Motivational Interviewing in Improving Oral Health: A Systematic Review of Randomized Controlled Trials

• Autores: Edward Chin Man Lo
• Localización: Journal of periodontology, ISSN 0022-3492, Nº. 3, 2014, págs. 426-437
• Idioma: inglés
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• Resumen

  • Background: The control and management of many oral health conditions highly depend on one�s daily self-care practice and compliance to preventive and curative measures. Conventional (health) education (CE), focusing on disseminating information and giving normative advice, is insufficient to achieve sustained behavioral changes. A counseling approach, motivational interviewing (MI), is potentially useful in changing oral health behaviors. This systematic review aims to synthesize the evidence on the effectiveness of MI compared with CE in improving oral health.

    Methods: Four databases (PubMed MEDLINE, Web of Science, Cochrane Library, and PsycINFO) were searched to identify randomized controlled trials that evaluated the effectiveness of MI compared with CE in changing oral health behaviors and improving oral health of dental patients and the public. The scientific quality of the studies was rated, and their key findings were qualitatively synthesized.

    Results: The search yielded 221 potentially relevant papers, among which 20 papers (on 16 studies) met the eligibility criteria. The quality of the studies varied from 10 to 18 out of a highest possible score of 21. Concerning periodontal health, superior effect of MI on oral hygiene was found in five trials and was absent in two trials. Two trials targeting smoking cessation in adolescents failed to generate a positive effect. MI outperformed CE in improving at least one outcome in four studies on preventing early childhood caries, one study on adherence to dental appointments, and two studies on abstinence of illicit drugs and alcohol use to prevent the reoccurrence of facial injury.

    Conclusions: Reviewed randomized controlled trials showed varied success of MI in improving oral health. The potential of MI in dental health care, especially on improving periodontal health, remains controversial. Additional studies with methodologic rigor are needed for a better understanding of the roles of MI in dental practice.

    The control and management of many oral health conditions highly depend on one�s daily self-care and compliance to preventive and curative measures. Under the current biopsychosocial model of health care, there is little dispute that empowering people to adopt healthy behaviors should be incorporated as part of the treatment plan for dental patients and oral health programs for a community.1,2 Two positive behaviors are of particular relevance to periodontal health, namely smoking cessation3 and self-maintenance of oral hygiene (by brushing and interdental cleaning).4 Both behaviors are essential for preventing occurrence and controlling progression of periodontal diseases4,5 and are the prerequisites for treatment success of periodontal diseases.6,7 Without patients� adherence to these two behaviors, even the most meticulous periodontal therapy is likely to be ineffective.2,7 Diligent efforts are made by periodontists and dental hygienists in educating their patients to adhere to plaque-control measures and quitting smoking. Nevertheless, the rate of patient compliance in long-term therapy appeared to be low.8,9 Similar dilemmas also exist in other disciplines of dentistry for managing other oral health problems.10 Conventionally, patient education focuses on disseminating information and giving normative advice. Although patients� knowledge may be improved, such knowledge gain does not translate into sustained changes in their oral health behaviors.10 A typical consultation session is often an exercise in overt persuasion. However, what appears to be a convincing line of reasoning to the dental professional falls on deaf ears or results in patients� resistance to change.11 The fruitless efforts of conventional education (CE) have led initially enthusiastic dental professionals to a state of burnout and created skepticism toward such attempts.12 Facing such a clinical dilemma, researchers and practitioners actively looked for solutions. A collaborative counseling method, motivational interviewing (MI), started to emerge in dentistry in recent years. MI is a �client-centered directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.�13 Clients assess their own behaviors, present arguments for change, and choose a behavior on which to focus, whereas the counselor helps to create, by skillful questioning and reflection, an acceptable resolution that triggers change.13 Such a client-centered approach is in clear contrast to CE, in which professionals are the active participants in presenting problems and offering solutions, whereas clients are normally excluded from problem definition and decision-making.11,13 MI has been found to be effective in treating a broad range of health-related lifestyle problems, such as substance abuse, diet disorder, lack of physical exercise, and poor adherence to medication regimens.14-17 Although reported effect size varied across studies, and some equivocal findings remained in some studies, current evidence in aggregation supports the effectiveness of MI in eliciting positive health behaviors.14,15 Despite the sizeable evidence collected in medical research, the potential of MI in dental health care is understood to a much lesser extent. To the best of the authors� knowledge, no systematic review on dental MI has been published. In a narrative review involving many health conditions, the authors identified two dental MI studies (reported in four papers) and acknowledged oral health was an emerging area for MI.18 However, without a systematic search of databases, this review might have only captured a small segment of the reported evidence. Moreover, papers included in this narrative review were published before 2007. The latest evidence collected in the past 5 years was not synthesized.

    MI started to be included in the latest editions of clinical textbooks in periodontology,19 showing the interest of periodontal experts in this promising method. To assist professionals� consideration of incorporating MI into their dental practice, this systematic review aims to synthesize the current evidence collected from randomized controlled trials on the effectiveness of MI compared with CE in changing oral health behaviors and improving oral health of dental patients and the public.