Standards of Care for Oral Hygiene and Oral Hygiene Instruction

Current Oral Hygiene Recommendations

Many dental professional and advocacy groups have made statements regarding the importance of regular and effective oral hygiene practices. A joint workshop between the European Federation of Periodontology (EFP) and the European Organisation for Caries Research (ORCA) concluded that “the most important behavioral factor, affecting both dental caries and periodontal diseases, is routinely performed oral hygiene with fluoride” and that “management of both dental caries and gingivitis relies heavily on efficient self-performed oral hygiene, that is toothbrushing with a fluoride containing toothpaste and interdental cleaning.”54 These conclusions are echoed by the ADA12 and the World Dental Federation (FDI).109 To achieve optimal oral hygiene for the public, whose risk, current habits, and abilities may be heterogeneous, population and individual-based interventions must be employed and reinforced.

Patient-centered Behavior Management

Manual toothbrushing alone is inadequate in the treatment of gingivitis, once inflammation is established, however, coupled with interdental plaque removal, it has been shown to reduce rates of interdental caries.53,93 Improvement in effectiveness of oral hygiene measures requires multiple rounds of oral hygiene instruction and reinforcement over time.110 Given the low adherence to daily flossing and interdental tooth cleaning in the population and the suboptimal performance of all oral hygiene measures,14,95,96 effective communication and targeting of patients to improve oral hygiene is of critical importance for all dental healthcare professionals.110 A systematic review shows psychological interventions, such as social cognition models, cognitive behavioral therapy, and motivational interviewing, have an improved effect on patient performance of oral hygiene measures.111

Individualized, patient-centered care, including individualized goal-setting and accountability, has been shown to increase the longevity of effectiveness of oral hygiene instructions and to demonstrate clinically superior outcomes.110-112 While this approach may be more time consuming to perform for dental healthcare professionals, it may represent a cost savings if it results in decreased incidence of oral diseases and their sequelae.