A look at the evidence-based practices for at-home oral care in pursuit of improved outcomes.
Parker (1999) wrote, “dental health care is a two-person endeavour”, rather than something that the dental professional resolves for the patient without the latter’s input.
Adding to this concept, according to Swapnadeep and colleagues (2014), the patient and dental professional need to work in sync to achieve successful oral health outcomes.
Tonetti and colleagues (2017) further suggested that, “[…] each individual should play a proactive role in awareness of oral health, selfcare measures, health promotion and disease prevention for optimal oral and general health in the course of life.”
The current situation
However, there seems to be a gap between the evidence base that recommends mechanical cleaning at home between appointments and the level of oral care patients are able to achieve.
Indeed, the Adult Dental Health Survey (2009) indicates that two-thirds of participants had visible plaque, even though three-quarters of dentate adults surveyed claimed to brush their teeth at least twice a day and a quarter of those also reported they flossed daily.
There appears to be a disconnect in the process, with Swapnadeep and colleagues (2014) suggesting that the key to success may be to address any mismatch in perspective between the dental professional and patient, using effective communication and motivational tools.
For instance, telling a patient that they can have fresher breath if they brush their teeth may motivate them to make positive changes to their routine, as opposed to trying to get them to care about their oral health care needs.
Patient perspectives
Although the dental team is armed with extensive knowledge as to why oral health is important, Tonetti and colleagues (2017) indicated that the ideal strategy for patient compliance and motivation may be found by capitalising on their own wants and needs. For example, by communicating the extent to which it can affect their quality of life or self-esteem.
In line with this, Newton and Asimakopoulou (2015) wrote, “The evidence suggests that there are several variables across all the models which predict the likelihood of engaging in a behaviour – perhaps most important amongst these are the perceived benefits of a behaviour and an individual’s self-efficacy with regard to that behaviour.”
Offering a further point of view on this, Tonetti and colleagues (2015) shared, “Delivery of OHI [oral health instruction] includes assessing patients’ perceptions regarding harmful consequences, their own susceptibility, their benefits of change and their selfefficacy in order to identify and address perceptions which might hamper [a] patient’s motivation for behavioural change.”
An updated evidence base
The evidence suggests that although tooth brushing is able to remove biofilm from the buccal, lingual and occlusal surfaces of the teeth successfully, it does not reach into the interdental spaces effectively. To help to bridge this gap, there are a number of interdental cleaning devices available, to meet various patient needs.
In addition, while the bedrock of athome care remains to brush the teeth and clean interdentally, a growing body of research indicates that the adjunctive use of a mouthwash may provide benefits beyond mechanical cleaning alone.
Offering further insight into this issue, Figuero and colleagues (2020) conducted a systematic review and meta-analysis exploring the adjunctive use of 11 different mouthwash formulations.
They concluded that adjunctive antiseptics in mouthwash provide statistically significant reductions in plaque compared to controls (mechanical cleaning alone) at six months.
They further came to the conclusion that, “… despite the high variability in the number of studies comparing each active agent and the different risks of bias, CHX [chlorhexidine] and EOs [essential oils], in mouthrinses appeared to be the most effective active agents for plaque […] control.”
Furthermore, the Figuero and colleagues’ (2020) outcomes add to the earlier evidence base from Araujo and colleagues (2015), which was the first meta-analysis to demonstrate the clinically significant, site-specific benefit of adjunctive essential oil mouthwash in people within a sixmonth period (between dental visits).
The analysis revealed that 36.9 per cent of subjects using mechanical methods with EO-containing mouthwash experienced at least 50 per cent plaque-free sites after six months, compared to just 5.5 per cent of patients using mechanical methods alone.
A patient-centred approach
Offering a practical overview of the situation, Schmalz and Ziebolz (2020) wrote, “The basis of patient-centred dental care is the understanding of the complex and individual needs, risks, and perceptions of a patient.”
They continued, “Before appropriate risk and need classifications can be applied, a sufficient … dentist-patient relationship remains a mandatory prerequisite; this includes the integration of the patient’s values and preferences in the context of shared decision-making.”
Ultimately, it is suggested, “Within individual preventive care, particular importance can be seen in the communication between dental teams and patients. This should include participative communication and motivational interviewing by well-educated dental team members. Accordingly, patients’ individually perceived needs and concerns are the primary focus of dental care.”
References available on request.