Compliance with Supportive Periodontal Therapy. Part II: Risk of Non-Compliance in a 10-Year Period


Arthur B. NOVAES Jr.
Arthur B. NOVAES

Discipline of Periodontics, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil


Correspondence: Dr. Arthur B. Novaes Jr., Departamento de Cirurgia e Periodontia, Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, Av. do Café s/n, 14040-904 Ribeirão Preto, SP, Brasil. e-mail: novaesjr@forp.usp.br


Braz Dent J (2001) 12(1): 47-50 ISSN 0103-6440

INTRODUCTION | MATERIAL AND METHODS | RESULTS | DISCUSSION | RESUMO | REFERENCES


Supportive periodontal therapy (SPT) is needed for the success of periodontal therapy; however, patient compliance is poor. Part II of this study analyzes compliance during a 10-year period in an attempt to identify the profile of patients with a higher risk of becoming non-compliant. Data from the records of 874 patients from a private periodontal clinic who had completed active periodontal treatment up to 10 years before and had begun supportive periodontal therapy were analyzed for risk of non-compliance and compliance. The factors evaluated were gender (326 males and 548 females), type of therapy (surgical or non-surgical) and age (£30 years, 31 to 40, 41 to 50, and ³51 years old) and the association amongst them. In the period studied, compliance with SPT was 45.8%. Forty-three percent of males and 47% of females discontinued SPT. In the surgical group 43.9% were non-compliant and in the non-surgical group 53.2% were non-compliant. Fifty-nine percent of the patients £30 years of age were also non-compliant. Female patients £30 years and ³51 years of age that underwent non-surgical therapy were found to be of higher risk for non-compliance in the 10-year period studied.

Key Words: compliance, supportive periodontal therapy, risk groups, periodontal diseases/therapy.


INTRODUCTION

Supportive periodontal therapy (SPT) is directly related to the medium and long-term success of active periodontal therapy (1-3) but patient collaboration is poor (4-7). In recent publications, Novaes Jr. et al. (8,9) not only confirmed previous studies with data from a multi-practice study involving private practices in 4 countries, but also emphasized the importance of non-compliance when alterations in bleeding index are associated with compliance regularity by patients.

It is important to establish a profile of patients with greater risk of non-compliance to educate and motivate these patients during active therapy. In Part I of this study (10) data of patients who had concluded active therapy up to 5 years earlier but abandoned SPT were used. In this part II of the study we analyzed this group up to 10 years of follow up, also taking into account gender, age groups and type of therapy.


MATERIAL AND METHODS

Data from 874 patients, from a private periodon tal practice, who had completed the proposed active periodontal treatment 10 years before, including surgical procedures, and had initiated SPT were analyzed for compliance with SPT. Patient compliance was evaluated in relation to gender, type of therapy (surgical or non-surgical), and age (£30 years, 31-40, 41 to 50, and ³51 years old).

Cases were considered to be surgical if they received basic periodontal therapy followed by surgical interventions in at least 3 areas of the mouth. Patients treated with intensive scaling and root planing or isolated surgical procedures for esthetics, prosthetics and emergencies were considered non-surgical.

Recall visits were scheduled with intervals of 3-4 months. The patients who initiated SPT and attended the recommended visits during a short period but abandoned the program during the next 10 years or returned sporadically were considered non-compliant. Non-compliant patients who returned were examined as new patients.

The profiles of the non-compliant patients were analyzed in relation to gender, type of therapy, age and the association of the three factors to determine if any of these factors could be related to non-compliance.

Statistical analysis was performed using the 95% confidence interval (CI) for the incidence of non-compliance and ratios between incidences or risks of two categories (i.e. males and females) of one variable (i.e. gender) known as relative risk.


RESULTS

Of the 874 initially compliant patients (326 males and 548 females), 373 patients (120 males and 253 females) had ended active treatment at least 10 years before and were considered for this study. At the end of the 10 year period, 171 patients (52 males and 119 females, 43.3% and 47.0%, respectively) were non-compliant. Statistical analysis showed a 95% CI of 1.09 (0.85; 1.35) which is non-significant and shows that gender was not a factor for non-compliance. Of the 373 patients, 294 had undergone surgical treatment and 79 non-surgical treatment. After 10 years, 129 (43.9%) of the surgical patients and 42 (53.2%) of the non-surgical group were non-compliant. Using the surgical group as the basis for comparison, statistical analysis showed a 95% CI of 1.21 (0.95; 1.55), which is non-significant and indicates that type of treatment is also not a factor for non-compliance.

The 372 patients (age of one of the participants was not available) were divided into age groups: <30 years = 122 patients, 31-40 years = 69 patients, 41-50 years = 136 patients, and >51 years = 45 patients. Results of statistical analysis, using the <30 years of age group as the basis for comparison, indicated that age is a factor for this 10-year period. The 31 to 40 (33.3% = 23 patients) and the 41 to 50 (41.9% = 57 patients) age groups were significantly less non-compliant than the <30 years of age group (59.0% = 72 patients), whereas the >51 years of age group (42.2% = 19 patients) was less non-compliant but the difference was not statistically different (Figure 1).

The data with the percentage of non-compliance considering gender, type of therapy and age groups (Table 1) show a tendency to larger percentages in the non-surgical female category: 60.8% of the total, 69.2% in the £30 year group, 57.1% in the 31-40 year group, 42.8% in the 41-50 year group, and 75.0% in the ³51 year group. The incidence of non-compliance evaluating the association of 3 factors, gender, type of therapy and age groups is shown in Figure 2. Females £30 years of age of the non-surgical group were significantly more non-compliant (69.2%) as were those patients who were ³51 years of age (75.0%).


DISCUSSION

The results of these 10 years of follow up compared to the previous study of 5 years of follow up (10) identified some changes in the patient profile risk factor of non-compliance. It was confirmed that gender (43.3% vs 47.0%) and type of therapy (43.9% vs 53.2%) were not statistically significant factors. However, age was significant for the £ 30 years of age group (59.0% vs 33.3, 41.9 and 42.2% in the other groups). Data referring to the 3 factors were associated for comparison if these
factors, considered non-significant individually, could suggest further information regarding risk for non-compliance to indicate a profile of patient risk factor (Table 1).

Table 1 and Figure 2 show the incidence of non-compliance by gender, age and type of therapy. It is notable that there is a significantly greater incidence of non-compliance of the female patient with non-surgical treatment compared to the other groups (surgical female, surgical male and non-surgical male). The incidence of non-compliance is slightly higher (69.2%) in the £30 years of age non-surgical female group compared to 53.9, 60.0 and 66.6% for the other groups. The difference is greater in the 31-40 year non-surgical group (57.1% compared to 27.0, 40.0 and 35.0%). The incidence falls notably for the 41-50 year non-surgical female group being similar to the other groups (42.8% compared to 42.8, 38.5 and 41.0%). The incidence for this non-surgical ³51 years of age female group increases notably while the other groups remain either stable or decrease (75.0% compared to 36.8, 20.0, and 47.1%).

In the study of the first 5 years of SPT (10), we suggested that the profile of the patient considered at risk for non-compliance was young (£40 years old), male and who had received non-surgical treatment. This 10-year follow-up study confirms the information that the factors considered separately are not important but that the association of these factors leads to a tendency to establish a profile for the patient risk factor for non-compliance. It was confirmed that this patient is young; however, in this study the patients were even younger (£30 years of age), who had received non-surgical treatment. The gender of the greatest risk factor changed from male at 5 years of follow-up to female at 10 years of follow-up.

In conclusion, clinicians should consider the profile defining the patient group at higher risk for non-compliance: female patients, with non-surgical treatment, with less than 30 years of age or 51 or more years of age. As the time of follow-up increased from 5 to 10 years, the young non-surgical patients remained at greater risk for non-compliance while the male group was replaced by the female group which also presented a high incidence of non-compliance with SPT in the 51 plus age group.


RESUMO

Novaes Jr AB, Novaes AB. Cooperação com terapia periodontal de suporte. Parte II: Risco de não-cooperação no período de 10 anos. Braz Dent J 2001;12(1):47-50.

Terapia periodontal de suporte (TPS) é necessária para o sucesso do tratamento periodontal: no entanto, o paciente coopera muito pouco. A Parte II deste estudo analisa a cooperação durante o período de 10 anos na tentativa de identificar o perfil dos pacientes com maior risco de tornar-se um não-cooperador. Dados de fichas de 874 pacientes de clínica periodontal particular, que haviam concluído o tratamento periodontal ativo mais de 10 anos antes e que haviam iniciado a terapia periodontal de suporte, foram analisados para anotar quantos ofereceram risco de serem não-cooperadores ou haviam cooperado. Os fatores avaliados foram sexo (326 masculinos e 548 femininos), tipo de terapia (cirúrgica ou não-cirúrgica) e faixa etária (até 30 anos, 31 a 40, 41 a 50, e acima de 51 anos de idade) e a associação dos diversos fatores. No geral a cooperação com a TPS foi de 45,8%. Em sexo, 43% dos homens e 47% entre as mulheres interromperam a TPS. No grupo ciúrgico, 43,9% e no não-cirúrgico 53,2% foram não-cooperadores. Na idade, 59% dos pacientes jovens (menos de 30 anos) foram não-cooperadores. Associando-se os vários grupos observou-se que o perfil do paciente com maior risco de não-cooperação no período de 10 anos foi: feminino com terapia não-cirúrgica e com idade abaixo de 30 anos ou acima de 51 anos.

Unitermos: cooperação de paciente, terapia periodontal de suporte, grupos de risco, terapia periodontal.


REFERENCES

1. Lindhe J, Nyman S. The effect of plaque control and surgical pocket elimination on the establishment and maintenance of periodontal health. A longitudinal study of periodontal therapy in cases of advanced disease. J Clin Periodontol 1975;2:67-79.

2. Shick RA. Maintenance phase of periodontal therapy. J Periodontol 1981;52:576-583.

3. Axelsson P, Lindhe J. The significance of maintenance care in the treatment of periodontal diseases. J Clin Periodontol 1981;8:281-294.

4. Wilson Jr TG, Glover ME, Schoen J, Jacobs T. Compliance with maintenance therapy in a private periodontal practice. J Periodontol 1984;55:468-473.

5. Mendoza AR, Newcomb GM, Nixon KC. Compliance with supportive periodontal therapy. J Periodontol 1991;62:731-736.

6. Checci L, Pellicini GA, Gatto MPA, Kelescian L. Patient compliance with maintenance therapy in an Italian periodontal practice. J Clin Periodontol 1994;21:309-312.

7. Novaes AB, Novaes Jr AB, Moraes N, Maia Campos G, Grisi MFM. Compliance with supportive periodontal therapy. J Periodontol 1996;67:213-216.

8. Novaes Jr AB, Lima FR, Novaes AB. Compliance with supportive periodontal therapy and its relation to the bleeding index. J Periodontol 1996;67:976-980.

9. Novaes Jr AB, Novaes AB, Bustamanti A, Villaviccencio JJB, Muller E, Pulido JE. Compliance with supportive periodontal therapy in South America. A retrospective multi-practice study. J Periodontol 1999;70:301-306.

10. Novaes Jr AB, Novaes AB. Compliance with supportive periodontal therapy. Part I. Risk of non-compliance in a 5-year period. J Periodontol 1999;70:679-682.


Accepted May 23, 2000
Braz Dent J 12(1) 2001


BACK TO CONTENTS