Improving the delivery of oral hygiene advice by dental professionals

Good oral hygiene is fundamental in preventing dental plaque-induced diseases, which are highly prevalent. Most general dental practice (GDP) patients receive oral hygiene advice (OHA), yet 66% have plaque present and on average 25% clean their teeth less than twice daily. By implication, OHA provided in GDP is not effective at improving plaque control or changing behaviour. Application of psychological behaviour change theory, such as COM-B, could improve patient compliance with OHA. This research aims to investigate how dental professionals (DPs) are taught to give OHA, how and what OHA is given in GDP, and evaluate two OHA behavioural interventions that aim to improve efficacy of OHA delivery and reduce preventable plaque-induced oral disease prevalence. A cross-sectional questionnaire-based study that captured a snapshot of undergraduate OHA and behaviour change teaching found dental hygienist and therapist students received more training than dental students, and both groups indicated more teaching on implementing behaviour change techniques (BCT) was desirable. Little high-quality continuing professional development (CPD) on behaviour change and OHA was available post-graduation. Questionnaire-based cross-sectional studies collected patient experiences on receiving, and qualified DP perspectives on their delivery, of OHA. All groups reported that OHA was predominantly delivered verbally, focussed on practical skills, and that motivation factors were most commonly cited by patients for non-adherence. In a pilot randomised controlled trial (RCT), OHA delivered alongside images of patient's teeth and gums improved gingival health more than the standard of care delivered in GDP. In an OHA behavioural intervention RCT, goal setting, planning, and self-monitoring significantly reduced gingivitis compared to standard OHA in GDP patients. In conclusion, use of BCTs addressing more than the physical capability of performing oral hygiene improved patient oral health more effectively than the current standard of OHA provided in GDP. Furthermore, extended training for DPs is recommended in BCTs.