The aim of this review was to focus on oral health promotion efforts and interventions within the context of a dental practice. The review was commissioned by NICE www.nice.org.uk to inform the development of their guidance on oral health promotion in general dental practice. Eight difference dimensions were considered:-

• Does the application of behavioural and psychological theory to oral health behaviour lead to effective oral health promotion interventions?
• What is the most effective mode of delivery (channel) of oral health promotion?
• Is verbal delivery of oral health promotion effective?
• Is delivery of oral health promotion by leaflet/written material effective?
• Is delivery of oral health messages by means other than verbally/in writing effective?
• What is the content of oral health messages and how does content influence effectiveness?
• What is the influence of ‘receiver’ characteristics on the effectiveness of oral health promotion?
• What influence do ‘sender’ characteristics have on the effectiveness of oral health promotion?
• What influence does framing have on the effectiveness of oral health promotion messages?
• What are the barriers and facilitators to effective oral health promotion?
• What factors affect patient satisfaction and motivation after a dental visit?

Methods

Searches were conducted in the AMED, CINAHL, Cochrane Library, Embase, Medline, PsycINFO, PsycARTICLES, ScienceDirect, SocINDEX, ASSIA, Social Policy and Practice, HMIC (Health Management Information Consortium), The Knowledge Network, Intute, MedNar, Copac, EPPI-Centre, EThOS, OpenGrey, and TRIP databases.   Searches were limited to publications in the English language published after 1994. Study quality was assessed using methods for the he development of NICE public health guidance.

Results

• 44 studies reported in 52 papers were included
• There were, 15 RCTs, 2 cluster RCTs, 1 controlled trial, 5 quasi-experimental studies, 2 before and after studies without control groups, three surveys, eleven qualitative studies, three mixed methods studies, one audit and one pilot study.
• The evidence was very disparate and the quality of reporting was highly variable. Many studies relied on patient-reported behaviour rather than objective clinical measures or observed behaviours. Many had short follow-up periods. Narrative summaries of the findings in the following areas were provided.
  • Psychological and behavioural models
  • Verbal advice
  • Written advice
  • Other methods of conveying advice
  • Message content
  • Sender characteristics
  • Receiver factors
  • ‘Framing’ of advice
  • Barriers and facilitators
  • Patient satisfaction

Conclusions

The authors concluded

There is strong evidence that oral hygiene and gingival health can be improved by using psychological behaviour change models as the basis of the intervention and that patients’ knowledge levels can be improved by receiving verbal oral health messages from an oral health practitioner.

There is also strong evidence that leaflets and written material are effective in promoting patients’ knowledge but there is no evidence that leaflets are effective for changing people’s behaviour.

Additionally, there is strong evidence pertaining to the existence of a number of barriers and facilitators to the successful delivery of oral health promotion in the dental surgery.

There is moderate evidence that patient motivation and satisfaction are dependent on the oral health professional’s communication skills and ability to build therapeutic alliances with their patients.

There is also moderate evidence that the nature (but not the professional role) of the ‘sender’ of oral health promotion messages and their attitudes and beliefs about oral health promotion can act as either a barrier or facilitator to effectiveness.

There is also weak evidence that improvements in knowledge lead to improved oral health behaviour, at least in the short-term.

However, there is no evidence available regarding the effectiveness of linking oral health promotion messages to wider health outcomes.

Comments

The reviewers have undertaken a broad search for studies and have followed NICE methodology is assessing study quality. However they do highlight the variable quality of the available studies and outcome measures used in these studies. Many of these outcome measures were considered to be ad hoc limiting the ability for the reviewers to undertake direct comparisons.

It is interesting to note that this review finds that there is strong evidence to support interventions bases on psychological behaviour change models to improve oral hygiene and gingival health although the review we looked at last week, which included just RCTs considered that the quality of the available evidence to support interventions based on psychological models was low.

Links

Primary paper

Kay E, Vascott D, Hocking A, Nield H, Dorr C, Barrett H. A review of approaches for dental practice teams for promoting oral health. Community Dent Oral Epidemiol. 2016 Feb 19. doi: 10.1111/cdoe.12220. [Epub ahead of print] Review. PubMed PMID: 26892435.

Other references

NICE – Oral Health Promotion: general dental practice

Dental Elf – 18^th Feb 2016 – Psychological interventions to improve oral health