Efficacy of four motivational techniques for improving oral hygiene. Two-year follow-up of a randomised controlled trial

PURPOSE. The aim of this randomised clinical trial with blinded examiner was to compare the efficacy of four different methods of enhancing oral hygiene motivation in: (i) reducing the full-mouth plaque score (FMPS) and full-mouth bleeding score (FMBS); (ii) modifying patient behaviour; (iii) the amount of intervention time required; and (iv) the degree of patient satisfaction at two-year follow-up. MATERIALS AND METHODS. In a private practice, 100 subjects aged 18-75 years with at least 20 teeth/implants and an FMPS ≥40% were consecutively recruited. From baseline to two-year follow-up, subjects were randomly allocated to four different oral hygiene motivational techniques: standard oral hygiene instructions (SOHI), reading a pamphlet (P), watching a video (V), or Brief Motivational Interview (BMI). The outcome variables considered were: reduction in FMPS, reduction in FMBS, frequency of daily tooth brushing, frequency of daily flossing, motivational intervention time, degree of patient satisfaction, patient perception of oral health (by means of a questionnaire), and number of teeth lost in association with each method. A single operator delivered all motivational sessions and professional oral hygiene at baseline, and 1, 3, 6, 12, 18, and 24 months. Another operator, blinded to the methods used, recorded the variables at baseline, and at 6, 12, 18, and 24 months. RESULTS. At 24-month follow-up, there were no significant differences between the four tested methods in either FMPS (-20.9 for SOHI, -23.1 for P, -25.1 for V, and -27.1 for BMI; P = 0.4407), FMBS (-1.9 for SOHI, -3.1 for P, -0.7 for V, and -4.0 for BMI; P = 0.3110), degree of patient satisfaction (P = 0.3559), improvement in perception of oral health (P = 0.8069), frequency of daily flossing (P = 0.2118), or number of teeth lost (P = 0.2108). Although the total time required for motivation was significantly greater for the BMI as compared to all other techniques (P <0.0001), the frequency of daily tooth brushing significantly increased after BMI as compared to SOHI and V (the difference between BMI and SOHI was 0.6; 95%CI from 0.2 to 1.0, and the difference between BMI and V was 0.5 95%CI from 0.0 to 0.9; P = 0.0022). CONCLUSIONS. All tested methods improved FMPS and FMBS and were appreciated by all subjects. The change in patient behaviour was more pronounced in the BMI group, but the intervention time required was greater than for the other techniques; nevertheless, it was compatible with a professional oral hygiene session of one-hour duration.