral health-related behaviours in women with gestational diabetes. As no literature exists on oral health interventions in gestational diabetes, it was deemed appropriate to synthesise the evidence on oral health interventions designed for pregnant women and individuals with type 2 diabetes. METHODOLOGY The scoping review will be conducted using the Joanna Briggs Institute's methodology for scoping reviews. Studies including pregnant women and individuals with type 2 diabetes over 18 years of age will be included. Only studies including a psychologically informed oral health intervention will be considered. The authors will consider experimental and quasi-experimental research designs. The Ovid Interface including EMBASE, Medline, Global Health, APA PsychInfo, Health Management Information, Maternity, Infant Care Database and the Cochrane Library will be used as information sources. The planned searches will commence on the week of the 25 July 2022. Only articles in Danish and English will be considered. The study selection will follow the Preferred Reporting Items for Scoping Reviews process. The data will be presented using narrative synthesis. ETHICS AND DISSEMINATION No ethical approval is needed for this review. The results will be published in a relevant scientific journal.
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Affiliation(s)
| | - Mark Ide
- Centre for Host-Microbiome Interactions, King's College London, London, UK
| | - Angus Forbes
- Nursing, Midwifery & Palliative Care, King's College London, London, UK
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15
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Rogers AA, Willumsen T, Strømme H, Johnsen JAK. Top-down self-regulation processes as determinants of oral hygiene self-care behaviour: A systematic scoping review. Clin Exp Dent Res 2022; 8:807-826. [PMID: 35396799 PMCID: PMC9382055 DOI: 10.1002/cre2.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 02/03/2022] [Accepted: 02/11/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives Understanding the psychological mechanisms that moderate oral hygiene self‐care behavior is anticipated to benefit efforts to change such behavior. Top‐down self‐regulatory (TSR) processes represent one group of relatively unexplored, yet potentially influential, moderating factors. This systematic scoping review aims to explore whether there is evidence that TSR processes moderate oral hygiene self‐care engagement within the current literature. Methods CINAHL, The Cochrane Library, Embase, MEDLINE, PsycINFO, Scopus, and Web of Science databases were searched up to April 2020 for articles that compared measures of TSR processes (such as self‐monitoring, inhibitory control, and task switching) to oral hygiene self‐care behavior, or tested interventions that aimed to change or support TSR processes. Results The search returned 6626 articles, with 25 included in the final sample. Weak evidence supported both the role of TSR processes as moderators of interdental cleaning and the value of interventions targeting self‐monitoring of interdental cleaning behavior. Overall, methodological limitations rendered the findings somewhat inconclusive, with an absence of objective assessments of TSR capacity, and little focus on TSR processes as moderators of intervention effects. Conclusions The inconclusive, but reasonably promising, findings point to the value of continuing to apply TSR processes within studies of oral hygiene behavior. Exploring why interdental cleaning appears more reliant on TSR processes than toothbrushing, employing objective neuropsychological assessment, and measuring TSR constructs within interventions targeting TSR processes, are encouraged. As a scoping review, the study hopes to generate interest and serve as a starting point for further investigation.
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Affiliation(s)
- Adam A Rogers
- Institute of Clinical Dentisty, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tiril Willumsen
- Institute of Clinical Dentisty, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Hilde Strømme
- University of Oslo Library, University of Oslo, Oslo, Norway
| | - Jan-Are K Johnsen
- Department of Clinical Dentistry, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
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Holloway JA, Davies M, McCarthy C, Khan I, Claydon NCA, West NX. Randomised controlled trial demonstrating the impact of behaviour change intervention provided by dental professionals to improve gingival health. J Dent 2021; 115:103862. [PMID: 34706268 DOI: 10.1016/j.jdent.2021.103862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
AIMS To determine impact of oral hygiene behaviour change intervention compared to the prevailing standard of oral hygiene advice provided in general dental practice, on bleeding on probing (BOP) in gingivitis patients, over 3-months. The effect of providing power-brushes was also evaluated. MATERIALS AND METHODS NHS dental practices were cluster-randomised to intervention or control (2:1). Dentists at intervention sites received behaviour modification training. Participants were stratified to high (≥20% BOP) or low (<20% BOP) presence of gingivitis and a subset assigned a power-brush. BOP and plaque scores were assessed at baseline and 3-months. RESULTS A total of 538 participants (369:169; intervention: control) completed the study. BOP reduced in both gingivitis groups with significantly greater reduction in intervention compared to control group (BOP:38% vs 19%, p = 0.0236); Borderline significance favouring the intervention was demonstrated for the low gingivitis group (BOP:37% vs 15%, p = 0.0523). A highly significant reduction in BOP (intervention vs control) was demonstrated for volunteers who swapped from manual to power-brush (44% vs 37%, p = 0.0039). Plaque score improved more in control than intervention group (Plaque:37% vs 44%, p = 0.00215). CONCLUSIONS Behaviour change techniques were readily mastered by the dental professional researchers. The introduction of an oral hygiene behaviour change intervention significantly reduced gingivitis in volunteer patients compared to control at 3 months. Swapping to a power-brush significantly favoured BOP reduction compared to manual brush continuation although plaque reduction did not follow expectation in comparison to BOP scores. Behaviour change techniques should routinely be considered in patient care. CLINICAL SIGNIFICANCE Plaque-induced gingivitis is highly prevalent in the UK despite being preventable with good oral hygiene. Its continuum, periodontitis, negative impacts quality of life. This study suggests oral hygiene behavioural interventions (GPS) significantly reduce gingivitis and that GPS introduction will improve oral health and may improve quality of life.
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Affiliation(s)
- Jessica A Holloway
- Clinical Trials Group, School of Oral and Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY, United Kingdom.
| | - Maria Davies
- Clinical Trials Group, School of Oral and Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY, United Kingdom.
| | | | | | - Nicholas C A Claydon
- Clinical Trials Group, School of Oral and Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY, United Kingdom.
| | - Nicola X West
- Clinical Trials Group, School of Oral and Dental Sciences, University of Bristol, Lower Maudlin Street, Bristol BS1 2LY, United Kingdom.
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Periodontal care in general practice: 20 important FAQs - Part two. Br Dent J 2019; 227:875-880. [PMID: 31758122 DOI: 10.1038/s41415-019-0944-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This is the second in a two-part series that aims to summarise answers to common questions facing dentists in general practice. The first part of this series is entitled 'Periodontal care in general practice: 20 important FAQs - Part one' (Br Dent J 2019;226: 850-854) and contains the first set of ten FAQs.
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