Effectiveness of Real‐Time Volatile Sulphur Compounds Biofeedback as a Motivational Tool in Non‐Surgical Periodontal Therapy: A Quasi‐Experimental Parallel‐Group Trial

BACKGROUND: To determine the superior efficacy of real-time volatile sulphur compounds (VSCs) biofeedback via the Oral Chroma as a motivational tool over conventional oral hygiene instruction (OHI) for improving oral hygiene behaviours and clinical parameters in periodontitis patients. METHODS: This quasi-experimental, parallel-group trial enrolled 60 participants (age ≥ 30 years) with periodontitis in accordance with the 2018 AAP/EFP classification. Subjects were allocated to receive either standard-of-care OHI alone or supplemental VSCs biofeedback. VSCs levels were evaluated exclusively in the test group at baseline (charting) and at the 2nd oral hygiene check-up visit. Non-surgical periodontal therapy was administered to both groups. Clinical periodontal health outcomes, including bleeding on probing (BOP) and plaque index (PI), were assessed at baseline, the 1st and the 2nd oral hygiene check-up visits. RESULTS: The final analysis included 52 participants (Test: n = 28, Control: n = 24). Most participants presented with comparable disease severity (p = 0.623). The prevalence of Stage III and Stage IV periodontitis was 87.5% (n = 21) in the control and 82.1% (n = 23) in the test group. Although the test group exhibited significantly higher baseline BOP compared to the control (68.3% vs. 48.4%; p = 0.025), both groups demonstrated significant longitudinal improvements in PI and BOP (p < 0.001). Notably, by the 2nd oral hygiene check-up visit, inter-group BOP differences were not significant, with both groups reaching comparable levels (test: 22.6% vs. control: 22.5%; p = 0.295). Given the initial 20 percentage-point difference, the greater absolute reduction in the test group may have been contributed by the intervention's effect alongside regression to the mean. Though both groups showed significant longitudinal reductions, no significant inter-group differences in PI were observed at any time point (p > 0.05). Furthermore, the test group displayed a substantial reduction in VSCs levels at the 2nd oral hygiene check-up visit compared to the charting visit (p < 0.001). CONCLUSIONS: Real-time VSCs biofeedback significantly accelerated initial reductions in BOP, although it did not achieve greater plaque reduction than standard OHI. Both groups reached similar clinical outcomes by the study's conclusion. Biofeedback may serve as a useful clinical tool to expedite the early improvement of gingival inflammation in individuals with periodontitis. TRIAL REGISTRATION: Thai Clinical Trials Registry: TCTR20190701002.