Adherence to Supportive Periodontal Treatment
Periodontal disease is a chronic disease that must be maintained, currently, there is no cure. Maintenance requires keeping a healthy balance of the oral ecosystem by eliminating bacterial plaque. For long-term efficacy, this must be achieved daily. Essentially this lays most of the responsibility on the patient. Patient adherence is difficult to maintain long-term. A review article published in February 2019 in the journal Periodontology 2000 investigates the likelihood of patient adherence and explores the best ways to achieve long-term patient compliance.1
In order to achieve optimal patient adherence, it is important for the patient to understand the disease, recommended treatment and the importance of adhering to recommended homecare instructions. With a complete understanding of these areas of the maintenance process, often there is an increase in their autonomy and their capacity for self-care.
Studies have shown in the past that periodontal therapy without maintenance is of little value in restoring health. The consensus is that regular maintenance appointments, every 3 months helps reduce the loss of periodontal support. However, in some cases maintenance appointments twice a year showed good results IF the patient has excellent plaque control. The goal is to change patients’ habits and improve their ability and motivation to achieve optimal home care, which could lead to fewer maintenance appointments and better long-term health of the periodontium.
Three reasons for the lack of adherence have been established. These include lack of knowledge, lack of skills, and lack of motivation. To better help, dental professionals need to master active listening, shaping, and verbal reinforcement. Changing the focus from informative to a more useful persuasive technique.
Motivation is required for compliance and the development of habits. The good news is that studies show once a habit is established motivation has limited influence. Considering studies that show an increased risk of tooth loss due to lack of adherence, this could be a great motivational factor for patients. One review concluded, “patients’ perceptions of the benefits and their self-efficacy beliefs predict the likelihood that they will follow advice”. We must be our patient’s cheerleader to help improve adherence and improve long-term outcome post periodontal therapy.
Ultimately, the two driving factors for better adherence from patients in regard to supportive periodontal treatment is recall interval and motivational interventions. These are the two factors the dental team should focus on to improve patient adherence and better long-term success.
In the final comments of this review, the authors state, “According to motivational interviewing technique, all persons considering behavior change experience an internal conflict regarding the pros and cons of change.” This indicates it may take some time to establish good habits and optimal adherence from patients’ undergoing periodontal therapy and maintenance.
Do you currently use motivational interviewing to help better encourage adherence to maintenance and oral hygiene instructions? Do you adjust the frequency of maintenance appointments depending on the patient’s adherence and ability to effectively reduce plaque?
- Echeverría JJ, Echeverría A, Caffesse RG. Adherence to supportive periodontal treatment. Periodontol 2000. 2019;79(1):200–209. doi:10.1111/prd.12256
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