Articles

EFFICACY OF FOUR MOTIVATIONAL TECHNIQUES FOR IMPROVING ORAL HYGIENE: THREE-YEAR FOLLOW-UP OF A RANDOMIZED CONTROLLED TRIAL

PURPOSE. The aim of this randomized controlled trial with blinded examiner was to compare the efficacy of four different methods of enhancing oral hygiene motivation in: (i) reducing the full-mouth plaque score (FMPS) and full-mouth bleeding score (FMBS), (ii) modifying patient behaviour, (iii) amount of intervention time required, and (iv) the degree of patient satisfaction at three-year follow-up.

MATERIALS AND METHODS. In a private practice, 100 subjects aged 18-75 years with at least 20 teeth/implants and a FMPS ≥40% were consecutively recruited. At baseline, subjects were randomly allocated to four different oral hygiene motivational techniques: standard oral hygiene instructions (SOHI), reading a pamphlet (P), watching a video (V), or Brief Motivational Interviewing (BMI). For each method the outcome variables considered were: reduction in FMPS, reduction in FMBS, frequency of daily tooth brushing, frequency of daily flossing, motivational intervention time, degree of patient satisfaction, patient perception of oral health (by means of a questionnaire), and number of teeth lost. A single operator carried out all motivational sessions and/or professional oral hygiene at baseline and at 1, 3, 6, 12, 18, 24, 30 and 36 months. Another operator, blinded to the motivational method used, recorded the variables at baseline and at 6, 12, 18, 24, 30, and 36 months.

RESULTS. At 36-month follow-up, there had been 3, 6, 5 and 2 drop-outs for SOHI, P, V, and BMI, respectively. The reduction from baseline in FMPS was 19.7 for SOHI, 20.0 for P, 23.7 for V, and 29.9 for BMI. The difference between BMI and P was significant, a difference of 10.3 favouring BMI; 95%CI from 0.0 to 10.3; P = 0.0445. There were no significant differences between the four tested methods in FMBS reduction from baseline (2.1 for SOHI, 3.2 for P, 2.3 for V, and 3.6 for BMI; P = 0.9716), degree of patient satisfaction (P = 0.1605), improvement in perception of oral health (P = 0.3305), frequency of daily flossing (P = 0.1991), or number of teeth lost (P = 0.2847). The frequency of daily tooth brushing significantly increased after BMI compared to SOHI (the difference between BMI and SOHI was 0.6; 95%CI from 0.2 to 1.0, P = 0.0017). The total time required for motivation was significantly greater for the BMI as compared to all other techniques (P <0.0001).

CONCLUSIONS. All tested methods improved FMPS and FMBS, and were appreciated by all subjects. The reduction in FMPS was higher with BMI than with P. The change in patient behaviour (frequency of daily tooth brushing) was more pronounced in the BMI group, but the intervention time required was greater than for the other techniques.