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Patient Educ Couns. 2009 Feb;74(2):191-6. doi: 10.1016/j.pec.2008.08.014. Epub 2008 Oct 1.

Systematic cognitive behavioral approach for oral hygiene instruction: a short-term study.

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  • 1Department of Periodontology and Endodontology, Division of Oral Health Science, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan.



Determine whether a six-step behavioral cognitive method is more effective than traditional oral hygiene instruction.


Thirty-eight patients with chronic periodontitis were randomly assigned to two groups. The control group was given traditional oral hygiene instruction for 20 min. The intervention group received counseling by Farquhar's six-step method for 10 min after traditional oral hygiene instruction. In both groups, oral hygiene instruction was given once a week, and performed three times in total for 3 weeks. Clinical characteristics, deposition of dental plaque, frequency and duration of brushing, frequency of interdental cleaning and scores based on scale of "self-efficacy for brushing of the teeth" were compared in both groups.


There were no differences between the two groups in clinical, demographic, behavioral and self-efficacy characteristics at the baseline examination. However after the third visit, the intervention group had a significantly higher self-efficacy, lower plaque index, longer brushing duration and higher frequency of inter-dental cleaning than those of the control group. Multiple regression analysis showed significant association of toothbrushing duration with self-efficacy for brushing of the teeth (p<0.001).


The six-step method might be more effective for enhancing self-efficacy and behavioral change of oral hygiene than traditional oral hygiene instruction alone.


Dentists and dental hygienists can use the six-step method for effective oral hygiene instruction.

[PubMed - indexed for MEDLINE]
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