Dentists Need Tools To Improve Brushing And Flossing Behavior

Armen Hareyan's picture

Tooth Brushing And Flossing

Even when they have gum disease, many people don't bother to brush or floss properly.

A new review suggests there is limited evidence that using behavior management approaches will help dentists convince patients to take better care of their teeth and gums.

British reviewers found a handful of studies that looked at approaches to behavior management in periodontal patients. These studies were far from perfect, making it difficult for the researchers come to any firm conclusions.

"We need better-quality trials assessing the effects of psychological interventions to improve people's oral health," said review co-author Dr. Peter Robinson, professor of dental public health at the University of Sheffield in England. "I also think we need broader research on the benefits of the application of psychological theory to dentistry, as I believe it has a great deal to offer."

Even in these days of high-tech medicine, toothbrushing and flossing remain the keys to oral health: "Removing the plaque from teeth and gums every day with proper brushing and flossing is the most important step in helping to keep a person's teeth for a lifetime," said Dr. Preston Miller, president of the American Academy of Periodontology.


Still, brushing and flossing are not as popular as dentists would like. Excuses run the gamut from "my hands are too big" and "I get my teeth professionally cleaned twice a year, so I don't have to brush and floss" to "my teeth are too tight for the floss" and "it takes too long," Miller said.

According to Miller, a 2000 survey found that nearly 90 percent of 201 periodontists polled said patients are lax about flossing frequently and 61 percent reported that their patients could improve their flossing technique.

Some dentists have explored behavior management approaches designed to serve as psychology-based alternatives to changing brushing and flossing behavior. The new Cochrane Library review examines whether there is evidence to support such approaches in periodontal (gum) disease.

The Cochrane Library is a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The review authors found four studies that examined the effect of behavior management approaches on patients with gum disease. In all cases, the studies tested a psychological theory or model.

One study required selected patients to attend five 90-minute group sessions about periodontal care; two others required some subjects to meet with psychologists. A fourth study tested the value of making patients call or visit a periodontist twice a week.

The authors judged the quality of the studies