Evidence-based dental hygenist practice in the non-surgical therapy of patients with periodontitis: outcomes of therapy and factors associated with the quality of care

Sammanfattning: The overall aim was to investigate clinical and patient-reported outcomes of non-surgical treatment approaches to periodontitis and factors associated with the quality of care provided by dental hygienists (DHs) in general practice. The goal of non-surgical therapy of periodontitis is to establish infection con-trol. In Sweden, DHs perform >90% of such non-surgical interventions, but little is known about the effectiveness of the therapy and factors associated with the quality of care. Study I was a questionnaire study including 291 DHs, with the focus on professional competencies and behavioral interventions in periodontal therapy, perceived work-related support and work satisfaction. Perceived competencies in the treatment of periodontitis patients were related to the practice of behav-ioral interventions as a part of the therapy. A supportive work environment was important for DHs work satisfaction. Studies II & III were based on a randomized clinical field study focusing on the effectiveness of two non-surgical treatment approaches to periodontitis; a guided approach to periodontal infection control (GPIC) versus conventional non-surgical therapy (CNST). The study involved 689 patients and 95 DHs. Study II included 494 patients with questionnaire and clinical data at baseline and 6 months. No substantial differ-ences were found between the treatment approaches regarding patient-reported experiences or outcomes of therapy. The patient’s experience of being involved in the therapy decisions was a significant predictor for positive patient-reported outcomes as well as clinical outcomes in terms of patients’ adherence to treatment regimens, i.e. self-performed infection control. Study III included 615 patients who had com-pleted the initial treatment phase. Both approaches resulted in significant clinical improvements, with no differences between treatment groups. Smoking and age affected the outcome in terms of pocket closure (PPD≤4 mm) at 6 months. The GPIC was significantly more time-effective than CNST. Study IV was a qualitative interview study including 18 DHs who had participated in the preceding clinical study. The findings emphasized the DHs’ ambivalence between theory and practice in the treatment of patients with periodontitis. DHs were aware of what to do to offer adequate care, but this did not coincide with how they usually worked. Established routines and the culture in the clinic, predetermined beliefs about patients’ lack of motivation and ability to cooperate, lack of time and reflection, financial demands on the care offered and lack of interest/support from co-working dentists were considered as barriers in the periodontal care. In conclusion, the results bring knowledge about the clinical effectiveness of non-surgical treatment approaches performed by DHs in a real-world setting. In addition, the findings provide knowledge about patients’ experiences and therapy benefits. The results also elucidate facilitators and barriers influencing the quality of care offered to patients with periodontitis and emphasize the need for improvement on both a professional and organizational level. The focus should be on the competencies of dental profes-sionals to provide therapy based on the best available knowledge and on creating an organizational envi-ronment that supports good quality of care.