Effectiveness of motivational interviewing at improving oral health: a systematic review

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

OBJECTIVE

This systematic review with meta-analysis was performed to assess whether motivational interviewing (MI) effectively prevents oral morbidities in adults.

METHODS

Studies considered were randomized controlled trials, cluster-randomized controlled trials and community-based randomized trials assessing interventions based on MI or indicating that a counselling technique based on the principles developed by Miller and Rollnick was used. Controls were any type of oral health education or negative controls. Participants were 18-60 years old. The main outcome was any oral morbidity. From 602 studies identified in MEDLINE, Scopus, Web of Science and LILACS databases, seven studies were included in the synthesis.

RESULTS

Studies included only evaluated periodontal outcomes, no studies were found for other oral morbidities. Patients' mean age was 43.7 years, and the follow-up time after MI or MI-based intervention varied between 1 month and 1 year. The total study population was 272 people with moderate-to-severe periodontitis; other groups analysed were pregnant women (n = 112) and patients with mental disorders and alcohol problems (n = 60). Meta-analysis for the plaque index (four studies, n = 267), bleeding on probing (two studies, n = 177) and gingival index (two studies, n = 166) were carried out. The summary effects for the random-effects model were estimated respectively as -3.59 percentage points (CI: [-11.44; 4.25] for plaque index, -6.41 percentage points (CI: [-12.18, -0.65]) for bleeding on probing and -0.70 (CI: [-1.87; 0.48]) for gingival index, marginally favouring the MI group. The reduced number of studies, the non-disclosure of some aspects of the data and the heterogeneity among them undermine the precision of the estimates.

CONCLUSION

The current evidence available is limited to periodontal outcomes, and it is not possible to determine whether MI effectively prevents oral morbidities in adults.

Healthcare accessibility in the prison environment: oral health

This article aims to assess the importance of caring for oral health among prisoners, as an often-overlooked aspect of general health well-being in prisons. The incidence of oral disease among prisoners compared to the general population is much higher due to many factors such as limited access to dental care, unhealthy lifestyles and overcrowded cells. The research review confirms the need to increase access to dental care and promote hygiene awareness among inmates. Differences between genders and the impact of the length of the sentence on oral health are also pointed out.

Dental professionals' views on motivational interviewing for the prevention of dental caries with adolescents in central Norway

BACKGROUND

Establishing positive oral health behaviours during adolescence should be a key priority to improve lifelong oral health. However, changing adolescent behaviours is known to be a challenge. Motivational interviewing (MI) is a method of working with patients to activate their motivation for change and has shown promising results within the dental setting. Yet, little is known about the actual experiences and perspectives of Norwegian dental health professionals in delivering motivational interviewing as part of routine care to their young patients. The overall aim of the present study was to explore the implementation of motivational interviewing by dentists and dental hygienists, employed by the Norwegian Public Dental Service, for their adolescent patients.

METHODS

As part of the larger #Care4YoungTeeth <3 project, a Norwegian Research Council funded four-year Collaborative Project to Meet Societal and Industry-related Challenges, an online survey was developed and administered to dental personnel (n = 168) in one region of Central Norway. Data were analysed by descriptive statistics and two-sample tests of proportions at the 95% confidence level.

RESULTS

A total of 98 dental personnel responded to the survey (response rate 58.3%), of which 37 were dental hygienists (response rate 72.5%) and 61 were dentists (response rate 52.1%). A greater proportion of hygienists reported implementing this intervention compared to dentists (78.4% versus 50.8%; p = 0.007). Similarly, a greater proportion of hygienists (83.8%) stated that they had received training in MI compared to dentists (65.6%; p = 0.051). About 80% of dentists and 90% of dental hygienists felt that they understood the principles of MI. However, only about 45% and 60%, respectively, felt confident in its use. Dental hygienists found MI more usable in their work (p = 0.052), to a greater extent want to use MI (p = 0.002) and found that using MI works well (p < 0.001), as compared to dentists.

CONCLUSIONS

A high proportion of dental professionals working within a Norwegian public dental service have received training in MI. However, barriers to implementation for adolescent patients and differences in practice between dentists and hygienists warrant further enquiry.

Using behaviour change science to deliver oral health practice: A commentary

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.

Development and acceptability of behavioral interventions promoting mothers' brushing of pre-school children's teeth: The preparation phase of the multi-phase optimization strategy framework

BACKGROUND

Early childhood caries can be prevented through regular parental-supported toothbrushing, indicating the importance of behavior modification interventions targeting parents. Mobile oral health (m-oral health) interventions are gaining increased popularity although their production is not always based on solid theoretical frameworks and evidence about the efficacy of individual intervention components is not available. The Multiphase Optimization Strategy (MOST) offers a framework to develop complex m-oral health interventions and assessing the efficacy of individual components.

AIM

This study describes the development and assesses the acceptability of 3 intervention components using MOST to promote mothers' brushing of their preschool children's teeth.

METHODS

The Theory of Planned Behavior guided the development of 3 components: motivational interviewing (MI), storytelling videos (STVs), and oral health promotion messages (OHPMs). A researcher received training to conduct MI. Twenty-four OHPMs were developed, and 14 STVs scripts were developed based on the "And, But, Therefore" framework. A feasibility pilot study was conducted to determine the optimization objective and assess mothers' preferences regarding the frequency and timing of receiving the intervention components. The mothers participated in a semi-structured interview to assess the acceptability of the components using 7 open-ended questions based on the framework of acceptability and thematic analysis was used to analyze the qualitative data. The mothers also responded to questions assessing the perceived and experienced acceptability of the components using close-ended questions. Descriptive statistics were presented as means and standard deviations for continuous variables and median and interquartile range for categorical variables.

RESULTS

Sixteen mothers were included. The mothers expressed positive affective attitude towards the interventions. They felt the components served as "good reminders" to brush their children's teeth. However, "time" was a burden for the mothers. 80% of the mothers preferred receiving the OHPMs and STVs once per week, from 8 pm to 2 am (50%), and 60% indicated they can set 15-30 min to receiving the interventions.

CONCLUSION

The 3 components were acceptable to the mothers. The OHPMs and STVs will be sent to the mothers once per week, between 8 pm to 2 am. The MI and follow-up phone calls will be limited to 15 min.

Use of Motivational Interviewing in Older Patients with Multiple Chronic Conditions and Their Informal Caregivers: A Scoping Review

The use of motivational interviewing is relatively new in multiple chronic conditions (MCCs). A scoping review was conducted according to JBI methodology to identify, map and synthesize existing evidence on the use of motivational interviewing to support self-care behavior changes in older patients with MCCs and to support their informal caregivers in promoting patient self-care changes. Seven databases were searched, from database inception to July 2022, for studies that used motivational interviewing in interventions for older patients with MCCs and their informal caregivers. We identified 12 studies, reported in 15 articles, using qualitative, quantitative, or mixed-method designs, conducted between 2012 and 2022, describing the use of motivational interviewing for patients with MCCs. We could not locate any study regarding its application for informal caregivers. The scoping review showed that the use of motivational interviewing is still limited in MCCs. It was used mainly to improve patient medication adherence. The studies provided scant information about how the method was applied. Future studies should provide more information about the application of motivational interviewing and should address self-care behavior changes relevant to patients and healthcare providers. Informal caregivers should also be targeted in motivational interviewing interventions, as they are essential for the care of older patients with MCCs.

Comparative Evaluation of Oral Health and Behavior Changes in Children after Motivational Interviewing and Traditional Method of Oral Health Education among Mothers: A Systematic Review and Meta-analysis

Aim

To analyze the effectiveness of motivational interviewing (MI) compared to traditional health education among mothers in improving children's oral health and behavioral changes.

Review methods

The search strategy was framed using relevant MeSH terms and free text terms in PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Directory of Open Access Journals (DOAJ), Cochrane Library, and Google Scholar for the articles published in the English language between 1st January 2000 and 31st December 2020. Only randomized controlled trials, non-randomized controlled trials, and clinical trials comparing MI with traditional health education were included. Cochrane risk of bias (ROB) tool was used for the quality assessment of the included studies, and Review Manager 5.3 software was used for computing results.

Results

A total of 9 studies were included for qualitative synthesis and 5 for quantitative synthesis from an initial search of 3,708 articles. The cumulative mean difference for dental caries was -1.03 [95% confidence interval (CI)-1.37-0.70] p < 0.00001, for frequency of toothbrushing Pooled odds ratio was 1.69 (95% CI-0.68-4.25) p = 0.26 and for in-between snacking was 0.83 with (95% CI-0.48-1.44) p = 0.51. A significant difference was present in dental caries among children with mothers in the MI group, while no difference was present in in-between snacking and frequency of toothbrushing between both the groups.

Conclusion

Motivational interviewing (MI) prove to be significantly effective in reducing newer dental caries for shorter duration; however, long-term effectiveness could not be assessed.

Clinical significance

Motivational interviewing (MI) can be considered an effective and feasible method for oral health education to mothers, which will, in turn, improve the oral health of their children.

Protocol registration

International prospective register of systematic reviews (PROSPERO) under registration code. CRD42021224278.

How to cite this article

Karande PH, Shetty VB, Vinay V, et al. Comparative Evaluation of Oral Health and Behavior Changes in Children after Motivational Interviewing and Traditional Method of Oral Health Education among Mothers: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2023;16(3):464-473.

Health Coaching-Based Interventions for Oral Health Promotion: A Scoping Review

Background: Health coaching-based interventions can support behaviour change to improve oral health. This scoping review aims to identify key characteristics of health coaching-based interventions for oral health promotion. Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist and the Joanna Briggs Institute manual for evidence synthesis were used in this review. A search strategy using medical subject heading terms and keywords was developed and applied to search the following databases: CINAHL, Ovid, PubMed, Cochrane Library and Scopus. Thematic analysis was used to synthesise the data. Results: Twenty-three studies met the inclusion criteria and were included in this review. These studies were predominantly based on health coaching and motivational interviewing interventions applied to oral health promotion. The following are the characteristics of health coaching-based interventions extracted from themes of the included studies: (a) Health professionals should be trained on the usage of motivational interviewing/health coaching interventions; (b) oral health professionals should acquire motivational techniques in their practice to engage patients and avoid criticisms during the behaviour change process; (c) routine brief motivational interviewing/health coaching intervention sessions should be introduced in dental clinics; (d) traditional oral health education methods should be supplemented with individually tailored communication; and (e) for cost-effectiveness purposes, motivational interviewing/health coaching strategies should be considered. Conclusions: This scoping review reveals that health coaching-based techniques of health coaching and motivational interviewing can significantly impact oral health outcomes and behaviour change and can improve oral health professional–patient communication. This calls for the use of health coaching-based techniques by dental teams in community and clinical settings. This review highlights gaps in the literature, suggesting the need for more research on health coaching-based intervention strategies for oral health promotion.

Theoretical and methodological approaches in designing, developing, and delivering interventions for oral health behaviour change

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.

Behavioral strategies for periodontal health

The impact of lifestyle factors has been increasingly studied and discussed in oral healthcare. Positive lifestyle factors are important in maintaining oral health or controlling disease, but they are not easy to adopt over the long term. Along with public health initiatives within communities and groups, there is a role for behavior change interventions delivered in dental practice settings to improve the periodontal health of individuals. Behavior management is now seen as a part of both prevention and therapy of periodontal diseases. This article summarizes the evidence on behavioral strategies for periodontal health to inform and assist oral healthcare professionals in implementing behavior change in their practice. In addition, strategies for education and training in communication and behavior change techniques are considered.

Motivational interviewing versus conventional caries prevention strategies in high-caries-risk children and families: a non-randomised trial

Background This study compared the effectiveness of motivational interviewing (MI) and conventional caries prevention (CCP) for primary (caries increment) and secondary outcomes (caries intensity, gingival health, caregiver-reported oral health-related knowledge, behaviours and attitudes) over 12 months.Methods High-caries-risk children and caregivers received CCP or MI with comprehensive dental care. Fidelity was monitored using MI treatment integrity code 4.2.1. Caries increment, intensity and gingival health were measured at baseline, six and twelve months. Readiness Assessment of Parents Concerning Infant Dental Decay questionnaires recorded oral health-related knowledge, behaviours and attitudes.Results In total, 86 caregiver-child dyads (CCP = 51; MI = 35) were recruited. The mean difference (95% confidence interval [CI]) in caries increment (ΔdICDAS1-6mfs + DICDAS1-6MFS) was significantly higher with MI compared to CCP at six (MI 2.3 [1.2, 3.5] vs CCP 0.6 [0.1, 1.0]; p <0.001) and twelve (MI 4.3 [2.5, 6.0] vs CCP 1.2 [0.6, 1.8]; p <0.001) months. Multivariate analysis with CCP as reference group, odds ratio (95% CI) for new/progressed caries (Δdecayed, missing and filled surface score [permanent] + decayed, missing and filled surface score [primary] >0) at six and twelve months were 18.2 (4.0, 81.7); p <0.001 and 12.6 (3.3, 47.8); p <0.001, respectively. The MI group reported positive behaviours and attitudes.Conclusions CCP was more effective in reducing caries increment when behaviour change technique was incorporated into the preventative strategies as per current paediatric dentistry guidelines.

Fidelity of motivational interviewing in an oral health intervention with caregivers of young children

The aim of this study was to assess the fidelity of a motivational interviewing (MI) intervention with caregivers of young children in primary healthcare in Southern Brazil. Seven trained interventionists conducted one MI session with each caregiver at their home. The sessions were audio-recorded and a randomly selected subset (n = 109) was coded by a single reviewer using the Motivational Interviewing Treatment Integrity 3.1.1. criteria (MITI 3.1.1.). This instrument establishes parameters of MI proficiency for beginners and experts measuring the global ratings of five MI principles (evocation, collaboration, autonomy/support, direction and empathy), the global MI spirit score, and the behavior counts of MI basic skills: to inform, to ask, and to listen. The mean global MI spirit rating was 4.0 (95%CI 3.9-4.1). Mean MI principle scores ranged from 3.8 (95%CI 3.7-3.9) to 4.3 (95%CI 4.2-4.4). The overall reflection-to-question ratio was 0.9 (95 CI 0.8-1.0), % open questions was 76.3 (95%CI 73.1-79.6), % complex reflections was 66.1 (95%CI 63.1-69.1), and % MI-adherent information was 94.1 (95%CI 93.5-94.5). Interventionists with higher scores conducted more and longer sessions than those with lower scores (p = 0.012). Those with beginner proficiency had a higher proportion of caregivers changing their oral health knowledge (p = 0.005). In conclusion, a good degree of MI fidelity was found, with higher fidelity among interventionists who conducted more interviews and spent more time talking with caregivers.

Impact of Motivational Interviewing on Parental Risk-Related Behaviors and Knowledge of Early Childhood Caries: A Systematic Review

BACKGROUND

Behavior is important in dental disease etiology, so behavioral interventions are needed for prevention and treatment. Motivational interviewing (MI) has been proposed as a potentially useful behavioral intervention for prevention of early childhood caries.

METHODS

Studies have evaluated the effectiveness of MI on reduction of the risk-related behaviors for early childhood caries (ECC) compared to dental health education (DHE) The aim of this systematic review was to assess the scientific evidence on MI applied to change parental risk-related behaviors. The potentially eligible studies involved the assessment of caries-related behaviors in caregivers receiving MI. Electronic search of English published literature was performed in February 2020 in the Scopus, Cochrane, PubMed, and Embase databases. Assessment of risk of bias was done by the Cochrane risk of bias tool.

RESULTS

Of 329 articles retrieved initially, seven were eligible for inclusion in this review. Four studies evaluated the behavior of tooth brushing and four studies assessed the cariogenic feeding practice, while only one study investigated the behavior of checking teeth for pre-cavities. Moreover, two studies examined dental attendance for varnish fluoride use and oral health-related knowledge. It was not possible to perform a meta-analysis.

CONCLUSIONS

Generally, results support the application of MI to improve the "dental attendance behavior for fluoride use" and participants' knowledge. However, the results were inconclusive for other behaviors. We need further and better designed interventions to completely evaluate the impact of MI on specific ECC-related behaviors.

Improving oral health in people with severe mental illness (SMI): A systematic review

BACKGROUND

Those with severe mental illness (SMI) are at greater risk of having poor oral health, which can have an impact on daily activities such as eating, socialising and working. There is currently a lack of evidence to suggest which oral health interventions are effective for improving oral health outcomes for people with SMI.

AIMS

This systematic review aims to examine the effectiveness of oral health interventions in improving oral health outcomes for those with SMI.

METHODS

The review protocol was registered with PROSPERO (ID CRD42020187663). Medline, EMBASE, PsycINFO, AMED, HMIC, CINAHL, Scopus and the Cochrane Library were searched for studies, along with conference proceedings and grey literature sources. Titles and abstracts were dual screened by two reviewers. Two reviewers also independently performed full text screening, data extraction and risk of bias assessments. Due to heterogeneity between studies, a narrative synthesis was undertaken.

RESULTS

In total, 1462 abstracts from the database search and three abstracts from grey literature sources were identified. Following screening, 12 studies were included in the review. Five broad categories of intervention were identified: dental education, motivational interviewing, dental checklist, dietary change and incentives. Despite statistically significant changes in plaque indices and oral health behaviours as a result of interventions using dental education, motivational interviewing and incentives, it is unclear if these changes are clinically significant.

CONCLUSION

Although some positive results in this review demonstrate that dental education shows promise as an intervention for those with SMI, the quality of evidence was graded as very low to moderate quality. Further research is in this area is required to provide more conclusive evidence.

Removable retention: enhancing adherence and the remit of shared decision-making

Patient adherence to removable retainer wear is integral to the long-term success of retention regimes. We discuss the factors influencing removable retainer wear, the methods of gauging wear levels, approaches to enhance adherence and the quality of online available information concerning retention. The potential value of patient involvement in approaches to retention within a shared decision-making framework and motivational interviewing are also highlighted.

A Randomized Clinical Trial Preventive Outreach Targeting Dental Caries and Oral-Health-Related Quality of Life for Refugee Children

Objective: The study assessed a preventive outreach educational intervention targeting improvements in dental caries and oral-health-related quality of life in the children of refugee families by comparing pre- and postintervention outcomes. Methods: This randomized controlled clinical trial assessed the outcomes at baseline and three times over six months using the WHO oral health assessment form (DMFT/dmft) and the parent version of the Michigan Oral-Health-Related Quality of Life scale. Children and at least one of their parents/caretakers were educated on oral health topics in two one-hour sessions. Results: Of the 66 enrolled families, 52 (72%) completed the six-month follow-up. DMFT/dmft scores increased significantly in both the control and intervention groups (p < 0.05); differences in the changes in the DMFT/dmft and MOHRQoL-P scores from baseline to the three- and six-month follow-up visits between groups were not significant (p > 0.05). Conclusions: Oral health education programs targeting a diverse group of refugee children and their parents/caregivers single-handedly did not reduce the increased number of caries lesions or improve oral-health-related quality of life.

Education intervention with respect to the oral health knowledge, attitude, and behaviors of refugee families: A randomized clinical trial of effectiveness

Objectives

The study assessed the effectiveness of an oral health educational and behavioral intervention program in improving the knowledge, attitudes, and behaviors of refugee families.

Methods

This randomized 2‐arms, controlled, single site, clinical trial assessed the dental knowledge, attitudes, and behaviors related to oral health at baseline and three times over the course of the 6 months of the intervention in recent refugee families. Participating families were educated on five topics in oral health in two 1‐hour sessions utilizing existing oral health education materials adapted to be linguistically and culturally appropriate for demonstration and instruction. Culturally competent techniques and motivational interviewing styles were also implemented during sessions. Pre/post surveys were used to assess changes to knowledge, attitudes, and behavior among refugee family participants.

Results

Out of the 66 families enrolled in the program, 52 (72 percent) completed visits over the course of 6 months. Differences between the intervention and control groups were not significant between baseline and 3 to 6 months later (P > 0.05).

Conclusions

A short‐term, culturally informed oral health educational and behavioral intervention program did not improve oral health‐related knowledge, attitudes, or behaviors in a diverse group of recent refugee families.

Motivational interviewing for preventing early childhood caries: A systematic review and meta-analysis

OBJECTIVES

This systematic review with meta-analysis was performed to assess whether motivational interviewing (MI) is effective in the prevention of early childhood caries (ECC) and to examine potential sources of heterogeneity.

METHODS

Interventions based on motivational interviewing were considered eligible. The main outcome was new caries lesions (some studies included white-spot lesions in total count), and secondary outcomes included caregivers' oral health knowledge, home-care behaviours, plaque index, gingival index and fluoride varnish applications. Controls were any type of oral health education or negative controls without any specific intervention.

RESULTS

From a total of 1498 studies identified in the databases search, 1078 were assessed for eligibility by reading titles and abstracts, after removal of duplicates. Full-text screening was performed in 61 articles, with 18 reporting on 14 different studies included in the qualitative synthesis and 8 in the quantitative synthesis (four studies included new white-spot lesions in total count). Subgroup analysis was performed by the control group dmft/dmfs and the test for subgroup differences suggests that there is a subgroup effect (P = .06), so population caries experience modifies the effect of MI-based intervention. In populations with high caries experience, the MI-based approach proved preventing an average of 3.15 (95% CI: -6.14, -0.17) dmfs in young children. In samples with low caries experience, differences were smaller, since the caries levels were already lower (-0.31; 95% CI: -0.63, 0.00).

CONCLUSION

Motivational interviewing has the potential to modify knowledge and behaviours and reduce ECC with a more significant impact on children with high caries experience.

Does motivational interviewing contribute to caries prevention in children from lower income families?

Aim To investigate the differential preventive effect of motivational interviewing on early childhood caries according to socioeconomic variables in a primary healthcare setting. Trial design Randomised, double-blind trial with two parallel groups, based in a community setting.Study population Selected from an invited subgroup of children born in 2013 and 2014 in the northern area of the city of Porto Alegre, Rio Grande do Sul, BrazilInterventions Primary caregivers of the patients were randomised to receive information about breastfeeding, child nutrition and oral hygiene during an initial dental appointment in the patient's first year of life either by conventional delivery techniques or by motivational interviewing.Outcomes Analysis of dmfs index from clinical examinationResults Nine-hundred and fifteen patients were randomised to the two arms and 414 children were included in the study, with 501 lost to follow up. One-hundred and eighty-six received conventional health education, and 228 received motivational interviewing. The caries rate per 100 surface year was 1.29 for the conventional education group, and 0.46 for the motivational interviewing group. The effect of motivational interviewing was statistically significant in the lower-income category with prevention of 57% of carious lesions. There was no such statistically significant difference in the higher income subjects.Conclusions The outcome showed reduced caries experience by children where their primary caregiver has received preventative advice via a motivational interviewing technique when compared to conventional education methods. This study suggests that motivational interviewing is more effective in more disadvantaged groups.

Impact of motivational interviewing on early childhood caries: A systematic review and meta-analysis

BACKGROUND

The authors aimed to assess the scientific evidence on motivational interviewing for the clinical reduction of early childhood caries compared with traditional dental health education.

METHODS

Search terms were selected on the basis of Medical Subject Headings and non-Medical Subject Headings terms. The main key words were motivational interviewing, early childhood caries, and education. Potentially eligible studies involved the clinical assessment of caries rate in children whose parents or caregivers received motivational interviewing as an intervention. The authors assessed the risk of bias using the Cochrane risk-of-bias tool. In March 2019, the authors performed an electronic database search of literature published in English within the following databases: Scopus, Cochrane, PubMed, and Embase.

RESULTS

Of 329 articles retrieved initially, 14 were eligible for inclusion in the systematic review and 3 articles contributed to the meta-analysis. For statistical analysis, the mean difference of continuous data was analyzed at a 95% confidence interval using the random-effects model.

CONCLUSIONS

Overall, the evidence presented in this review was limited. Although the results of the meta-analysis showed that motivational interviewing is as effective as dental health education in controlling early childhood caries, we need more and better designed and reported interventions to assess its impact on early childhood caries accurately.

Comparison of oral health behaviour between dental and non-dental undergraduates in a university in southwestern China--exploring the future priority for oral health education

Background

Based on a national survey in 2015, people’s oral health behaviour (OHB) has not kept up with the pace of knowledge and attitudes in China after decades of oral health education (OHE). Thus, we need to improve OHE to strengthen people’s OHB. Undergraduates are regarded as the best candidates for the improvement of OHE. The objective of this study is to determine undergraduates’ oral health status and existing problems in OHB by comparing dental and non-dental students at Sichuan University. We hope to provide some suggestions for future OHE to improve people’s OHB.

Methods

A quasi-experimental study designed with a pre-test and post-test group was conducted. A total of 217 dental students and 135 non-dental students were enrolled. They were administered an OHE course focused on OHB. A survey about oral health behaviour and knowledge was conducted before and after the course.

Results

According to the pre-course survey, dental students surpassed non-dental students in terms of toothbrushing frequency, method, and time, but unfortunately, flossing was overlooked by all the students. After the course, both dental and non-dental students showed strong willingness to improve their OHB. More non-dental students than dental students were willing to use toothpicks and Chinese herbal toothpaste before and after the course.

Conclusions

OHE focused on behaviour has a positive effect on university students. Future OHE and interventions should focus on flossing, toothbrushing methods, toothpicks, Chinese herbal toothpaste and modifications to adopt new media.

Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits

Background: Dental caries in pediatric patients are noted to have broad impacts on systemic health and well-being. Thus, utilizing an effectiveness-implementation hybrid I design, the Pediatric Providers Against Cavities in Children's Teeth (PACT) trial is investigating multi-level interventions at the practice (incorporation of oral health in electronic medical record [EMR]) and provider levels (theory-based didactic and skills training to communicate oral health facts to parent/caregiver, give a prescription to see a dentist and a list of area dentists) to increase dental utilization among 3 to 6 year old Medicaid-enrolled children attending well-child visits (WCV). The formative and pilot work for the larger main trial are presented. Methods: Formative work-Focus groups with 26 participants (Community leaders, providers, parent/caregivers); and key informant interviews with practice leadership (n = 4). Topics discussed were: core oral health (OH) information to communicate at WCVs and study logistics. Transcripts were coded and analyzed using Atlas.ti; Pilot study was refined using the formative findings and was conducted at two pediatric practices to test the implementation of: the provider didactic and skills training curriculum; EMR incorporation of four OH questions; logistics of incorporating OH activities at a WCV; and parent/caregiver recruitment. Results: Formative work showed that providers and parent/caregivers required knowledge of dental caries, and a list of area Medicaid-accepting dentists. Providers and practice leadership advised on the logistics of incorporating oral health into WCVs. All groups suggested asking parent/caregivers their preferred method of contact and emphasizing importance of OH to motivate participation. Utilizing these findings, the curriculum and protocol was revised. The pilot study in two practices successfully implemented the protocol as follows: all seven providers were trained in two 45 min didactic education and skills session; incorporation of OH questions into practices EMR; recruited 86 child-parent dyads (95% participation) at the WCV; providers delivered the OH intervention to parent/caregivers in <2 min and 90% completed EMR documentation of OH questions. These findings were instrumental in finalizing the main PACT trial in 18 practices. The RE-AIM framework is used in the main trial to collect effectiveness and implementation measures at baseline and follow-up visits. Conclusions: The formative and pilot findings were instrumental in refining the OH intervention and protocol which has resulted in successful implementation of the main trial. Trial Registration: Clinical trials.gov, Registered 9 November 2017, NCT03385629.

Effect of a health-education program using motivational interviewing on oral health behavior and self-efficacy in pregnant women: a randomized controlled trial

Oral health problems are common among pregnant women. The objective of this study was to examine the effectiveness of motivational interviewing (MI) as a behavior-change technique to enhance self-efficacy and oral health among pregnant women. A randomized controlled trial was conducted with 112 pregnant Iranian women. Women in the intervention group received an education program on oral health using MI during two face-to-face sessions, along with routine health education (two 1-h lectures on oral health changes and needs during pregnancy presented as a lecture by an oral health technician over a 2-wk period). Those in the control group received two 1-h lectures on oral health changes and needs during pregnancy. Oral health behaviors, oral health self-efficacy, and general self-efficacy, were assessed, along with gingival and dental health from baseline to the 3-month follow-up. Analysis of covariance was used to determine differences between intervention and control groups. Scores for both general and specific self-efficacy and for healthy behaviors increased in the intervention group, whereas there was no significant change within controls from baseline to follow-up. Between-group analyses also indicated a significant difference in the scores for self-efficacy and behavior favoring the intervention group. Scores on the gingival inflammation index decreased, as did the number of decayed teeth in the intervention group relative to the control group. The number of filled teeth increased significantly in the intervention group. Health education interventions using MI techniques may help to improve oral health-related self-efficacy and behaviors among pregnant women.

GoPerio - impact of a personalized video and an automated two-way text-messaging system in oral hygiene motivation: study protocol for a randomized controlled trial

Background

Oral hygiene is of paramount importance for the preservation of oral health, and for patients affected by periodontal disease establishing an effective oral hygiene routine is the first step of therapy. Several clinical frameworks have been developed to foster behavior change, such as motivational interviewing. However, two obstacles can be identified. First, patients tend to forget the advice they were given during the consultation. Second, it is hard to maintain motivation in the long term, thus leading to relapse. An innovative eHealth solution was designed with the aim to tackle both obstacles and supplement the current clinical standard of care. The primary objective is to compare the full mouth plaque scores of study groups (eHealth plus standard of care versus standard of care only) at 8 weeks of follow up. The main secondary objective is to compare the full mouth bleeding score at 8 weeks of follow up.

Methods/design

The “GoPerio” study is a multicenter, randomized, controlled trial assessing the impact of a novel eHealth concept for oral hygiene motivation (personalized video of oral hygiene routine available for the patient via a cloud server plus interactive text messages) in addition to the current standard of care (motivational interviewing plus tooth scaling and polishing). The minimum sample size required is 86 patients. Participants will be randomized (allocation ratio 1:1): test group (eHealth plus standard of care) versus control group (standard of care only). The primary outcome is oral hygiene as measured by the full mouth (six sites per tooth) plaque control record (PCR) index. The main secondary outcome is gingival inflammation as measured by the full mouth (six sites per tooth) bleeding on probing (BOP) index. Both the primary and the main secondary outcomes are evaluated by blinded and calibrated examiners at 8 weeks of follow up. The other secondary outcomes are patient satisfaction and patient behavior change and motivation.

Discussion

The study will investigate the value of an innovative eHealth approach to strengthen patient motivation for oral hygiene. If proven effective, such an approach would supplement the current clinical standard of care, resulting in improved clinical outcomes with negligible impact on productivity in a dental practice.

Trial registration

ClinicalTrials.gov, NCT03109808. Registered on 12 April 2017.

Sponsor: Hospices Civils de Lyon. BP 2251, 3 quai des Célestins, 69,229 Lyon cedex 02.

Protocol version: 1.0 as of 21 September 2016.

Brief Motivational Interviewing in Dental Practice

Motivational Interviewing has been demonstrated to be effective for a wide range of health behaviors. It is an effective behavior change method, which can be utilized in the dental practice setting. It can be used as a brief intervention to increase motivation to improve patients’ oral hygiene behaviors as well as providing a framework for delivering diet, smoking cessation, oral health changes, and alcohol advice. It involves four processes: engaging, focusing, evoking, and planning, guiding, which supports the patient towards a positive behavior change. Motivational Interviewing is a collaborative, patient-centered approach evoking the patient’s own motivation to change, thereby enhancing the relationship between the clinician and patient and improving patient outcomes. This review will provide an overview on the topic for dental professionals as well as helpful suggestions for supporting a positive behavior change in their dental practices.

Randomized Trial Based on the Common-Sense Model of Self-regulation to Increase Child Dental Visits

INTRODUCTION

School screening and the note home (pinned to a backpack) informing parents/caregivers that their child needs to see a dentist have not been effective.

OBJECTIVES

The Family Access to a Dentist Study (FADS) evaluated the effectiveness of school interventions based on the common-sense model of self-regulation (CSM) among K-4 children needing restorative treatment.

METHODS

FADS was a multisite double-blind randomized controlled trial with 5 arms. FADS tested a CSM-driven referral letter and dental information guide (DIG) to move caregivers from inaccurate to accurate perceptions of dental caries. Six school districts from Ohio and Washington (14 schools) participated in school years 2015 to 2016 and 2016 to 2017. A total of 611 caregivers were randomized, and 86% (n = 597 children) completed the exit examination. The primary outcome was receipt of care based on a change in oral health status determined clinically within 1 school year.

RESULTS

In accordance with our primary aims, 5 arms were collapsed into 3: CSM letter and reduced CSM letter (combined), CSM letter + DIG and reduced CSM letter + reduced DIG (combined), and standard letter. Among all sites, 39.7% received restorative care (237 of 597). Combined analysis of sites revealed that the CSM referral letter (with and without the DIG) did not increase dental visits when compared with the standard letter. However, for combined sites (East Cleveland, Ohio; Washington), the CSM + DIG increased dental visits when compared with standard letter in univariate analysis (51.3% vs. 40.9%), indicating 1.6-times increased odds of a dental visit (95% CI, 0.97 to 2.58) after imputation and adjustment for covariates. The CSM + DIG group had 1.9-times increased odds (95% CI, 1.21 to 3.08) of care when compared the CSM letter alone.

CONCLUSION

A CSM-driven approach to informing caregivers of the chronic nature of caries with resources in an illustrative manner can increase the benefit of school oral health screening (ClinicalTrials.gov NCT02395120).

KNOWLEDGE TRANSFER STATEMENT

A school dental referral (note home) that tells a parent that the child has cavities has not been effective. In this trial, a referral based on the common-sense model of self-regulation increased follow-up care for children with restorative needs.

Perioperative changes in knowledge and attitude toward oral health by oral health education

OBJECTIVES

Perioperative oral health care can prevent postoperative complications, but it is also important to maintain oral health afterward to avoid later adverse events. This study examined (a) the relationship between knowledge and attitude toward oral health (KAOH) and oral/periodontal status (OPS) in patients receiving surgery, and (b) the changes in KAOH by perioperative oral health care and education.

METHODS

Patients receiving surgery who visited our hospital's dental clinic beforehand were prospectively recruited. All participants received oral health care and education. In questionnaires assessing KAOH before and after surgery, respondent answers were generally classified as positive or negative. OPS was assessed before surgery. Associations between KAOH and OPS and perioperative changes in KAOH were statistically tested.

RESULTS

A total of 507 patients answered the questionnaire before surgery, among whom 324 patients also completed it afterward. Preoperative OPS was significantly worse in the negative than in the positive KAOH group. Positive answers for KAOH increased significantly from 68.6% to 92.2% during the perioperative period.

CONCLUSIONS

We found that patients with poor KAOH also had poor OPS, but KAOH could be improved by perioperative oral health care and education, suggesting that perioperative oral health management could improve oral health knowledge and attitudes.

Effectiveness of Motivational Interviewing Training for Primary Care Dentists and Dental Health Technicians: Results from a Community Clinical Trial

Motivational interviewing (MI) is an approach that uses dialogue about behavioral change to encourage a constructive relationship between professionals and patients. The aim of this study was to evaluate the maintenance of basic MI skills in the daily practice of dentists and oral health technicians (OHTs) after a training course and for two years of follow-up in the context of primary health care (PHC). A randomized community trial, from September 2012 to September 2014, was conducted at the Community Health Service of Conceição Hospital Group in Porto Alegre, RS, Brazil. The experimental group consisted of all 41 dentists and OHTs who received an intensive eight-hour training course in basic MI principles; the control group consisted of 31 dentists and OHTs who did not receive MI training. The follow-up assessments were at one and two years using three instruments validated for MI. In the one- and two-year follow-ups, improvement was maintained in responses with a statistically significant difference for use of open questioning, reflective listening, and total percentage of correct answers (p<0.001), with a large effect size (ES=1.12). On the Helpful Responses Questionnaire, the participants continued using open questioning and reflective listening (p<0.001), maintaining an increase in the percentage of responses compatible with MI (p<0.001). Likewise, the effect size remained large (ES=1.33) over time. These results suggest that the training course with dentists and OHTs of the PHC oral health staff was effective over the two-year follow-up in enabling them to act in the spirit and techniques of MI.

Effectiveness of Motivational Interviewing on adult behaviour change in health and social care settings: A systematic review of reviews

BACKGROUND

The challenge of addressing unhealthy lifestyle choice is of global concern. Motivational Interviewing has been widely implemented to help people change their behaviour, but it is unclear for whom it is most beneficial. This overview aims to appraise and synthesise the review evidence for the effectiveness of Motivational Interviewing on health behaviour of adults in health and social care settings.

METHODS

A systematic review of reviews. Methods were pre-specified and documented in a protocol (PROSPERO-CRD42016049278). We systematically searched 7 electronic databases: CDSR; DARE; PROSPERO; MEDLINE; CINAHL; AMED and PsycINFO from 2000 to May 2018. Two reviewers applied pre-defined selection criteria, extracted data using TIDIER guidelines and assessed methodological quality using the ROBIS tool. We used GRADE criteria to rate the strength of the evidence for reviews including meta-analyses.

FINDINGS

Searches identified 5222 records. One hundred and four reviews, including 39 meta-analyses met the inclusion criteria. Most meta-analysis evidence was graded as low or very low (128/155). Moderate quality evidence for mainly short term (<6 months) statistically significant small beneficial effects of Motivational Interviewing were found in 11 of 155 (7%) of meta-analysis comparisons. These outcomes include reducing binge drinking, frequency and quantity of alcohol consumption, substance abuse in people with dependency or addiction, and increasing physical activity participation.

CONCLUSIONS

We have created a comprehensive map of reviews relating to Motivational Interviewing to signpost stakeholders to the best available evidence. More high quality research is needed to be confident about the effectiveness of Motivational Interviewing. We identified a large volume of low quality evidence and many areas of overlapping research. To avoid research waste, it is vital for researchers to be aware of existing research, and the implications arising from that research. In the case of Motivational Interviewing issues relating to monitoring and reporting fidelity of interventions need to be addressed.

Educational interventions in health services and oral health: systematic review

OBJECTIVE

To analyze the effectiveness of educational interventions performed in health services in the improvement of clinical behaviors and outcomes in oral health.

METHODS

We have carried out a systematic review of the literature searching the PubMed, Lilacs, and SciELO databases. We have included studies that have investigated interventions performed by health professionals working in health services and who have used educational actions as main approach to improve behavioral and clinical outcomes in oral health.

RESULTS

The search amounted to 832 articles and 14 of them met all the inclusion criteria. Five studies have only exclusively evaluated the effectiveness of interventions on caries reduction, three have exceptionally evaluated oral health behaviors, and the other articles have evaluated the effectiveness of interventions for both clinical outcomes (dental caries and periodontal conditions) and behaviors in oral health. Most of the studies (n = 9) were based on randomized controlled trials; the other ones have evaluated before and after the intervention. Five studies have reported a significant reduction of dental caries, and five of the six studies evaluating behavioral outcomes have found some positive change.

CONCLUSIONS

Most studies evaluating behavioral and periodontal outcomes have shown significant improvements in favor of interventions. All studies evaluating caries have shown a reduction in new lesions or cases of the disease in the groups receiving the interventions, although only five of the eleven articles have found a statistically significant difference. Educational interventions carried out by health professionals in the context of their practice have the potential to promote oral health in the population.

Effective strategies to motivate nursing home residents in oral care and to prevent or reduce responsive behaviors to oral care: A systematic review

BACKGROUND

Poor oral health has been a persistent problem in nursing home residents for decades, with severe consequences for residents and the health care system. Two major barriers to providing appropriate oral care are residents' responsive behaviors to oral care and residents' lack of ability or motivation to perform oral care on their own.

OBJECTIVES

To evaluate the effectiveness of strategies that nursing home care providers can apply to either prevent/overcome residents' responsive behaviors to oral care, or enable/motivate residents to perform their own oral care.

MATERIALS AND METHODS

We searched the databases Medline, EMBASE, Evidence Based Reviews-Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science for intervention studies assessing the effectiveness of eligible strategies. Two reviewers independently (a) screened titles, abstracts and retrieved full-texts; (b) searched key journal contents, key author publications, and reference lists of all included studies; and (c) assessed methodological quality of included studies. Discrepancies at any stage were resolved by consensus. We conducted a narrative synthesis of study results.

RESULTS

We included three one-group pre-test, post-test studies, and one cross-sectional study. Methodological quality was low (n = 3) and low moderate (n = 1). Two studies assessed strategies to enable/motivate nursing home residents to perform their own oral care, and to studies assessed strategies to prevent or overcome responsive behaviors to oral care. All studies reported improvements of at least some of the outcomes measured, but interpretation is limited due to methodological problems.

CONCLUSIONS

Potentially promising strategies are available that nursing home care providers can apply to prevent/overcome residents' responsive behaviors to oral care or to enable/motivate residents to perform their own oral care. However, studies assessing these strategies have a high risk for bias. To overcome oral health problems in nursing homes, care providers will need practical strategies whose effectiveness was assessed in robust studies.

Comparison of Oral Health Education and Fluoride Varnish to Prevent Early Childhood Caries: A Randomized Clinical Trial

Early childhood caries, a serious health problem among young children, can be prevented with effective intervention. The aim of this study was to evaluate the efficacy of oral health education and a fluoride varnish in the prevention of caries in children under the age of 3 years. For this single-blind randomized parallel group 1-year clinical trial in Shiraz, 300 children aged 12-24 months with sound primary teeth were selected and randomly divided into three groups (n = 100): (1) control: no preventive intervention; (2) oral health counseling, and (3) oral health counseling and fluoride varnish at baseline and 6 months later. At baseline and 4, 8 and 12 months after the intervention, caries risk reduction was recorded as the primary outcome. The mothers' knowledge and performance regarding oral health in children was used as a secondary outcome. A total of 260 children (mean age: 20.49 ± 7.33 months) completed the study. Compared to group 1, caries risk reduction in group 2 was 28% (95% CI: -39.05 to -17.45) and 31% in group 3 (95% CI: -41.88 to -21.73). However, there was no significant difference between groups 2 and 3 (95% CI: -8.58 to 1.47). In all groups, mothers' knowledge and performance at baseline were low; however, they increased significantly in follow-up appointments in groups 2 and 3 (p < 0.001). Oral health education increased mothers' knowledge and performance regarding oral health in children. Oral health counseling alone or associated with the use of fluoride varnish reduced the caries incidence in young children.

Behaviour change counselling for tobacco use cessation and promotion of healthy lifestyles: a systematic review

AIM

To systematically assess the efficacy of oral health behaviour change counselling for tobacco use cessation (TUC) and the promotion of healthy lifestyles.

MATERIALS AND METHODS

Systematic Reviews, Randomized (RCTs), and Controlled Clinical Trials (CCTs) were identified through an electronic search of four databases complemented by manual search. Identification, screening, eligibility and inclusion of studies were performed independently by two reviewers. Quality assessment of the included publications was performed according to the AMSTAR tool for the assessment of the methodological quality of systematic reviews.

RESULTS

A total of seven systematic reviews were included. With the exception of inadequate oral hygiene, the following unhealthy lifestyles related with periodontal diseases were investigated: tobacco use, unhealthy diets, harmful use of alcohol, physical inactivity, and stress. Brief interventions for TUC were shown to be effective when applied in the dental practice setting while evidence for dietary counselling and the promotion of other healthy lifestyles was limited or non-existent.

CONCLUSIONS

While aiming to improve periodontal treatment outcomes and the maintenance of periodontal health current evidence suggests that tobacco use brief interventions conducted in the dental practice setting were effective thus underlining the rational for behavioural support.

Effective strategies to motivate nursing home residents in oral healthcare and to prevent or reduce responsive behaviours to oral healthcare: a systematic review protocol

INTRODUCTION

Oral healthcare in nursing homes is less than optimal, with severe consequences for residents' health and quality of life. To provide the best possible oral healthcare to nursing home residents, care providers need strategies that have been proven to be effective. Strategies can either encourage and motivate residents to perform oral healthcare themselves or can prevent or overcome responsive behaviours from residents when care providers assist with oral healthcare. This systematic review aims to identify studies that evaluate the effectiveness of such strategies and to synthesise their evidence.

METHODS AND ANALYSIS

We will conduct a comprehensive search in the databases MEDLINE, EMBASE, Evidence Based Reviews--Cochrane Central Register of Controlled Trials, CINAHL and Web of Science for quantitative intervention studies that assess the effectiveness of eligible strategies. 2 reviewers will independently screen titles, abstracts and retrieved full texts for eligibility. In addition, contents of key journals, publications of key authors and reference lists of all studies included will be searched by hand and screened by 2 reviewers. Discrepancies at any stage of the review process will be resolved by consensus. Data extraction will be performed by 1 research team member and checked by a second team member. 2 reviewers will independently assess methodological quality of studies included using 3 validated checklists appropriate for different research designs. We will present a narrative synthesis of study results.

ETHICS AND DISSEMINATION

We did not seek ethics approval for this study, as we will not collect primary data and data from studies included cannot be linked to individuals or organisations. We will publish findings of this review in a peer-reviewed paper and present them at an international peer-reviewed conference.

TRIAL REGISTRATION NUMBER

CRD42015026439.

A Traditional Mouthwash (Punica granatum var pleniflora) for Controlling Gingivitis of Diabetic Patients: A Double-Blind Randomized Controlled Clinical Trial

This study evaluates the safety and efficacy of Punica granatum var pleniflora mouthwash in treatment of diabetic gingivitis. In a double-blind randomized clinical trial 80 patients with diabetes mellitus and gingivitis were assigned to Golnaar and chlorhexidine 0.2% groups. After using mouthwashes for 2 weeks; participants underwent tooth scaling and the last visit was 2 weeks after scaling. The primary outcome measures were plaque, modified gingival and gingival bleeding indices, and pocket depth. Both interventions had significant improvement on all of the gingival and plaque indices (P < .001 for all indices). There were no significant differences between Golnaar and chlorhexidine in primary outcome measures except for modified gingival index for which Golnaar mouthwash had a superiority after 2 weeks when comparing with chlorhexidine (P = .039). Meanwhile, Golnaar mouthwash had no staining effect. Golnaar mouthwash is safe and effective in treatment of gingivitis in diabetic patients although further studies are recommended.

EAPD interim seminar and workshop in Brussels May 9 2015 : Non-invasive caries treatment

Aim

This was to collect information for the 9th European Academy of Paediatric Dentistry Interim Seminar and Workshops to discuss the state of art on non-invasive caries therapy to be used if possible to formulate clinical guidelines by European experts in paediatric dentistry

Methods

Based on systematic reviews and additional papers were assessed for methods to prevent caries initiation and caries progression both in the state of pre-cavitation and cavitation without invasive technologies.

Results

The use of fluoridated water, careful diligent daily use of fluoride toothpaste, fluoride varnishes, pit and fissure sealants and leak-proof restorative materials without excavation of caries are evidence based for caries prevention and for non-invasive treatment of pre-cavitated and cavitated caries. Other technologies are far less evidenced based and would not logically fit in guidelines for the non-invasive treatment of caries. Recent studies on cavitated lesions in the primary dentition demonstrate that thorough oral hygiene practices may arrest progression. This strategy depends heavily on the strategies in the dental surgery to change behaviour of children. An important aspect is for advice to be tailored at recall intervals to ensure compliance and to timely detect unnecessary and unwanted progression of the lesions.

Conclusion

Non-invasive therapies have been proven to be effective for caries prevention and the management of pre-cavitated caries lesions. Non-invasive therapies can also be effective to arrest cavitated lesions but the success depends greatly on behavioural changes of patients to brush the lesions.

Family Access to a Dentist Study (FADS): A multi-center randomized controlled trial

INTRODUCTION

Many low-income parent/caregivers do not understand the importance of cavity-free primary (baby) teeth and the chronic nature of dental caries (tooth decay). As a consequence, dental preventive and treatment utilization is low even when children are screened in schools and referred for care. This study aims to test a referral letter and Dental Information Guide (DIG) designed using the Common-Sense Model of Self-Regulation (CSM) framework to improve caregivers' illness perception of dental caries and increase utilization of care by children with restorative dental needs.

METHODS

A multi-site randomized controlled trial with caregivers of Kindergarten to 4th grade children in urban Ohio and rural Washington State will compare five arms: (1) CSM referral letter alone; (2) CSM referral letter+DIG; (3) reduced CSM referral letter alone; (4) reduced CSM referral letter+DIG; and (5) standard (control) referral. At baseline, children will be screened at school to determine restorative dental needs. If in need of treatment, caregivers will be randomized to study arms and an intervention packet will be sent home. The primary outcome will be dental care based on a change in oral health status by clinical examination 7 months post-screening (ICDAS sealant codes 1 and 2; restoration codes 3-8; extraction). Enrollment commenced summer 2015 with results in summer 2016.

CONCLUSION

This study uses the CSM framework to develop and test behavioral interventions to increase dental utilization among low-income caregivers. If effective this simple intervention has broad applicability in clinical and community-based settings.