Motivational Interviewing and Subgingival Instrumentation Outcomes in Periodontitis

Effect of Motivational Interviewing on the Outcomes of Subgingival Instrumentation in Patients With Periodontitis

Motivational Interviewing (MI) represents a patient centered counselling approach designed to facilitate behaviour change by guiding patients through the exploration and resolution of ambivalence toward positive health actions. Adapting OARS microskills (open ended questions fostering dialogue, affirmations building self-efficacy, reflective listening mirroring emotions, summarization making commitments) intertwined with the RULE framework (resisting the righting reflex, understanding personal motivations, empathic listening, empowering autonomy) helps cultivate patient's intrinsic motivation for sustained oral hygiene adherence. It effectively resolves ambivalence toward plaque control behaviours essential for periodontitis management. Grounded in MI's core spirit of equal partnership, evocation of inner values, acceptance and compassionate support, this approach fosters long term adherence to treatment. This is in contrast to oral hygiene instructions that typically employ a directive advice giving method, where clinicians provide patients with prescriptive guidance on maintaining optimal oral hygiene practices. Periodontitis staging, as defined by the 2017 World Workshop classification, delineates disease severity (Stages I-III), complexity of management, and extent of involvement, while grading (A-C) offers a prognostic indicator of the risk for future progression based on factors such as rate of advancement and responsiveness to therapy. Integrating motivational interviewing (MI) with periodontitis staging and grading creates a structured framework from diagnosis to patient centered action, enhancing adherence to stage specific treatment plans. This study seeks to investigate the influence of MI on Clinical outcomes, Patient motivation, Patient related outcomes and Patient's Self-efficacy in oral hygiene following subgingival instrumentation among patients stratified by periodontitis stage. By doing so, it aims to explore the potential of behavior change interventions to yield not only clinical improvements but also broader health benefits in the management of periodontitis.

Periodontitis is a chronic multifactorial inflammatory disease associated with dysbiotic plaque biofilms and characterized by progressive destruction of the tooth-supporting apparatus. Periodontal disease can cause physical discomfort and contribute to functional limitations, which in turn affect psychological well-being and self-esteem. Periodontitis poses a significant public health challenge due to its high prevalence and potential to cause tooth loss, disability, and impairments in chewing function and aesthetics. Sustaining periodontal health demands patient led interventions, including self-care practices and attention to lifestyle factors. Interventions based on health behaviour change models to target improvements in patient self-efficacy, enhances treatment adherence and increases the frequency of brushing and flossing. Behavioural determinants related to impaired periodontal health includes inadequate plaque control measures, smoking habits, sedentary living, excess alcohol, stress and detrimental eating behaviours. Although subject to modification, these lifestyle factors still generate substantial disease prevalence and economic demands globally.Motivational interviewing (MI) for periodontology is recommended by 1st European workshop on periodontal education, to enhance patient's intrinsic motivation. MI has been found to be effective in treating a broad range of health-related lifestyle problems, such as substance abuse, obesity, diabetes management, tobacco cessation, and poor adherence to medication regimens.

MI was first described in 1983, by Psychologist William R Miller. It was initially developed as a short term approach for problem drinking. Motivational Interviewing is a person centered counselling approach for eliciting behaviour change by helping clients to explore and resolve ambivalence. MI works by activating patients' own motivation for change and adherence to treatment.

The effective implementation of Motivational Interviewing (MI) depends on the practitioner's expertise in essential micro skills (OARS) i.e, Open-ended questions which promotes conversation between the clinician and patient encouraging patient to speak and the clinician listens; Affirmations that recognize the challenges in behaviour change while promoting patient self-efficacy by validation of their strengths; Reflective listening accounts for understanding patient's expressed thoughts and emotions and Summarization that illustrates the clinician's active listening to the patient and offers a brief outline of the discussion, while also aiding in addressing ambivalence. These OARS skills are used within "RULE" framework i.e- Resisting the righting reflex by suppressing the urge to correct or direct the patients as arguing for change evokes counter arguments from patients. Understanding patient's own motivation by exploring patients' perceptions about their current situations and their own reasons for change rather than clinician imposing their own. Listening to patient with empathy over informing to grasp the patient's perspective and help resolve ambivalence about change. Empowering the patient to support their autonomy and self-efficacy enabling them to envision and pursue solutions.

Given the importance of Patient's education and awareness about their periodontal health, this study seeks to investigate the impact of MI on the outcomes of subgingival instrumentation in patients with periodontitis. It also evaluates MI's effects on patient-reported outcomes, motivation, and self-efficacy. By addressing these gaps, the study aims to offer evidence based insights for enhancing periodontal therapy.

Inclusion Criteria:

• Systemically healthy Patients with age group 30-50 years diagnosed with (Stage I-III) periodontitis.

Exclusion Criteria:

• Systemic diseases that may affect periodontal disease progression or outcome of treatment
• Patients on long term antibiotics
• Pregnant and lactating women
• Female patients with history of menopause
• Current orthodontic treatment or planning to undergo orthodontic treatment during study