Motivational interviewing for preventing oral morbidities in adults: Systematic review and meta-analysis.

OBJECTIVE: This systematic review with meta-analysis was performed to assess whether motivational interviewing (MI) effectively prevents oral morbidities in adults. METHODS: Studies considered were randomized controlled trials, cluster-randomized controlled trials and community-based randomized trials assessing interventions based on MI or indicating that a counselling technique based on the principles developed by Miller and Rollnick was used. Controls were any type of oral health education or negative controls. Participants were 18-60 years old. The main outcome was any oral morbidity. From 602 studies identified in MEDLINE, Scopus, Web of Science and LILACS databases, seven studies were included in the synthesis. RESULTS: Studies included only evaluated periodontal outcomes, no studies were found for other oral morbidities. Patients' mean age was 43.7 years, and the follow-up time after MI or MI-based intervention varied between 1 month and 1 year. The total study population was 272 people with moderate-to-severe periodontitis; other groups analysed were pregnant women (n = 112) and patients with mental disorders and alcohol problems (n = 60). Meta-analysis for the plaque index (four studies, n = 267), bleeding on probing (two studies, n = 177) and gingival index (two studies, n = 166) were carried out. The summary effects for the random-effects model were estimated respectively as -3.59 percentage points (CI: [-11.44; 4.25] for plaque index, -6.41 percentage points (CI: [-12.18, -0.65]) for bleeding on probing and -0.70 (CI: [-1.87; 0.48]) for gingival index, marginally favouring the MI group. The reduced number of studies, the non-disclosure of some aspects of the data and the heterogeneity among them undermine the precision of the estimates. CONCLUSION: The current evidence available is limited to periodontal outcomes, and it is not possible to determine whether MI effectively prevents oral morbidities in adults.

Self-reported oral morbidities in long-term oropharyngeal cancer survivors: A cross-sectional survey of 906 survivors.

OBJECTIVE: The purpose of this study is to estimate the prevalence and severity of late oral morbidities in disease-free oropharyngeal cancer (OPC) survivors using patient reported outcomes. MATERIALS AND METHODS: Cross-sectional survivorship survey of patients who completed definitive treatment for oropharyngeal carcinoma  > 12-months previously without evidence of recurrence, second primary malignancy, or distant metastasis after index cancer. Using MD Anderson Symptom Inventory- Head and Neck Module (MDASI-HN), scores for 4 self-reported oral morbidities: dry mouth, mucus secretions, mouth and throat sores, and teeth and gum issues were evaluated. RESULTS: Among 906 survey respondents (57% response rate), (median survival time: 7 years), "dry mouth" and "problems with my mucus" were reported moderate/severe (MDASI-HN item score ≥5) in 39% and 22% of respondents, while 14% reported moderate/severe "problems with teeth and gums". Smoking at the time of survey was significantly associated with the severity of oral symptoms including "mucus" (p = 0.03), "dry mouth" (p = 0.02), "problems with my teeth and gums" (p = 0.001). All the oral morbidities symptom items significantly, positively correlated with the mean interference scores reflecting adverse impact to quality of life (QOL): "mucus" (r = 0.445, p < 0.001), "problems with teeth" (r = 0.446, p < 0.001), "mouth sores" (r = 0.321, p < 0.001) and "dry mouth" (r = 0.459, p < 0.001). CONCLUSION: This study showed that 45.5% reported at least one late oral morbidity at moderate/severe level which negatively correlated overall function, even years after treatment.

Dysphagia and Oral Morbidities in Chemoradiation-Treated Head and Neck Cancer Patients.

This study prospectively evaluated relationships between oral morbidities and swallowing ability in head/neck cancer patients following chemoradiation therapy (CRT) and at 3 months following CRT. Thirty patients with confirmed head/neck cancer undergoing chemoradiation were assessed with a battery of swallowing measures and measures of oral morbidities related to chemoradiation (xerostomia, mucositis, pain, taste/smell, oral moisture). All measures were completed at baseline (within the first week of CRT), at 6 weeks (end of treatment), and at 3 months following chemoradiation. Descriptive and univariate statistics were used to depict change over time in swallowing and each oral morbidity. Correlation analyses evaluated relationships between swallowing function and oral morbidities at each time point. Most measures demonstrated significant negative change at 6 weeks with incomplete recovery at 3 months. At 6 weeks, mucositis ratings, xerostomia, and retronasal smell intensity demonstrated significant inverse relationships with swallowing function. In addition, oral moisture levels demonstrated significant positive relationships with swallowing function. At 3 months, mucositis ratings maintained a significant, inverse relationship with swallow function. Taste and both orthonasal and retronasal smell intensity ratings demonstrated inverse relationships with measures of swallow function. Swallow functions and oral morbidities deteriorate significantly following CRT with incomplete recovery at 3 months post treatment. Furthermore, different patterns of relationships between swallow function measures and oral morbidities were obtained at the 6-week versus the 3-month assessment point suggesting that different mechanisms may contribute to the development versus the maintenance of dysphagia over the trajectory of treatment in these patients.