Abstract
Objective To compare the clinical effectiveness and cost benefit of different frequencies of scale and polish (S&P) treatments in combination with different types of oral hygiene advice (OHA).
Design Multi-centre, multi-level cluster randomised factorial open trial with blinded outcome evaluation. UK dental practices were cluster randomised to deliver OHA as usual or personalised. In a separate randomisation, patients were allocated to receive S&P 6-monthly, 12-monthly or never.
Setting UK primary dental care.
Participants Practices providing NHS care and adults who had received regular dental check-ups.
Main outcome measures The percent of sites with bleeding on probing, patient confidence in self-care, incremental net benefits (INB) over three years.
Results Sixty-three practices and 1,877 adult patients were randomised and 1,327 analysed (clinical outcome). There was no statistically significant or clinically important difference in gingival bleeding between the three S&P groups (for example, six-monthly versus none: difference 0.87% sites, 95% CI: 1.6 to 3.3, p = 0.48) or between personalised or usual OHA groups (difference -2.5% sites, -95%CI: -8.3 to 3.3, p = 0.39), or oral hygiene self-efficacy (cognitive impact) between either group (for example, six-monthly versus none: difference -0.028, 95% CI -0.119 to 0.063, p = 0.543). The general population place a high value on, and are willing to pay for, S&P services. However, from a dental health perspective, none of the interventions were cost-effective.
Conclusion Results suggest S&P treatments and delivering brief personalised OHA provide no clinical benefit and are therefore an inefficient approach to improving dental health (38% of sites were bleeding whatever intervention was received). However, the general population value both interventions.
Key points
-
Describes the process of successfully delivering a multi-centre, cluster randomised factorial open trial in general dental practice in the NHS, for the most frequently provided dental treatment, scale and polish (S&P), and oral hygiene advice.
-
Highlights the clinical, economic and patient-centred outcomes from providing S&P at different time intervals alongside personalised or routine oral hygiene advice to over 2,000 participants for three years.
-
Evidence from IQuaD concludes that there was no difference in gingival bleeding across trial arms at three years; however, the general population are willing to pay for and place a high value on both S&P and personalised oral hygiene advice.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Ramsay C R, Clarkson J E, Duncan A et al. Improving the Quality of Dentistry (IQuaD): A cluster factorial randomised controlled trial comparing the effectiveness and cost-benefit of oral hygiene advice and/or periodontal instrumentation with routine care for the prevention and management of periodontal disease in dentate adults attending dental primary care. Health Technol Assess 2018; 22: 1-144.
Azarpazhooh A, Leake J L. Systematic review of the association between respiratory diseases and oral health. J Periodontol 2006; 77: 1465-1482.
Neely A L, Holford T R, Loe H, Anerud A, Boysen H. The natural history of periodontal disease in man. Risk factors for progression of attachment loss in individuals receiving no oral health care. J Periodontol 2001; 2: 1006-1015.
Papapanou PN. Epidemiology of periodontal diseases: an update. J Int Acad Periodontol 1999; 1: 110-116.
Petersen P E, Ogawa H. The global burden of periodontal disease: Towards integration with chronic disease prevention and control. Periodontol 2000; 60: 15-39.
Kassebaum N J, Bernabe E, Dahiya M, Bhandari B, Murray C J, Marcenes W. Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res 2014; 93: 1045-1053.
Listl S, Galloway J, Mossey P A, Marcenes W. Global Economic Impact of Dental Diseases. J Dent Res 2015; 94: 1355-1361.
Steele J, O'Sullivan I. Executive Summary: Adult Dental Health Survey 2009. 2011. Available at http://content.digital.nhs.uk/catalogue/PUB01086/adul-dent-heal-surv-summ-them-exec-2009-rep2.pdf (accessed January 2021).
Chapple I L, Van der Weijden F, Doerfer C et al. Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol 2015; 42(Suppl 16): S71-S76.
Axelsson P, Nystrom B, Lindhe J. The long-term effect of a plaque control programme on tooth mortality, caries and periodontal disease in adults: Results after 30 years of maintenance. J Clin Periodontol 2004; 31: 749-757.
National Health Service. NHS Dental Statistics for England 2015-16. Available at https://files.digital.nhs.uk/publicationimport/pub21xxx/pub21701/nhs-dent-stat-eng-15-16-rep-v2.pdf (accessed January 2021).
NHS Information Services Division Scotland. Primary Care Dentistry in Scotland: Dental Statistics - NHS Treatment & Fees. Statistics as at March 2019. 2019. Available at (accessed January 2021).
Worthington H V, Clarkson J E, Bryan G, Beirne P. Routine scale and polish for periodontal health in adults. Cochrane Database Syst Rev 2013; DOI:10.1002/14651858.CD004625.pub5.
Goulão B, MacLennan G, Ramsay C. The split-plot design was useful for evaluating complex, multilevel interventions, but there is need for improvement in its design and report. J Clin Epidemiol 2018; 96: 120-125.
Clarkson J E, Ramsay C R, Averley P et al. IQuaD dental trial; improving the quality of dentistry: a multicentre randomised controlled trial comparing oral hygiene advice and periodontal instrumentation for the prevention and management of periodontal disease in dentate adults attending dental primary care. BMC Oral Health 2013; 13: DOI: 10.1186/1472-6831-13-58.
Bandura A. Health promotion from the perspective of social cognitive theory. Psychol Health 1998; 13: 623-649.
Gollwitzer P M. Implementation intentions: Strong effects of simple plans. Am Psychol 1999; 54: 493-503.
Hefti A F, Preshaw P M. Examiner alignment and assessment in clinical periodontal research. Periodontol 2012; 59: 41-60.
Loe H. The Gingival Index, the Plaque Index and the Retention Index Systems. J Periodontol 1967; 38(6 Suppl): 610-616.
Slade G D. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997; 25: 284-290.
Caton J G, Armitage G, Berglundh T et al. A new classification scheme for the periodontal and peri-implant diseases and conditions - Introduction and key chages from the 1999 classification. J Clin Periodontol 2018; 45 (suppl 20): S1-S8.
Lamont T, Worthington H V, Clarkson J E, Beirne P V. Routine scale and polish for periodontal health in adults (Review). Cochrane Database Syst Rev 2018; DOI: 10.1002/14651858.CD004625.pub5.
Scottish Dental Clinical Effectiveness Programme (SDCEP). Prevention and Treatment of Periodontal Diseases in Primary Care: Dental Clinical Guidance. Dundee: SDCEP, 2014. Available at www.sdcep.org.uk/wp-content/uploads/2015/01/SDCEP+Periodontal+Disease+Full+Guidance.pdf (accessed February 2020).
Watt R G. COVID-19 is an opportunity for reform in dentistry. Lancet 2020; 396: 462.
Acknowledgements
We would like to acknowledge the participating dental practice teams and patients without whose valuable contribution this study could not have taken place. We would also like to acknowledge the role of the IQuaD Group members from the NIHR HTA IQuaD final report for their dedication and support. In addition, we would like to thank the IQuaD Perio-Advisory Committee members for their support throughout the trial; Mary Cullinan, Mark Ide, Ian Needleman, Tim Newton, Greg Seymour. Ethical approval: a favourable ethical opinion for the trial was provided by the East of Scotland Research Ethics 24 March 2011 (REC reference number 10/S0501/65).
Funding information
This project was funded by the NIHR HTA Programme (project number 09/01/45) and was published in full in Health Technology Assessment 2018: 22(38) Current Controlled Trials number ISRCTN56465715: https://doi.org/10.3310/hta22380. The results have been reproduced as per the non-commercial Government licence: http://www.nationalarchives.gov.uk/doc/non-commercial-government-licence/version/2/. Further information available at: https://www.journalslibrary.nihr.ac.uk/HTA. The Health Services Research Unit and the Health Economics Research Unit are funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. This report presents independent research commissioned by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, MRC, CCF, NETSCC, the NIHR HTA programme or the Department of Health.
Author information
Authors and Affiliations
Contributions
JC, CR, HW, PH, M van der Pol, LY, GM contributed to conception and design. JC, CR, HW, PH, M van der Pol, LY, GM, TL, DB, AD, BG contributed to data acquisition, analysis and interpretation, drafted and critically revised the manuscript. All authors gave final approval and agreed to be accountable for all aspects of the work.
Corresponding author
Ethics declarations
None to disclose.
Electronic supplementary material
Rights and permissions
About this article
Cite this article
Clarkson, J., Ramsay, C., Lamont, T. et al. Examining the impact of oral hygiene advice and/or scale and polish on periodontal disease: the IQuaD cluster factorial randomised controlled trial. Br Dent J 230, 229–235 (2021). https://doi.org/10.1038/s41415-021-2662-3
Received:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41415-021-2662-3
