What are the effects of behavioural approaches to oral hygiene advice for adults with gum disease?

Key messages

• For people with periodontitis (a severe form of gum disease), we are very uncertain whether behavioural approaches to oral hygiene advice have any important benefits when compared to usual advice alone.

• For people with gingivitis (a less severe form of disease), we are also very uncertain whether behavioural approaches to oral hygiene advice have any important benefits when compared to usual advice alone.

• Future studies are needed to better understand the role of behavioural approaches in supporting people with gum disease.

What is gum disease?

Symptoms of gum disease include bleeding and swollen gums and bad breath. Gingivitis is the earliest stage of the disease. If left untreated, gingivitis can lead to periodontitis, which is a more severe form of gum disease. Periodontitis can cause lasting damage to the soft tissues and bone around the teeth, and in some cases people may lose their teeth.

How is it treated?

People may need treatment for gum disease from their dentist or dental hygienist, sometimes including surgery or antibiotics. However, people can reduce the symptoms of gum disease by following good oral hygiene habits (toothbrushing at least twice a day and using floss or other devices to clean at the gum line between the teeth). Self-care is very important for people living with gum disease, and the success of any dental treatment depends on this. Although people with gum disease are given this oral hygiene advice from their dentist or dental hygienist, we know that some people still do not maintain good enough oral hygiene to manage their disease.

What did we want to find out?

We wanted to find out if behavioural approaches to oral hygiene advice are more effective than usual advice alone at improving oral hygiene habits in adults with gum disease. Behavioural approaches include behaviour change techniques that are designed to help people change their usual behaviour patterns.

In particular, we looked at bleeding (after gentle probing or pressure of the affected sites), inflammation (swollen gums), plaque (sticky film of bacteria that forms on the teeth), depth of pockets (spaces around the teeth caused by gum disease), and attachment of the tooth to the bone. We also looked at whether people were more likely to report improved oral hygiene habits, and whether there were any harms associated with behavioural approaches.

What did we do?

We searched for studies on adults with gum disease. We included studies that compared behavioural approaches to oral hygiene advice with usual advice alone. We compared and summarised the results according to whether the intervention was given to people who had periodontitis or gingivitis. For people with periodontitis, we reported the results separately for those who had never been treated for gum disease (active treatment) or were receiving long-lasting care (supportive treatment). We rated our confidence in the evidence based on factors such as study methods and sizes.

What did we find?

We found 25 studies involving 1422 people. Nineteen studies involved only people with periodontitis; five involved only people with gingivitis; and one involved both disease types.

The included studies used different behavioural approaches to change people's oral hygiene habits. Types of approaches included using mobile phone apps (to provide oral hygiene information or to send reminders), intra-oral cameras or mirrors (to give people feedback on the progression of disease), providing more detailed and personalised advice, supplying oral hygiene treatment for home use, discussions using counselling or motivational interviewing techniques (to help change people's behaviours), or diary-keeping for later discussions in dental appointments.

Main results

For adults with periodontitis, it is unclear if behavioural approaches are better than usual advice alone at reducing bleeding, inflammation, plaque, or depth of pockets. It is also unclear if people receiving behavioural approaches are more likely to report improvement in their oral hygiene habits than those receiving usual advice alone. This finding was the same for people receiving active or supportive treatment for their disease.

For adults with gingivitis, it is unclear if behavioural approaches are better than usual advice alone at reducing the symptoms of gingivitis or improving people's oral hygiene habits.

At the time of our search, we found no studies that reported information about attachment of the tooth to the bone, or harms.

What are the limitations of the evidence?

We have very low confidence in the evidence in this review because:

• people may have been aware of the approach they were receiving, which could have affected the results;

• studies did not always report all the information that we needed;

• most studies included only very small numbers of people, or not enough people for us to be certain about the results;

• the studies were all designed differently, and there were sometimes differences between the results of the studies.

How up-to-date is this evidence?

This evidence is current to 3 July 2024.