The effect of a cognitive behavioral intervention on oral hygiene. Changes in dental knowledge and self-efficacy scores following interventions to change oral hygiene behavior. Psychological intervention in patients with poor compliance. Effective group behavioral intervention for older periodontal patients.
Several medical areas that require patient compliance have successfully used psychological interventions emphasizing cognitive behavioral components. However, there are no published reports on the effect of cognitive behavioral interventions on oral hygiene in adults using an experimental design. For this study, 100 male veterans age 21-65 years were randomly assigned to 4 groups (cognitive behavioral, education, attention control, and control); to compare the effectiveness of these interventions on oral hygiene, a 5-week pre-test-post-test design was utilized. The dependent variables were self-report of brushing and flossing behavior and dental plaque levels utilizing the plaque index. After the interventions, there was only one significant difference between the control and the experimental groups for brushing frequency. There were no significant differences among the experimental groups for this intervention. The self-report of flossing frequency significantly increased in all 3 treatment groups, but there were no significant differences between these groups. In addition, plaque levels decreased significantly in all 3 experimental groups. Plaque levels in the cognitive behavioral group were significantly lower than those of the educational group. It was not possible to determine whether the greater plaque reduction in the cognitive-behavioral group could be attributed to the nature of the intervention or to the extra time spent with patients in the cognitive behavioral group. One hundred twenty-three male veterans were randomly assigned to control, education, and psychological groups to improve oral hygiene behavior. The educational group received four 40-min sessions designed to increase knowledge of the causes and prevention of dental disease. The psychological intervention also consisted of four 40-min sessions. However, a psychologist provided the intervention using a Stage of Change intervention. The control group received pre- and post-testing only. There were no significant changes in dental knowledge for the control group while the increases in dental knowledge in the educational and psychological groups were similar and statistically significant. Pre-Post change scores for flossing self-efficacy scores showed significant changes for all groups. The magnitude of changes was similar when the control and educational groups were compared. In contrast, the psychological intervention group demonstrated significantly greater flossing self-efficacy changes when compared to either the control or the educational groups. These results suggest that increases in self-efficacy may be an important component of interventions designed to change health behavior and may serve a role in evaluating and comparing the efficacy of these interventions. In this article, the authors examine the compliance of periodontal patients from a behavioral psychology perspective. The causes of non-compliance are analyzed along with the main methods of intervention. An experiment was carried out in which various behaviour modification techniques were compared. This study, in particular, examined the effect of periodontist's use of behaviour modification techniques on patient compliance in four treatment maintenance conditions. A functional analysis of compliance and non-compliance behaviour revealed various treatment opportunities. Hence, 4 treatment conditions (which included basic oral hygiene instructions, performance feedback, behavioural self-management, and positive reinforcement) were compared in 3 phases. Data collected over a period of 3 months indicated that behavioural self-management plus positive reinforcement increase patient compliance significantly. Implications for further research are discussed in terms of analyzing the cost of each component procedure for both the patient and the doctor in terms of time, money and effort required. Hence, the present study demonstrates that behavioural strategies can make a significant contribution to the area of patient management. A randomized clinical trial assessed the effect of a group-based behavior modification intervention on oral hygiene skills, adherence and clinical outcomes for older periodontal patients. Subjects (n = 107) were aged 50-70 yr with moderate periodontal disease. They were randomly assigned to usual care or intervention. Intervention consisted of 5 weekly, 90-min sessions that included skill training, self-monitoring, weekly feedback about bleeding points and group support focused on long-term habit change. Four-month follow-up indicated significant improvements in the intervention versus the usual periodontal maintenance group for oral hygiene skills and self-reported flossing (p < 0.001), plaque, gingival bleeding, bleeding upon probing throughout the mouth, and pocket depth for sulcus depths that measured between 3 and 6 mm at baseline (p < 0.009). Group oral health intervention provides an effective and relatively inexpensive means of helping patients improve their self-care skills and achieve high levels of adherence to an effective self-care regimen.
There is tentative evidence from low quality studies that psychological approaches to behaviour management can improve oral hygiene related behaviours. However, the overall quality of the included trials was low. Furthermore, the design of the interventions was weak and limited, ignoring key aspects of the theories. Thus, there is a need for greater methodological rigour in the design of trials in this area.