Improving patients' compliance with the treatment of periodontitis: a controlled study of behavioural intervention

• Published in: Journal of clinical periodontology Vol. 32; no. 6; pp. 653 - 658
• Main Authors: Philippot, Pierre, Lenoir, Nathalie, D'Hoore, William, Bercy, Pierre
• Format: Journal Article
• Language: English
• Published: Oxford, UK Munksgaard International Publishers 01.06.2005
• Subjects: Adult; Aged; Analysis of Variance; behavioral intervention; chronic periodontitis; compliance; Dental Plaque Index; Dentistry; Female; Health Knowledge, Attitudes, Practice; Humans; illness representation; Male; Middle Aged; Oral Hygiene - psychology; Patient Compliance - psychology; Patient Education as Topic - methods; Periodontitis - psychology; Periodontitis - therapy; Statistics, Nonparametric; Surveys and Questionnaires; Time Factors
• ISSN: 0303-6979; 1600-051X
• DOI: 10.1111/j.1600-051X.2005.00732.x

Objectives: This clinical trial study investigates whether a behavioural educational intervention based on the autoregulation theory can improve periodontitis patients' compliance with proper dental care at a 1‐month follow‐up. Material and Methods: Thirty patients matched for gender (20 men), age (mean age=39 years) and education were randomly assigned to a control or an experimental treatment condition. In the control condition, patients received the regular treatment based on instruction of the proper prophylactic dental care. In the experimental treatment condition, patients received information about the symptoms of periodontitis, the causes, consequences and temporal course, and the types of effective strategy and they were requested to keep daily records of the effects of applying prophylactic dental care on their periodontitis symptoms. In both groups, plaque indices (PIs) (Silness & Löe 1964) were measured prior to treatment and at a 1‐month follow‐up. A self‐report questionnaire also assessed the representation of periodontitis in all patients. Results: A 2 (time of measurement: baseline versus follow‐up) × 3 (PI localization) × 2 (experimental group) mixed‐design anova computed on the PI reports a large effect of time, F(1, 28)=267.10, p<0.000, indicating that both groups improved from baseline (mean=1.73, SD=0.08) to the 1‐month follow‐up (mean=0.56, SD=0.06). It is important to point out that this analysis also revealed the expected Group × Time interaction, F(1, 28)=7.09, p<0.02, partial η2=0.19, indicating that smaller PI were observed in the experimental group (mean=0.24, SD=0.14) than in the control group (mean=0.88, SD=0.38) at follow‐up. Post hoc analyses showed that this pattern applies to the proximal and lingual PI but not to the vestibular PI. Conclusions: The present data show that the behavioural education intervention is (a) more effective than a classical intervention based on information and training about prophylactic techniques and (b) that it is effective in bringing most patients to normal levels of PI. For clinical practice, it suggests that better results can be obtained if (a) patients are taught a correct representation about periodontitis and (b) patients' sense of self‐efficacy is developed through their own direct experience, by observing the effects of their behaviour on periodontitis symptoms.