No conclusion is possible on the best methods of delivering one-to-one oral hygiene advice

Dentist using props to show a patient how to brush her teethPoor oral hygiene habits are known to be associated with high rates of dental decay and gum disease. The dental team routinely assesses oral hygiene methods, frequency and effectiveness or otherwise of oral hygiene routines carried out by their patients. Oral hygiene routines can include toothbrushing, reducing sugar intake, interdental cleaning with floss or interdental brushes, and using a fluoride mouthwash or dentifrice. One-to-one oral hygiene advice is regularly provided by members of the dental team with the aim of motivating individuals and improving their oral health. The most effective method of delivering one-to-one advice in the dental setting is unclear. This review’s aim is to determine if providing patients with one-to-one oral hygiene advice in the dental setting is effective, and if so what is the best way to deliver this advice.

What was the research?

A systematic review to assess the effects of one-to-one oral hygiene advice, provided by a member of the dental team within the dental setting, on patients’ oral health, hygiene, behaviour, and attitudes compared to no advice or advice in a different format.

Who conducted the research?

The research was conducted by a team led by Francesca A. Soldani of Bradford District Care NHS Foundation Trust, UK on behalf of Cochrane Oral Health. Thomas Lamont, Kate Jones, Linda Young, Tanya Walsh, Rizwana Lala and Janet E. Clarkson were also on the team.

What evidence was included in the review?

We included 19 randomised controlled trials. Oral hygiene advice was provided by a hygienist in eight studies, a dentist in four studies, a dental nurse in one study, a dentist or a hygienist in one study, a dental nurse and a hygienist in one study, and a dental nurse gave oral hygiene advice to the control group with further self-administration of the intervention in one study. It was unclear in three of the studies which member of the dental team carried out the intervention. Over half of the studies (10 of the 19) were conducted in a hospital setting, with only five studies conducted in a general dental practice setting (where oral hygiene advice is largely delivered).

What did the evidence say?

Overall we found insufficient evidence to recommend any specific method of one- to-one oral hygiene advice as being more effective than another in maintaining or improving oral health.

The studies we found varied considerably in how the oral hygiene advice was delivered, by whom and what outcomes were looked at. Due to this it was difficult to readily compare these studies and further well designed studies should be conducted to give a more accurate conclusion as to the most effective method of maintaining or improving oral health through one-to-one oral hygiene advice delivered by a dental care professional in a dental setting.

How good was the evidence?

We judged the quality of the evidence to be very low due to problems with the design of the studies. We can’t be certain that any of the methods of delivering oral hygiene advice were effective.

What are the implications for dentists and the general public?

There was insufficient high-quality evidence to recommend any specific one-to-one oral hygiene advice method as being effective in improving oral health or being more effective than any other method.

What should researchers look at in the future?

The quality of study reporting was variable with the use of CONSORT recommended for future studies (www.consort-statement.org).

Many of the studies did not make the exact nature of the oral hygiene advice intervention entirely clear; more detailed description of intervention(s) would be of benefit so that we could compare them more easily. Researchers conducting future studies should ensure that methods of randomisation are adequate and clearly reported along with ensuring allocation concealment, appropriate blinding and sample size determined at design stage. In addition, appropriate and validated patient-centred outcome measures should be included in future studies along with the need to determine the cost effectiveness of interventions.

The vast majority of the studies had a short follow-up; longer follow-up periods would be beneficial to determine longer term effects of one-to-one oral hygiene advice.

Given the vast majority of dental care is provided in a dental clinic environment or general dental practice, future studies should take this into account.

Link

Soldani FA, Lamont T, Jones K, Young L, Walsh T, Lala R, Clarkson JE. One-to-one oral hygiene advice provided in a dental setting for oral health. Cochrane Database of Systematic Reviews 2018 , Issue 10 . Art. No.: CD007447. DOI: 10.1002/14651858.CD007447.pub2

This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at the Cochrane Oral Health Editorial Base.