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achieve adequate self-performed oral hygiene practices, but also the control of local and systemic modifiable risk factors that significantly influence this disease. Although this first step of therapy is insuffi - cient to treat a periodontitis patient, it represents the foundation for optimal treatment response and long-term stable outcomes. This first step includes not only the educational and preventive interventions aimed to control gingival inflammation but also thev - professional mechanical removal of the supragingival plaque and cal - culus, together with the elimination local retentive factors.
reduce plaque and gingivitis. Re-enforcement of OHI may provide additional benefits. • Manual or power tooth brushing are recommended as a primary means of reducing plaque and gingivitis. The benefits of tooth brushing out-weigh any potential risks. • When gingival inflammation is present, inter-dental cleaning, preferably with interdental brushes (IDBs) should be profession - ally taught to patients. Clinicians may suggest other inter-den - tal cleaning devices/methods when the use of IDBs is not appropriate.
5.1 | Intervention: Supragingival dental biofilm control (by the patient)
R.1.2 | Are additional strategies in motivation useful?
Expert consensus-based recommendation (1.2) We recommend emphasizing the importance of oral hygiene and engaging the periodontitis patient in behavioural change for oral hygiene improvement. Supporting literature Carra et al. (2020) Grade of recommendation Grade A—↑↑ Strength of consensus Strong consensus (1.3% of the group abstained due to potential CoI)
R.1.1 | What are the adequate oral hygiene practices of periodontitis patients in the different steps of periodontitis therapy? Expert consensus-based recommendation (1.1) We recommend that the same guidance on oral hygiene practices to control gingival inflammation is enforced throughout all the steps of periodontal therapy including supportive periodontal care. Supporting literature Van der Weijden and Slot (2015) Grade of recommendation Grade A—↑↑ Strength of consensus Strong consensus [3.8% of the group abstained due to potential conflict of interest (CoI)]
Background
Intervention Oral hygiene instructions (OHI) and patient motivation in oral hygiene practices should be an integral part of the patient man - agement during all stages of periodontal treatment (Tonetti et al., 2015). Different behavioural interventions, as well as com - munication and educational methods, have been proposed to im - prove and maintain the patient's plaque control over time (Sanz & Meyle, 2010). See additional information in the next section on “Methods of motivation.” R.1.3 | Are psychological methods for motivation effective to improve the patient's compliance in oral hygiene practices? Evidence-based statement (1.3) To improve patient's behaviour towards compliance with oral hygiene practices, psychological methods such as motivational interviewing or cognitive behavioural therapy have not shown a significant impact. Supporting literature Carra et al. (2020) Quality of evidence Five randomized clinical trials (RCTs) (1716 subjects) with duration ≥6 months in untreated periodontitis patients [(4 RCTs with high and 1 RCT with low risk of bias (RoB)] Grade of recommendation Statement—unclear, additional research needed Strength of consensus Strong consensus (1.3% of the group abstained due to potential CoI)
Background
Intervention Supragingival dental biofilm control can be achieved by mechanical and chemical means. Mechanical plaque control is mainly performed by tooth brushing, either with manual or powered toothbrushes or with supplemental interdental cleaning using dental floss, interden - tal brushes, oral irrigators, wood sticks, etc. As adjuncts to mechani - cal plaque control, antiseptic agents, delivered in different formats, such as dentifrices and mouth rinses have been recommended. Furthermore, other agents aimed to reduce gingival inflammation have also been used adjunctively to mechanical biofilm control, such as probiotics, anti-inflammatory agents and antioxidant micronutrients. Available evidence Even though oral hygiene interventions and other preventive meas - urements for gingivitis control were not specifically addressed in the systematic reviews prepared for this Workshop to Develop Guidelines for the treatment of periodontitis, evidence can be drawn from the XI European Workshop in Periodontology (2014) (Chapple et al., 2015) and the systematic review on oral hygiene practices for the prevention and treatment of gingivitis (Van der Weijden & Slot, 2015). This available evidence supports the following:
• Professional oral hygiene instructions (OHI) should be provided to
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