Use of the Theory of Planned Behavior and Implementation Intentions in Dentistry: Evidence of Literature

Denise Cristina Aceituno Braulio Simpriano, Thaís Moreira São-João, Fábio Luiz Mialhe


Objective: To identify and discuss the evidence on the use of two psychological theories in preventive oral health behaviors: the Theory of Planned Behavior (TPB) and the theory of Implementation Intentions (II). Material and Methods: We conducted a literature review from the keywords ‘theory of planned behavior’, ‘oral health’ and ‘implementation intentions’ and their equivalents in Portuguese, referring to the databases Bireme (BVS), PubMed (Medline version) and Scielo, from January 1991 to July 2015. After the selection of studies, they were divided into three groups according to their use in the field of oral health: a) use of TPB, b) use of II and c) those which used an association of both theories. Results: We recovered 159 articles on the topic. After analysis, 25 articles met the inclusion criteria. Of these, 21 used the TPB in oral health, three the theory of Intent Implementation in oral health and one used the two together (TPB and II) in oral health. We found that the TPB and II showed promising results both in terms of prediction of preventive behaviors and in the promotion of changes in preventive oral health behaviors. Conclusion: The evidence raised in this study showed that the TPB and II are theories that can help researchers / health professionals to predict and to change preventive oral health behaviors. However, additional research is needed to test their effectiveness in other oral health behaviors, age groups and longer follow-up times.

Full Text:



Petry PC, Pretto SM. Educação e motivação em saúde bucal. In: Kriger L (editor). Promoção de saúde bucal - ABOPREV. 2. ed. São Paulo: Artes Médicas; 1999. p. 365-70.

Ajzen I. The theory of planned behavior. Organizational behavior and human decision processes. Psychol Rev 1991; 50(2):179-211.

Gollwitzer PM. Implementation intentions: strong effects of simple plans. Am Phychol 1999; 54(7): 493-503.

Armitage CJ, Conner M. Efficacy of the Theory of Planned Behaviour: a meta analytic review. Br J Soc Psychol 2001; 40(4):471-99.

Prestwich A, Kellar I. How can the impact of implementation intentions as a behavior change intervention be improved? Revue européenne de psychologie appliquée 2014; 64(1):35-41.

Buunk-Werkhoven YA, Dijkstra A, Van der Schans CP. Determinants of oral hygiene behavior: a study based on the theory of planned behavior. Community Dent Oral Epidemiol 2011; 39(3):250-9.

Clarkson JE, Young L, Ramsay CR, Bonner BC, Bonetti D. How to influence patient oral hygiene behavior effectively. J Dent Res 2009; 88(10):933-7.

Schüz B, Wiedemann AU, Mallach N, Scholz U. Effects of a short behavioural intervention for dental flossing: randomized controlled trial on planning when, where and how. J Clin Periodontal 2009; 36(6):498-505.

Dumitrescu AL, Wagle M, Dogaru BC, Manolescu B. Modeling the theory of planned behavior for intention to improve oral health behaviors: the impact of attitudes, knowledge and current behavior. J Oral Sci 2011; 53(3):369-77.

Sniehotta FF, Araujo Soares V, Dombrowski SU. Randomized controlled trial of a one-minute intervention changing oral self-care behavior. J Dent Res 2007; 86(7):641-5.

Schüz B, Sniehotta FF, Wiedemann A, Seemann R. Adherence to a daily flossing regimen in university students: effects of planning when, where, how and what to do in the face of barriers. J Clin Periodontol 2006; 33(9):612-19.

Astrom AN, Kiwanuka SN. Examining intention to control preschool children’s sugar snacking: a study of carers in Uganda. Int J of Paediatr Dent 2006; 16 (1):10-8.

Astrom AN, Okullo I. Temporal stability of the theory of planned behavior: a prospective analysis of sugar consumption among Ugandan adolescents. Community Dent Oral Epidemiol 2004; 32 (6):426–34.

Bonetti D, Johnston M, Clarkson J, Turner S. Applying multiple models to predict clinicians’ behavioural intention and objective behaviour when managing children’s teeth. Psychol Health 2009; 24(7):843-60.

Wade J, Smith H, Hankins M, Llewellyn C. Conducting oral examinations for cancer in general practice: what are the barriers? Family Practice 2010; 27(1):77–84.

Freeman T, Roche AM, Williamson P, Pidd K. What Factors need to be addressed to support dental hygienists to assist their patients to quit smoking? Nicotine & Tobaco Research 2012; 14(9):1040–47.

Koyio LN, Kikwilu E, Mulder J, Frencken JE. Attitudes, subjective norms, and intention to perform routine oral examination for oropharyngeal candidiasis as perceived by primary health-care providers in Nairobi Province. J Public Health Dent 2013; 73(2):127–34.

Vanagas G, Milasauskiene Z, Grabauskas V, Mickeviciene A. Associations between parental skills and their attitudes toward importance to develop good oral hygiene skills in their children. Medicina (Kaunas) 2009; 45(9):718-23.

Van den Branden S, Van den Broucke S, Leroy R, Declerck D, Hoppenbrouwers K. Effects of time and socio economic status on the determinants of oral health related behaviours of parents of preschool children. Eur J Oral Sci 2012; 120(2):153-60.

Van den Branden S, Van den Broucke S, Leroy R, Declerck D, Hoppenbrouwers K. Measuring determinants of oral health behaviour in parents of preschool children. Community Dent Health 2013; 30(1):19-25.

Weatherwax JA, Bray KK, Williams KB, Gadbury-Amyot CC. Exploration of the relationship between parent/guardian sociodemographics, intention, and knowledge and the oral health status of their children/wards enrolled in a Central Florida Head Start Program. Int J Dent Hyg 2015; 13(1):49–55.

Lavin D e Groarke A. Dental floss behaviour: a test of the predictive utility of the Theory of planned behaviour and the effects of making implementation intentions. Psychology, Health & Medicine 2005; 10(3):243-52.

Anderson CN, Noar SM, Rogers BD. The persuasive power of oral health promotion messages: a theory of planned behavior approach to dental checkups among young adults. Health Commun 2013; 28(3):304-13.

Buunk-Werkhoven YA, Burrekers SY, Jongboer A, Quant DF, van Maanen-Schakel NW. Determinants of oral hygiene behavior in the Dominican Republic. Int Dent J 2011; 61(6):328-33.

Buunk-Werkhoven YA, Dijkstra A, Bink P, Van Zanten S, Van der Schans CP. Determinants and promotion of oral hygiene behavior in the Caribbean and Nepal. Int Dent J 2011; 61(5):267-73.

Buunk-Werkhoven YA, Dijkstra A, van der Wal H, Basic N, Loomans SA, van der Schans CP et al. Promoting oral hygiene behavior in recruits in the Dutch Army. Mil Med 2009; 174(9):971-6.

Dumitrescu AL, Duta C, Dogaru CB, Manolescu B. Predicting undergraduates' intentions to improve oral health behaviors: the importance of self-identity - a pilot study. J Dent Hyg 2013; 87(4):224-34.

Dumitrescu AL, Dogaru BC, Duta C, Manolescu BN. Testing five social-cognitive models to explain predictors of personal oral health behaviours and intention to improve them. Oral Health Prev Dent 2014; 12(4):345-55.

Pakpour AH, Hidarnia A, Hajizadeh E, Plotnikoff RC. Action and coping planning with regard to dental brushing among Iranian adolescents. Psychology, Health & Medicine 2012; 17(2):176-87.

Pakpour AH, Sniehotta FF. Perceived behavioural control and coping planning predict dental brushing behavior among Iranian adolescents. J Clin Periodontol 2012; 39(2):132-7.