Cochrane · intervention · CD007447
One‐to‐one oral hygiene advice provided in a dental setting for oral health
Soldani, FA, Lamont, T, Jones, K, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
26
current version
GRADE rated
11
No studies
1
Included studies
19
as reported
No studies 1 · 3.8%Ungraded 14 · 53.8%Very low 10 · 38.5%Low 1 · 3.8%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 | Children (with or without guardian/parent) or adults who were fit and healthy or groups with well-defined medical conditions; those wearing a removable prosthesis or orthodontic appliance excluded | 19 studies, 4232 participants across 14 countries; 16 studies in adults (mean age 20 to 58 years) and 3 in children/infants (mean age 20 months, 3 years, 6 years); some with periodontitis, type 1 diabetes or hyposalivation (n=19) |
| Intervention | One-to-one OHA provided by any member of the dental team within the dental setting (general dental practice, community dental setting or dental hospital) | Any form of one-to-one OHA (n=4); personalised one-to-one OHA (n=4); self-management/self-monitored OHA (n=5); enhanced/intensive one-to-one OHA (n=7); delivered by hygienist (8), dentist (4), dental nurse (1), dentist or hygienist (1), dental nurse and hygienist (1), unclear (3) |
| Comparison | No advice; or advice in an alternative format; or advice from a different member of the dental team | No OHA (n=4); routine one-to-one OHA (n=4); professional OHA (n=5); one-to-one OHA (n=7) |
| Outcomes | Primary - Clinical status: Periodontal health (plaque levels, gingivitis, probing depths); Caries (dmft/DMFT). Secondary - Patient-centred: Patient-reported behaviour changes; Patient satisfaction with advice provided; Patient-reported changes in knowledge, attitudes and quality of life. Secondary - Economic: Cost effectiveness. Other: Any adverse events due to OHA | Gingivitis (n=15); Plaque levels (n=15); Probing depth (n=4); Dental caries (n=4); Patient-reported behaviour changes (n=5); Patient satisfaction with advice provided (n=1); Patient-reported changes in knowledge, attitudes and quality of life (n=5); Economic net benefits (n=1); Adverse events (none reported) |
| Study designs | Randomised controlled trials (RCTs); unit of randomisation could be individuals, clusters or dental setting | Randomised controlled trials (n=19) |
| Timing | Minimum follow-up period of 8 weeks; outcome assessed at least 8 weeks after the intervention | Follow-up 2 to 36 months (Weinstein 2mo; Soderholm/Jonsson 2006/Schmalz/Lepore 2-3mo; Munster Halvari 5.5mo; Baab/Glavind 6mo; Tedesco 9mo; Bali/Hoogstraten/Van Leeuwen/Memarpour 12mo; Hugoson/Ramsay/Jonsson 2009 12-36mo) |
Search date: 2017-11. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov); World Health Organization International Clinical Trials Registry Platform
Questions and results
Current version onlyAny form of one-to-one oral hygiene advice (OHA) vs No OHA
Population: Children or adults (fit and healthy, or with a well-defined medical condition)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental caries 4 to 12 months | SoF: 1 study in adults reported only 'small and statistically insignificant changes' but no usable data; the other study on infants provided evidence of a benefit for OHA at 8 and 12 months but not at 4 months.… | 2 studies · 244 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Periodontal health: gingivitis 3 to 36 months | SoF: 1 small study in adults had contradictory results at 3 and 6 months; the other study in adults showed evidence of a benefit for OHA at all time points (12, 24, 36 months). Results: Hetland 1982 MD 0.25 (0.05 to… | 2 studies · 235 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Probing depth | Hetland 1982 reported pocket depths > 4 mm; measured but not synthesised or GRADE-rated (no usable pooled estimate). | 1 study | Ungraded |
Patient-reported changes in knowledge, attitudes and quality of life | Hoogstraten 1983 (dental knowledge, attitude, behaviour, fear of dental treatment) and Memarpour 2016 (parents' knowledge and performance regarding oral health); measured, not synthesised or GRADE-rated. | 2 studies | Ungraded |
Periodontal health: plaque levels 6 to 36 months | SoF: Both studies at all time points consistently showed a benefit in plaque reduction for OHA. Results: Hetland 1982 MD -0.41 (-0.54 to -0.28) at 3mo, -0.44 (-0.56 to -0.32) at 6mo; Hugoson 2007 MD -13.00 (-19.89 to… | 2 studies · 235 participants | Low Downgraded: risk of bias, indirectness |
Adverse events | No adverse events due to OHA were reported in the included trials (review-wide; assessed across all 19 included studies). | NR | Ungraded |
Personalised one-to-one OHA vs Routine one-to-one OHA
Population: Children or adults (fit and healthy, or with a well-defined medical condition)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient-reported changes in knowledge, attitudes and quality of life | Jonsson 2009 (OHQoL-UK oral health-related quality of life) and Ramsay 2018 (dental quality of life, oral hygiene self-efficacy); measured, not synthesised or GRADE-rated. | 2 studies | Ungraded |
Probing depth | Jonsson 2009 and Ramsay 2018 reported probing depths; measured but not synthesised or GRADE-rated. | 2 studies | Ungraded |
Periodontal health: gingivitis 2 to 36 months | SoF: 1 large study showed little or no difference at 36 months; 1 study showed a benefit for personalised OHA at 3 and 12 months; 1 study in children reported 'statistically significant (P < 0.05) improvement' but no… | 4 studies · 1635 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Patient-reported behaviour changes and health indices | Ramsay 2018 (oral health behaviour) and Jonsson 2009 (patient-reported health indices: GOHAI and self-rated oral health); measured, not synthesised or GRADE-rated. | 2 studies | Ungraded |
Dental caries 2 months | SoF: 1 study in children between the ages of 1 year and 6 years old reported 'statistically significant (P < 0.05) improvement' for personalised OHA but did not report usable data. Results: Lepore 2011 not estimable… | 1 study · 69 participants | Very low Downgraded: indirectness |
Economic net benefits (cost effectiveness) | Ramsay 2018 reported economic net benefits of OHA; measured, not synthesised or GRADE-rated. | 1 study | Ungraded |
Periodontal health: plaque levels 2 to 12 months | SoF: 1 study showed a benefit for personalised OHA at 3 and 12 months; 1 study in children reported 'statistically significant (P < 0.05) improvement' but no usable data; 1 study showed little or no difference at 3… | 3 studies · 308 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Self-management (self-administered/self-monitored OHA) vs Professional OHA
Population: Children or adults (fit and healthy, or with a well-defined medical condition)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Probing depth | Jonsson 2006 (probing depth) and Lopez-Jornet 2014 (CPITN score); measured but not synthesised or GRADE-rated. | 2 studies | Ungraded |
Patient-reported behaviour changes | Baab 1986 (time spent brushing, number of oral hygiene aids), Aljafari 2017 (child's dietary habits, self-reported snacking and toothbrushing), Jonsson 2006 (oral self-care habits); measured, not synthesised or… | 3 studies | Ungraded |
Patient satisfaction with advice provided | Aljafari 2017 reported parent and child satisfaction with their educational intervention; measured, not synthesised or GRADE-rated. | 1 study | Ungraded |
Periodontal health: gingivitis 2 to 6 months | SoF: 2 studies reported no significant differences but no usable data; 1 study showed little or no difference at 3 months; 1 study in adults with hyposalivation gave weak evidence of a benefit in gingivitis for… | 4 studies · 181 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Dental caries | No studies were found that looked at dental caries. | 0 studies | No studies |
Patient-reported changes in knowledge, attitudes and quality of life | Aljafari 2017 reported child's dietary knowledge; measured, not synthesised or GRADE-rated. | 1 study | Ungraded |
Periodontal health: plaque levels 2 to 6 months | SoF: 2 studies reported no significant differences but no usable data; 1 study gave weak evidence of a benefit in plaque reduction at 3 months for self-management; 1 study in adults with hyposalivation gave very weak… | 4 studies · 181 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Enhanced one-to-one OHA vs One-to-one OHA (standard)
Population: Children or adults (fit and healthy, or with a well-defined medical condition)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Probing depth | Bali 1999 (probing depths) and Soderholm 1982 (pocket depths > 5 mm); measured but not synthesised or GRADE-rated. | 2 studies | Ungraded |
Patient-reported behaviour changes | Tedesco 1992 reported self-reported brushing and flossing behaviours and self-efficacy (Oral Health Behavior Expectation Scale); measured, not synthesised or GRADE-rated. | 1 study | Ungraded |
Periodontal health: gingivitis 2 to 12 months | SoF: 2 studies did not report usable data; 1 study gave low-quality evidence of a benefit in gingivitis reduction at 5.5 months for enhanced OHA; 3 studies found little or no difference across all time points. Results:… | 5 studies · 430 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Periodontal health: plaque levels 2 to 12 months | SoF: 2 studies did not report usable data; 1 study gave low-quality evidence of a benefit in plaque reduction at 5.5 months for enhanced OHA; 3 studies found little or no difference; 1 study gave weak evidence of a… | 6 studies · 440 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Dental caries 12 months | SoF: 1 study in adults did not report usable data. Results: Bali 1999 (DMFT) not estimable (no usable data). | 1 study · 70 participants | Very low Downgraded: risk of bias, indirectness |
Patient-reported changes in knowledge, attitudes and quality of life | Hoogstraten 1983 (dental knowledge, attitude, behaviour, fear), Munster Halvari 2012 (multiple psychological measures: autonomy, motivation, perceived competence), Tedesco 1992 (theory of reasoned action variables);… | 3 studies | Ungraded |
One-to-one oral hygiene advice (OHA) provided by any member of the dental team within the dental setting vs No advice, or advice in an alternative format, or advice from a different member of the dental team
Population: Children (with or without guardian/parent) or adults who are fit and healthy, or groups with well-defined medical conditions; those wearing a removable prosthesis or orthodontic appliance excluded
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR Minimum 8 weeks follow-up | Protocol only; no studies included. Planned primary outcomes: periodontal health (plaque, gingivitis, probing depths), caries, oral infection; secondary: patient-reported behaviour, satisfaction,… | 0 studies | No studies |