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Ravidà A, Saleh MHA, Ghassib IH, Qazi M, Kumar PS, Wang HL, Eke PI, Borgnakke WS. Impact of smoking on cost-effectiveness of 10-48 years of periodontal care. Periodontol 2000 2024. [PMID: 39054672 DOI: 10.1111/prd.12585] [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: 02/23/2024] [Revised: 06/02/2024] [Accepted: 06/03/2024] [Indexed: 07/27/2024]
Abstract
The study aims were (1) to explore whether "periodontal treatment" consisting of surgical therapy (flap, resective, or regenerative) or scaling and root planing treatment with long-term periodontal maintenance treatment, is cost-effective in terms of preventing periodontitis-attributable tooth extraction and replacement by implant-supported crowns ("extraction/replacement"); (2) to assess the effect of cigarette smoking on this cost-effectiveness. Data for this observational retrospective study were collected from dental charts of patients who had received periodontal therapy and at least annual follow-up visits for >10 years were analyzed by linear regression generalized estimating equations and generalized linear models. Among 399 adults (199 males, 200 females), those with the least mean annual treatment cost experienced the greatest mean annual costs for extraction/replacement, indicating general cost-effectiveness. Cigarette smoking adversely impacted this cost-effectiveness, with current heavy smokers experiencing no cost-effectiveness. Former smokers with Grade C periodontitis benefitted most, whereas smoking did not influence cost-effectiveness for Grade B periodontitis. Assessed by mean annual costs of "extraction/replacement," periodontal treatment was cost-effective, which decreased in a dose-response manner by former and current smoking intensity. Cigarette smoking should be factored into treatment planning and cost-effective analyses of periodontal treatment. Smoking cessation should be encouraged.
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Affiliation(s)
- Andrea Ravidà
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Iya H Ghassib
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Periodontics, The Virginia Commonwealth University, Richmond, Virginia, USA
| | - Musa Qazi
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
| | - Purnima S Kumar
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Paul I Eke
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Wenche S Borgnakke
- Department of Periodontics and Oral Medicine, The University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Saleh MHA, Dias DR, Kumar P. The economic and societal impact of periodontal and peri-implant diseases. Periodontol 2000 2024. [PMID: 38693603 DOI: 10.1111/prd.12568] [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: 02/01/2024] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
Periodontal and peri-implant diseases result from a chronic inflammatory response to dysbiotic microbial communities and are characterized by inflammation in the soft tissue and the ensuing progressive destruction of supporting bone, resulting in tooth or implant loss. These diseases' high prevalence, multifactorial etiology, extensive treatment costs, and significant detriment to patients' quality-of-life underscore their status as a critical public health burden. This review delineates the economic and sociocultural ramifications of periodontal and peri-implant diseases on patient welfare and healthcare economics. We delve into the implications of diagnosis, treatment, supportive care, and managing destructive tissue consequences, contrasting these aspects with healthy patients.
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Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Debora R Dias
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
| | - Purnima Kumar
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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3
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Karlsson K, Derks J, Wennström JL, Petzold M, Berglundh T. Health economic aspects of implant-supported restorative therapy. Clin Oral Implants Res 2021; 33:221-230. [PMID: 34888933 DOI: 10.1111/clr.13885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/10/2021] [Accepted: 11/25/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND It is poorly understood how much additional dental care patients consume subsequent to implant therapy. The aim of the present study is to evaluate costs associated with implant-supported restorative therapy during the long-term follow-up. MATERIAL AND METHODS Costs associated with preventive measures and complication-related procedures over a mean follow-up period of 8.2 years were assessed in patient files of 514 Swedish subjects provided with implant-supported restorative therapy. The restorative therapy and each of the subsequent interventions were assigned a specific cost. Accumulated costs were calculated in three categories: (i) total cost including initial restorative therapy and complication-related interventions, (ii) cost of preventive measures alone, and (iii) cost of complication-related procedures alone. Potential differences by background variables were analyzed using growth curve models. RESULTS In the whole sample, costs during follow-up ranged from 878 € (95% CI 743; 1,014) for patients with single-tooth restoration(s) to 1,210 € (95% CI 1,091; 1,329) for subjects with full-jaw restoration(s). The majority of costs during follow-up originated from preventive measures (741 € 95% CI 716; 766). Among individuals receiving ≥1 intervention dealing with a complication (n = 253), complication-related costs amounted to 557 € (95% CI 480; 634). For patients with full-jaw restorations, the corresponding amount was 769 € (95% CI 622; 916). Procedures related to peri-implantitis and technical complications resulted in costs similar to each other. Implant loss generated greater costs than any other type of complication. CONCLUSIONS Costs related to implant-supported restorative therapy during follow-up were associated with the extent of initial therapy. The higher costs during follow-up noted in patients provided with full-jaw restorations were explained by complication-associated procedures. Implant loss was the most costly type of complication.
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Affiliation(s)
- Karolina Karlsson
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Derks
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan L Wennström
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Tord Berglundh
- Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Smoking Cessation therapy is a cost-effective intervention to avoid tooth loss in Brazilian subjects with periodontitis: an economic evaluation. BMC Oral Health 2021; 21:616. [PMID: 34861866 PMCID: PMC8642876 DOI: 10.1186/s12903-021-01932-2] [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: 02/10/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Smokers present a higher prevalence and severity of periodontitis and, consequently, higher prevalence of tooth loss. Smoking cessation improves the response to periodontal treatment and reduces tooth loss. So, the aim of this study was to evaluate the efficiency in resources allocation when implementing smoking cessation therapy vs. its non-implementation in smokers with periodontitis. Methods We adopted the Brazilian public system perspective to determine the incremental cost-effectiveness (cost per tooth loss avoided) and cost-utility (cost per oral-related quality-adjusted life-year ([QALY] gained) of implementing smoking cessation therapy. Base-case was defined as a 48 years-old male subject and horizon of 30 years. Effects and costs were combined in a decision analytic modeling framework to permit a quantitative approach aiming to estimate the value of the consequences of smoking cessation therapy adjusted for their probability of occurrence. Markov models were carried over annual cycles. Sensitivity analysis tested methodological assumptions. Results Implementing the therapy saved approximately US$ 100 over the time horizon accompanied by a slightly better effect, both in CEA and CUA. Considering uncertainties, the therapy could be cost-effective in the most part of simulated cases, even being cheaper and more effective in 35% of cases in which the oral-health related outcome is used as effect. Considering a willingness-to-pay of US$100 per health effect, smoking cessation therapy was cost-effective, respectively, in 72% and 99% of cases in cost-utility and cost-effectiveness analyses. Conclusions Implementation of smoking cessation therapy may be cost-effective, considering the avoidance of tooth loss and oral health-related consequences to patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01932-2.
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Ng E, Tay JRH, Ong MMA. Minimally Invasive Periodontology: A Treatment Philosophy and Suggested Approach. Int J Dent 2021; 2021:2810264. [PMID: 34257659 PMCID: PMC8245214 DOI: 10.1155/2021/2810264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 01/20/2023] Open
Abstract
Severe periodontitis is a highly prevalent dental disease. With the advent of implant dentistry, teeth are often extracted and replaced. Periodontal surgery, where indicated, could also result in increased trauma to the patient. This literature review discusses different treatment modalities for periodontitis and proposes a treatment approach emphasizing maximum preservation of teeth while minimizing morbidity to the patient. Scientific articles were retrieved from the MEDLINE/PubMed database up to January 2021 to identify appropriate articles that addressed the objectives of this review. This was supplemented with hand searching using reference lists from relevant articles. As tooth prognostication does not have a high predictive value, a more conservative approach in extracting teeth should be abided by. This may involve repeated rounds of nonsurgical periodontal therapy, and adjuncts such as locally delivered statin gels and subantimicrobial-dose doxycycline appear to be effective. Periodontal surgery should not be carried out at an early phase in therapy as improvements in nonsurgical therapy may be observed up to 12 months from initial treatment. Periodontal surgery, where indicated, should also be minimally invasive, with periodontal regeneration being shown to be effective over 20 years of follow-up. Biomarkers provide an opportunity for early detection of disease activity and personalised treatment. Quality of life is proposed as an alternative end point to the traditional biomedical paradigm focused on the disease state and clinical outcomes. In summary, minimally invasive therapy aims to preserve health and function of the natural dentition, thus improving the quality of life for patients with periodontitis.
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Affiliation(s)
- Ethan Ng
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
| | - John Rong Hao Tay
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
| | - Marianne Meng Ann Ong
- Department of Restorative Dentistry, National Dental Centre Singapore, Singapore 168938, Singapore
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore 169857, Singapore
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Gunpinar S, Meraci B. Periodontal health education session can improve oral hygiene in patients with gingivitis: A masked randomized controlled clinical study. J Periodontol 2021; 93:218-228. [PMID: 34048073 DOI: 10.1002/jper.21-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The aim of this clinical trial was to evaluate the effect of a periodontal health education session (PHES), which included education on the pathogenesis and consequences of periodontal diseases on oral hygiene motivation in patients with gingivitis. METHODS A randomized controlled clinical trial was conducted on 50 (26 females and 24 males) patients with gingivitis who underwent periodontal treatment. Subjects were randomly allocated into the PHES group (experimental group) and standard oral hygiene education group (control group). The Rustogi Modified Navy Plaque Index (RMNPI) and Papillary Bleeding Index (PBI) were used to evaluate oral hygiene at baseline and were repeated after 1, 3, and 6 months. Knowledge about periodontal disease was measured and the participants' motivation was determined using the Oral Hygiene Motivation Scale. RESULTS Although baseline knowledge levels and motivation scores were not different between the groups, following the educational motivational interviewing (MI) session, levels were higher in the experimental compared with the control group. The subjects' RMNPI and PBI scores at the 1-, 3-, and 6- month re-examinations were statistically higher in the control group than the experimental group. Furthermore, the level of knowledge and intrinsic and total motivation scores were moderately positively correlated with a reduction in clinical indices at 6 months compared with baseline. CONCLUSIONS The results of this study indicated that increased knowledge and awareness about periodontal diseases and its consequences, including systemic effects, via educational MI session increased intrinsic motivation and improved oral hygiene of patients with gingivitis, especially regarding interproximal surfaces.
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Affiliation(s)
- Sadiye Gunpinar
- Department of Periodontology, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Bilge Meraci
- Department of Periodontology, Faculty of Dentistry, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Tay JRH, Ng E, Nair R, Tan ZS, Tan SHX. Economic evaluations in the treatment and evaluation of patients with periodontal disease: A critical review. J Clin Periodontol 2021; 48:679-694. [PMID: 33768622 DOI: 10.1111/jcpe.13456] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 12/25/2022]
Abstract
AIM To evaluate the types and quality of reporting of economic evaluations carried out in the clinical management of periodontal disease over 32 years from 1987 to 2019. MATERIAL AND METHODS A systematic search of articles from 1987 to 2019 was conducted using PubMed, Web of Science, The Cochrane Central Register of Controlled Trials, Health Technology Assessment Database and Embase. The quality of the economic evaluations was assessed based on the Consolidated Health Economic Evaluation Reporting Standard checklist. Due to considerable between-study heterogeneity, a meta-analysis was not performed. RESULTS Twenty one publications were included. 11 studies used cost-effectiveness analysis, five used cost-minimization analysis, four used cost-utility analysis and two used cost-benefit analysis. Comparators, choice of health outcomes, estimating resources and costs were fully reported in all studies. Many studies had inadequate reporting in terms of estimating resources and costs, choice of health outcomes, characterizing heterogeneity and study perspective. CONCLUSIONS There has been an increase in health economics studies in the field of clinical periodontology over the past decade. Several studies did not report study perspective, and the health outcomes chosen were not relevant for some studies. Future studies should follow an economic evaluation checklist for high-quality reporting and consistency.
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Affiliation(s)
- John Rong Hao Tay
- Discipline of Periodontics, Faculty of Dentistry, National University of Singapore, Singapore City, Singapore.,Department of Restorative Dentistry, National Dental Centre Singapore, Singapore City, Singapore
| | - Ethan Ng
- Discipline of Periodontics, Faculty of Dentistry, National University of Singapore, Singapore City, Singapore.,Department of Restorative Dentistry, National Dental Centre Singapore, Singapore City, Singapore
| | - Rahul Nair
- Department of Dentistry - Quality and Safety of Oral Healthcare, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Zhe Sheng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
| | - Sharon Hui Xuan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
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The lived experience of performing a periodontal treatment in the context of general dentistry. BDJ Open 2021; 7:7. [PMID: 33510136 PMCID: PMC7843605 DOI: 10.1038/s41405-021-00059-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/26/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022] Open
Abstract
Aim To describe what characterises the lived experience of performing a periodontal treatment in the context of general dentistry. Materials and methods Three dental hygienists from general dentistry in Sweden, were purposively selected as participants and interviewed. The participants described a situation in which they had performed a periodontal treatment. The descriptions were analysed using the descriptive phenomenological psychological method. Results The general meaning structure of the lived experience of performing a periodontal treatment comprised five constituents, (a) an established treatment routine, (b) importance of oral hygiene, (c) self-awareness and motivation of the patient, (d) support and doubt, and (e) mechanical infection control. The periodontal treatment is perceived as being set prior to its commencement and as following established routines, in which the patients’ oral hygiene is experienced as a crucial part. The patients’ self-awareness and a supportive clinician are seen as important factors in motivating the patient towards positive behavioural change, although there is a presence of doubt in patients’ ability to maintain this positive change. Mechanical infection control is perceived as successful but sometimes difficult to perform. Conclusions Important, patient-related, factors are constituting the phenomenon of performing a periodontal treatment but an experience that the pre-existing standardised workflow influences patient management was also present.
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Donos N, Suvan JE, Calciolari E, Nibali L, Rollnick S. The effect of a behavioural management tool in adults with mild to moderate periodontitis. A single-blind, randomized controlled trial. J Periodontal Res 2020; 56:46-57. [PMID: 32959898 DOI: 10.1111/jre.12790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 12/22/2022]
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.
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Affiliation(s)
- Nikolaos Donos
- Centre for Oral Immunobiology & Regenerative Medicine and Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jeanie E Suvan
- Unit of Periodontology, Eastman Dental Institute, University College London (UCL), London, UK
| | - Elena Calciolari
- Centre for Oral Immunobiology & Regenerative Medicine and Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Department of Medicine and Surgery, School of Dental Medicine, University of Parma, Parma, Italy
| | - Luigi Nibali
- Centre for Oral Immunobiology & Regenerative Medicine and Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Centre for Host-Microbiome Interactions, Guy's Hospital, Kings College London, London, UK
| | - Stephen Rollnick
- Cochrane School of Primary Care & Public Health, Cardiff University, Cardiff, UK
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Kitzmann J, Ratka‐Krueger P, Vach K, Woelber JP. The impact of motivational interviewing on communication of patients undergoing periodontal therapy. J Clin Periodontol 2019; 46:740-750. [DOI: 10.1111/jcpe.13132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/02/2019] [Accepted: 05/05/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Julia Kitzmann
- Private Practice Hamburg Germany
- Department of Operative Dentistry and Periodontology, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Petra Ratka‐Krueger
- Department of Operative Dentistry and Periodontology, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Kirstin Vach
- Faculty of Medicine, Institute for Medical Biometry and Statistics Medical Center – University of Freiburg Freiburg Germany
| | - Johan P. Woelber
- Department of Operative Dentistry and Periodontology, Faculty of Medicine University of Freiburg Freiburg Germany
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Soldani FA, Lamont T, Jones K, Young L, Walsh T, Lala R, Clarkson JE. One-to-one oral hygiene advice provided in a dental setting for oral health. Cochrane Database Syst Rev 2018; 10:CD007447. [PMID: 30380139 PMCID: PMC6516798 DOI: 10.1002/14651858.cd007447.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Effective oral hygiene measures carried out on a regular basis are vital to maintain good oral health. One-to-one oral hygiene advice (OHA) within the dental setting is often provided as a means to motivate individuals and to help achieve improved levels of oral health. However, it is unclear if one-to-one OHA in a dental setting is effective in improving oral health and what method(s) might be most effective and efficient. OBJECTIVES To assess the effects of one-to-one OHA, provided by a member of the dental team within the dental setting, on patients' oral health, hygiene, behaviour, and attitudes compared to no advice or advice in a different format. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 November 2017); the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 10) in the Cochrane Library (searched 10 November 2017); MEDLINE Ovid (1946 to 10 November 2017); and Embase Ovid (1980 to 10 November 2017). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were also searched for ongoing trials (10 November 2017). No restrictions were placed on the language or date of publication when searching the electronic databases. Reference lists of relevant articles and previously published systematic reviews were handsearched. The authors of eligible trials were contacted, where feasible, to identify any unpublished work. SELECTION CRITERIA We included randomised controlled trials assessing the effects of one-to-one OHA delivered by a dental care professional in a dental care setting with a minimum of 8 weeks follow-up. We included healthy participants or participants who had a well-defined medical condition. DATA COLLECTION AND ANALYSIS At least two review authors carried out selection of studies, data extraction and risk of bias independently and in duplicate. Consensus was achieved by discussion, or involvement of a third review author if required. MAIN RESULTS Nineteen studies met the criteria for inclusion in the review with data available for a total of 4232 participants. The included studies reported a wide variety of interventions, study populations, clinical outcomes and outcome measures. There was substantial clinical heterogeneity amongst the studies and it was not deemed appropriate to pool data in a meta-analysis. We summarised data by categorising similar interventions into comparison groups.Comparison 1: Any form of one-to-one OHA versus no OHAFour studies compared any form of one-to-one OHA versus no OHA.Two studies reported the outcome of gingivitis. Although one small study had contradictory results at 3 months and 6 months, the other study showed very low-quality evidence of a benefit for OHA at all time points (very low-quality evidence).The same two studies reported the outcome of plaque. There was low-quality evidence that these interventions showed a benefit for OHA in plaque reduction at all time points.Two studies reported the outcome of dental caries at 6 months and 12 months respectively. There was very low-quality evidence of a benefit for OHA at 12 months.Comparison 2: Personalised one-to-one OHA versus routine one-to-one OHAFour studies compared personalised OHA versus routine OHA.There was little evidence available that any of these interventions demonstrated a difference on the outcomes of gingivitis, plaque or dental caries (very low quality).Comparison 3: Self-management versus professional OHAFive trials compared some form of self-management with some form of professional OHA.There was little evidence available that any of these interventions demonstrated a difference on the outcomes of gingivitis or plaque (very low quality). None of the studies measured dental caries.Comparison 4: Enhanced one-to-one OHA versus one-to-one OHASeven trials compared some form of enhanced OHA with some form of routine OHA.There was little evidence available that any of these interventions demonstrated a difference on the outcomes of gingivitis, plaque or dental caries (very low quality). AUTHORS' CONCLUSIONS There was insufficient high-quality evidence to recommend any specific one-to-one OHA method as being effective in improving oral health or being more effective than any other method. Further high-quality randomised controlled trials are required to determine the most effective, efficient method of one-to-one OHA for oral health maintenance and improvement. The design of such trials should be cognisant of the limitations of the available evidence presented in this Cochrane Review.
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Affiliation(s)
- Francesca A Soldani
- Bradford District Care NHS Foundation TrustCommunity Dental ServiceBradfordUK
| | - Thomas Lamont
- University of Dundee, Dental School & HospitalPark PlaceDundeeTaysideUKDD1 4HN
| | | | - Linda Young
- NHS Education for ScotlandScottish Dental Clinical Effectiveness ProgrammeDundee Dental Education CentreSmall's WyndDundeeUKDD1 4HN
| | - Tanya Walsh
- The University of ManchesterDivision of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and HealthJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Rizwana Lala
- School of Clinical Dentistry, University of SheffieldUnit of Dental Public HealthClaremont CrescentSheffieldUKS10 2TA
| | - Janet E Clarkson
- Dundee Dental School, University of DundeeDivision of Oral Health SciencesPark PlaceDundeeScotlandUKDD1 4HR
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Colvara BC, Faustino-Silva DD, Meyer E, Hugo FN, Hilgert JB, Celeste RK. Motivational Interviewing in Preventing Early Childhood Caries in Primary Healthcare: A Community-based Randomized Cluster Trial. J Pediatr 2018; 201:190-195. [PMID: 29885752 DOI: 10.1016/j.jpeds.2018.05.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/05/2018] [Accepted: 05/10/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To assess the effectiveness of motivational interviewing in preventing early childhood caries compared with conventional oral health education. STUDY DESIGN Twelve health care units in southern Brazil were randomly allocated in 2 groups of 6 and professionals in 1 group were trained in motivational interviewing. The mothers/children and external examiners were blinded to the intervention. The data were collected by calibrated examiners using questionnaires and a clinical examination based on modified International Caries Detection and Assessment System criteria. Of the 674 children born in the catchment area in the year 2013, 469 received the intervention (224 in the conventional oral health education group, 245 in the motivational interviewing group), and 320 were examined by the end of the study (145 in the conventional oral health education group, 175 in the motivational interviewing group), with mean age of 30 months. The final follow-up was 68%, after 3 years. RESULTS Mean of decayed, missing, and filled surfaces at the end of the study period for the whole sample was 1.34 (95% CI 0.97-1.71). The caries rate per 100 surface-year in the conventional oral health education group was 1.74 (95% CI 1.14-2.34) and in the motivational interviewing group, it was 0.92 (95% CI 0.63-1.20). To correct for clustering effect and unbalanced factors, multilevel Poisson regression was fitted and the effect of motivational interviewing on the incidence rate ratio was 0.40 (95% CI 0.21-0.79). CONCLUSIONS An intervention based on the principles of motivational interviewing style was more effective in reducing the number of surfaces affected by early childhood caries compared with conventional oral health education intervention. TRIAL REGISTRATION ClinicalTrials.govNCT02578966, Brazilian Registry of Clinical Trials RBR-8fvwxq.
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Affiliation(s)
| | - Daniel Demétrio Faustino-Silva
- Graduate Program in Assessment Technology for the National Health System (SUS), Grupo Hospitalar Conceição (GHC), Porto Alegre, Brazil
| | - Elisabeth Meyer
- Graduate Health Sciences Program, Cardiology Institute (IC/FUC), Porto Alegre, Brazil
| | - Fernando Neves Hugo
- Graduate Program in Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Balbinot Hilgert
- Graduate Program in Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Epidemiology, Federal University of Rio Grande do Sul, Brazil
| | - Roger Keller Celeste
- Graduate Program in Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Graduate Program in Assessment Technology for the National Health System (SUS), Grupo Hospitalar Conceição (GHC), Porto Alegre, Brazil
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Manresa C, Sanz‐Miralles EC, Twigg J, Bravo M. Supportive periodontal therapy (SPT) for maintaining the dentition in adults treated for periodontitis. Cochrane Database Syst Rev 2018; 1:CD009376. [PMID: 29291254 PMCID: PMC6491071 DOI: 10.1002/14651858.cd009376.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Periodontitis is a bacterially-induced, chronic inflammatory disease that destroys the connective tissues and bone that support teeth. Active periodontal treatment aims to reduce the inflammatory response, primarily through eradication of bacterial deposits. Following completion of treatment and arrest of inflammation, supportive periodontal therapy (SPT) is employed to reduce the probability of re-infection and progression of the disease; to maintain teeth without pain, excessive mobility or persistent infection in the long term, and to prevent related oral diseases.According to the American Academy of Periodontology, SPT should include all components of a typical dental recall examination, and importantly should also include periodontal re-evaluation and risk assessment, supragingival and subgingival removal of bacterial plaque and calculus, and re-treatment of any sites showing recurrent or persistent disease. While the first four points might be expected to form part of the routine examination appointment for periodontally healthy patients, the inclusion of thorough periodontal evaluation, risk assessment and subsequent treatment - normally including mechanical debridement of any plaque or calculus deposits - differentiates SPT from routine care.Success of SPT has been reported in a number of long-term, retrospective studies. This review aimed to assess the evidence available from randomised controlled trials (RCTs). OBJECTIVES To determine the effects of supportive periodontal therapy (SPT) in the maintenance of the dentition of adults treated for periodontitis. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 8 May 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 5), MEDLINE Ovid (1946 to 8 May 2017), and Embase Ovid (1980 to 8 May 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating SPT versus monitoring only or alternative approaches to mechanical debridement; SPT alone versus SPT with adjunctive interventions; different approaches to or providers of SPT; and different time intervals for SPT delivery.We excluded split-mouth studies where we considered there could be a risk of contamination.Participants must have completed active periodontal therapy at least six months prior to randomisation and be enrolled in an SPT programme. Trials must have had a minimum follow-up period of 12 months. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results to identify studies for inclusion, assessed the risk of bias in included studies and extracted study data. When possible, we calculated mean differences (MDs) and 95% confidence intervals (CIs) for continuous variables. Two review authors assessed the quality of evidence for each comparison and outcome using GRADE criteria. MAIN RESULTS We included four trials involving 307 participants aged 31 to 85 years, who had been previously treated for moderate to severe chronic periodontitis. Three studies compared adjuncts to mechanical debridement in SPT versus debridement only. The adjuncts were local antibiotics in two studies (one at high risk of bias and one at low risk) and photodynamic therapy in one study (at unclear risk of bias). One study at high risk of bias compared provision of SPT by a specialist versus general practitioner. We did not identify any RCTs evaluating the effects of SPT versus monitoring only, or of providing SPT at different time intervals, or that compared the effects of mechanical debridement using different approaches or technologies.No included trials measured our primary outcome 'tooth loss'; however, studies evaluated signs of inflammation and potential periodontal disease progression, including bleeding on probing (BoP), clinical attachment level (CAL) and probing pocket depth (PPD).There was no evidence of a difference between SPT delivered by a specialist versus a general practitioner for BoP or PPD at 12 months (very low-quality evidence). This study did not measure CAL or adverse events.Due to heterogeneous outcome reporting, it was not possible to combine data from the two studies comparing mechanical debridement with or without the use of adjunctive local antibiotics. Both studies found no evidence of a difference between groups at 12 months (low to very low-quality evidence). There were no adverse events in either study.The use of adjunctive photodynamic therapy did not demonstrate evidence of benefit compared to mechanical debridement only (very low-quality evidence). Adverse events were not measured.The quality of the evidence is low to very low for these comparisons. Future research is likely to change the findings, therefore the results should be interpreted with caution. AUTHORS' CONCLUSIONS Overall, there is insufficient evidence to determine the superiority of different protocols or adjunctive strategies to improve tooth maintenance during SPT. No trials evaluated SPT versus monitoring only. The evidence available for the comparisons evaluated is of low to very low quality, and hampered by dissimilarities in outcome reporting. More trials using uniform definitions and outcomes are required to address the objectives of this review.
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Affiliation(s)
- Carolina Manresa
- Dental School, University of BarcelonaAdult Comprehensive DentistryFeixa LLarga s/nHospitalet de LlobregatBarcelonaSpain08907
| | - Elena C Sanz‐Miralles
- Dental School, University of BarcelonaAdult Comprehensive DentistryFeixa LLarga s/nHospitalet de LlobregatBarcelonaSpain08907
- Columbia UniversityDivision of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental MedicineNew YorkNYUSA
| | - Joshua Twigg
- Cardiff UniversitySchool of DentistryDepartment of Oral and Biomedical SciencesHeath ParkCardiffUKCF14 4XY
| | - Manuel Bravo
- Dental School, University of GranadaPreventive DentistryCampus de la Cartuja s/nGranadaSpain08071
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Unsupported conclusions. Br Dent J 2017; 223:463-4. [DOI: 10.1038/sj.bdj.2017.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hoffman LM, Rollins L, Henry Akintobi T, Erwin K, Lewis K, Hernandez N, Miller A. Oral Health Intervention for Low-Income African American Men in Atlanta, Georgia. Am J Public Health 2017; 107:S104-S110. [PMID: 28661811 PMCID: PMC5497882 DOI: 10.2105/ajph.2017.303760] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe the Minority Men's Oral Health Dental Access Program (MOHDAP) intervention and report participants' outcomes and satisfaction. METHODS MOHDAP was designed to increase the oral health knowledge of low-income, African American men in Atlanta, GA, in 2013. A community-based participatory approach and needs assessment guided the intervention development, which consisted of 3 educational modules delivered over a 2-day period. All participants (n = 45; mean age = 50 years) were African American men. We assessed changes in oral health knowledge and attitudes at baseline and postintervention via survey. RESULTS After the intervention, the percentage of correct responses to questions about gingivitis increased by 24.2% (P = .01), about use of a hard (instead of a soft) toothbrush increased by 42.2% (P < .01), and knowledge of ways to prevent gum diseases increased by 16.0% (P = .03). The percentage agreeing with erroneous statements decreased 11.3% (P = .02) regarding oral health-related fatalism and oral health self-care and 17.4% (P = .05) regarding saving front versus back teeth. CONCLUSIONS Community-based oral health educational interventions designed for African American men may reduce oral health disparities among this population.
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Affiliation(s)
- LaShawn M Hoffman
- LaShawn M. Hoffman, Latrice Rollins, Tabia Henry Akintobi, Katherine Erwin, and Natalie Hernandez are with the Morehouse School of Medicine, Atlanta, GA. Kimberly Lewis is with the Fulton County Department of Health and Wellness, Atlanta. Assia Miller is with McKing Consulting Corporation, Atlanta
| | - Latrice Rollins
- LaShawn M. Hoffman, Latrice Rollins, Tabia Henry Akintobi, Katherine Erwin, and Natalie Hernandez are with the Morehouse School of Medicine, Atlanta, GA. Kimberly Lewis is with the Fulton County Department of Health and Wellness, Atlanta. Assia Miller is with McKing Consulting Corporation, Atlanta
| | - Tabia Henry Akintobi
- LaShawn M. Hoffman, Latrice Rollins, Tabia Henry Akintobi, Katherine Erwin, and Natalie Hernandez are with the Morehouse School of Medicine, Atlanta, GA. Kimberly Lewis is with the Fulton County Department of Health and Wellness, Atlanta. Assia Miller is with McKing Consulting Corporation, Atlanta
| | - Katherine Erwin
- LaShawn M. Hoffman, Latrice Rollins, Tabia Henry Akintobi, Katherine Erwin, and Natalie Hernandez are with the Morehouse School of Medicine, Atlanta, GA. Kimberly Lewis is with the Fulton County Department of Health and Wellness, Atlanta. Assia Miller is with McKing Consulting Corporation, Atlanta
| | - Kimberly Lewis
- LaShawn M. Hoffman, Latrice Rollins, Tabia Henry Akintobi, Katherine Erwin, and Natalie Hernandez are with the Morehouse School of Medicine, Atlanta, GA. Kimberly Lewis is with the Fulton County Department of Health and Wellness, Atlanta. Assia Miller is with McKing Consulting Corporation, Atlanta
| | - Natalie Hernandez
- LaShawn M. Hoffman, Latrice Rollins, Tabia Henry Akintobi, Katherine Erwin, and Natalie Hernandez are with the Morehouse School of Medicine, Atlanta, GA. Kimberly Lewis is with the Fulton County Department of Health and Wellness, Atlanta. Assia Miller is with McKing Consulting Corporation, Atlanta
| | - Assia Miller
- LaShawn M. Hoffman, Latrice Rollins, Tabia Henry Akintobi, Katherine Erwin, and Natalie Hernandez are with the Morehouse School of Medicine, Atlanta, GA. Kimberly Lewis is with the Fulton County Department of Health and Wellness, Atlanta. Assia Miller is with McKing Consulting Corporation, Atlanta
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Motivational interviewing in general dental practice: A review of the evidence. Br Dent J 2016; 221:785-791. [DOI: 10.1038/sj.bdj.2016.952] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 11/08/2022]
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Albrecht M, Kupfer R, Reissmann DR, Mühlhauser I, Köpke S. Oral health educational interventions for nursing home staff and residents. Cochrane Database Syst Rev 2016; 9:CD010535. [PMID: 27689868 PMCID: PMC6457754 DOI: 10.1002/14651858.cd010535.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Associations between nursing home residents' oral health status and quality of life, respiratory tract infections, and nutritional status have been reported. Educational interventions for nurses or residents, or both, focusing on knowledge and skills related to oral health management may have the potential to improve residents' oral health. OBJECTIVES To assess the effects of oral health educational interventions for nursing home staff or residents, or both, to maintain or improve the oral health of nursing home residents. SEARCH METHODS We searched the Cochrane Oral Health Trials Register (to 18 January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2015, Issue 12), MEDLINE Ovid (1946 to 18 January 2016), Embase Ovid (1980 to 18 January 2016), CINAHL EBSCO (1937 to 18 January 2016), and Web of Science Conference Proceedings (1990 to 18 January 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 18 January 2016. In addition, we searched reference lists of identified articles and contacted experts in the field. We placed no restrictions on language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-RCTs comparing oral health educational programmes for nursing staff or residents, or both with usual care or any other oral healthcare intervention. DATA COLLECTION AND ANALYSIS Two review authors independently screened articles retrieved from the searches for relevance, extracted data from included studies, assessed risk of bias for each included study, and evaluated the overall quality of the evidence. We retrieved data about the development and evaluation processes of complex interventions on the basis of the Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare: revised guideline (CReDECI 2). We contacted authors of relevant studies for additional information. MAIN RESULTS We included nine RCTs involving 3253 nursing home residents in this review; seven of these trials used cluster randomisation. The mean resident age ranged from 78 to 86 years across studies, and most participants were women (more than 66% in all studies). The proportion of residents with dental protheses ranged from 62% to 87%, and the proportion of edentulous residents ranged from 32% to 90% across studies.Eight studies compared educational interventions with information and practical components versus (optimised) usual care, while the ninth study compared educational interventions with information only versus usual care. All interventions included educational sessions on oral health for nursing staff (five trials) or for both staff and residents (four trials), and used more than one active component. Follow-up of included studies ranged from three months to five years.No study showed overall low risk of bias. Four studies had a high risk of bias, and the other five studies were at unclear risk of bias.None of the trials assessed our predefined primary outcomes 'oral health' and 'oral health-related quality of life'. All trials assessed our third primary outcome, 'dental or denture plaque'. Meta-analyses showed no evidence of a difference between interventions and usual care for dental plaque (mean difference -0.04, 95% confidence interval (CI) -0.26 to 0.17; six trials; 437 participants; low quality evidence) or denture plaque (standardised mean difference -0.60, 95% CI -1.25 to 0.05; five trials; 816 participants; low quality evidence). None of the studies assessed adverse events of the intervention. AUTHORS' CONCLUSIONS We found insufficient evidence to draw robust conclusions about the effects of oral health educational interventions for nursing home staff and residents. We did not find evidence of meaningful effects of educational interventions on any measure of residents' oral health; however, the quality of the available evidence is low. More adequately powered and high-quality studies using relevant outcome measures are needed.
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Affiliation(s)
- Martina Albrecht
- University of HamburgMIN Faculty, Unit of Health Sciences and EducationMartin‐Luther‐King PlatzHamburgGermany20146
| | - Ramona Kupfer
- University of HamburgMIN Faculty, Unit of Health Sciences and EducationMartin‐Luther‐King PlatzHamburgGermany20146
- Institute of Social Medicine, University of LübeckNursing Research Group, Institute of Social Medicine and EpidemiologyLübeckGermany
| | - Daniel R Reissmann
- University Medical Center Hamburg‐EppendorfDepartment of Prosthetic DentistryMartinistr. 52HamburgGermany20246
| | - Ingrid Mühlhauser
- University of HamburgMIN Faculty, Unit of Health Sciences and EducationMartin‐Luther‐King PlatzHamburgGermany20146
| | - Sascha Köpke
- University of LübeckNursing Research Group, Institute of Social Medicine and EpidemiologyRatzeburger Allee 160LübeckGermanyD‐23538
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Wilder RS, Bray KS. Improving periodontal outcomes: merging clinical and behavioral science. Periodontol 2000 2016; 71:65-81. [DOI: 10.1111/prd.12125] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 02/03/2023]
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Kay E, Vascott D, Hocking A, Nield H, Dorr C, Barrett H. A review of approaches for dental practice teams for promoting oral health. Community Dent Oral Epidemiol 2016; 44:313-30. [PMID: 26892435 DOI: 10.1111/cdoe.12220] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 01/20/2016] [Indexed: 11/27/2022]
Abstract
To determine the circumstances in which oral health promotion (OHP) in General Dental Practice is at its most effective, a systematic review was conducted to identify, critically appraise and synthesize the available evidence. The research question was: Is oral health promotion within dental practice effective and how can its effects be optimized? Systematic searches of 20 online resources (including Ovid Medline and Embase) were conducted. A call for evidence was also issued, and citation lists of other relevant systematic reviews were included. All studies published since 1994 which were set in the context of general dental practice and investigated promoting good oral health in adult or child patients were considered. 44 studies reported in 52 papers were included in the review. The evidence was heterogeneous and the quality of reporting was variable. Results showed that oral health promotion based on behavioural and psychological models was effective for improving oral health. Verbal advice affected knowledge and reported behaviour, written advice promoted oral health knowledge. There was moderate evidence that the attributes of the 'sender' of an oral health promotion message influenced its effectiveness. Many barriers and facilitators were shown to influence the effectiveness of OHP in dental practice. The results of this review suggest that the psychology of behaviour change is the key to oral health promotion and greater emphasis on teaching oral health professionals about health psychology would make oral health promotion in the dental surgery more effective.
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Affiliation(s)
- Elizabeth Kay
- Peninsula Dental School, Plymouth University Schools of Medicine and Dentistry, Plymouth, UK
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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. J Dent Res 2016; 95:506-14. [DOI: 10.1177/0022034516628506] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this systematic review and meta-analysis was to study the effectiveness of psychological interventions in adults and adolescents with poor oral health. The review follows the PRISMA guidelines for systematic reviews. The PICO format (population, intervention, comparison, and outcome) was used to define eligible studies. The populations were adults or adolescents (≥13 y of age and independent of others) with poor oral health (defined as dental caries, periodontal disease, and/or peri-implantitis). The interventions were psychological and/or behavioral models and theories, in comparison with traditional oral health education/information. 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. The systematic literature search identified 846 articles in December 2013 and 378 articles in July 2015. In total, 11 articles on 9 randomized controlled trials were found to meet the inclusion criteria. These reported on adults with periodontal disease, and several used motivational interviewing (MI) as their mode of intervention. The CONSORT guidelines and the GRADE approach were used for study appraisal and rating of evidence. The meta-analysis showed no statistically significant differences in gingivitis or plaque presence. In addition, a meta-analysis on MI compared with education/information found no statistically significant differences in gingivitis presence. Only 1 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 certainty of evidence was low. Future research needs to address several methodological issues and not only study adults with periodontal disease but also adolescents and patients with dental caries and peri-implantitis.
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Affiliation(s)
- H. Werner
- Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M. Hakeberg
- Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - L. Dahlström
- Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M. Eriksson
- Medical Library, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P. Sjögren
- Health Technology Assessment–centre, Region Västra Götaland, Gothenburg, Sweden
| | - A. Strandell
- Health Technology Assessment–centre, Region Västra Götaland, Gothenburg, Sweden
| | - T. Svanberg
- Medical Library, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L. Svensson
- Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - U. Wide Boman
- Department of Behavioral and Community Dentistry, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Mohd-Dom T, Ayob R, Mohd-Nur A, Abdul-Manaf MR, Ishak N, Abdul-Muttalib K, Aljunid SM, Ahmad-Yaziz Y, Abdul-Aziz H, Kasan N, Mohd-Asari AS. Cost analysis of periodontitis management in public sector specialist dental clinics. BMC Oral Health 2014; 14:56. [PMID: 24884465 PMCID: PMC4033493 DOI: 10.1186/1472-6831-14-56] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 05/09/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The objective of this paper is to quantify the cost of periodontitis management at public sector specialist periodontal clinic settings and analyse the distribution of cost components. METHODS Five specialist periodontal clinics in the Ministry of Health represented the public sector in providing clinical and cost data for this study. Newly-diagnosed periodontitis patients (N = 165) were recruited and followed up for one year of specialist periodontal care. Direct and indirect costs from the societal viewpoint were included in the cost analysis. They were measured in 2012 Ringgit Malaysia (MYR) and estimated from the societal perspective using activity-based and step-down costing methods, and substantiated by clinical pathways. Cost of dental equipment, consumables and labour (average treatment time) for each procedure was measured using activity-based costing method. Meanwhile, unit cost calculations for clinic administration, utilities and maintenance used step-down approach. Patient expenditures and absence from work were recorded via diary entries. The conversion from MYR to Euro was based on the 2012 rate (1€ = MYR4). RESULTS A total of 2900 procedures were provided, with an average cost of MYR 2820 (€705) per patient for the study year, and MYR 376 (€94) per outpatient visit. Out of this, 90% was contributed by provider cost and 10% by patient cost; 94% for direct cost and 4% for lost productivity. Treatment of aggressive periodontitis was significantly higher than for chronic periodontitis (t-test, P = 0.003). Higher costs were expended as disease severity increased (ANOVA, P = 0.022) and for patients requiring surgeries (ANOVA, P < 0.001). Providers generally spent most on consumables while patients spent most on transportation. CONCLUSIONS Cost of providing dental treatment for periodontitis patients at public sector specialist settings were substantial and comparable with some non-communicable diseases. These findings provide basis for identifying potential cost-reducing strategies, estimating economic burden of periodontitis management and performing economic evaluation of the specialist periodontal programme.
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Affiliation(s)
- Tuti Mohd-Dom
- Department of Dental Public Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rasidah Ayob
- Oral Health Division, Ministry of Health, Malaysia, Putra Jaya, Malaysia
| | - Amrizal Mohd-Nur
- International Centre for Casemix and Clinical Coding, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mohd R Abdul-Manaf
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noorlin Ishak
- Oral Health Division, Ministry of Health, Malaysia, Putra Jaya, Malaysia
| | | | - Syed M Aljunid
- International Centre for Casemix and Clinical Coding, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Hanizah Abdul-Aziz
- Oral Health Division, Ministry of Health, Malaysia, Putra Jaya, Malaysia
| | - Noordin Kasan
- Oral Health Division, Ministry of Health, Malaysia, Putra Jaya, Malaysia
| | - Ahmad S Mohd-Asari
- Oral Health Division, Ministry of Health, Malaysia, Putra Jaya, Malaysia
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Gao X, Lo ECM, Kot SCC, Chan KCW. Motivational Interviewing in Improving Oral Health: A Systematic Review of Randomized Controlled Trials. J Periodontol 2014; 85:426-37. [DOI: 10.1902/jop.2013.130205] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jönsson B, Öhrn K. Evaluation of the effect of non-surgical periodontal treatment on oral health-related quality of life: estimation of minimal important differences 1 year after treatment. J Clin Periodontol 2013; 41:275-82. [DOI: 10.1111/jcpe.12202] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Birgitta Jönsson
- The Public Dental Health Service Competence Centre of Northern Norway (TkNN); Tromsø Norway
- School of Health and Social Studies; Dalarna University; Falun Sweden
| | - Kerstin Öhrn
- School of Health and Social Studies; Dalarna University; Falun Sweden
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Fardal Ø, Grytten J. A comparison of teeth and implants during maintenance therapy in terms of the number of disease-free years and costs - an in vivo internal control study. J Clin Periodontol 2013; 40:645-51. [DOI: 10.1111/jcpe.12101] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jostein Grytten
- Institute of Community Dentistry; University of Oslo; Blindern Oslo Norway
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Listl S, Birch S. Reconsidering value for money in periodontal treatment. J Clin Periodontol 2013; 40:345-8. [DOI: 10.1111/jcpe.12085] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Stefan Listl
- Department of Conservative Dentistry; University of Heidelberg; Heidelberg Germany
- Munich Center for the Economics of Aging; Max-Planck-Institute for Social Law and Social Policy; Munich Germany
| | - Stephen Birch
- Centre for Health Economics and Policy Analysis; McMaster University; Hamilton ON Canada
- School of Community Based Medicine; University of Manchester; Manchester UK
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