Routine scale and polish for periodontal health in adults

  • Review
  • Intervention

Authors

  • Paul V Beirne,

    Corresponding author
    1. University College Cork, Brookfield Health Sciences Complex, Department of Epidemiology and Public Health, Wilton, Cork, Ireland
    • Paul V Beirne, Department of Epidemiology and Public Health, University College Cork, Brookfield Health Sciences Complex, College Road, Wilton, Cork, Ireland. p.beirne@ucc.ie.

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  • Helen V Worthington,

    1. School of Dentistry, The University of Manchester, Cochrane Oral Health Group, MANDEC, Manchester, UK
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  • Jan E Clarkson

    1. University of Dundee, Dental Health Services Research Unit, Dundee, UK
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Abstract

Background

Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of 'routine scaling and polishing' and the 'optimal' frequency at which it should be provided.

Objectives

The main objectives were: to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; to compare the effects of routine scaling and polishing provided by a dentist or professionals complementary to dentistry (PCD) (dental therapists or dental hygienists) on periodontal health.

Search methods

We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted where possible to identify trials and obtain additional information.
Date of most recent searches: 5th March 2007.

Selection criteria

Trials were selected if they met the following criteria: design - random allocation of participants; participants - anyone with an erupted permanent dentition who were judged to have received a 'routine scale and polish' (as defined in this review); interventions - 'routine scale and polish' (as defined in this review) and routine scale and polish provided at different time intervals; outcomes - tooth loss, plaque, calculus, gingivitis, bleeding and periodontal indices, changes in probing depth, attachment change, patient-centred outcomes and economic outcomes.

Data collection and analysis

Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two review authors. Authors were contacted where possible and where deemed necessary for further details regarding study design and for data clarification. A quality assessment of all included trials was carried out. The Cochrane Collaboration's statistical guidelines were followed and both standardised mean differences and mean differences were calculated as appropriate using random-effects models.

Main results

Nine studies were included in this review. All studies were assessed as having a high risk of bias.

Two split-mouth studies provided data for the comparison between scale and polish versus no scale and polish. One study, involving patients attending a recall programme following periodontal treatment, found no statistically significant differences for plaque, gingivitis and attachment loss between experimental and control units at each time point during the 1 year trial. The other study, involving adolescents in a developing country with high existing levels of calculus who had not received any dental treatment for at least 5 years, reported statistically significant differences in calculus and gingivitis (bleeding) scores between treatment and control units at 6, 12 and 22 months (in favour of 'scale and polish units') following a single scale and polish provided at baseline to treatment units.

For comparisons between routine scale and polish provided at different time intervals, there were some statistically significant differences in favour of scaling and polishing provided at more frequent intervals: 2 weeks versus 6 months, 2 weeks versus 12 months (for the outcomes plaque, gingivitis, pocket depth and attachment change); 3 months versus 12 months (for the outcomes plaque, calculus and gingivitis).

There were no studies comparing the effects of scaling and polishing provided by dentists or professionals complementary to dentistry.

Authors' conclusions

The research evidence is of insufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals. High quality clinical trials are required to address the basic questions posed in this review.

摘要

背景

例行性洗牙和拋光對成人牙周健康的影響

許多牙醫或口腔衛生士定期給病人洗牙和磨牙,即使有些病人得到牙周病的風險不大.'例行性洗牙和磨牙‘和’最適’頻率的臨床效益和成本效益有爭議

目標

主要目的:研究例行性洗牙,洗牙間隔時間不同對牙周健康的益處和缺點;比較由牙醫師或牙科治療護理士執行對牙周健康的益處和缺點

搜尋策略

搜尋Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE 和 EMBASE. 檢查相關文章的文獻列表,連絡合格試驗的作者以確認試驗和獲取額外資料.最近一次搜尋日期: 2007年3月5日

選擇標準

符合以下條件的試驗選入:設計隨機分派;受試者具恆牙齒列的人,有接受例行性洗牙(本回顧有其定義);介入例行性洗牙(本回顧有其定義)和治療間隔時間不同的狀況;結果變項掉牙,痛,結石,牙齦炎,流血和牙周指數,牙周深度,牙周附著狀態的改變,以病患為主的變項和經濟變項.

資料收集與分析

關於方法,受試者,介入,結果變項和結果的資訊都由兩位檢閱者獨立重複擷取.若可能或需有更多試驗設計或釐清資料的需求時,則聯繫作者.對納入試驗進行品質評估.遵循The Cochrane Collaboration’統計準則,以隨機效果模式計算標準平均差和平均差

主要結論

納入9試驗.都被評估為高偏差風險.兩個分口試驗比較洗牙和沒有洗牙.一個試驗要求患者牙周治療後回診,發現在為期一年的試驗中,實驗組和對照組在任何時間點的牙菌斑,牙齦炎和牙周附著狀態都沒有顯著差別.另個試驗研究開發中國家結石嚴重且之前至少五年沒接受過治療的成年人,發現實驗組和對照組,單次洗牙後的6,12,22月時,其結石和牙齦炎(流血)分數顯著有差. (洗牙組較好).比較不同間隔時間的例行性洗牙,較頻繁的洗牙較好: 2 週比上6 個月, 2週比上12 個月(對疲勞,牙齦炎,牙囊深度和牙周附著狀態); 3個月比上12 個月(對牙菌斑,結石,牙齦炎).沒有比較由牙醫師或牙科治療護理士執行

作者結論

試驗證據品質不足,無法有任何例行性洗牙執行間隔期間不同,對牙周健康的益處和副作用的結論.需高品質的試驗研究本回顧提到的基本問題

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

例行性洗牙和拋光,洗牙間隔時間不同對牙周健康的影響不明.許多牙醫或口腔衛生士定期給病人洗牙和磨牙,即使有些病人得到牙周(牙齦)疾病的風險不大.試驗證據品質不足,無法有任何例行性洗牙執行間隔期間不同,對牙周健康的益處和副作用的結論.需高品質的試驗研究本回顧提到的基本問題

Plain language summary

Routine scale and polish for periodontal health in adults

The effects on periodontal health of a routine scale and polish and of providing this intervention at different time intervals are unclear.
Many dentists and hygienists regularly provide scaling and polishing for patients, even if those patients are considered to be at low risk of developing periodontal (gum) disease. The trials included in this review were judged to be of poor quality. The research evidence was of insufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals.

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