| Objectives1 To investigate self-efficacy for oral self-care and its associated factors among patients with chronic periodontitis(CP).2 To test the effectiveness of a six-step behavioral cognitive method on self-efficacy for oral self-care,oral self-care behaviors and periodontal health of patients with CP.Methods1 A cross-sectional study was carried out in Department of Periodontology,Hospital of Stomatology,Tianjin Medical University during May to October 2016.Patients diagnosed with CP were recruited and inquiried by Clinical and Demographic Questionnaire,Oral Self-care Behaviors Questionnaire,Self-Efficacy Scale for Self-care,Dental Fear Scale,Social Support Rating Scale and Medical Coping Modes Questionnaire.Multiple linear regression analysis was used to test associated factors on self-efficacy for oral self-care.2 A quasi-experimental study was performed during November 2016 to April 2017.Patients with CP were sampled and divided into two groups based on odd-even month of their initial diagnosis.The patients in control group received conventional oral hygiene instructions.The patients in intervention group obtained extra support by a six-step behavioral cognitive method.1,3 and 6 months later,self-efficacy for oral self-care and oral self-care behaviors were further recorded.3 and 6 months later,periodontal health parameters were further gathered.Repeated-measures ANOVA was used for testing the differences between two groups in self-efficacy for oral self-care,daily frequency of toothbrushing,daily toothbrushing duration,weekly frequency of interdental cleaning,probing depth and attachment loss.Results1 Results of cross-sectional study1.1 We investigated 420 CP patients and eliminated 20 invalid questionnaires.The effective return ratio was 95.24%.1.2 The average age of the 400 patients was 39.48±11.30 years old.158 patients(39.50%)were male and 242 patients(60.50%)were female.335 patients(83.75%)were associate degree education and higher.331 patients(82.75%)were employed.326 patients(81.50%)were more than 3000 yuan in per capita income of family per month.319 patients(79.75%)were supported by medical insurance.169 patients(42.25%)had family history of oral diseases.122 patients(30.50%)had tooth loss.298 patients(74.50%)were diagnosed with moderate-severe CP.Probing depth was 3.46(2.78,3.64)millimeters.Attachment loss was 3.06(2.47,3.39)millimeters.The score of patient’s satisfaction with their oral health was 2.38±0.75 points.1.3 The age of the 400 patients when they began to brush their teeth was 6.00(3.00,9.00)years old.Daily frequency of toothbrushing was 1.72±0.46 times.Daily toothbrushing duration was 1.77±0.67 minutes.Weekly frequency of interdental cleaning was 0.46±0.17 times.98 patients(24.50%)used soft toothbrush with a small head.132 patients(33.00%)used horizontal brushing methods.241 patients(60.25%)used vertical brushing methods.27 patients(6.75%)used circle or horizontal vibration method.126 patients(31.50%)used dental floss and/or interdental brushing.71 patients(17.75%)underwent regular oral examination.164 patients(41.00%)did daily exercise.82 patients(20.50%)frequently ate sweets.200 patients(50.00%)occasionally ate sweets.118 patients(29.50%)seldom or hardly ate sweets.132 patients(33.00%)paid very attention to oral self-care.121 patients(30.25%)paid occasional attention to oral self-care.147 patients(36.75%)paid little or no attention to oral self-care.1.4 The total score of self-efficacy for oral self-care of the 400 patients was 58.67±7.04 points.The scores of three factors were 19.82±2.58 points,18.32±2.92 points and 20.54±2.83 points,respectively.1.5 The total score of dental fear of the 400 patients was 51.20±18.26 points.The scores of three factors were 21.06±9.62 points,14.27±2.78 points and 17.34±6.69 points,respectively.The scores of dental fear and its factors were higher than those of norm(P<0.01).1.6 The total score of social support of the 400 patients was 33.53±3.02 points.The scores of three factors were 19.33±2.19 points,8.36±1.86 points and 5.85±1.64 points accordingly.The total score of social support was lower when compared with norm(P<0.01).1.7 The three factors scores of coping styles of the 400 patients were 18.34±2.30 points,17.48±2.38 points and 10.25±1.34 points,respectively.Compared with norm,confrontation score was lower while avoidance and acceptance-resignation scores were higher(P<0.001).1.8 T-test,single-factor ANOVA and Mann-Whitney U test suggested there were significant differences in self-efficacy for oral self-care among educational levels,family history of oral diseases,regular oral examination,tooth loss and disease severity(P<0.05).Correlation analysis showed that self-efficacy for oral self-care was negatively correlated with age(r=-0.324,P<0.001),dental fear(r=-0.405,P<0.001),avoidance of dental treatment and anticipated anxiety(r=-0.356,P<0.001),somatic symptoms of anxiety(r=-0.266,P<0.001),anxiety caused by dental stimuli(r=-0.191,P<0.001),avoidance(r=-0.157,P<0.01),acceptance-resignation(r=-0.253,P<0.001),and positively correlated with probing depth(r=0.211,P<0.001),attachment loss(r=0.252,P<0.001),daily frequency of toothbrushing(r=0.119,P<0.05),daily toothbrushing duration(r=0.282,P<0.001),weekly frequency of interdental cleaning(r=0.236,P<0.001),social support(r=0.375,P<0.001),subjective support(r=0.166,P<0.01),objective support(r=0.221,P<0.001),utilization degree of support(r=0.217,P<0.001),confrontation(r=0.464,P<0.001).Multiple linear regression analysis suggested age,disease severity,dental fear,social support and confrontation were involved in the equation and the coefficients were-0.126,0.372,-0.358,0.457,0.584,which explained 57.2% total variation of self-efficacy for oral self-care.2 Results of quasi-experimental study2.1 The baseline information of two groups including clinical and demographic data,self-efficacy for oral self-care,oral self-care behaviors,dental fear,social support,coping styles and periodontal health was balanced and comparable(P>0.05).2.2 Self-efficacy for oral self-care,daily frequency of toothbrushing,daily toothbrushing duration and weekly frequency of interdental cleaning were statistically improved in intervention group at 1,3 and 6 months than those of control group(P<0.001).Probing depth and attachment loss decreased in intervention group than those of control group at 3 months,while the differences were not statistically significant(P>0.05).Probing depth and attachment loss statistically decreased in intervention group than those of control group at 6 months(P<0.01).Repeated-measures ANOVA showed that there were significant differences in self-efficacy for oral self-care,oral self-care behaviors and periodontal health between two groups(P<0.01).There were significant differences in self-efficacy for oral self-care,oral self-care behaviors and periodontal health at different time points(P<0.001).The trends of self-efficacy for oral self-care,oral self-care behaviors and periodontal health of two groups were different at different time points before and after intervention(P<0.05).1 month later,self-efficacy for oral self-care and oral self-care behaviors of two groups showed upward trends,but the increases of intervention group were greater than those of control group(P<0.001).3 months later,self-efficacy for oral self-care and oral self-care behaviors of two groups showed downward trends,but the decreases of control group were greater than those of intervention group(P<0.001).All indicators of two groups improved than those of baseline data,but intervention group improved more significantly(P<0.001).6 months later,self-efficacy for oral self-care and oral self-care behaviors of two groups showed steady downward trends,but the decreases of control group were greater than those of intervention group(P<0.05).All indicators of two groups improved than those of baseline data,but intervention group improved more significantly(P<0.001).3,6 months later,probing depth and attachment loss of intervention group showed downward trends,while control group showed upward trends.The ascend ranges of probing depth and attachment loss of intervention group were greater than those of descend ranges of control group,and the statistical differences were significant(P<0.001).Conclusions1 The self-efficacy for oral self-care of patients with CP was at the medium level.Age,disease severity,dental fear,social support and coping style were its associated factors.The CP patients with following characters: older,lighter illness,greater dental fear,lower social support,more negative coping style,tended to be lower-level self-efficacy for oral self-care.2 CP patients￠ self-efficacy for oral self-care and oral self-care behaviors were obviously affected by time factor.The six-step behavioral cognitive method could promote and maintain self-efficacy for oral self-care and oral self-care behaviors of patients with CP,improve their periodontal health.It played an active role in oral self-care behaviors management of patients with CP. |
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