Regular effective oral hygiene measures are essential for the maintenance of good oral health.  The provision of one-to-one oral hygiene advice (OHA) by members of the dental team in the dental setting is important to help patients achieve good levels of oral health.  Current guidance recommends that OHA should be tailored to an individual patient needs and reinforced regularly. However, there is uncertainty regarding the most effective method of delivering this advice.

The aim of this review was 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.

Methods

Cochrane Oral Health’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) Medline, Embase, ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform with no restrictions on language or date of publication. Reference lists of relevant articles and reviews were hand searched and where feasible, trial authors were contacted to identify any unpublished work. Randomised controlled trials (RCTs) assessing the effects of one‐to‐one OHA delivered by a dental care professional in a dental care setting with a minimum of 8 weeks follow‐up were considered.

At least 2 reviewers independently selected, extracted data and assessed risk of bias using the Cochrane tool.  The primary outcomes considered were clinical status factors for periodontal health and caries. For continuous outcomes mean difference (MD) and 95% confidence intervals (CI) were used when studies used the same scale and standardised mean difference (SMD) and 95% CI when difference scales were employed. Risk ratio (RR) with 95% CI were used for dichotomous outcomes.  Data pooling was not carried out because of heterogeneity in relation to participants, interventions, settings and outcome measures.

Results

• 19 studies involving a total of 4232 patients were included.
• None of the studies was a low risk of bias, 3 were at high risk of bias and 16 at unclear risk.
• 4 studies compared any form of one-to-one OHA versus no OHA.
  • 2 studies reported on gingivitis. Although one small study had contradictory results at 3 months and 6 months, the other study showed very low-quality evidence of a benefit for OHA at all time points (very low-quality evidence).
  • These 2 studies also reported on plaque providing low-quality evidence of a benefit for OHA in plaque reduction at all time points.
  • 2 studies reported on dental caries at 6 months and 12 months respectively providing very low-quality evidence of a benefit for OHA at 12 months.
• 4 studies compared personalised OHA versus routine OHA. There was little evidence available that any of these interventions demonstrated a difference on the outcomes of gingivitis, plaque or dental caries (very low quality).
• 5 trials compared some form of self-management with some form of professional OHA providing very low quality evidence that any of the interventions demonstrated a difference on the outcomes of gingivitis or plaque. None of the studies measured dental caries.
• 7 trials compared some form of enhanced OHA with some form of routine OHA. There was little evidence available that any of these interventions demonstrated a difference on the outcomes of gingivitis, plaque or dental caries (very low quality).

Conclusions

The authors concluded: –

There was insufficient high‐quality evidence to recommend any specific one‐to‐one OHA method as being effective in improving oral health or being more effective than any other method. Further high‐quality randomised controlled trials are required to determine the most effective, efficient method of one‐to‐one OHA for oral health maintenance and improvement. The design of such trials should be cognisant of the limitations of the available evidence presented in this Cochrane Review.

Comments

Dental Caries and periodontal disease are two of the world’s commonest disease and are largely preventable.  Establishing and maintaining good oral hygiene habits are essential in preventing caries and periodontal disease in order to maintain good oral health.   Promoting and advising on oral health is a key component of the dental curriculum and much has been written about it as is highlighted by the large number of references ( 15,188) initially identified by the search for this review. However only 19 studies met the inclusion criteria for this review and they provide very low quality evidence about one of one oral health advice.   What this review and other reviews in the area show is significant variation in the type of oral health promotion activities undertaken but a lack of clarity in describing the exact nature of the OHA interventions which coupled with a lack of  good quality reporting of important methodological elements like adequate randomisation allocation concealment and blinding  leave us with poor quality evidence.   Improving oral health and reducing the disease burden through prevention is important  but we need good quality evidence to identify the most effect and cost -effective way of doing this so high quality studies are needed in primary care where the vast majority of dental care is provided.

Links

Primary Paper

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

Other references

Cochrane Oral Health Group Blog – No conclusion is possible on the best methods of delivering one-to-one oral hygiene advice

Dental Elf – 7^th Jul 2017

Periodontitis: risk increased by poor oral hygiene

Dental Elf – 23rd Feb 2016

Oral health promotion in dental practices

Dental Elf – 27th Apr 2016

Oral health-related behaviours: improved with interventions using goal setting, self-monitoring and planning