| 1. |
- Dimenäs, Sandra L., 1989, et al.
(author)
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A person-centred, theory-based, behavioural intervention programme for improved oral hygiene in adolescents: A randomized clinical field study
- 2022
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In: Journal of Clinical Periodontology. - : Wiley. - 0303-6979 .- 1600-051X. ; 49:4, s. 237-387
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Journal article (peer-reviewed)abstract
- Aim: To test the effectiveness of a person-centred and theory-based educational intervention to increase adolescents′ adherence to adequate oral hygiene behaviour, that is, self-performed periodontal infection control. Materials and Methods: Data were derived from a prospective, multi-centred, two-arm, quasi-randomized field study in which treatment was performed by dental hygienists (DHs) within the Public Dental Service, Västra Götaland, Sweden. Adolescents with poor oral hygiene conditions were invited to participate. The test intervention was based on cognitive behavioural theory and principles, and the DHs used a collaborative communicative approach, inspired by motivational interviewing. The control intervention consisted of conventional information/instruction. Clinical assessments and oral hygiene behaviours were evaluated at 6 months. Results: Three-hundred and twelve adolescents were enrolled, of whom 274 followed the treatment to 6-month follow-up. There were significant improvements in gingival bleeding and plaque scores for both treatment groups at 6 months, with significantly greater improvements in the test group. Adolescents in the test group brushed their teeth and used interdental cleaning aids more frequently compared to participants in the control group at 6 months. Conclusion: A person-centred and theory-based oral health education programme is more effective than conventional oral health education in improving adolescents' oral hygiene behaviour and periodontal infection control. ClinicalTrials.gov (NCT02906098). © 2022 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.
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| 2. |
- Dimenäs, Sandra L., 1989, et al.
(author)
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Adolescents' experiences of a theory-based behavioural intervention for improved oral hygiene: A qualitative interview study
- 2022
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In: International journal of dental hygiene. - : Wiley. - 1601-5029 .- 1601-5037. ; 20:4, s. 609-619
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Journal article (peer-reviewed)abstract
- Objectives Adequate oral hygiene, that is self-performed infection control, is crucial to prevent periodontal disease. Epidemiological studies reveal poor oral hygiene conditions among Swedish adolescents and indicate a need for more effective prevention programs. The aim of the current study was to analyse adolescents' experiences of a person-centred, theory-based, oral health education program for improved oral hygiene. Methods Data were obtained by interviewing 19 adolescents treated by dental hygienists in accord with the person-centred education program in a preceding clinical field study ( NCT02906098). Study participants were selected to reflect a variation of male and female adolescents, treated at clinics in areas with various socio-demographic profiles within Region Vastra Gotaland, Sweden. Interviews were audio-taped, transcribed verbatim and analysed with qualitative content analysis. Results A main theme was identified: 'Adolescents on a guided and challenging journey towards beneficial oral hygiene behavior'. The results elucidate the importance of a person-centred approach in therapy. The adolescents described insight on a personal level about the importance of improved oral hygiene as fundamental for behavioural change. Planning and monitoring of the behaviour, with guidance and support by the dental hygienist, was considered to facilitate change and encouraged further behavioural efforts. However, the adolescents expressed a need of reminders and support to keep up oral hygiene routines over time. Conclusions The study brings knowledge on factors of importance in educational interventions to increase beneficial health behaviours among adolescents and emphasize areas for further improvements of such interventions.
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| 3. |
- Dimenäs, Sandra L., 1989, et al.
(author)
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Adolescents' self-reported experiences following a person-centred, theory-based educational intervention versus conventional education for improved oral hygiene: Analysis of secondary outcomes of a randomized field study
- 2023
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In: JOURNAL OF CLINICAL PERIODONTOLOGY. - 0303-6979. ; 51:1, s. 63-73
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Journal article (peer-reviewed)abstract
- Aim: To analyse adolescents' self-reported experiences and behavioural outcomes of a person-centred, theory-based intervention in comparison with conventional information/instruction for improved oral hygiene.Materials and Methods: Data were derived from a prospective, multi-centred, two-arm, quasi-randomized field study focusing on the effectiveness of educational interventions for improved oral hygiene. Dental hygienists working within the Public Dental Service, Vastra Gotaland, Sweden, provided treatments, and adolescents with poor oral hygiene conditions were eligible for participation. The person-centred test intervention was based on social cognitive constructs, and motivational interviewing was used as an approach in communication. The control intervention included conventional information/instructions. Clinical examinations were performed, and questionnaires were distributed at baseline and at 6 months. Three-hundred and twelve patients were enrolled, and data from 276 patients, following treatment per protocol, were analysed.Results: The test group was more satisfied with the education about gingivitis (very good: 61% vs. 37%) and communication during therapy (very good: 69% vs. 50%) and reported to a larger extent that they were much more careful regarding their oral hygiene after the treatment (30% vs. 15%) and had higher confidence about keeping up healthy gingival conditions, in comparison with the control group (all p < .01).Conclusions: The person-centred, theory-based intervention was superior in terms of adolescents' experiences of education and communication during therapy and self-reported oral hygiene behavioural outcomes at 6 months, in comparison with conventional information/instruction.
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| 4. |
- Enlund, Karolina Brunius, et al.
(author)
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Long-term effects of motivational interviewing vs. traditional counseling on dog owners' adherence to veterinary dental home care: a three-year follow-up study
- 2024
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In: FRONTIERS IN VETERINARY SCIENCE. - 2297-1769. ; 11
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Journal article (peer-reviewed)abstract
- Introduction Periodontal disease is one of the most common health issues in dogs. However, disease is largely preventable by eliminating dental plaque, best achieved by daily tooth brushing. Unfortunately, owner adherence is low to the recommendation of daily tooth brushing in dogs. Objective This study aimed to evaluate the impact of various communication strategies, traditional advice (TA) versus motivational interviewing (MI), and compare them to a control group receiving no additional communication (CG), on dog owners' performance of dental home care and the oral health of their dogs. Methods The study was conducted as a longitudinal clinical intervention study spanning 3 years, and involved 75 dog owners with young dogs who were randomly assigned to one of three groups: TA, MI, or CG. Intervention groups received annual telephone consultations based on their assigned methodology. A questionnaire was administered twice to all groups, and the dental health of the dogs was assessed at the study's conclusion. Result Tooth brushing frequency demonstrated a significant increase in the MI group compared to the CG group (p < 0.01), albeit with a relatively low occurrence of daily brushing among owners. Dental health assessment revealed a significantly lower plaque index in the MI group compared to the CG group (p < 0.05), and a lower calculus index in the TA group compared to the CG group (p < 0.01). No statistically significant differences were observed between the MI and TA groups in terms of dental health. Conclusion Regular veterinary communication appears to have a positive influence on dog owner adherence to veterinary recommendations concerning dental care in dogs. Communication with veterinarians (MI and traditional advice) improved owner knowledge, attitude, and decreased frequency of not brushing. Although dental health parameters improved, the effect size was small, suggesting the complexity of adherence. Personalized calls to dog owners offer potential for dental health improvement, warranting further comparison of MI with traditional advice.
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| 5. |
- Jönsson, Birgitta, 1962, et al.
(author)
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Overcoming behavioral obstacles to prevent periodontal disease: Behavioral change techniques and self-performed periodontal infection control
- 2020
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In: Periodontology 2000. - : Wiley. - 0906-6713 .- 1600-0757. ; 84:1, s. 134-144
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Journal article (peer-reviewed)abstract
- It is well established that periodontal infection control, by means of adequate oral hygiene such as daily toothbrushing and interdental cleaning, is essential for prevention of periodontal disease. Evidence suggests that oral health behavioral intervention is more effective if based on a theoretic framework that includes behavioral change techniques based on goals and planning and on feedback and monitoring. This review focuses on factors that influence behavioral changes in oral hygiene measures (both obstacles and facilitators) and a person-centered approach to treatment planning and communication with patients. A person-centered model of oral hygiene is presented that can be integrated into periodontal treatment using different behavioral techniques.
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| 6. |
- Liss, Anna, 1979, et al.
(author)
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Complexity of best-evidenced practice in periodontal therapy: Views of Swedish Dental Hygienists
- 2020
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In: International Journal of Dental Hygiene. - : Wiley. - 1601-5029 .- 1601-5037. ; 18:3, s. 220-227
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Journal article (peer-reviewed)abstract
- Objectives: Dental hygienists (DHs) have an important role in the treatment of patients with periodontitis. The objective of the current qualitative interview study was to gain understanding about personal and organizational factors that influence best-evidenced DH practice in the treatment of periodontitis. Methods: Data were obtained by interviewing Swedish DHs, who had been engaged in a preceding clinical field study on evidence-based periodontal therapy. Qualitative content analysis was used for analysis. Data sampling was terminated after 18 interviews, when deemed that sufficient amount of information had been gained. Results: In the analysis of the interview data, a main theme was identified as “I know what to do, but I do as I usually do; DHs' ambivalence between theory and practice in the treatment of patients with periodontitis.” The results elucidated that the DHs were well aware of “what to do” in order to offer their patients adequate periodontal care, but this knowledge was not congruent with how they usually worked. Established routines and culture at the clinic, DHs' predetermined beliefs about lack of motivation and ability to cooperate among patients, lack of time and reflection, economic demands in care and lack of interest and support by co-working dentists were barriers to best-evidenced DH practice in periodontal care. Conclusions: The results elucidate the complexity of best-evidenced DH practice in the treatment of periodontal patients and indicate needs for quality improvement of the periodontal care provided in general dental practice, by actions taken on both individual/professional and organizational levels. © 2020 The Authors. International Journal of Dental Hygiene published by John Wiley & Sons Ltd
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| 7. |
- Liss, Anna, 1979, et al.
(author)
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Patient-reported experiences and outcomes following two different approaches for non-surgical periodontal treatment: a randomized field study
- 2021
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In: BMC Oral Health. - : Springer Science and Business Media LLC. - 1472-6831. ; 21
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Journal article (peer-reviewed)abstract
- Context: The current report is part of a prospective, multi-center, two-arm, quasi-randomized field study focusing on the effectiveness in general praxis of evidence-based procedures in the non-surgical treatment of patients with periodontitis. Objective: The specific aims were to (i) evaluate patient-reported experience and outcome measures of treatment following a guided approach to periodontal infection control (GPIC) compared to conventional non-surgical therapy (CNST) and to (ii) identify potential predictors of subjective treatment outcomes and patient’s adherence to self-performed infection control, i.e. adequate oral hygiene. Methods: The study sample consisted of 494 patients treated per protocol with questionnaire- and clinical data at baseline and 6-months. The GPIC approach (test) comprised patient education for adequate oral hygiene prior to a single session of full-mouth ultra-sonic instrumentation, while the CNST approach (control) comprised education and instrumentation (scaling and root planing) integrated at required number of consecutive appointments. Clinical examinations and treatment were performed by Dental Hygienists, i.e. not blinded. Data were processed with bivariate statistics for comparison between treatment groups and with multiple regression models to identify potential predictors of subjective and clinical outcomes. The primary clinical outcome was gingival bleeding scores. Results: No substantial differences were found between the two treatment approaches regarding patient-reported experiences or outcomes of therapy. Patients’ experiences of definitely being involved in therapy decisions was a significant predictor for a desirable subjective and clinical outcome in terms of; (i) that oral health was considered as much improved after therapy compared to how it was before, (ii) that the treatment definitively had been worth the cost and efforts, and (iii) adherence to self-performed periodontal infection control. In addition, to be a current smoker counteracted patients’ satisfaction with oral health outcome, while gingival bleeding scores at baseline predicted clinical outcome in terms of bleeding scores at 6-months. Conclusions: The results suggest that there are no differences with regard to patient-reported experiences and outcomes of therapy following a GPIC approach to periodontal infection control versus CNST. Patients’ experiences of being involved in therapy decisions seem to be an important factor for satisfaction with care and for adherence to self-performed periodontal infection control. Registered at: ClinicalTrials.gov (NCT02168621).
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| 8. |
- Tomasi, Cristiano, 1964, et al.
(author)
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A randomized multi-centre study on the effectiveness of non-surgical periodontal therapy in general practice
- 2022
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In: Journal of Clinical Periodontology. - : Wiley. - 0303-6979 .- 1600-051X. ; 49:11, s. 1092-1105
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Journal article (peer-reviewed)abstract
- Aim To evaluate the effectiveness of two non-surgical treatment protocols for periodontitis patients in general dental practice. Materials and Methods Ninety-five dental hygienists (59 dental clinics) were randomly assigned to one of two treatment protocols: (i) establishment of adequate self-performed oral hygiene prior to a single session of ultrasonic instrumentation (guided periodontal infection control [GPIC]) or (ii) conventional non-surgical therapy (CNST) including patient education and scaling and root planing integrated in multiple sessions. Residual pockets at 3 months were retreated in both groups. The primary outcome was pocket closure (probing pocket depth <= 4 mm) at 6 months. Multilevel models were utilized. Results Based on data from 615 patients, no significant differences with regard to clinical outcomes were observed between treatment protocols. Treatment-related costs (i.e., chair time, number of sessions) were significantly lower for GPIC than CNST. Smoking and age significantly affected treatment outcomes. Conclusions No significant differences between the two approaches were observed in regard to clinical outcomes. GPIC was more time-effective. Patient education should include information on the detrimental effects of smoking. ClinicalTrials.gov (NCT02168621).
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| 9. |
- Tomasi, Cristiano, 1964, et al.
(author)
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Subgingival instrumentation
- 2023
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In: Periodontology 2000. - 0906-6713.
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Research review (peer-reviewed)abstract
- The S3-level clinical guidelines for the treatment of patients with periodontitis stages I-III published by the European Federation of Periodontology in 2020, suggest a pre-established stepwise approach for oral-healthcare professionals with precise therapeutic pathways. The second step of this approach consists of the subgingival instrumentation of periodontal pockets by non-surgical means to disrupt the microbial biofilm and remove soft and mineralized deposits This step aims to resolve periodontal inflammation by closure of periodontal pockets (probing pocket depth <= 4 mm, absence of bleeding on probing) employing different types of instruments and treatment protocols toward this end. Novel non-surgical treatment approaches that adopt micro instruments or subgingival application of biological agents have been recently tested. Subgingival instrumentation has been shown to effectively restore the subgingival microbiota to one associated with periodontal health and to modulate the inflammatory response. The outcomes of the subgingival instrumentation have to be evaluated in order to guide the therapist in providing additional but focused treatment in the remaining pockets OR at sites with residual inflammation. Of great importance is the impact that non-surgical periodontal treatment has on the patient's well-being, based on evidence that emerges from studies evaluating patient related outcomes and quality of life.
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