11th July 2018 0
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A preliminary study has shown how useful it is to classify orthodontics patients into different stages of change in order to focus on improving the oral hygiene habits of those who are considered to be at the early stages of this classification. 

Rigau-Gay M et al. Assessment of readiness to change for oral hygiene behaviours in adolescents wearing fixed appliances: a preliminary study. Poster presented at EOS 2017. Montreux, Switzerland. 


Motivation is one of the most important aspects for improving oral hygiene among orthodontic patients. There are different models for studying and improving patient motivation, among which, Prochanska and DiClemente’s transtheoretical model of change of 1984* is one of the most well-known. 


The main objective was to evaluate the association between the different stages of the transtheoretical model of change and the level of oral hygiene in orthodontic patients. It was hypothesised that the lowest plaque index scores (≤ 1) would be more predominant in patients who were classified into the more advanced stages of change. 


All of the adolescents who visited the Orthodontics Department at the University of Barcelona School of Dentistry between July 2016 and May 2017 and who used fixed appliances on both arches during the first six months of treatment were included in the study. Participants received 15 minutes of conventional oral hygiene instruction and, at the subsequent dental appointment, the following were assessed: 
• Löe & Silness plaque and gingival indices. 
• The stage of change derived from the Prochaska and DiClemente transtheoretical model for oral hygiene behaviour. For the evaluation, participants were asked to choose one of the following five options: 
> Pre-contemplation: I don’t think I need to change my oral hygiene.
> Contemplation: I don’t clean my teeth very well, but I’d like to improve.
> Preparation: I have decided to brush my teeth better or longer.
> Action: In the last six months, I have begun to improve my oral hygiene.
> Maintenance: I always brush my teeth properly and I’ve been doing so for over six months. 
The participants in the study were characterised by means of descriptive statistics. The ANOVA and Student's t-test were used to assess the association between the stages of change of the transtheoretical model and the degree of oral hygiene. 


A total of 89 orthodontic patients aged between 13 and 15 years were included in the study. The highest subject classification was 43%, pertaining to the third stage of change—preparation—and it was found that none of the subjects in the study identified with the pre-contemplation stage. 
The participants showed an average plaque index of 1.02 ± 0.46 and an average gingival index of 0.72 ± 0.38. Subjects classified as part of the most advanced stages of change showed lower plaque and gingival indices. Likewise, statistically significant differences were found between the subjects classified into the action and maintenance stages, in comparison with those in the contemplation and preparation stages. 


Participants who were at more advanced stages of change had better oral hygiene compared to those who were at the stages of contemplation and preparation. It is useful to classify orthodontic patients into different stages of change in order to focus on improving the oral hygiene habits of those subjects who are considered to be at the early stages of this classification. 
* By asking the question “What is it that makes people change when they try to modify an undesirable or problematic situation?”, James Prochaska and Carlo Diclemente created a model to try to understand what, how, when and why people change. Through research focused on studying the phenomenon of intentional change, they developed their transtheoretical model, made up of different stages, processes and levels. 



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