Cochrane · intervention · CD005097
Psychological interventions to improve adherence to oral hygiene instructions in adults with periodontal diseases
Cochrane Database of Systematic Reviews · 2007 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
19
current version
GRADE rated
0
No studies
0
Included studies
4
as reported
No studies 0 · 0%Ungraded 19 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Participants aged 18 or over; Participants diagnosed with periodontal disease (diagnosis from a dental clinician, including gingivitis and periodontitis); Studies sampling male and/or female participants; Studies sampling special populations at greater risk for periodontal disease (smokers, pregnant women) | Four studies included 344 participants; Little 1997: 107 patients aged 50 to 70 with moderate to severe periodontal disease; Stewart 1991: 100 males aged 21 to 65 with periodontal disease; Stewart 1996: 117 male patients eligible for comprehensive dental treatment; Weinstein 1996: 20 patients aged 32 to 50 with periodontal problems |
| Intervention | Interventions designed to increase adherence to oral hygiene advice, based on one of the specified psychological models/theories: Health Belief Model; Theory of Reasoned Action; Theory of Planned Behaviour; Self-Efficacy Model; Transtheoretical Model (Stages of Change); Protection Motivation Model; Health Locus of Control; Implementation Intentions; Unrealistic Optimism Bias; Self-regulatory Model; Health Action Process Approach; Precaution Adoption Process Model; Outcome Expectancy; Cognitive Hypothesis Model of Compliance; Social Learning Theory; Operant and Classical Conditioning; group and individual interventions both included; interventions aimed at smoking cessation excluded | Social Learning Theory group intervention (Little 1997, n=54); Cognitive behavioural intervention (Stewart 1991, n=25); Stages of Change psychological intervention (Stewart 1996, n=39); Operant and Classical Conditioning intervention (Weinstein 1996, n=10) |
| Comparison | Control group (receives only the standard treatment programme) and/or at least one alternative intervention group of any theoretical basis (not necessarily psychological); analysis distinguished active from placebo control designs | Usual dental care / no-treatment control (Little 1997, n=53); No-intervention control (Stewart 1991, n=25); Attention control (Stewart 1991, n=25); Educational intervention (Stewart 1991, n=25); No-additional-treatment control (Stewart 1996, n=39); Educational intervention (Stewart 1996, n=39); Oral hygiene instruction control/attention groups (Weinstein 1996, n=10) |
| Outcomes | Behavioural outcomes (self-reported and observed measures of adherence to oral hygiene instructions, e.g. changes in toothpaste weight); Psychological outcomes (changes in patients' attitudes, beliefs and intentions; secondary: pain, patient satisfaction, quality of life); Clinical status outcomes (plaque scores, pocket probing depth, attachment levels, gingival inflammation indices such as redness, oedema or bleeding); Adverse effects (e.g. hard and soft tissue trauma); time and financial costs | Plaque scores (n=3); Gingival bleeding (n=1); Pocket depth (n=1); Attachment loss (n=1); Self reported tooth brushing (n=2); Self reported flossing (n=2); Observed brushing and flossing skills (n=1); Dental knowledge (n=1); Self efficacy beliefs concerning flossing (n=1); Self efficacy beliefs concerning tooth brushing (n=1) |
| Study designs | Only randomised controlled trials | Randomised controlled trials (n=4) |
| Timing | Only trials with at least 3 weeks follow-up | Follow-up ranged from 5 weeks to 4 months; Little 1997: 4 months; Stewart 1991: 5 weeks (2 weeks post-intervention); Stewart 1996: post-intervention (not clearly specified); Weinstein 1996: 30 and 60 days |
Search date: 2004-12. Databases: The Cochrane Oral Health Group's Trials Register; The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; PsycINFO; Ingenta; CINAHL
Questions and results
Show all 2 versionsPsychological intervention based on a specified psychological model/theory (to increase adherence to oral hygiene instructions) vs No (active) intervention (usual/standard dental care or no-treatment control)
Population: Adults (aged 18 or over) diagnosed with periodontal disease (gingivitis or periodontitis)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Observed flossing skill 4 months | Little 1997 observed and rated participants on flossing skill; Analysis of Covariance found a significant difference favouring the intervention group. | 1 study · 107 participants | Ungraded |
Self-efficacy beliefs (flossing) | Stewart 1996: the psychological intervention group demonstrated significantly higher change in self efficacy scores for flossing at post-intervention compared to the other two groups (control and educational). Flossing… | 1 study · 117 participants | Ungraded |
Plaque score | The impact of psychological interventions on clinical markers was assessed in three studies (Little 1997; Stewart 1991; Weinstein 1996). All three found that psychological interventions resulted in improved plaque… | 3 studies | Ungraded |
Gingival bleeding 4 months | Little 1997 reported decreased gingival bleeding in the active intervention group: gingival bleeding present in 9% of the intervention group at baseline and 4% at 4-month follow up, versus 10% of the control group on… | 1 study · 107 participants | Ungraded |
Pocket (probing) depth 4 months | Little 1997: no change in pocket depth; there were no differences between the intervention and control groups in overall change in pocket depth. (Some analyses suggested greater change in the intervention group when… | 1 study · 107 participants | Ungraded |
Attachment loss 4 months | Little 1997: no change in attachment loss; no differences between the intervention and control groups in overall change in attachment (loss of attachment) markers. | 1 study · 107 participants | Ungraded |
Observed tooth brushing skill 4 months | Little 1997 observed and rated participants on brushing skill; Analysis of Covariance found a significant difference favouring the intervention group (one of four measures on which significant differences were found… | 1 study · 107 participants | Ungraded |
Dental knowledge | Stewart 1996: for dental knowledge the control group showed no change pre- and post-intervention, whereas the psychological intervention group improved dental knowledge significantly (both intervention groups improved… | 1 study · 117 participants | Ungraded |
Self-efficacy beliefs (tooth brushing) | Stewart 1996: the psychological intervention had no discernible effect on self efficacy beliefs concerning tooth brushing; the data on perceived self efficacy for tooth brushing were not analysed due to ceiling effects… | 1 study · 117 participants | Ungraded |
Self-reported flossing | Self assessed flossing was assessed in two studies (Little 1997; Stewart 1991); both reported improvements for the intervention groups. Little 1997: Analysis of Covariance found significant differences favouring the… | 2 studies | Ungraded |
Self-reported tooth brushing | Self assessed brushing was assessed in two studies (Little 1997; Stewart 1991); both found the intervention groups reported improved brushing. Little 1997: Analysis of Covariance found significant differences favouring… | 2 studies | Ungraded |
Psychological intervention based on a specified psychological model/theory (to increase adherence to oral hygiene instructions) vs Educational intervention (oral hygiene education/instruction)
Population: Adults (aged 18 or over) diagnosed with periodontal disease (gingivitis or periodontitis)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self-reported tooth brushing 5 weeks (2 weeks post-intervention) | Stewart 1991: for self reported brushing only the comparison of the control group with the cognitive behavioural intervention was significant; the cognitive behavioural (psychological) intervention showed no… | 1 study · 50 participants | Ungraded |
Plaque score 5 weeks (2 weeks post-intervention) | Stewart 1991: while the educational intervention group and the cognitive behavioural intervention group both showed significant differences compared to the control group in plaque scores, the cognitive behavioural… | 1 study · 50 participants | Ungraded |
Self-reported flossing 5 weeks (2 weeks post-intervention) | Stewart 1991: there were no differences between the educational intervention group and the cognitive behavioural (psychological) intervention group for self reported flossing; improvements in flossing could not be… | 1 study · 50 participants | Ungraded |
Dental knowledge | Stewart 1996: there was no difference in change in dental knowledge at post-intervention between the educational and psychological groups (both improved significantly relative to control). | 1 study · 78 participants | Ungraded |
Self-efficacy beliefs (flossing) | Stewart 1996: the psychological intervention group demonstrated significantly higher change in self efficacy scores for flossing at post-intervention compared to the educational group (there was no difference in the… | 1 study · 78 participants | Ungraded |
Psychological intervention based on a specified psychological model/theory (to increase adherence to oral hygiene instructions) vs Attention control (attention/contact without an active psychological intervention)
Population: Adults (aged 18 or over) diagnosed with periodontal disease (gingivitis or periodontitis)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Plaque score | Weinstein 1996 reported that the psychological intervention led to improvements in plaque score greater than that noted in the attention control group; however the sample size in each arm was very small (n=5) and the… | 2 studies | Ungraded |
Self-reported flossing 5 weeks (2 weeks post-intervention) | Stewart 1991: there were no differences between the attention control group and the cognitive behavioural (psychological) intervention group for self reported flossing; it cannot be concluded that the cognitive… | 1 study · 50 participants | Ungraded |
Self-reported tooth brushing 5 weeks (2 weeks post-intervention) | Stewart 1991: for self reported brushing only the comparison of the control group with the cognitive behavioural intervention was significant; the cognitive behavioural (psychological) intervention conveyed no… | 1 study · 50 participants | Ungraded |