Cochrane · intervention · CD006540
One‐to‐one dietary interventions undertaken in a dental setting to change dietary behaviour
Harris, R, Gamboa, A, Dailey, Y, et al. · Cochrane Database of Systematic Reviews · 2012 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
22
current version
GRADE rated
0
No studies
1
Included studies
5
as reported
No studies 1 · 4.5%Ungraded 21 · 95.5%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 of any age (both child and adult) receiving dietary advice as a one-to-one intervention in a dental practice setting or in dental settings where one-to-one advice is given. A dental setting was defined as a place where dental care was the main, or at least one of the services delivered in that building. Studies based on participants recruited from populations with medical problems with systemic effects were excluded. | Adults with frequent sugar intake (Wennerholm 1995, n=20); young adult males with an alcohol-related facial injury (Smith 2003, n=151); edentulous adults aged 45-80 years (Bradbury 2006, n=58); adults at a group dental practice (Hoogstraten 1983); children aged 11-12 years with active caries lesions (Hausen 2007, n=497) |
| Intervention | One-to-one dietary intervention to prevent dental caries or erosion or to influence general health. Included dietary education/advice and interventions with an explicit intention to change behaviour: brief advice, skills training, self-help materials, counselling, lifestyle strategies, or any combination. Delivered by a dentist, dental hygienist, dental assistant or staff in any dental setting. Studies were excluded if they involved medication or non-dietary supplements (e.g., fluoride), unless the fluoride supplement was given as part of a multiple intervention that included attempts to change dietary behaviour; multi-intervention studies were included but subject to subgroup analysis. | Sugar-restriction advice (n=12); motivational interviewing to reduce alcohol (n=75); dietary counselling to increase fruit/vegetables (n=30); 30-minute hygienist instruction, multi-intervention; film plus instruction, multi-intervention; individualised patient-centred preventive programme, multi-intervention (n=250) |
| Comparison | No dietary advice; or different dietary advice | No dietary advice (n=8); treatment as usual (n=76); usual care (n=28); no instruction; standard prevention (n=247) |
| Outcomes | Primary: dietary behaviour change (changes in frequency, amount or timing of food/drink consumption; sugary/low-sugar foods, chewing gum, drinks, non-milk extrinsic sugars, intrinsic sugars/fruit, sucrose, glucose, xylitol and other sweeteners; self-reported measures, diaries, 24-hour recall). Secondary: dental caries outcomes (caries experience, caries increment, DMFT/dmft, sound teeth/surfaces, white spot lesions, early carious lesions arrested/reversed, root caries); dental erosion outcomes (tooth wear indices); general health outcomes (adiposity/Body Mass Index, waist:hip, cholesterol, blood sugar, lipids) | Sugar intake frequency - main meals, between meals, total (n=1); alcohol consumption >21 units/week (n=1); fruit consumption g/day (n=1); vegetable consumption g/day (n=1); fruit and vegetable Stage of Change (n=1); fruit juice consumption (n=1); Body Mass Index (n=1); mean sugar consumption 1-5 scale (n=1); xylitol use, candy, soft drinks, sports drinks, nibbling, warm meals, healthy snacks (n=1); DMFS caries increment at 2 and 4 years (n=1) |
| Study designs | Randomised controlled trials (RCTs) following individuals for a minimum of 1 month; unit of randomisation could be individual patients, clusters of individuals, or dental practices | Randomised controlled trials (n=5) |
| Timing | Minimum of 1 month follow-up | Follow-up periods ranged from 6 weeks to 4 years; two studies had follow-up of less than 12 months and three of over a year |
Search date: 2012-01. Databases: The Cochrane Oral Health Group Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; CINAHL via EBSCO; PsycINFO via OVID; Web of Science; Conference proceedings (IADR and ORCA); Dissertation Abstracts Online
Questions and results
Current version onlyOne-to-one advice on sugar restriction: detailed information on the sugar content of foods, with instruction to refrain from sugar-containing foods between meals and to reduce sugar in main meals (6-week sugar restriction) vs No advice on sugar restriction
Population: Adults with frequent sugar intake harbouring Streptococcus mutans and Streptococcus sobrinus in saliva (14 dental technical students and 6 cariology patients), University of Gothenburg, Sweden
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sugar intake frequency between meals (mean number of intakes per day) Follow-up at 3, 6 and 12 weeks | Table 5, mean (SD) intakes/day between meals: intervention 6.7 (1.9) baseline, 0.8 (1.0) at 3 weeks, 0.9 (1.0) at 6 weeks, 5.6 (3.0) at 12 weeks; control 5.3 (2.3), 5.2 (2.9), 4.6 (3.5), 4.7 (1.5). Significant… | 1 study · 20 participants | Ungraded |
Sugar intake frequency at main meals (mean number of intakes per day) Follow-up at 3, 6 and 12 weeks | Table 5, mean (SD) intakes/day at main meals: intervention 2.8 (0.5) baseline, 0.7 (0.7) at 3 weeks, 0.8 (0.9) at 6 weeks, 2.3 (0.8) at 12 weeks; control 1.9 (1.1), 1.9 (1.2), 1.9 (1.1), 2.0 (0.9). Significant… | 1 study · 20 participants | Ungraded |
Total sugar intake frequency (mean number of intakes per day) Follow-up at 3, 6 and 12 weeks | Table 5, total mean (SD) intakes/day: intervention 9.5 (1.9) baseline, 1.6 (1.4) at 3 weeks, 1.8 (1.5) at 6 weeks, 7.8 (3.5) at 12 weeks; control 7.2 (2.6), 7.1 (3.7), 6.5 (4.2), 6.7 (2.2). Significant reduction versus… | 1 study · 20 participants | Ungraded |
Brief one-session, manual-guided discussion based on the principles of motivational interviewing (aimed at reducing alcohol consumption) vs Treatment at the outpatient clinic as usual
Population: Male patients aged 16 to 35 years attending an oral and maxillofacial surgery outpatient clinic for follow-up of an alcohol-related facial injury, Welsh dental teaching hospital
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Alcohol consumption: consuming more than 21 units of alcohol per week 12 months | RR 0.52 [0.32, 0.85] | 1 study · 151 participants | Ungraded |
Dietary counselling tailored to a Stage of Change (Transtheoretical Model) to increase fruit and vegetable intake (two counselling sessions) vs Usual care
Population: Edentulous patients aged 45 to 80 years attending dental-student teaching clinics for replacement dentures, Newcastle Dental Hospital, UK
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Fruit consumption (grams per day) 6 weeks after receiving replacement dentures (about 10 weeks after baseline) | Mean (SD) g/day (Table 1): fruit - intervention 111 (80) at baseline rising to 254 (194) at follow-up; control 87 (82) to 106 (116). A significant change in the weight of fruit consumed was found in the intervention… | 1 study · 58 participants | Ungraded |
Body Mass Index (BMI, kg/m2) 6 weeks after receiving replacement dentures (about 10 weeks after baseline) | Mean (SD) BMI kg/m2 (Table 1): intervention 27.4 (3.5) to 27.2 (3.4); control 26.1 (3.3) to 26.1 (3.4). No statistically significant difference between intervention and control (P=0.22). | 1 study · 58 participants | Ungraded |
Vegetable consumption behaviour: proportion in the Action Stage of Change (versus Pre-Action) 6 weeks after receiving replacement dentures (about 10 weeks after baseline) | At follow-up 75% (22) of the intervention group versus 21% (6) of the control were in the Action Stage of Change for vegetable consumption (P<0.001); baseline 23% (7) versus 25% (7). Significant difference between… | 1 study · 58 participants | Ungraded |
Vegetable consumption (grams per day) 6 weeks after receiving replacement dentures (about 10 weeks after baseline) | Mean (SD) g/day (Table 1): vegetables - intervention 157 (73) to 224 (109); control 168 (83) to 175 (91). No significant between-group change in vegetable consumption. | 1 study · 58 participants | Ungraded |
Fruit juice consumption: risk of starting to drink fruit juice 6 weeks after receiving replacement dentures (about 10 weeks after baseline) | RR 1.09 [0.42, 2.85] | 1 study · 58 participants | Ungraded |
Fruit consumption behaviour: proportion in the Action Stage of Change (versus Pre-Action) 6 weeks after receiving replacement dentures (about 10 weeks after baseline) | At follow-up 75% (22) of the intervention group versus 29% (8) of the control were in the Action Stage of Change for fruit consumption (P<0.001); baseline 20% (6) versus 8% (2). Significant difference between groups.… | 1 study · 58 participants | Ungraded |
30 minutes of one-to-one instruction by a dental hygienist covering the relationship between sugar consumption and dental health, plus oral hygiene, fluoride and regular dental visits (a multi-intervention) vs No instruction
Population: Adults newly registered at a group dental practice in a suburban Dutch village, the Netherlands
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mean sugar consumption (self-reported, 1 to 5 scale; higher score = more positive behaviour) 6 to 12 months | Table 3, mean (SD) sugar consumption (1-5 scale): instruction group 3.41 (1.50) at baseline to 3.58 (1.07) at follow-up (significant versus baseline); control 2.89 (0.99) to 2.88 (1.27). The review judges the results… | 1 study | Ungraded |
A 10-minute film followed by the same 30-minute one-to-one hygienist instruction on sugar consumption and dental health, plus oral hygiene, fluoride and regular visits (a multi-intervention) vs No instruction
Population: Adults newly registered at a group dental practice in a suburban Dutch village, the Netherlands
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mean sugar consumption (self-reported, 1 to 5 scale; higher score = more positive behaviour) 6 to 12 months | Table 3, mean (SD) sugar consumption (1-5 scale): film-plus-instruction group 3.53 (1.27) at baseline to 3.06 (1.12) at follow-up (significant versus baseline); control 2.89 (0.99) to 2.88 (1.27). Results judged… | 1 study | Ungraded |
Individually designed, patient-centred preventive programme: dietary counselling (snacking timing, regular meals, fermentable carbohydrates) plus toothbrushing counselling, delivered by trained dental hygienists (a multi-intervention) vs Basic prevention offered as standard in public dental clinics
Population: Children aged 11 to 12 years with at least one active initial caries lesion, screened in a town in Finland
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Nibbling less than daily 2 to 4 years | Table 2: 52% (130) versus 53% (131) at follow-up (baseline 41% versus 44%). No significant change. | 1 study · 497 participants | Ungraded |
Dental caries increment: DMFS increment after 4 years 4 years | Mean (95% CI) DMFS increment after 4 years: intervention 2.56 (2.07 to 3.05) versus control 4.60 (3.99 to 5.21); significant difference favouring the intervention (P<0.0001; non-overlapping CIs). No between-group point… | 1 study · 497 participants | Ungraded |
Eating candy less than daily 2 to 4 years | Table 2: 86% (215) intervention versus 83% (205) control at follow-up (baseline 74% versus 77%). No significant change. | 1 study · 497 participants | Ungraded |
Drinking soft drinks less than daily 2 to 4 years | Table 2: 77% (193) versus 75% (185) at follow-up (baseline 71% versus 69%). No significant change. | 1 study · 497 participants | Ungraded |
Eating healthy snacks at least twice per day 2 to 4 years | Table 2: 71% (178) versus 68% (168) at follow-up (baseline 69% versus 65%). No significant change. | 1 study · 497 participants | Ungraded |
Eating warm meals more than twice per day 2 to 4 years | Table 2: 77% (193) versus 81% (200) at follow-up (baseline 83% versus 74%, a significant baseline difference). No significant change at follow-up. | 1 study · 497 participants | Ungraded |
Drinking sports drinks no more than once per week 2 to 4 years | Table 2: 87% (218) versus 86% (212) at follow-up (baseline 81% versus 87%). No significant change. | 1 study · 497 participants | Ungraded |
Using xylitol products more than 3 times per day 2 to 4 years | RR 1.32 [1.04, 1.68] | 1 study · 497 participants | Ungraded |
Dental caries increment: DMFS increment after 2 years 2 years | Mean (95% CI) DMFS increment after 2 years: intervention 1.86 (1.50 to 2.21) versus control 2.44 (2.12 to 2.77); significant difference favouring the intervention (P<0.05, comparing intervention and control). No… | 1 study · 497 participants | Ungraded |
One-to-one dietary intervention aimed at preventing tooth erosion (e.g., reducing consumption of acidic/carbonated drinks) vs No dietary advice, or different dietary advice
Population: Participants of any age receiving one-to-one dietary advice in a dental setting
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental erosion / tooth wear (tooth wear indices) | There were no studies concerned with dietary change aimed at preventing tooth erosion. | 0 studies | No studies |
One-to-one dietary intervention: dietary education/advice, or an intervention with an explicit intention to change behaviour (brief advice, skills training, self-help materials, counselling, lifestyle strategies, or any combination) vs No dietary advice, or different dietary advice
Population: Participants of any age (both children and adults) receiving dietary advice as a one-to-one intervention in a dental practice or other dental setting where one-to-one advice is given; participants with medical problems excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
General health (adiposity/Body Mass Index, waist:hip ratio, cholesterol, blood sugar, lipids) At least 1 month follow-up | no estimate extracted | NR | No studies |
Dietary behaviour change (changes in frequency, amount or timing of food/drink consumption; sugary/low-sugar foods, chewing gum, drinks, non-milk extrinsic sugars, intrinsic sugars, sucrose, glucose, xylitol and other sweeteners) At least 1 month follow-up | no estimate extracted | NR | No studies |
Dental caries (caries experience/increment, DMFT/dmft, sound teeth/surfaces, white spot lesions, early carious lesions arrested or reversed, root caries) At least 1 month follow-up | no estimate extracted | NR | No studies |
Dental erosion (tooth wear indices) At least 1 month follow-up | no estimate extracted | NR | No studies |