Efetividade da entrevista motivacional na melhoria da saúde bucal: revisão sistemática

Cascaes, Andreia Morales; Bielemann, Renata Moraes; Clark, Valerie Lyn; Barros, Aluísio J D

doi:10.1590/S0034-8910.2014048004616

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Sumário

Revisões • Rev. Saúde Pública 48 (1) • Fev 2014 • https://doi.org/10.1590/S0034-8910.2014048004616 copiar

Efetividade da entrevista motivacional na melhoria da saúde bucal: revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

OBJETIVO

: Analisar a efetividade da entrevista motivacional na melhoria dos comportamentos em saúde bucal (higiene bucal, consumo de açúcar, uso de serviços odontológicos e uso de fluoretos) e dos desfechos clínicos (placa dentária, cárie e condições periodontais).

MÉTODOS

: Revisão sistemática da literatura com busca nas bases de dados PubMed, Web of Science, Lilacs, SciELO, PsyINFO, Cochrane e Google Scholar. Foram incluídos estudos que investigaram a entrevista motivacional como a principal abordagem para melhorar os desfechos em saúde bucal investigados.

RESULTADOS

: De 78 estudos localizados, dez foram incluídos, todos randomizados e controlados; a maioria (n = 8) avaliou múltiplos desfechos. Cinco intervenções acessaram o impacto da entrevista motivacional nos comportamentos em saúde bucal e nove em desfechos clínicos (três em cárie, seis em placa dentária, quatro em gengivite e três em bolsas periodontais). A melhor qualidade de evidência foi encontrada nos estudos que investigaram cárie, os quais também possuíam as maiores amostras populacionais. A evidência do efeito da entrevista motivacional na melhoria da saúde bucal foi conflituosa. Quatro estudos reportaram efeitos positivos, enquanto outros quatro mostraram efeito nulo. A real diferença entre os grupos não foi apresentada ou possível de recalcular em duas intervenções.

CONCLUSÕES

: Encontramos resultados inconclusivos para a maioria dos desfechos. São necessárias mais intervenções com metodologias mais apropriadas que avaliem amplamente o impacto da entrevista motivacional na saúde bucal, além de conhecer a dosagem adequada para as intervenções.

Entrevista Motivacional, utilização; Comportamentos Saudáveis; Aceitação pelo Paciente de Cuidados de Saúde; Promoção da Saúde, métodos; Saúde Bucal; Revisão

Author, year and country	Sample characteristics	Control group	Intervention group	Number of MI sessions	Duration of MI session (minutes)	Oral health clinical outcomes and measures	Oral health behaviors outcomes and measures	Follow-up (months)	Response rate (%)
Almomani et al¹ (2009) United States	N = 60 Adults between 22 and 62 years old with mental illness from a community program (program not described)	N = 30; TOHE	N = 30; MI + TE	One	15-20	1. Dental plaque^a	–	Two	93.0
Brand et al⁶ (2012) United States	N = 56 Adults with mean age of 61.9, from a university dental school graduate periodontics maintenance program	N = 27; TOHE	N = 29; MI	One	15-20	1. Dental plaque^a 2. Bleeding on probing^b 3. Periodontal probing depth (PPD 4-6 mm and > 7 mm)^b	–	Three	95.0
Freudenthal et al¹³ (2010) United States	N = 72 Parents of children between the ages of 6 to 24 months, enrolled in the Supplemental Nutritional Program for Women, Infants and Children (WIC)	N = 32; Nothing	N = 40; MI	Three	20-30	–	1. Reported frequency of child mouth cleaning or tooth-brushing (mean of a Likert scale)	One	94.4
Godard et al¹⁴ (2011) France	N = 51 Adults with mean age of 50 from the Department of Periodontology of a university hospital	N = 27; TOHE	N = 24; MI + TOHE	Two	15-20	1. Dental plaque^c	–	One	100.0
Harisson et al¹⁵ (2007) Canada	N = 240 Mothers of South Asian immigrants children between 6 to18 months of age	N = 122; TOHE	N = 118; MI+ TOHE	Seven	45	1. Dental caries^d	1. Reported number of child fluoride applications received per year (mean)	24	85.4
Harisson et al¹⁶ (2012) Canada	N = 272 Mothers of indigenous children who had recently given birth or were between 12^th and 34^th weeks of pregnancy from Cree indigenous communities	N = 141; TOHE	N = 131; MI	Seven	Not informed	Dental caries^e	Reported child visits to dentist for tooth ache (%)	24	88.6
Ismail, et al¹⁸ (2011) United States	N = 1,021 Caregivers of low-income African-American children aged 0 to 5 from a population-based sample	N = 515; TOHE	N = 506; MI+ TOHE	Two	40	1. Dental caries^f	Reported frequency of tooth-brushing per day and times a week (%) Reported tooth-brushing before bedtime (%)	24	64.0
Lopez-Jornet et al²² (2012) Spain	N = 60 Adults with mean age of 56.7, with hyposalivation and attending the Department of Oral Medicine clinic	N = 30; TOHE	N = 30; MI	Four	Not informed	Dental plaque^g Bleeding on probing^h Periodontal probing depth (PPD 4-5 mm and ≥6 mm)^h	Reported frequency of tooth-brushing per day Reported duration of tooth-brushing in minutes (%) Reported frequency of interdental cleaning (%)	Two	100.0
Jonsson et al¹⁹ (2010) Sweden	N = 113 Adults with mean age of 51.2 referred to a specialized dental clinic for periodontics	N = 56; TOHE + non- surgical periodontal treatment	N = 57; MI + non-surgical periodontal treatment	Seven	Not informed	1. Dental plaqueⁱ 2. Bleeding on probing^b 3. Periodontal probing depth^b	–	12	95.6
Stemann et al⁴⁰ (2013) Sweden	N = 44 Adults with mean age of 50.4, with moderate chronic periodontitis from a dental clinic specialized in periodontology	N = 22; TOHE	N = 22; MI	One	20-90	Dental plaque^b Bleeding on probing^b	–	Six	100.0

Studies	Reporting [0 to 10]	External validity [0 to 3]	Bias^a [0 to 6]	Confounding [0 to 6]	Power [0 to 1]	Overall score [0 to 26]
Brand et al⁶ (2012)	10	0	6	5	1	22
Harisson et al¹⁵ (2007)	10	2	6	4	0	22
Ismail et al¹⁸ (2011)	9	2	5	5	1	22
Godard et al¹⁴ (2011)	10	1	6	4	0	21
Stemman et al⁴⁰ (2012)	8	1	5	6	0	20
Jonsson et al¹⁹ (2010)	9	1	5	4	0	19
Almomani et al¹ (2009)	8	1	4	4	1	18
Lopez-Jornet et al²² (2013)	7	1	5	5	0	18
Harisson et al¹⁶ (2012)	5	0	6	5	1	17
Freudenthal et al¹³ (2010)	5	2	4	3	0	14
Mean (SD) Total (N = 10)	8.1 (1.9)	1.1 (0.7)	5.2 (0.8)	4.5 (0.8)	0.4 (0.5)	19.3 (2.6)

Outcomes	Reference	Summary findings		p-value^a
Outcomes	Reference	Control group	Intervention group	p-value^a
Oral health behaviors
Dental utilization	Harisson et al¹⁶ (2012)	B: 35.5% (N = 39) F: 15.4% (N = 17)	B: 50.0% (N = 65) F: 24.4% (N = 32)	0.085^a
Sugar consumption	–	–	–	–
Oral hygiene	Freudenthal et al¹³ (2010)	B: mean 3.2 (SD NI) F: mean 3.3 (SD NI)	B: mean 2.8 (SD NI) F: mean 3.7 (SD NI)	NI
	Ismail et al¹⁸ (2011)	Brushing 2x per day: B: 47.3% (N = 142) F: NI Brushing 7 days per week: B: 77.3% (N = 232) F: NI Brushing 7 days a week at bedtime: B: 25.3% (N = 76) F: NI	Brushing 2x per day: B: 56.1% (N = 168) F: NI Brushing 7 days per week: B: 76.2% (N = 228) F: NI Brushing 7 days a week at bedtime: B: 34.4% (N = 103) F: NI	0.700^b 0.860^b 0.830^b
	Lopez-Jornet et al²² (2012)	Brushing 2x or more per day: B: 53.3% (N = 16) F: 90.0% (N = 27) Brushing duration ≥ 2 min: B: 30.0% (N = 9) F: 70.0% (N = 21) Interproximal tooth brushing 1x day: B: 36.6% (N = 11) F: 59.9% (N = 18)	Brushing 2x or more per day: B: 86.6% (N = 26) F: 100.0% (N = 30) Brushing duration ≥ 2 min: B: 13.3% (N = 4) F: 80.0% (N = 24) Interproximal tooth brushing 1x day: B: 19.7% (N = 6) F: 56.6% (N = 17)	0.037^a 0.038^a 0.260^a
Fluoride application^c	Harisson et al¹⁵ (2007)	B: mean 0.0 F: mean 0.25 (SD 0.5)	B: mean 0.0 F: mean 3.81 (SD 1.2)	0.001^b
Oral health clinical outcomes
Dental caries	Harisson et al¹⁵ (2007)	dmfs: B: mean almost 0.0 (2 children) F: mean 7.59 (SD 14.2) dmfs plus noncavitated lesions: B: mean almost 0.0 (2 children) F: mean 7.91 (SD 14.2)	dmfs: B: mean dmfs almost 0.0 (4 children) F: mean dmfs 3.35 (SD 7.8) dmfs plus noncavitated lesions: B: mean dmfs almost 0.0 (4 children) F: mean 3.52 (SD 8.0)	0.001^b 0.01^b
	Harisson et al¹⁶ (2012)	Total incidence: B: NI F: 76.4% (N=100)	Total incidence: B: NI F: 65.4% (N = 72)	0.17^b
	Ismail et al¹⁸ (2011)	Cavitated and noncavitated caries: B: mean of 5.59 F: incidence of 6.4	Cavitated and noncavitated caries: B: 5.65 F: incidence of 6.5	0.990^b
Dental plaque	Almomani et al¹ (2009)	B: mean 3.3 (SD 0.8) F: mean 2.5 (SD 0.9)	B: mean 3.6 (SD 0.6) F: mean 1.9 (SD 0.7)	NI
	Brand et al⁶ (2012)	B: mean 2.6 (SD 0.5) F: mean 2.3 (SD 0.7)	B: mean 2.4 (SD 0.6) F: mean 2.1 (SD 2.1)	0.390^b
	Godard et al¹⁴ (2011)	B: mean 58.0% of sites (SD 12) F: mean 54.0% of sites (SD 12)	B: mean 55.0% of sites (SD 15) F: mean 34.0% of sites (SD 20)	0.01^b
Dental plaque	Lopez-Jornet et al²² (2012)	B: mean 0.4 (SD 0.2) F: mean 0.2 (SD 0.1)	B: mean 0.7 (SD 0.1) F: mean 0.3 (SD 0.2)	NI
	Jonsson et al¹⁹ (2010)	B: mean 57.0% of sites (SD 17) F: mean 28.0% of sites (SD 13)	B: mean 59.0% of sites (SD 18) F: mean 14.0% of sites (SD 12)	< 0.001^b
	Stemann et al⁴⁰ (2013)	B: mean 43.1% of sites (SD 19.2) F: mean 18.6% of sites (SD 13.2)	B: mean 50.2% of sites (SD 21.5) F: mean 25.2% of sites (SD 15.4)	> 0.05^b
Bleeding on probing	Brand et al⁶ (2012)	B: mean 55.0% of sites (SD 18) F: mean 36.0% of sites (SD 20)	B: mean 50.0% of sites (SD 18) F: mean 33.0% of sites (SD 15)	0.263^b
	Lopez-Jornet et al²² (2012)	B: mean 22.4% of sites (SD 34.7) F: mean 6.1% of sites (SD 13.4)	B: mean 29.7% of sites (SD 34.9) F: mean 18.4% of sites (SD 25.8)	NI
	Jonsson et al¹⁹ (2010)	B: mean 75.0% of sites (SD 18) F: mean 29.0% of sites (SD 14)	B: mean 70.0% of sites (SD 20) F: mean 19.0% of sites(SD 13)	< 0.001^b
	Stemann et al⁴⁰ (2013)	B: mean 33.0% of sites (SD 12.4) F: mean 18.4% of sites (SD 14.1)	B: mean 36.6% of sites (SD 17.1) F: mean 18.8% of sites (SD 10.9)	> 0.05^b
Periodontal probing depth	Brand et al⁶ (2012)	PPD 4-6 mm: B: mean 23.3% of sites (SD 23.1) F: mean 16.1% of sites (SD 21.4) PPD > 7 mm: B: mean 1.8% of sites (SD 6.9) F: mean 1.4% of sites (SD 5.7)	PPD 4-6 mm: B: mean 23.8% of sites (SD 15.8) F: mean 20.3% of sites (SD 15.0) PPD > 7 mm: B: mean 2.0% of sites (SD 4.1) F: mean 1.7% of sites (SD 3.9)	0.777^b 0.844^b
	Jonsson et al¹⁹ (2010)	PPD 4-5 mm: B: mean 33.0% of sites (SD 14.0) F: mean 12.2% of sites (SD 10.8) PPD ≥ 6 mm: B: mean 9.3% of sites (SD 11.0) F: mean 1.5% of sites (SD 3.2)	PPD 4-5 mm: B: mean 31.0% of sites (SD 14.3) F: mean 10.4% of sites (SD 7.9) PPD ≥ 6 mm: B: mean 9.2% of sites (SD 9.3) F: mean 1.6% of sites (SD 2.9)	> 0.05^b > 0.05^b
	Lopez-Jornet et al²² (2012)	PPD 4-5 mm: B: mean 1.7 (SD 7.5) F: mean 1.5 (SD 7.1) PPD ≥ 6 mm: B: mean 0.0 F: mean 0.0	PPD 4-5 mm: B: mean 3.5 (SD 9.5) F: mean 2.6 (SD 7.1) PPD ≥ 6 mm: B: mean 0.8 (SD 4.5) F: mean 1.0 (SD 5.6)	NI NI

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[1] Correspondence
: Andreia Morales Cascaes. Faculdade de Odontologia. Departamento de Odontologia Social e Preventiva. Universidade Federal de Pelotas. Rua Gonçalves Chaves, 457 96015-560 Pelotas, RS, Brasil. E-mail: andreiacascaes@hotmail.com