In order that health service resources are allocated in the way which most benefits the population, systematic review of the available evidence regarding the effectiveness of programmes and interventions are required. This study examined papers relating to dental health education interventions, which were published between 1982 and 1994 (n = 143). Each was scored by two independent researchers according to twenty predetermined validity criteria. For each paper which achieved a validity score of more than 12 (n = 37), data concerning the objectives of the intervention, the types and numbers of participants, and the outcomes, were extracted from the article. Where sufficient data were provided in a paper which met more than 15 of the validity criteria quantitative meta-analysis was carried out i.e. the results of the studies were pooled in order to calculate an overall intervention effect with confidence intervals. This combination of qualitative and quantitative review techniques showed that dental health interventions have: a small positive, but temporary effect on plaque accumulation (reduction in plaque index = 0.37 95% CI -0.29-0.59); no discernible effect on caries increment and a consistent positive effect on knowledge levels. The results of this analysis suggest that further efforts to synthesise current information about dental health education, in a systematic way, are required, along with maintenance of rigorous scientific standards in evaluation research.

Is dental health education effective? A systematic review of current evidence

Oral hygiene in the prevention of caries and periodontal disease

A clinical trial was performed to study the result of periodontal treatment following different modes of periodontal surgery in patients not recalled for maintenance care. The material consisted of 25 patients distributed into 5 groups. Following an initial examination, all patients underwent presurgical treatment including case presentation and instruction in oral hygiene measures. This instruction was given once. The various patient groups were then subjected to one of the following surgical procedures: 1) the apically repositioned flap operation including elimination of bony defects 2) the apically repositioned flap operation including curettage of bony defects but without removal of bone 3) the "Widman flap" technique including elimination of bony defects 4) the "Widman flap" technique including curettage of bony defects but without removal of bone 5) gingivectomy including curettage of bony defects but without removal of bone. Six, 12 and 24 months after completion of the treatment, the patients were recalled for assessment of their oral hygiene standard and periodontal conditions. The results showed that case presentation and oral hygiene instruction given once, only temporarily improved the patient's oral hygiene habits. Renewed accumulation of plaque in the operated areas resulted in recurrence of periodontal disease including a significant further loss of attachment. All five different techniques for surgical pocket elimination were equally ineffective in preventing recurrence of destructive periodontitis.

Periodontal surgery in plaque‐infected dentitions

Positive correlation between the proportions of subgingival spirochetes and motile bacteria and susceptibility of human subjects to periodontal deterioration

Self-report is an efficient and accepted means of assessing many population characteristics, risk factors, and diseases, but has rarely been used for periodontal disease (chronic periodontitis). The availability of valid self-reported measures of periodontal disease would facilitate epidemiologic studies on a much larger scale, allow for integration of new studies of periodontal disease within large ongoing studies, and facilitate lower-cost population surveillance of periodontitis. Several studies have been conducted to validate self-reported measures for periodontal disease, but results have been inconsistent. In this report, we conducted a systematic review of the validation studies. We reviewed the 16 studies that assessed the validity of self-reported periodontal and gingivitis measures against clinical gold standards. Seven of the studies included self-reported measures specific to gingivitis, four included measures only for periodontitis, and five included both gingivitis and periodontal measures. Three of the studies used a self-assessment method where they provided the patient with a detailed manual for performing a self-exam. The remaining 13 studies asked participants to self-report symptoms, presence of periodontal disease itself, or their recollection of a dental health professional diagnosing them or providing treatment for periodontal disease. The review indicates that some measures showed promise, but results varied across populations and self-reported measures. One example of a good measure is, "Has any dentist/hygienist told you that you have deep pockets?", which had a sensitivity of 55%, a specificity of 90%, positive predictive value of 77%, and negative predictive value of 75% against clinical pocket depth. Higher validity could be potentially obtained by the use of combinations of several self-reported questions and other predictors of periodontal disease.

Validation of Self-reported Periodontal Disease: A Systematic Review

The need for improved oral cleanliness in adults presents a large scale resource requirement for professional manpower if oral hygiene instruction is to be accomplished conventionally on an individual basis at the chairside. Therefore a self-instructional manual in oral hygiene measures, to be used by the patients at home, has been designed. The effect on oral hygiene of periodontal patients following instruction by means of this manual has been compared with the effect of one instruction carried out by a dental hygienist as well as with the effect of minimal instruction by the aid of a short brochure. Thirty-seven patients (25--64 years of age) were allocated to three groups matched with regard to baseline scores of dento-gingival plaque, age and sex. Presence of disclosed dento-gingival plaque (Plak-lite) and gingival bleeding on probing were recorded at the start, 1, 2 and 6 weeks, 3 and 6 months. Toothbrushing performance of the patients was evaluated at each visit by a "brushing test". The treatment of all the patients consisted of scaling and polishing of the teeth at the start and after 3 months as well as the patients being supplied with the necessary oral hygiene aids including a lighted mouth mirror, a toothbrush, toothpicks and disclosing tablets. The baseline mean plaque and bleeding scores of 64 and 40% decreased during the first 6 weeks to a level of 20 and 14%. This improvement was maintained during the 6-month study period. Among the three groups no significant differences were observed in oral hygiene and gingival health. The results indicate that an oral hygiene instructional mode relatively independent of professional manpower may be equally effective as one single personal instruction. Furthermore the results suggest that factors other than the instruction per se are important for obtaining improvements in oral home care.

Oral hygiene instruction of adults by means of a self-instructional manual

The beneficial effects of comprehensive dental prophylaxis programs are well recognized. In order to study the factors determining the effectiveness of these programs, 28 periodontal recall patients were subjected to monthly professional mechanical tooth cleanings. Experimental and control teeth were randomly selected according to a splitmouth cross-over method. The Plaque and Gingival indices were recorded 1 month prior to the study, at the start, and at 4, 8, and 12 months. One month prior to the study calculus and bacterial plaque were thoroughly removed from all teeth. During the study period only the experimental teeth were cleaned. Efforts were made not to influence the oral hygiene of the participants by any other means. Following the initial tooth cleaning and during the preexperimental period the Plaque and Gingival indices decreased to a low level on both the experimental and control teeth (mean P1I = 0.4, mean GI = 0.3). This high standard of oral hygiene and gingival health was maintained throughout the study period, and no differences could be observed between experimental and control teeth. This indicates that factors other than the mechanical professional cleaning were responsible for the maintenance of gingival health. It is suggested that participation in the program in itself may have motivated the patients to improve their oral home care.

Effect of monthly professional mechanical tooth cleaning on periodontal health in adults.

The institution of proper oral hygiene procedures and habits is a learning process. This paper describes a self-instructing periodontal self-examination program to be used in the initial phase of periodontal treatment. The program was designed in an effort to facilitate learning by taking the teaching conditions into consideration. The program tries to utilize the patient's curiosity and need for activity and to involve the patient himself in an effort to make the patient apprehend the relevance of subject matter. The program also allows for an individualized learning speed of the patient. The self-examination program was tested on 108 periodontal patients (19-75 years of age) and the patients' findings were compared to those made by a dentist. Questionnaires before and after the self-examination were used in the evaluation of opinions of the patient. The present study showed that the patients were able to perform the self-examination without individual professional guidance. A rather close correlation was noted between findings made by the patient and the dentist. Furthermore, the program was well accepted and appreciated by the patients according to their answers on the questionnaires.

Periodontal self-examination A motivational tool in periodontics

The effectiveness of an electric toothbrush (Rota-dent), which in design and mode of action resembles the rotating instruments used by professionals in tooth cleaning, was assessed. 40 adult periodontal patients were divided into 2 groups matched with regard to oral cleanliness: an electric toothbrush group (EB) comprising 20 patients who received an electric toothbrush as well as instruction in it's use by a dental hygienist; a control group (CO) comprising 20 patients who were provided with an oral hygiene kit containing a conventional toothbrush, an interspace brush, toothpicks, disclosing tablets and a lighted mouth mirror and who received the oral hygiene instruction by means of a self-teaching manual. All patients received professional mechanical tooth cleaning 1 week prior to the instruction. At a 3-week follow-up session, additional instruction was given by a dental hygienist according to needs. The presence or absence of dento-gingival plaque after disclosing with the Plak-lite system and gingival bleeding by gentle probing was recorded on 4 tooth surfaces of all teeth, initially and after 3 months. The findings showed a similar improvement in the status of oral hygiene in both groups, indicating that in the hands of the patients, the electric toothbrush was just as effective as the comprehensive oral hygiene kit.

The effectiveness of a rotary electric toothbrush on oral cleanliness in adults.

The purpose of the present study was to examine the effect on oral hygiene and gingival health of plaque scoring and the performance of a “tooth brushing test” at each visit during initial periodontal treatment, A total of 63 adult periodontal patients (22–67 years of age) was allocated to 4 matched groups: Brushing test group (B), open scoring group (0), minimal feedback group (M) and control group (C). The oral hygiene instruction for groups B, O and M was provided by handing out a self-educational manual on oral home care, while the patients of control group (C) received a short brochure describing the Bass brushing technique and the use of toothpicks. Feedback on the improvement of oral hygiene performance was delivered to groups B and O by scoring of plaque and gingival bleeding by probing while this feedback was avoided in the 2 other groups (M, C). The patients of group B performed a tooth brushing test at each of 3 visits. After 3 months the plaque scores of groups B (27%) and O (22%) had improved more than those of the 2 other groups (35%). However, the improvement in gingival bleeding scores was similar in all 4 groups (from 55% initially to 17% at 3 months). At later examinations only minor differences in plaque and gingival bleeding scores were recorded between the various groups. The findings show that, irrespective of the mode of instruction, a considerable improvement occurs and that this improvement is not related to open scoring of plaque or the tooth brushing test.

Leif Glavind

Papers

Oral hygiene instruction of adults by means of a self-instructional manual

Effect of monthly professional mechanical tooth cleaning on periodontal health in adults.

Periodontal self-examination A motivational tool in periodontics

The effectiveness of a rotary electric toothbrush on oral cleanliness in adults.

Evaluation of various feedback mechanisms in relation to compliance by adult patients with oral home care instructions