Effectiveness of Oral Hygiene Instructions Given in Computer-Assisted Format versus a Self-Care Instructor

Effect of mobile app-based oral hygiene instructions on clinical parameters, oral bacterial diversity, and composition of subgingival microbiota in periodontitis patients

Introduction

Oral hygiene instruction (OHI) is essential during periodontitis treatment. Various OHI approaches have been explored, including mobile apps.

Objective

To evaluate the mobile app-based OHI's effect on periodontitis management by analyzing clinical parameters and subgingival microbiota.

Methods

Forty-four periodontitis patients were randomly assigned into two groups. The test group (n = 22) received scaling and root planing (SRP), OHI, and mobile app-based OHI, whereas the control group (n = 22) received SRP and OHI. Full mouth plaque score (FMPS), bleeding on probing (BOP) and probing pocket depth at the sampling sites (site-PPD) were assessed at baseline, one- and three-month visits. The 16S rRNA next-generation sequencing (NGS) was used to analyze subgingival plaque samples.

Results

Significant reduction in FMPS, BOP, and site-PPD at one- and three-month visits compared to baseline (p < 0.001) with no significant differences across groups (p > 0.05). In test groups, intra-group analysis showed better improvement in BOP and site-PPD (p < 0.05) than control. The diversity and composition of subgingival microbiota did not differ between groups or timepoints (p > 0.05).

Conclusions

Mobile app-based OHI showed no superior effects on improving clinical parameters and subgingival microbiota compared to conventional OHI. Further investigation into its long-term impact on periodontitis treatment is needed.

Mobile Application-Based Support for Periodontal Treatment Improves Clinical, Cognitive, and Psychomotor Outcomes: A Randomized Controlled Trial Study

This study aims to evaluate the clinical, cognitive, and psychomotor changes that emerged among patients with gingivitis and patients with periodontitis via mobile application assistance. Forty subjects were randomly and evenly distributed into test and control groups and were administered a professional mechanical plaque removal (PMPR) procedure. The clinical parameters examined were bleeding on probing (BoP), probing pocket depth (PPD), and the oral hygiene index (OHI-S). The test group was administered a mobile application intervention, namely PerioUICare, which provided users with continuous education and motivation and served as a daily dental hygiene reminder. The comparative results of the mean values of all parameters between the groups (inter-group) and within the groups (intra-group) after one- and three-month evaluations were analyzed. A one-month inter-group evaluation uncovered significant differences in the BoP, PPD, cognitive, and psychomotor scores of subjects with gingivitis and the BoP, OHI-S, cognitive, and psychomotor scores of subjects with periodontitis. A three-month inter-group evaluation revealed significant differences across all parameters except for PPD in subjects with periodontitis. The results of the intra-group comparison demonstrated statistically significant differences in all parameters in the test group but no significant differences in the cognitive and psychomotor scores of the control group. This study revealed that mobile application-based support for periodontal treatment can be considered effective.

Efficacy of Visual Oral Health Reinforcement in Reducing Plaque Accumulation and Gingival Bleeding: A Pilot Randomized Controlled Trial

AIM

To compare oral hygiene (OH) differences during verbal or video OH instructions with or without images displaying poor oral health consequences.

MATERIALS AND METHODS

Twenty-one healthy females (18-30 years) were randomly and equally divided into three intervention OH instruction groups: (1) verbal, (2) video-based, (3) video-based with image displaying the consequences of poor OH. Gingival bleeding on probing (BOP), gingival bleeding index (BI), and plaque score (PS) were assessed at baseline and after 4 weeks. Within- and between-group differences were assessed by non-parametric tests.

RESULTS

Plaque score only showed a statistical group difference after follow-up [H(2) = 9.214, p = 0.01]. The post hoc test revealed that group III showed a significantly lower PS than groups I and II (p = 0.04 and p = 0.017, respectively). No differences were observed in PS between groups I and II. Group I showed no follow-up reduction in PS, BI, and BOP, while group II showed a statistically significant reduction in BI only after follow-up (p = 0.028). However, group III showed a statistically significant reduction in BOP and PS (p = 0.023 and p = 0.045, respectively) but not BI.

CONCLUSIONS

Verbal and video-alone OH instructions similarly affect gingival health, while participants who were exposed to images displaying the severe OH consequences had lower PS than verbal or video-alone groups.

CLINICAL SIGNIFICANCE

The mode of OH instructions is not influential for optimum oral health. However, employing visuals highlighting the severe consequences of poor OH leads to short-term reduction of plaque accumulation. How to cite this article: Aleid AA, Alnowaiser A, AlSakakir A, et al. Efficacy of Visual Oral Health Reinforcement in Reducing Plaque Accumulation and Gingival Bleeding: A Pilot Randomized Controlled Trial. J Contemp Dent Pract 2024;25(2):186-190.

Reporting characteristics of nonsurgical periodontal therapy trials registered in ClinicalTrials.gov: an observational study

Aim: To evaluate the completeness of the description of nonsurgical periodontal therapy interventions in clinical trials registered in ClinicalTrials.gov and correspondence of registered information for trial participants and outcome measures with published articles. Materials & methods: We retrieved data from ClinicalTrials.gov and corresponding publications. The completeness of intervention reporting was assessed using the Template for Intervention Description and Replication (TIDieR) checklist for oral hygiene instructions (OHI), professional mechanical plaque removal (PMPR), and subgingival instrumentation, antiseptics and antibiotics. The completeness of registration of trial protocol information was assessed according to the WHO Trial Registration DataSet for participant information (enrollment, sample size calculation, age, gender, condition) and primary/secondary outcome measures. Results: 79 included trials involved OHI (n = 38 trials, 48.1%), PMPR (n = 19, 24.1%), antiseptics (n = 11, 12.7%), or antibiotics (n = 11, 12.7%). There was a great variety in the terms used to describe these interventions. Most of the analyzed trials (93.7%) were completed and did not provide any data on study phase (74.7%). The description of intervention in the registry in ClinicalTrials.gov was inadequate for all analyzed interventions, with description inconsistencies in matching publications. There were also discrepancies in registered and published outcomes: for 39 trials with published results, 18 had different registered and reported primary outcomes, and 29 different registered and reported secondary outcomes. Conclusion: The completeness of the description of nonsurgical therapy of periodontitis in clinical trials is unsatisfactory, reducing the quality of translation of the new evidence and procedures into clinical practice. Significant discrepancy in registered and reported trial outcomes calls into question the validity of reported results and relevance for practice.

Behavioral Interventions on Periodontitis Patients to Improve Oral Hygiene: A Systematic Review

This systematic review aimed to investigate the impact of different psychological models, strategies, and methods to improve plaque control and/or gingival inflammation in patients with periodontal diseases. Methods: The PubMed/MEDLINE, Cochrane Library, and Embase online databases were explored to identify relevant studies published before October 2022. Articles investigating the effects of different psychological approaches and intervention strategies on periodontitis patients’ oral hygiene (OH) behavioral change were screened. Results: 5460 articles were identified, and 21 fulfilled the inclusion criteria. In total, 2 studies tested audio-visual modalities, and the remaining 19 publications involved six psychological models of health-related behavioral interventions, including Social Cognitive Theory, the Theory of Planned Behavior, the Health Action Process Approach, Leventhal’s self-regulatory theory, Motivational Interviewing, and Cognitive Behavioral Therapy. A meta-analysis of the results was not carried out due to the high heterogeneity among the interventions. Conclusions: Considering the limitations of the available studies, psychological interventions based on social cognitive models that combine some of the techniques of this model (goal setting, planning, self-monitoring, and feedback) may improve OH in periodontitis patients, having a positive impact on periodontal clinical outcomes. Delivering cognitive behavioral therapy in combination with motivational interviewing may result in an improvement in OH as evaluated by decreasing plaque and bleeding scores.

Comparison of effectiveness of oral hygiene instruction methods in improving plaque scores among 8-9-year children: a randomized controlled trial

PURPOSE

The relative effectiveness of different methods used for delivery of information regarding oral health in children has not been widely raised in the literature. This study aimed at evaluating the effect of verbal oral hygiene instruction (OHI) against the verbal instruction supplemented by three different methods (written, teeth teaching model, and videotape) on the mean plaque scores and to determine factors that may influence the effectiveness of methods used.

METHODS

Prospective-comparative randomized controlled trial carried out on 120 children aged 8-9 years. Participants were randomly divided into four groups (verbal, verbal and written, verbal and teeth teaching model, and verbal and video). Plaque Control Index was evaluated at baseline and 4 weeks after OHI. ANOVA and post hoc, t test, and ANCOVA were used for statistical analysis.

RESULTS

A statistically significant decrease of the mean percentage of plaque scores was found indicating the effectiveness of different methods of delivery of OHI (p < 0.01, 0.001). Verbal supported by teaching model was the most statistically effective method (p < 0.001) followed by the verbal (p < 0.001). There was a significant difference in the improvement in plaque score (p < 0.001) between the four methods of OHI after controlling for age, gender, monthly income, mother's and father's educational levels and plaque index before delivery of OHI.

CONCLUSIONS

Regardless of the method used, a gradient of effectiveness was observed in improving plaque scores. Verbal instruction supplemented by teaching model was the most effective. Effectiveness was influenced by monthly income, mother's and father's educational levels and plaque index before OHI.

Teledentistry and mHealth for Promotion and Prevention of Oral Health: A Systematic Review and Meta-analysis

The dental profession has experienced a dramatic acceleration in the use of communication systems and information-based technologies over recent years, originating new paradigms for the prevention and promotion of oral health. The purpose of this systematic review was to determine the effect of teledentistry-based (telematic) strategies, reported in randomized controlled trials and quasi-randomized trials, with a focus on oral health prevention and promotion-related outcomes in patients of all ages. We searched Medline via PubMed, SCOPUS, and Web of Science from inception until August 2020, regardless of the language of publication. We selected studies for inclusion and conducted data extraction, assessed risk of bias (Cochrane tool), and evaluated the certainty of the evidence (GRADE approach) in duplicate and independently. Out of 898 potentially eligible references, we selected 43 for full-text screening, of which 19 studies proved eligible: 18 randomized controlled trials and 1 quasi-randomized study. Virtual interventions were mostly asynchronous via apps (n = 9), text messages (n = 9), or computer-aided learning (n = 1). The use of teledentistry as compared with conventional strategies may result in a large reduction in the plaque index (standardized mean difference, -1.18; 95% CI, -1.54 to -0.82; I² = 92%; low certainty) and will likely result in a large reduction in the gingival index (standardized mean difference, -2.17; 95% CI, -3.15 to -1.19; I² = 97%; moderate certainty) and in the incidence of white spot lesions (risk ratio, 0.48; 95% CI, 0.35 to 0.66; I² = 0%; moderate certainty), with an increased effect over time. Evidence suggests that teledentistry, particularly mHealth (messages and apps), is a promising clinical tool for preventing and promoting oral health, especially under the accelerated virtualization of dentistry. Future studies should include a broader spectrum of the population, including adults and elders, to better inform policy and implementation of teledentistry (PROSPERO: CRD42020192685).

Gingival health and oral hygiene practices among high school children in Saudi Arabia

BACKGROUND

Gingivitis is a site-specific inflammatory condition initiated by dental biofilm accumulation. The accumulation of dental plaque on the gingival margin triggers inflammatory effects that can become chronic. In addition to its local effect, gingival inflammation has recently been suggested to have an impact on general health.

OBJECTIVE

Determine the prevalence of gingivitis and its relationship to oral hygiene practices in high school children in Saudi Arabia.

DESIGN

Cross-sectional.

SETTING

High schools from different regions in Saudi Arabia.

PATIENTS AND METHODS

Periodontal examinations were conducted on a randomly selected sample of high school children between the ages of 15 and 19 years. Gingival and plaque indices, probing depth, clinical attachment level, oral hygiene practices and sociodemographic characteristics were recorded. Data were analyzed using descriptive statistics, chi-square and the independent t test.

MAIN OUTCOME MEASURE

Prevalence of gingivitis as defined by mean gingival index.

SAMPLE SIZE

2435 high school students.

RESULTS

Twenty-one percent of the sample had slight gingivitis, 42.3% had moderate, and 1.8% had severe. Gender, toothbrushing, tongue brushing, plaque index, and the percentage of pocket depth (PD) ≥4 mm showed a significant relationship with the severity of gingivitis. Almost 39.3% of females had a healthy periodontal status when compared to males (30.7%). Thirty-five percent (35.5%) of students who brushed their teeth had a healthy periodontium compared to 26.9% who did not brush. The mean plaque index was significantly higher in students with severe gingivitis when compared to students with healthy periodontium (2.4 vs. 0.79, respectively).

CONCLUSION

Gingivitis prevalence was high compared with Western countries in a nationally representative sample of high school students in Saudi Arabia and was influenced by oral hygiene practices.

LIMITATIONS

The half-mouth study design may underestimate disease prevalence. Data on oral hygiene practices was self-reported and may thus have been affected by social desirability bias.

CONFLICT OF INTEREST

None.

Development of an intervention tool for precision oral self-care: Personalized and evidence-based practice for patients with periodontal disease

Background

Oral self-care plays an important role in maintaining oral health and preventing the occurrence of oral diseases. The association between good oral care and good oral hygiene is well known. However, the adherence to a proper daily oral hygiene regimen generally remains poor, so the prevalence of oral diseases remains high. Periodontal disease is the most common oral disease in the population. To enhance the adherence to good oral hygiene behaviors for patients with periodontal disease, we developed a personalized and evidence-based mobile application as an intervention tool for the purpose of initiating and improving good oral self-care.

Objective

The objective of this study was to demonstrate the systematic development process and content of the oral self-care mobile application, OSCA.

Methods

The systematic development process of OSCA consists of three phases: behavioral diagnosis, intervention design, and assessment of OSCA. Firstly, behavioral problem of oral self-care was identified by the experts in periodontics care. Secondly, the intervention functions and the mode of delivery were designed based on the capability-opportunity-motivation behavioral model, which is the underpinning model behind the behavior change wheel framework. Thirdly, the developed app was evaluated by the experts through a heuristics evaluation checklist by adopting Morville’s Honeycomb model, and the final version of OSCA was assessed by the patients with periodontal disease using the System Usability Scale (SUS).

Results

The problems of target behavior were identified and incorporated into the design of intervention functions. For the beta version of the OSCA, experts proposed four main suggestions to improve the usefulness. Experts evaluated the beta and final versions of the app using a heuristics evaluation checklist, providing mean scores of 4.38 and 4.62, respectively. For usability testing, 87 participants completed both the specified tasks and the SUS questionnaire, providing an SUS median score of 77.5 (IQR = 12.5) and an overall mean completion time of 12.22 minutes for the specified tasks. The mean scores of the intervention functions for capability establishment, motivation enhancement, and opportunity creation were 6.13, 5.88, and 6.06, respectively.

Conclusions

The study presents a rigorous design process of developing an evidence-based and personalized mobile application for oral self-care. The results of the expert evaluation confirmed the validated design and the participants were satisfied with the designed app.