Theory-based behavioral change interventions to improve periodontal health

Abstract

Periodontal disease is a significant global health burden affecting half of the world's population. Given that plaque and inflammation control are essential to the attainment of periodontal health, recent trends in preventive dentistry have focused on the use of behavioral models to understand patient psychology and promote self-care and treatment compliance. In addition to their uses in classifying, explaining and predicting oral hygiene practices, behavioral models have been adopted in the design of oral hygiene interventions from individual to population levels. Despite the growing focus on behavioral modification in dentistry, the currently available evidence in the field of periodontology is scarce, and interventions have primarily measured changes in patient beliefs or performance in oral hygiene behaviors. Few studies have measured their impact on clinical outcomes, such as plaque levels, gingival bleeding and periodontal pocket reduction, which serve as indicators of the patient's disease status and quality of oral self-care. The present narrative review aims to summarize selected literature on the use of behavioral models to improve periodontal outcomes. A search was performed on existing behavioral models used to guide dental interventions to identify their use in interventions measuring periodontal parameters. The main models were identified and subsequently grouped by their underlying theoretical area of focus: patient beliefs (health belief model and cognitive behavioral principles); stages of readiness to change (precaution adoption process model and transtheoretical model); planning behavioral change (health action process approach model, theory of planned behavior and client self-care commitment model); and self-monitoring (self-regulation theory). Key constructs of each model and the findings of associated interventions were described. The COM-B model, a newer behavioral change system that has been increasingly used to guide interventions and policy changes, is discussed with reference to its use in oral health settings. Within the limitations of the available evidence, interventions addressing patient beliefs, motivation, intention and self-regulation could lead to improved outcomes in periodontal health. Direct comparisons between interventions could not be made due to differences in protocol design, research populations and follow-up periods. The conclusions of this review assist clinicians with implementing psychological interventions for oral hygiene promotion and highlight the need for additional studies on the clinical effects of behavioral model-based interventions.

Knowledge, Attitude and Practice regarding the effect of yoga on periodontal health among Indian adults: A questionnaire study.

“…A recent paper has demonstrated that physical activity can be a modifiable risk factor for periodontal disease. 51 In the present study, the KAP regarding the effect of yoga on oral health is at a medium level. This may be attributed to the fact that there are a few studies that have identified the favourable effects of yoga on oral health and specifically periodontal health, 28 and a systematic review in 2021 has given the evidence that yoga can have beneficial effects on periodontal health through its effect on stress reduction.…”

Israeli Dentists’ Knowledge, Attitudes, and Practices Regarding Smoking Cessation Care

“…Other surveys demonstrate a wide range of percentages of dentists routinely performing 'Ask and Advise'. (17,20,24,33,35) The high 'often and always' performance of our sample could be, in part, attributed to the relatively high percentage of specialists among our participants (38%), exceeding that of the general dentist population (about 10%). (36) Our results con rmed that specialists were better at providing SCC to their patients than non-specialists.…”

“…Similar results of decline in the level of involvement through the 5A', and lowest performance of the nal steps are seen in other studies elsewhere. (17,19,(33)(34)(35) The low numbers come from self-report of 5A's performance and are likely to be an overestimation. As each additional 5A's step requires more time and involvement from the dentist, this trend is not surprising.…”

“…Hence, more training on smoking cessation strategies are needed, including formal training in dental school's curriculum. (17) In Israel, the IDA arranged seven training workshops for dentists from 2016 to 2019, aimed at enhancing their SCC practices (n = ~ 200 dentists). Each workshop lasted for six hours, with participation being voluntary.…”

“…The model's rst 2A's -Ask and Advice -are most frequently carried out in interventions. (17) In this case, providing just brief advise (BA), which refers to the 2A's might be a more feasible rst step in dental settings. (25) This study aimed to determine: a) the extent to which Israeli dentists adhere to the 5A's SCC guidelines; b) their knowledge and attitudes regarding SCC provision; and c) the factors that in uence their provision of SCC.…”