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Routine scale and polish for periodontal health in adults

  1. Helen V Worthington1,*,
  2. Jan E Clarkson1,2,
  3. Gemma Bryan1,
  4. Paul V Beirne3

Editorial Group: Cochrane Oral Health Group

Published Online: 7 NOV 2013

Assessed as up-to-date: 15 JUL 2013

DOI: 10.1002/14651858.CD004625.pub4


How to Cite

Worthington HV, Clarkson JE, Bryan G, Beirne PV. Routine scale and polish for periodontal health in adults. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD004625. DOI: 10.1002/14651858.CD004625.pub4.

Author Information

  1. 1

    School of Dentistry, The University of Manchester, Cochrane Oral Health Group, Manchester, UK

  2. 2

    University of Dundee, Dental Health Services Research Unit, Dundee, Scotland, UK

  3. 3

    University College Cork, Department of Epidemiology and Public Health, Cork, Ireland

*Helen V Worthington, Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Coupland III Building, Oxford Road, Manchester, M13 9PL, UK. helen.worthington@manchester.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 7 NOV 2013

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Summary of findings    [Explanations]

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

 
Summary of findings for the main comparison.

Routine scale and polish compared with no treatment for periodontal health

Patient or population: Healthy dentate adults

Settings: General dental practice

Intervention: Routine scale and polish (either 6-monthly or 12-monthly)

Comparison: No treatment

OutcomesRelative effect
(95% CI)
No of participants
(studies)
Quality of the evidence
(GRADE)
Comments

Gingivitis (proportion of index sites bleeding) at 24 months

6-monthly scale and polish

Mean proportion in control group is 0.40 sites
MD -0.02 (-0.10 to 0.06)1 study1

(207 participants)
⊕⊕⊝⊝
low
The results for 12-monthly scale and polish were similar and also not significant

Calculus (mean depth in mm at index sites) at 24 months

6-monthly scale and polish

Mean in control group is 0.95 mm
MD -0.24 (-0.51 to 0.03)1 study1

(207 participants)
⊕⊕⊝⊝
low
The results for 12-monthly scale and polish were similar and also not significant

Plaque (proportion of index sites with plaque) at 24 months

6-monthly scale and polish

Mean proportion in control group is 0.44 sites
MD -0.04 (-0.13 to 0.05)1 study1

(207 participants)
⊕⊕⊝⊝
low
The results for 12-monthly scale and polish were similar and also not significant

CI: confidence interval; MD: mean difference

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

 1Single study at unclear risk of bias

 Summary of findings 2

 Summary of findings 3

 Summary of findings 4

 

Background

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms
 

Description of the condition

'Periodontal (gum) disease' is a broad term that encompasses a cluster of diseases that result in inflammatory responses and chronic destruction of the tissues that surround and support the teeth, namely the gingiva, periodontal ligament, cementum and alveolar bone (collectively referred to as the 'periodontium'). Dental plaque is the principal aetiological factor in the pathogenesis of periodontal disease. Plaque is necessary but is not sufficient for periodontal disease to occur. The host response, the modifying effect of various risk factors and the bacterial attack from dental plaque can account for a variety of disease patterns, both between different individuals and between different sites in the mouth within the same individual. Calcified plaque (calculus) does not have a major role in the pathogenesis of periodontal disease, although it does act as a 'retention web' for bacteria (Ismail 1994) and reduces the effectiveness of personal oral hygiene control.

Plaque-induced periodontal disease has traditionally been divided into two general categories: gingivitis and periodontitis. Gingivitis is a reversible disease and can be defined as the presence of gingival inflammation (where the gum can appear reddened and swollen and may bleed easily) without loss of connective tissue attachment. Gingivitis is a precursor to periodontitis in some individuals - that is, gingivitis does not inevitably progress to periodontitis. Periodontitis can be defined as the presence of gingival inflammation at sites where there has been a pathological loss of attachment (AAP 2003). This loss of attachment contributes to pocket formation and the denuded cementum may become contaminated by microorganisms and their products (Jenkins 2003).

The rate of progression of periodontitis is neither predictable nor steady. The disease is considered to progress in relatively short episodes of rapid tissue destruction, sometimes followed by some repair, and mostly by prolonged periods of quiescence (Pilot 1997). Some diseased sites may progress by as much as three mm per year (Haffajee 1991; Lindhe 1989).

Epidemiological studies of periodontal diseases are difficult to interpret due to the diversity of measures used to describe and quantify disease and the absence of uniform definition and classification. This is reflected in the World Health Organization Global Data Bank estimates (WHO 2004) which state that the prevalence of moderate severity disease ranges from 2% to 67% and that advanced disease occurs in 1% to 79% of the population. Gingivitis is highly prevalent in most populations and at most ages (Albandar 2002; Corbet 2002; Sheiham 1986) with global values ranging from 50% to 90%. In the UK, it was reported in the 1998 Adult Dental Health Survey (Kelly 2000) that 54% of dentate adults had some periodontal pocketing of 4 mm or more and 5% had deep pocketing (of 6 mm or more); 43% had some loss of attachment of 4 mm or more and 8% had loss of attachment of 6 mm or more. The prevalence of pocketing and loss of attachment increased with age. For example, the proportion of dentate adults with some loss of attachment increased from 14% among those aged 16 to 24 years to 85% of those aged 65 and over.

The goals of periodontal therapy have been defined in many different ways. Some authors have defined the ultimate aim of periodontal treatment as being to control disease progression or achieve a rate of progression which is compatible with a functional dentition for the lifetime of the individual (Pilot 1980; Sheiham 2002; Wennstrom 1990). Others have defined the key goals as improving periodontal health and thereby satisfying a patient's aesthetic and functional needs or demands. Currently accepted clinical signs of a healthy periodontium include the absence of inflammatory signs of disease such as redness, swelling, suppuration, and bleeding on probing; maintenance of a functional periodontal attachment level; minimal or no recession in the absence of interproximal bone loss; and, where present, functional dental implants (AAP 2001).

A fundamental component of the preventive management of periodontal disease is the control of dental plaque by the patient. Hence patient education and training in personal oral hygiene should form an integral part of any treatment plan for a patient with periodontal disease. Conventional periodontal therapy also includes non-surgical treatment as well as a variety of surgical approaches (Needleman 2002). The precise choice of intervention may be influenced by the clinical severity of the disease, with surgery generally reserved for cases of advanced disease to allow for adequate access to, and full debridement of, areas with deep pocketing.

 

Description of the intervention

Scaling and polishing of the teeth by a dentist or a dental care professional (DCP) (dental therapist or dental hygienist) ) is a non-surgical intervention that is intended to supplement (and is not a substitute for) the patient's home-care plaque control. This is frequently provided as part of the dental recall appointment (Beirne 2005a). Scaling is the removal of plaque, mineralised plaque deposits (also referred to as calculus or tartar), debris and staining from the crown and root surfaces of the teeth. Specially designed sharp dental instruments ('hand scalers') or ultrasonic scalers can be used to perform the scaling procedure. Polishing is the mechanical removal of any residual extrinsic stains and deposits, typically undertaken by using a rubber cup or bristle brush loaded with a prophylaxis paste. Scaling and polishing can be used with or without a variety of adjuncts such as antimicrobial agents (either topical or systemic), gingival crevice irrigation and root planing. Root planing is a procedure for smoothening the root surface of a tooth that involves the "removal of cementum or surface dentin that is rough or impregnated with calculus, toxins or microorganisms" (Greenstein 1992). The rationale for root planing is to allow the gingival tissue to heal close to the root, shrinking the tissue and reducing the depth of the pocket that has formed (Bonito 2004).

Within the confines of this Cochrane review a 'routine scale and polish' is defined as scaling or polishing or both of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), that does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing. The definition includes both supragingival and subgingival scaling. The term 'routine' is simply used to indicate that the scale and polish is "a regular course or procedure" (Oxford Dict 1995) i.e. that the scale and polish is an intervention that is intended to be provided at 'regular intervals' to patients (without specifying any one particular frequency e.g. every month, every six months, every nine months, every 12 months, etc. at which patients may receive this intervention).

 

How the intervention might work

Scaling and polishing of the teeth may reduce plaque, calculus, bleeding and gingival inflammation over time, to reduce gingivitis and therefore progression to or progress of periodontitis.

 

Why it is important to do this review

Scaling and polishing of the teeth is a commonly provided intervention in general dental practice. In the United Kingdom approximately 50% of all adult courses of treatment provided under the National Health Service (NHS) (General Dental Services) regulations "consist of the patient having nothing more than an examination (and a) scale and polish" (DoH 2000). In 1999/2000, approximately 13 million scale and polishes were provided for NHS patients in England at a gross cost to the NHS of GBP 122 million (DoH 2000). In a survey of general dental practitioners preventive recommendations in western New York State, 86% of respondents stated that they would recommend scaling and polishing every six months for 'low risk' patients of all ages (a 'low risk' patient was defined as a patient having "adequate brushing and flossing habits" and "no history of periodontal disease") (Frame 2000). There has been debate over the clinical effectiveness and cost effectiveness associated with the routine scaling and polishing of teeth and the frequency with which it should be provided for patients. This debate is complicated by the fact that a 'routine scale and polish' is not a precisely defined intervention in periodontal disease management and there is no universally accepted definition of the term. In the United States the term 'oral prophylaxis' is most often used and has been defined as "the removal of plaque, calculus and stain from exposed and unexposed surfaces of the teeth by scaling and polishing as a preventive measure for the control of local irritational factors" (AAP 1992). The role and contribution of DCPs (dental hygienists and dental therapists) in maintaining periodontal health has increased in recent years. Any differences in treatment outcome following intervention by a dentist or DCP are not well understood and require investigation. This is an update of this review (Beirne 2005b; Beirne 2007).

 

Objectives

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

  1. To determine the beneficial and harmful effects of routine scaling and polishing for periodontal health.
  2. To determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health (which could be determined by tests).
  3. To compare the beneficial and harmful effects of routine scaling and polishing with or without oral hygiene instruction.
  4. To compare the beneficial and harmful effects of routine scaling and polishing provided by dentists or dental care professionals (dental therapist or dental hygienist) on periodontal health.

 

Methods

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms
 

Criteria for considering studies for this review

 

Types of studies

We included randomised controlled trials with at least six months follow-up. We excluded split-mouth studies as this design does not reflect a routine scale and polish.

 

Types of participants

Healthy dentate adults. We included trials where participants had mild to moderate gingivitis at baseline. We excluded trials where participants were described as having severe periodontal disease (e.g. alveolar bone loss involving most teeth, or individuals requiring referral for specialist (surgical) periodontal treatment). We also included trials where participants had undergone specialist periodontal treatment in the six months prior to the study and were in the maintenance phase.

 

Types of interventions

We included trials where the intervention group(s) received scale and polish treatments with or without oral hygiene instruction delivered at planned regular intervals by a dentist, dental hygienist or dental therapist. We excluded trials where patients were given only a single scale and polish treatment.

We included trials where the comparison or control group received either:

  • no scale and polish (e.g. dental examination or oral health instruction only or both); 
  • scale and polish in response to signs and symptoms of developing gingival or periodontal disease.

We also included trials directly comparing routine scale and polish treatments delivered at different time intervals (e.g. every six months versus every 12 months).

 

Types of outcome measures

We included trials reporting clinical status, patient-centred and economic cost outcomes.

 

Primary outcomes

Periodontal disease, assessed by gingivitis indices (both inflammatory and bleeding).

 

Secondary outcomes

 
Clinical status factors

  • Calculus and plaque indices.
  • Changes in probing depth.
  • Changes in attachment level.
  • Periodontal indices.
  • Tooth loss.
  • Adverse events.

 
Patient-centred factors

  • Halitosis.
  • Patient satisfaction with oral comfort.
  • Patient satisfaction with appearance (including gingival recession).
  • Patient satisfaction with actual care received.
  • Patient satisfaction with provider of care (i.e. dentist, therapist or hygienist).

 
Economic cost factors

  • Economic and resource cost of scale and polish.

 

Search methods for identification of studies

For the identification of studies included or considered for this review, detailed search strategies were developed for each database searched. These were based on the search strategy developed for MEDLINE (Appendix 1) but appropriately revised for each database to take account of differences in syntax rules and controlled vocabulary. The search strategy used a combination of controlled vocabulary and free text terms and was linked with the Cochrane Highly Sensitive Search Strategy (CHSSS) for identifying randomised trials (RCTs) in MEDLINE: sensitivity maximising version (2008 revision) as referenced in Chapter 6.4.11.1 and detailed in box 6.4.c of the Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011) (Higgins 2011). The search of EMBASE was linked to the Cochrane Oral Health Group filter for identifying RCTs (Appendix 2).

 

Electronic searches

The following databases were searched.

  • The Cochrane Oral Health Group's Trials Register (to 15 July 2013) (Appendix 3).
  • The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 6) (Appendix 4).
  • MEDLINE via OVID (1946 to 15 July 2013) (Appendix 1).
  • EMBASE via OVID (1980 to 15 July 2013) (Appendix 2).

Only handsearching carried out as part of the Cochrane Worldwide Handsearching Programme and uploaded to CENTRAL was included in the search (see the Cochrane Masterlist of journals searched to date).

We searched for ongoing and completed trials using the following trial registries (Appendix 5):

 

Searching other resources

The reference lists of related review articles and all articles obtained were checked for further trials. The author(s) of some eligible studies published and any researchers involved in the ongoing debate on recall intervals were contacted, where possible and when considered necessary, to obtain the information on additional published or unpublished studies possibly eligible for inclusion.

 

Data collection and analysis

 

Selection of studies

Two review authors independently assessed titles, keywords and abstracts. The review authors remained unblinded regarding the author(s), their institutional affiliations and the site of publication of reports. The full report was obtained for all studies appearing to meet the inclusion criteria or in instances where there was insufficient information from the title, keywords and abstract to make a clear decision. All of the potentially relevant studies were assessed independently for eligibility by both review authors. Instances of disagreement in the study selection process were referred to the other members of the review team and ultimately resolved by mutual discussion among all review team members. Studies rejected at this or subsequent stages were recorded in a table of excluded studies, and reasons for exclusion noted. All of the studies meeting the inclusion criteria were subjected to risk of bias assessment and data extraction.

 

Data extraction and management

All randomised controlled trials which appeared to meet the inclusion criteria for this review were assessed by at least two review authors to confirm eligibility, assess risk of bias and extract data using a piloted data extraction form. The following data were recorded.

  • Study design, location, funding, number of centres.
  • Inclusion and exclusion criteria, number of patients recruited, number of patients randomised to each group, number of patients withdrawn, numbers evaluated.
  • Intervention(s), comparator, provider characteristics (dentist, hygienist, dental therapist or other), diagnostic criteria and diagnostic thresholds used.
  • Primary and secondary outcomes, times measured, numbers of patients included in the outcome evaluation, direct and indirect cost (where provided).
  • Whether a sample size calculation was performed.

Information was entered into the table of characteristics of included studies and additionally into an Excel spreadsheet from which a summary of the characteristics of the studies was made. Where the published paper was unclear concerning aspects of trial design, attempts were made to contact the study authors for clarification or more information or both.

 

Assessment of risk of bias in included studies

This was conducted using the recommended approach for assessing the risk of bias in studies included in Cochrane reviews (Higgins 2011). We used the two-part tool, addressing six specific domains (namely sequence generation, allocation concealment, blinding of outcome assessment, incomplete outcome data, selective outcome reporting and other bias). Each domain included one specific entry in a 'Risk of bias' table. Within each study, the first part of the tool involved describing what was reported to have happened in the study. The second part of the tool involved assigning a judgement relating to the risk of bias for that entry. This was achieved by answering a pre-specified question about the adequacy of the study in relation to the entry, such that a judgement of 'low' indicated low risk of bias, 'high' indicated high risk of bias, and 'unclear' indicated unclear or unknown risk of bias.

All of the domains of sequence generation, allocation concealment, incomplete outcome data, selective outcome reporting and other sources of bias were each addressed in the tool by a single entry for each study. It is not possible to blind patients to which intervention they are receiving. Scale and polish visits can be considered to be a 'complex intervention' as the delivery of the clinical care may have impact on oral hygiene behaviour in between scale and polish visits leading to different clinical outcomes. Blinding of participants was not therefore considered as a risk of bias domain, only blinding of outcome assessor. Where the patients self assessed the outcomes to the trial this was noted.

The risk of bias assessments were undertaken independently and in duplicate by two review authors as part of the data extraction process.

After taking into account the additional information provided by the authors of the trials, studies were grouped into the following categories.

  • Low risk of bias (plausible bias unlikely to seriously alter the results) for all key domains.
  • Unclear risk of bias (plausible bias that raises some doubt about the results) if one or more key domains were assessed as unclear.
  • High risk of bias (plausible bias that seriously weakens confidence in the results) if one or more key domains were assessed to be at high risk of bias.

A 'Risk of bias' table was completed for each included study. The results were also presented graphically.

 

Measures of treatment effect

For continuous outcomes, means and standard deviations were used to summarise the data for each group (standardised mean differences were used when different scales, measuring the same concept, were reported). For dichotomous outcomes, the estimates of effect were expressed as risk ratios together with 95% confidence intervals.

 

Dealing with missing data

Where data were missing from the published report of a trial we attempted to contact the author(s) to obtain the data and clarify any uncertainty. The analysis generally included only the available data (ignoring missing data) however, methods for estimating missing standard deviations in section 7.7.3 of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011) were used if necessary. Otherwise we did not intend to undertake any imputations nor to use statistical methods to allow for missing data.

 

Assessment of heterogeneity

We planned to assess heterogeneity by inspection of the point estimates and confidence intervals on the forest plots. The variation in treatment effects was to be assessed by means of Cochran's test for heterogeneity and quantified by the I2 statistic. Heterogeneity was to be considered statistically significant if P value is < 0.1. A rough guide to the interpretation of I2 given in the Cochrane Handbook for Systematic Reviews of Interventions is: 0% to 40% might not be important, 30% to 60% may represent moderate heterogeneity, 50% to 90% may represent substantial heterogeneity, 75% to 100% considerable heterogeneity (Higgins 2011).

 

Assessment of reporting biases

If there had been sufficient numbers of trials (more than 10) in any meta-analysis, publication bias would have been assessed according to the recommendations on testing for funnel plot asymmetry (Egger 1997) as described in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 (Higgins 2011). If asymmetry were identified we would have examined possible causes.

 

Data synthesis

A meta-analysis was only to be conducted if there were studies of similar comparisons reporting the same outcome measures. A fixed-effect model was used where there were fewer than four studies.

 

Subgroup analysis and investigation of heterogeneity

We planned to investigate clinical heterogeneity. Providing there were sufficient studies of each intervention and outcome, we planned a priori to conduct subgroup analyses for age, sex, smoking, oral cleanliness and degree of periodontal disease at baseline and different groups of systemically compromised adults.

 

Sensitivity analysis

Provided there were sufficient studies for each outcome and intervention, we planned to undertake sensitivity analysis based on the trials at low risk of bias.

 

Summary of results

The results for each objective of the review are presented in a 'Summary of findings' table, with the GRADE assessment of the quality of the body of evidence.

 

Results

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms
 

Description of studies

 

Results of the search

All titles and abstracts retrieved through the search strategy were scanned for relevance and the full texts of 88 papers considered potentially relevant to the review were obtained. Seven of these papers were either partially or fully translated in order to determine their eligibility for the review (four German (Grimm 1986; Katay 1990; Sandig 1981 (partially translated); Schulz 1989 (fully translated)); one Finnish (Ketomaki 1993) (partially translated); one Norwegian (Lunder 1994) (fully translated) and one Japanese (Tsuboi 2003) (partially translated)).

 

Included studies

Following detailed assessment of all of the potentially relevant papers, five papers reporting three studies (Jones 2011; Lightner 1971; Listgarten 1985) were judged to have satisfied the eligibility criteria for the review.

 

Characteristics of the trial settings and investigators

See Characteristics of included studies table for further details.

Of the three included studies, two were conducted in North America (Lightner 1971; Listgarten 1985), and one in the UK (Jones 2011).

The studies were conducted in different settings: dental school/hospital (Listgarten 1985), general dental practice (Jones 2011) and US Air Force Academy (Lightner 1971).

Treatment was provided by dental hygienists in Lightner 1971 and in Listgarten 1985, and using a pool of nine therapists and hygienists in Jones 2011.

Outcomes were assessed by dentists in two studies (Jones 2011; Lightner 1971); it was unclear who carried out the outcome assessment in Listgarten 1985.

One study was funded by the National Institute of Dental Research (NIDR) (Listgarten 1985), one study funded by a university grant (Jones 2011), the funding being unclear in the remaining study (Lightner 1971).

 

Characteristics of the participants

See Characteristics of included studies table for further details.

The three trials included 836 participants in the analyses, ranging from 61 to 470 in each trial. Participants were adults aged 18 to 73 (Jones 2011), adults aged 20 to 73 (Listgarten 1985) whereas in the third study (Lightner 1971) participants were young air force cadets with an average age of 22 years.

One study was conducted on patients attending one of three general dental practices for check-up appointments (Jones 2011). This study only included patients with calculus or bleeding on probing and no pockets greater than 3.5 mm. Another study (Lightner 1971) was conducted on young adult male US Air Force Academy cadets. The third study (Listgarten 1985) was conducted on patients attending a dental hygiene clinic at a dental school. All participants had varying degrees of gingivitis, but no evidence of alveolar bone loss. Some, but not all of the subjects had been receiving periodontal prophylaxes at intervals of three to six months (no further information on the latter point was provided in this paper).

 
Heterogeneity of participants

As can be seen from the descriptions provided above and from the Characteristics of included studies table there was considerable heterogeneity in the characteristics of the participants included in different studies.

 

Characteristics of the interventions

See the Characteristics of included studies table for further details.

 
Comparison 1: Scale and polish versus no scale and polish

In one study (Jones 2011) all participants received a scale and polish at baseline, and then were randomly allocated to a further scale and polish every six months, or every 12 months or to no further scale and polish during the study period (two years).

 
Comparison 2: Scale and polish at a fixed interval versus scale and polish in response to the signs or symptoms or both of periodontal disease

In the study by Listgarten 1985, the control group received a 'periodontal prophylaxis' every six months (no further details were given of the precise nature of the prophylaxis, however, it was assumed to fall within the definition of 'routine scale and polish' used in this review). In the experimental group, periodontal prophylaxes were administered according to a variable schedule, based on the outcome of differential dark-field microscopy (DDFM) tests. For participants with negative DDFM tests, recall intervals were gradually extended from one to two, to three, to six, to 12, to 24 months (see Characteristics of included studies table for further details of the DDFM test and subsequent assignment of recall intervals on the basis of the test). Eleven subjects in the experimental group reached the end of the study without receiving a single prophylaxis over the three-year duration of the trial.

 
Comparison 3: Scale and polish at a fixed interval versus scale and polish at a different fixed interval

There were two studies (Jones 2011; Lightner 1971) that made this comparison. One study (Lightner 1971) compared scale and polish treatments provided at three-month, six-month and 12-month intervals (see Characteristics of included studies table for further details of the precise interventions provided). In Jones 2011 all the participants received a thorough scale and polish followed by a baseline examination. Patients were then allocated to groups having no scale and polish, one every six months and one every 12 months.

 
Comparison 4: Scale and polish with oral hygiene instruction (OHI) at a fixed interval versus scale and polish without OHI at the same fixed interval

Only one study (Lightner 1971) provided data for this comparison. The comparisons made were:

  • scale and polish treatment with OHI at three-month intervals versus scale and polish treatment without OHI at three-month intervals;
  • scale and polish treatment with OHI at 12-month intervals versus scale and polish treatment without OHI at 12-month intervals.

(See Characteristics of included studies table for further details of the precise interventions provided.)

 
Comparison 5: Scale and polish by a dentist versus scale and polish by a dental care professional

No studies were found for this comparison.

 
Heterogeneity of interventions

As can be seen from the descriptions provided above and from the Characteristics of included studies table there was considerable heterogeneity in the characteristics of the interventions provided in different studies. The OHI components also varied, with some studies (Lightner 1971) giving toothbrushing instruction only, where the participants in those groups who received OHI were instructed to use the Bass technique for the lingual surface of the mandibular molars but the modified Roll technique for all other areas. In one study (Listgarten 1985) the intervention was described as a "periodontal prophylaxis" and there was no indication given regarding the delivery or otherwise of OHI to the participants. In Jones 2011 the participants were allocated a 15-20 minute appointment for oral hygiene advice plus intervention, however additional time was permitted as required. In Lightner 1971 the duration of the scale and polish given to comparison groups varied from 30 to 50 minutes, with or without an additional 10 minutes of oral hygiene instruction. Only one study (Jones 2011) stated they used an ultrasonic scaler.

 

Characteristics of the outcome measures

Details of the different indices used in each individual trial to record the outcomes are presented in Additional  Table 1 'Indices used in trials.'

Details of the outcomes recorded in different studies, the time points when measured, and the frequency of provision of scale and polish for each of the three comparisons (scale and polish versus no scale and polish; scale and polish versus scale and polish in response to signs or symptoms or both of periodontal disease; scale and polish versus scale and polish at a different interval), are presented in Additional  Table 2 ,  Table 3, and  Table 4 respectively.

 
Primary outcome measure
 
Gingivitis indices (inflammatory and bleeding)

Gingivitis/gingival bleeding was used as an outcome measure in all three studies and was measured at the following data points in each study:

  • 12, 24, 36, 46 months (Lightner 1971)
  • 6, 12, 18, 24, 30, 36 months (Listgarten 1985)
  • 6, 12, 18, 24, 30, 36, 42, 48 months (Listgarten 1986). Due to a problem with study design only the six-month data were used (for further details see the section below on 'Handling of data/data assumptions made in review')
  • 24 months (Jones 2011).

 
Secondary outcome measures

There was little consistency in the other outcome measures reported.

 
Clinical status factors

  • Calculus and plaque indices

Calculus was used as an outcome measure in two studies (Jones 2011; Lightner 1971). It was measured at the following data points:

- 12, 24, 36, 46 months (Lightner 1971)
- 24 months (Jones 2011).

Plaque was used as an outcome measure in the three included studies and was measured at the following data points in each study:

- 12, 24, 36, 46 months (Lightner 1971)
- 6, 12, 18, 24, 30, 36 months (Listgarten 1985)
- 24 months (Jones 2011).

  • Changes in probing depth

Changes in probing depth were reported as an outcome measure in only one study (Listgarten 1985) and were measured at the following data points: 6, 12, 18, 24, 30, and 36 months.

  • Changes in attachment level

Changes in attachment level were reported as an outcome measure in only one study (Lightner 1971); however, the data could not be used as no standard deviations were provided.

  • Periodontal indices

Lightner 1971 reported periodontal index data which could not be used as they were in an inappropriate format for inclusion in this review.

  • Tooth loss

No studies reported this outcome.

  • Adverse events

No studies reported any adverse effects.

 
Patient-centred factors and economic cost factors

One study (Jones 2011) reported some patient-centred factors. No economic cost outcomes were reported in any of the included studies.

 

Handling of data/data assumption made in review

In one study (Lightner 1971) there were five comparison groups (groups 1, 2, 3, 4A and 4B) (see Characteristics of included studies table for full details of the interventions provided). For Comparison 3 we compared groups 2, 3 and 4A with each other (where oral hygiene instruction (OHI) was provided alongside the scale and polish), and compared groups 4B and 1 with each other (where no OHI was provided). We did not make comparisons between groups that did and did not receive OHI alongside the scale and polish in Comparison 3.
For Comparison 4 we compared group 4A (scale and polish with OHI at three-month intervals) with group 4B (scale and polish without OHI at three-month intervals) and group 2 (scale and polish with OHI at 12-month intervals) with group 1 (scale and polish without OHI at 12-month intervals). In this study, group 2 received one scale and polish treatment per year given in two 30-minute appointments, five to 11 days apart. Similarly, group 3 received two scale and polish treatments per year, the first of which was provided over two visits, five to 11 days apart. In our comparisons and analyses, groups 2 and 3 have been described as '12-month interval' and 'six-month interval' groups respectively and no distinction has been drawn between the 'two-visit' and 'one-visit' scale and polish treatments.

In Listgarten 1985 no standard deviations for the data were given in the paper. In order to use the data we made the assumption that the standard deviations would be similar to those from the Listgarten 1986. To be conservative we assumed a common standard deviation for the test and control groups based on the control group standard deviation for the Listgarten 1986 study that was larger than that for the test. As no statistically significance differences were found, an analysis assuming larger standard deviations than this would not affect the results and conclusions for this study.

 

Excluded studies

Of the 88 potentially relevant papers considered, 83 study reports (of 75 studies) were excluded. Although many studies could be excluded for more than one reason, in general only the main reason for exclusion has been recorded in the Characteristics of excluded studies table.

 

Ongoing studies

There is one ongoing study funded by the National Health Service in the UK, ISRCTN56465715, which will be included in a future version of this review (Characteristics of ongoing studies). The trial should be published in 2016/17.

 

Risk of bias in included studies

The review authors' judgements about each risk of bias item presented as percentages across all included studies is given in Figure 1, and the review authors' judgements about each risk of bias item for each included study is given in Figure 2.

 FigureFigure 1. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
 FigureFigure 2. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

 

Allocation

 

Random sequence generation

One study was judged to be at low risk of bias for random sequence generation, as a computer generated sequence was used (Jones 2011). The other two studies were judged to be at unclear risk of bias for this. Listgarten 1985 gave no more information than that they were "randomised" and Lightner 1971, that patients were "randomly assigned."

 

Allocation concealment

One study described the randomisation as centrally randomised and was judged as at low risk of bias (Jones 2011). Neither of the other studies described adequate methods of allocation concealment and were therefore classified as being at unclear risk of bias for this domain.

 

Blinding

Participant blinding was not possible in any of the studies and was not considered as part of the risk of bias assessment. We assessed blinding for the outcome assessors.

Two studies described adequate outcome assessor blinding and were therefore classified as being at low risk of bias for this domain (Jones 2011; Lightner 1971). The remaining study was classified as being at unclear risk of bias as the outcome assessor blinding was unclear in the report (Listgarten 1985).

 

Incomplete outcome data

Jones 2011 was considered to be at low risk of attrition bias due to approximately equal numbers withdrawing from each treatment group and full explanations provided of reasons for withdrawal. Risk of attrition bias was assessed as unclear in the other two trials due to either high attrition or lack of reporting of reasons.

 

Selective reporting

All three studies reported all the outcomes planned in the methods section in full and were all assessed as at low risk of reporting bias (Jones 2011; Lightner 1971; Listgarten 1985).

 

Other potential sources of bias

All three studies were assessed as being at unclear risk of bias for this domain for different reasons. There was possible bias resulting from the withdrawal of patients with Basic Periodontal Examination (BPE) > 3 in one study (Jones 2011). In the other two studies there was baseline imbalance in important prognostic factors (Lightner 1971; Listgarten 1985).

 

Overall risk of bias

We judged the risk of bias for all three studies as unclear (Jones 2011; Lightner 1971; Listgarten 1985).

 

Effects of interventions

See:  Summary of findings for the main comparison;  Summary of findings 2;  Summary of findings 3;  Summary of findings 4

 

Comparison 1: Scale and polish versus no scale and polish (Objective 1)

Only one study at unclear risk of bias provided data for this comparison (Jones 2011), where both a six-monthly scale and polish and a 12-monthly scale and polish treatments are compared with no scale and polish. The clinical data are shown graphically as forest plots for the three outcomes of gingivitis, calculus and plaque at 24 months ( Analysis 1.1;  Analysis 1.2;  Analysis 1.3).

 

Six-monthly scale and polish versus no scale and polish

  • Mean difference (MD) = -0.02 (95% confidence interval (CI) -0.10 to 0.06) for gingivitis (mean proportion of bleeding sites per patient); P value = 0.65.
  • MD = -0.24 (95% CI -0.51 to 0.03) for calculus (mm); P value = 0.08.
  • MD = -0.04 (95% CI -0.13 to 0.05) for plaque (mean proportion of sites with plaque per patient); P value = 0.35.

 

12-monthly scale and polish versus no scale and polish

  • MD = -0.01 (95% CI -0.09 to 0.07) for gingivitis (mean proportion of bleeding sites per patient); P value = 0.82.
  • MD= -0.06 (95% CI -0.33 to 0.21) for calculus (mm); P value = 0.67.
  • MD = -0.00 (95% CI -0.10 to 0.09) for plaque (mean proportion of sites with plaque per patient); P value = 0.97.

 

Patient-centred outcomes

At 24 months, participants in the no scale and polish group were significantly less likely (P value < 0.001) to report a 'high' level of oral cleanliness (29%, odds ratio (OR) 0.36; 95% CI 0.20 to 0.65) compared to the six-month group (52%), or the 12-month group (47%, OR 0.45; 95% CI 0.25 to 0.81).

There is little evidence from this study that scale and polish at six-monthly or 12-monthly intervals was beneficial when compared with no scale and polish.

 

Comparison 2: Scale and polish at a fixed interval versus scale and polish in response to the signs or symptoms or both of periodontal disease (Objective 2)

One study assessed as at unclear risk of bias provided data for this comparison (Listgarten 1985). A six-monthly scale and polish was compared with a variable scale and polish interval determined by the results of a differential dark-field microscopy (DDFM) test. The data for the three outcomes reported (gingivitis, plaque and pocket depth) are shown for all time points measured (6, 12, 18, 24, 30, and 36 months) in Additional  Table 5. There was no evidence that six-monthly scale and polish was better than or worse than variable interval scale and polish for the outcomes of gingivitis, plaque or pocket depth. The mean differences for each outcome at 24 months are given below:

  • MD 0.05 (95% CI -0.08 to 0.18) gingivitis (mean per patient based on 0-3 scale); P value = 0.45
  • MD -0.10 (95% CI -0.22 to 0.02) plaque (mean per patient based on 0-3 scale); P value = 0.10
  • MD -0.05 (95% CI -0.14 to 0.04) pocket depth (mm); P value = 0.17.

 

Comparison 3: Scale and polish at a fixed interval versus scale and polish at a different fixed interval (Objective 2)

Two studies at unclear risk of bias provided data for this comparison comparing different fixed intervals of treatment (Jones 2011; Lightner 1971). The data are shown for gingivitis, calculus and plaque at all time points measured in Additional  Table 6. As both studies provided data at the 24-month follow-up assessment, these data are also shown in forest plots ( Analysis 3.1;  Analysis 3.2;  Analysis 3.3;  Analysis 3.4). The results for each individual comparison are summarised below.

 

Three months versus six months

Only one study at unclear risk of bias (Lightner 1971) provided data and there was no evidence of any differences in gingivitis, calculus or plaque comparing three and six-monthly scale and polish treatments. The 24-month outcome data are presented below:

  • MD -0.10 (95% CI -0.20 to 0.00) gingivitis (mean per patient based on 0-3 scale); P value = 0.04
  • MD 0.00 (95% CI -0.13 to 0.13) calculus (mean per patient based on 0-3 scale); P value = 1.00
  • MD 0.05 (95% CI -0.08 to 0.18) plaque (mean per patient based on 0-3 scale); P value = 0.44.

 

Three months versus 12 months

Only one study at unclear risk of bias (Lightner 1971) provided data for this comparison. Levels of gingivitis, calculus and plaque were consistently lower in the three-month scale and polish treatment group compared to the 12-month group. The outcome data after 24 months of follow-up are presented below:

  • MD -0.14 (95% CI -0.23 to -0.05) gingivitis (mean per patient based on 0-3 scale); P value = 0.003
  • MD -0.13 (95% CI -0.25 to -0.01) calculus (mean per patient based on 0-3 scale); P value = 0.04
  • MD -0.02 (95% CI -0.14 to 0.10) plaque (mean per patient based on 0-3 scale); P value = 0.75.

For scale and polish alone, without oral hygiene instruction (OHI) in either group, there are consistent statistically significant differences favouring three-monthly scale and polish compared to 12-monthly scale and polish for the outcomes of gingivitis, calculus and plaque. The 24-month outcome data are presented below:

  • MD -0.21 (95% CI -0.30 to -0.12) gingivitis (mean per patient based on 0-3 scale); P value < 0.001
  • MD -0.18 (95% CI -0.30 to -0.06) calculus (mean per patient based on 0-3 scale); P value = 0.005
  • MD -0.15 (95% CI -0.27 to -0.03) plaque (mean per patient based on 0-3 scale); P value = 0.02.

 

Six months versus 12 months (with OHI)

Most of these results (Additional  Table 6) were based on a single study (Lightner 1971), but outcome data for this comparison for 24 months of follow-up were based on the meta-analysis of two studies (Jones 2011; Lightner 1971) ( Analysis 3.4), both assessed as at unclear risk of bias. A standardised mean difference (SMD) was used to combine the different scales used for all three outcome measurements:

  • SMD -0.08 (95% CI -0.27 to 0.10) gingivitis; P value = 0.38
  • SMD -0.25 (95% CI -0.44 to -0.06) calculus; P value = 0.009
  • SMD -0.16 (95% CI -0.35 to 0.03) plaque; P value = 0.10.

There is some weak evidence that calculus is reduced for the six-monthly scale and polish treatment, but no difference between scale and polish at six-month and 12-month intervals for the outcomes of gingivitis and plaque.

 

Patient-centred outcomes

Jones 2011 reported some patient-centred outcome data. At 24 months there was no significant difference between the 12-month group (47%, OR 0.95; 95% CI 0.53 to 1.70) and the six-month group.

 

Comparison 4: Scale and polish with OHI at a fixed interval versus scale and polish without OHI at the same fixed interval (Objective 3)

This comparison is to evaluate the effect of combining oral hygiene instruction with the scale and polish treatment. One study (Lightner 1971) provided data comparing a three-monthly scale and polish treatment with or without OHI for the outcomes of gingivitis, calculus and plaque. This study also compared 12-monthly scale and polish treatment with or without OHI. The data are shown for gingivitis, calculus and plaque at all time points measured in Additional  Table 7. These data are also shown in forest plots ( Analysis 4.1;  Analysis 4.2). The results for each individual comparison are summarised below.

 

Three-monthly scale and polish treatment

After 24 months there was evidence of a difference favouring three-monthly scale and polish with OHI being associated with significantly lower plaque levels. There was no evidence of a difference in the outcomes of gingivitis or calculus for this comparison. The results for the 24-month assessment are given below:

  • MD -0.07 (95% CI -0.18 to 0.04) gingivitis (mean per patient based on 0-3 scale); P value = 0.20
  • MD -0.02 (95% CI -0.16 to 0.12) calculus (mean per patient based on 0-3 scale); P value = 0.78
  • MD -0.17 (95% CI -0.31 to -0.03) plaque (mean per patient based on 0-3 scale); P value = 0.02.

 

12-monthly scale and polish treatment

There was evidence of a difference favouring 12-monthly scale and polish with OHI being associated with lower gingivitis and plaque levels after 24 months of follow-up.The results for the 24-month assessment are given below:

  • MD -0.14 (95% CI -0.22 to -0.06) gingivitis (mean per patient based on 0-3 scale); P value < 0.001
  • MD -0.07 (95% CI -0.18 to 0.04) calculus (mean per patient based on 0-3 scale); P value = 0.20
  • MD -0.30 (95% CI -0.41 to -0.19) plaque (mean per patient based on 0-3 scale); P value < 0.001.

 

Comparison 5: Scale and polish by a dentist versus scale and polish by a dental care professional (Objective 4)

No studies were found for this comparison.

 

Discussion

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

The three studies included in this review were clinically and methodologically heterogeneous, one being conducted in general practice, one in a dental school and the third on US Air Force cadets, however they did provide some limited data for three of the four objectives of the review. Only two studies compared the same outcomes for the same comparison and could be included in a meta-analysis.

 

Summary of main results

 

Objective 1: Routine scale and polish versus no scale and polish

One study (Jones 2011) provided data for the comparison between scale and polish versus no scale and polish. The patient population and setting for Jones 2011 were most appropriate to answer the questions posed by this review, and this study was assessed as at unclear risk of bias. Jones 2011 provides a comparison between six-monthly and 12-monthly scale and polish treatments with no treatment, with a follow-up of 24 months. This study was conducted in general dental practice and included patients attending for check-up appointments who had no pockets greater than 3.5 mm. After 24 months of follow-up there were no clinically important differences between scale and polish treatments and no treatment for the outcomes of gingivitis, calculus and plaque. This body of evidence (a single study, at unclear risk of bias), was considered to be of low quality and should be interpreted with caution.

 

Objective 2: Routine scale and polish at different time intervals on periodontal health (based on a test for periodontal disease)

One study (Listgarten 1985) provided data for the comparison between scale and polish at a fixed interval versus scale and polish in response to the signs or symptoms or both of periodontal disease. This study compared scale and polish provided at six-monthly intervals with scale and polish provided in response to bacterial assessments. No statistically significant differences were observed between treatment (scale and polish in response to bacterial assessments) and control (six-monthly scale and polish) groups at any time point over the course of this three-year trial. Participants in the treatment group were initially recalled more frequently than those in the control group, however, by the end of the trial, recall intervals for scaling and polishing were considerably extended for many participants in the treatment group and 11 participants had not received a scale and polish by the end of the study. Despite this extension of recall interval, the periodontal health of participants in the test group (as measured using the outcomes gingivitis, plaque and pocket depth) was not adversely affected compared to the control group. However, neither treatment nor control regimen was successful in preventing gingivitis and mean gingival index scores in control and test groups generally increased at each time point over the course of the trial.

Two studies (Jones 2011; Lightner 1971) provided data for the comparison between scale and polish at a fixed interval versus scale and polish at a different fixed interval. The studies were conducted in two distinct populations -regular attenders in general practice (Jones 2011) and young adult males aged 17 to 22 years (Lightner 1971). As already mentioned the patient population and setting for Jones 2011 were most appropriate to answer some of the questions posed by this review. There were consistent results in Lightner 1971 towards improved outcomes (lower levels of plaque, calculus and gingivitis) in more frequent interval groups compared with less frequent interval groups. However, the differences generally only reached statistical significance when comparisons were made between the most frequent interval groups (scale and polish delivered at three or four-monthly intervals) with the least frequent interval groups (scale and polish delivered at 12-monthly intervals). We have reported the comparison between six-monthly and 12-monthly scale and polish intervals combined with oral hygiene instruction ( Analysis 3.4) in the summary of findings table. The body of evidence was assessed as of low quality.

 

Objective 3: Scale and polish with and without oral hygiene instruction (OHI)

Only one study (Lightner 1971) provided data for the comparison between scale and polish with OHI at a fixed interval versus scale and polish without OHI at the same fixed interval. The provision of OHI in conjunction with three-monthly and 12-monthly scale and polish treatments was associated with significantly lower plaque levels and significantly lower plaque and gingivitis levels respectively after 24 months of follow-up. However, the effect sizes were generally small. The body of evidence for comparing scale and polish treatments with and without OHI was assessed as of low quality.

 

Objective 4: Scale and polish provided by a dentist compared with a dental care professional

No included studies provided data for this objective.

 

Overall completeness and applicability of evidence

One of the included studies (Jones 2011) was more appropriate than the others for answering many of the questions posed by this review. This study was conducted on adults attending their dentist in general dental practice for check-ups. More trials in a primary care setting including a more representative group of participants with higher levels of disease would enhance the evidence base for answering the questions posed by this review. The other two older studies were not conducted in primary care, and included patients who were either young, or who had had or were referred for treatment for periodontal disease. It is difficult to envisage how the experimental intervention in Listgarten 1985 could reasonably be used in general practice and its applicability in different patient populations with varying levels of risk for destructive periodontitis is uncertain.

Three of the four objectives were addressed by at least one included trial, however there were no trials addressing the fourth objective comparing scale and polish provided by a dentist with a professional complementary to dentistry.

 

Outcomes reported

The outcomes used in different studies were measured using different indices. The three included studies reported: three different gingivitis indices, two different calculus indices, three different plaque indices and probing depth was only reported in one study. Many primary and secondary outcomes were not reported in any of the three studies: tooth loss, attachment change, adverse events and economic cost factors. It is important that trials measure the harms as well as the benefits of interventions. Scaling is an invasive procedure and has been associated with a number of adverse effects, including damaged enamel surfaces by repeated scaling, tooth sensitivity and gingival recession (Brothwell 1998). It is also recognised that subgingival scaling of shallow pockets can cause permanent loss of periodontal attachment (Brothwell 1998). The latter would have been captured in 'attachment change' data but these were not reported in any of the trials included in this review. It would undoubtedly be advisable for future randomised controlled trials assessing the effects of scaling and polishing to report on adverse events to allow for a more balanced appraisal of benefits and harms.

It is increasingly recognised that the signs and symptoms of periodontal disease can impact on patients' oral health related quality of life (Needleman 2004). Therefore, interventions designed to ameliorate these signs and symptoms might be expected to have a positive impact on a patient's quality of life. However, studies of the effects of periodontal therapy have only rarely used patient-centred outcome measures (Elley 2000; Needleman 2004) and none of the trials included in this review reported such outcomes. We are therefore unable to make any statements regarding the impact of routine scaling and polishing (as defined in this review) on patients' quality of life.

Similarly, although economic cost outcomes (such as time foregone to attend for appointments and provider costs) are relevant to the debate regarding the merits and demerits of routine scaling and polishing, such outcomes were not reported in any trials included in this review.

Again, it would be advisable for future trials to include quality of life and economic cost outcomes to allow for a full evaluation of the beneficial and harmful effects of this intervention.

 

Quality of the evidence

Given the considerable resources involved in providing routine scale and polish treatments for adults in many countries (DoH 2000; Frame 2000), it is disappointing that there is a paucity of good quality, reliable research evidence to inform clinical practice. Only three studies met the inclusion criteria for this review, all judged to be at unclear risk of bias. It is impossible to blind patients to the timing of scale and polish treatments, and as having a scale and polish treatment may influence personal oral hygiene behaviour, participant blinding was not included in the risk of bias assessment. The quality of the body of evidence available for each outcome (gingivitis, calculus and plaque) for three of the four objectives of this review was found to be low ( Summary of findings for the main comparison;  Summary of findings 2;  Summary of findings 3;  Summary of findings 4). Therefore the results presented in this review should be interpreted cautiously.

 

Potential biases in the review process

A sensitive search strategy was used for this review. Every effort was made to identify all relevant studies. No studies were excluded due to language restrictions.

Data collection and analysis were done by two review authors independently, and any disagreement between review authors was resolved by discussion to minimise/exclude bias during the review process.

It is possible not all relevant studies have been identified for inclusion in this review due to grey literature bias and the publication of studies in non-indexed journals. In addition, post-hoc changes to a protocol may potentially bias the results of a review. For this updated review we made some important alternations to the selection criteria specified in the original protocol. Firstly, we excluded split-mouth studies as this design does not reflect the manner in which routine scaling and polishing is provided in practice. Secondly, we excluded trials where participants were described as having severe periodontal disease (e.g. alveolar bone loss involving most teeth or individuals requiring referral for specialist periodontal treatment). We also excluded trials where participants had undergone specialist periodontal treatment in the six months preceding the trial and who were in the 'maintenance phase.' These exclusions were made because best clinical practice would suggest that these categories of patients should receive more advanced periodontal treatment than the 'routine scale and polish' as defined in this review. Finally, we also excluded trials where only a single scale and polish treatment was provided as, once again, this does not reflect the manner in which 'routine scaling and polishing' is provided in practice. As specified in the Background section of our review, a 'routine scale and polish' is an intervention that is intended to be provided at regular intervals to patients, and not as a 'stand alone' intervention provided at a single point in time.

We consider that these adjustments to the selection criteria have resulted in a review that will ultimately be more useful to practitioners who are providing 'routine scale and polish treatments' and patients who are receiving this intervention.

 

Agreements and disagreements with other studies or reviews

We did not find any other reviews that addressed the specific objectives of this Cochrane review. Reviews of oral health promotion and dental health education have demonstrated that, in general, oral hygiene instruction can induce limited behaviour change in patients and reduce plaque levels in the short term, but there is no lasting effect (Brown 1994; Kay 1996; Kay 1998; Sprod 1996). In our review only one trial (Lightner 1971) evaluated the effects of providing oral hygiene instruction in conjunction with scale and polish treatments on plaque levels. The provision of oral hygiene instruction with three-monthly and 12-monthly scale and polish treatments was associated with small but statistically significant reductions in plaque at 24 and 48 months when compared with three-monthly and 12-monthly scale and polish treatments without oral hygiene instruction.

 

Authors' conclusions

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

 

Implications for practice

There is insufficient evidence to determine the effects of routine scale and polish treatments.

 
Implications for research

There is a need for well conducted trials in this area which include a sufficient number of patients to detect a true difference, if any, and that are of sufficient duration (five years or more). Given that scaling and polishing is a commonly provided intervention in general dental practice, we would recommend that additional trials should be conducted in primary care settings and considered as a complex intervention with oral hygiene instruction. Outcomes should include clinical measures (such as those reported in the trials included in this review) and tooth loss, patient-centred factors and economic factors. As one of the principal known aetiological agents (plaque) is the same for gingivitis and periodontitis, long-term studies may also include caries outcomes. In addition, studies should be carried out to determine the clinical effectiveness and cost effectiveness of routine scaling and polishing provided by different dental personnel. We would also recommend that due attention be given in future studies to what levels of improvement in various outcomes should be considered clinically significant. Such information is needed to help guide changes in actual dental practice. It is also recommended that all trials should be reported according to the Consolidated Standards of Reporting Trials (CONSORT) guidelines (www.consort-statement.org/).

 

Acknowledgements

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

We acknowledge the contribution of Andrew Forgie to the protocol of the review. We wish to thank Anne Littlewood (Cochrane Oral Health Group) for her assistance with literature searching; Luisa Fernandez Mauleffinch and Phil Riley (Cochrane Oral Health Group) for their help with the preparation of this review; Regina Mitezki for translating three German articles; Mikako Hayashi for translating a Japanese study; Lowell Smith, Ram Nanda, Jan Lindhe and Lim Lum Pen for responding to our requests for information on specific trials. The review authors are also grateful for the comments of members of the Guideline Development Group on recall intervals between routine dental examinations conducted under the auspices of the National Institute for Health and Care Excellence (NICE) and co-ordinated by the National Collaborating Centre for Acute Care. In particular the review authors would like to thank Jacqueline Dutchak and Nigel Pitts.

 

Data and analyses

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms
Download statistical data

 
Comparison 1. Scale and polish versus no scale and polish (control)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Gingivitis at 24 months1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    1.1 6-monthly S&P
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    1.2 12-monthly S&P
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 2 Calculus at 24 months1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    2.1 6-monthly S&P
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    2.2 12-monthly S&P
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 3 Plaque at 24 months1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    3.1 6-monthly S&P
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    3.2 12-monthly S&P
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 2. Scale and polish at a fixed interval versus scale and polish in response to the signs and/or symptoms of perio

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Gingivitis at 24 months1Mean Difference (IV, Fixed, 95% CI)Totals not selected

 2 Plaque at 24 months1Mean Difference (IV, Fixed, 95% CI)Totals not selected

 3 Pocket depth at 24 months1Mean Difference (IV, Fixed, 95% CI)Totals not selected

 
Comparison 3. Scale and polish at a fixed interval versus scale and polish at a different fixed interval

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 S&P: 3-monthly versus 6-monthly (with OHI)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    1.1 Gingivitis at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    1.2 Calculus at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    1.3 Plaque at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 2 S&P: 3-monthly versus 12-monthly (with OHI)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    2.1 Gingivitis at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    2.2 Calculus at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    2.3 Plaque at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 3 S&P: 3-monthly versus 12-monthly (without OHI)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    3.1 Gingivitis at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    3.2 Calculus at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    3.3 Plaque at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 4 S&P: 6-monthly versus 12-monthly (with OHI)2Std. Mean Difference (IV, Fixed, 95% CI)Subtotals only

    4.1 Gingivitis at 24 months
2438Std. Mean Difference (IV, Fixed, 95% CI)-0.08 [-0.27, 0.10]

    4.2 Calculus at 24 months
2438Std. Mean Difference (IV, Fixed, 95% CI)-0.25 [-0.44, -0.06]

    4.3 Plaque at 24 months
2438Std. Mean Difference (IV, Fixed, 95% CI)-0.16 [-0.35, 0.03]

 
Comparison 4. Scale and polish at a fixed interval with OHI versus scale and polish without OHI at the same fixed interval

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 S&P every 3 months with OHI versus without OHI1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    1.1 Gingivitis at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    1.2 Calculus at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    1.3 Plaque at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 2 S&P every 12 months with OHI versus without OHI1Mean Difference (IV, Fixed, 95% CI)Totals not selected

    2.1 Gingivitis at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    2.2 Calculus at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

    2.3 Plaque at 24 months
1Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

 

Appendices

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms
 

Appendix 1. MEDLINE (OVID) search strategy

1. exp Periodontal Diseases/
2. (periodonti$ or (periodont$ adj3 disease$)).ti,ab.
3. gingivitis.ti,ab.
4. ((gingiva$ or gum$) adj5 (inflam$ or disease$ or bleed$ or swell$)).ti,ab.
5. Dental plaque/
6. Dental calculus/
7. ((tooth or teeth or dental) adj5 (plaque or calculus)).ti,ab.
8. or/1-7
9. exp Dental prophylaxis/
10. ((dental or tooth or teeth) and (scal$ or polish$ or prophylax$)).ti,ab.
11. (periodont$ adj5 scal$).ti,ab.
12. or/9-11
13. 8 and 12

The above subject search was linked to the Cochrane Highly Sensitive Search Strategy (CHSSS) for identifying randomised trials in MEDLINE: sensitivity maximising version (2008 revision) as referenced in Chapter 6.4.11.1 and detailed in box 6.4.c of theCochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0 [updated March 2011] (Higgins 2011).

1. randomized controlled trial.pt.
2. controlled clinical trial.pt.
3. randomized.ab.
4. placebo.ab.
5. drug therapy.fs.
6. randomly.ab.
7. trial.ab.
8. groups.ab.
9. or/1-8
10. exp animals/ not humans.sh.
11. 9 not 10

 

Appendix 2. EMBASE (OVID) search strategy

1. exp Periodontal Disease/
2. (periodonti$ or (periodont$ adj3 disease$)).ti,ab.                       
3. gingivitis.ti,ab.
4. ((gingiva$ or gum$) adj5 (inflam$ or disease$ or bleed$ or swell$)).ti,ab.
5. Tooth plaque/
6. Tooth calculus/
7. ((tooth or teeth or dental) adj5 (plaque or calculus)).ti,ab.       
8. or/1-7
9. ((dental or tooth or teeth) and (scal$ or polish$ or prophylax$)).ti,ab.
10. (periodont$ adj5 scal$).ti,ab.
11. 9 or 10
12. 8 and 11

The above subject search was linked to the Cochrane Oral Health Group filter for identifying RCTs in EMBASE via OVID:

1. random$.ti,ab.
2. factorial$.ti,ab.
3. (crossover$ or cross over$ or cross-over$).ti,ab.
4. placebo$.ti,ab.
5. (doubl$ adj blind$).ti,ab.
6. (singl$ adj blind$).ti,ab.
7. assign$.ti,ab.
8. allocat$.ti,ab.
9. volunteer$.ti,ab.
10. CROSSOVER PROCEDURE.sh.
11. DOUBLE-BLIND PROCEDURE.sh.
12. RANDOMIZED CONTROLLED TRIAL.sh.
13. SINGLE BLIND PROCEDURE.sh.
14. or/1-13
15. ANIMAL/ or NONHUMAN/ or ANIMAL EXPERIMENT/
16. HUMAN/
17. 16 and 15
18. 15 not 17
19. 14 not 18

 

Appendix 3. Cochrane Oral Health Group's Trials Register search strategy

From July 2013, searches of the Cochrane Oral Health Group's Trials Register were undertaken using the Cochrane Register of Studies and the search strategy below:

#1 ((routine* or recall* or regular* or periodic* or "six month*" or six-month* or "6 month*" or 6-month* or "three month*" or three-month* or "3 month*" or 3-month*):ti,ab) AND (INREGISTER)
#2 ((scaling or "scale and polish" or "dental prophylaxis" or "oral prophylaxis"):ti,ab) AND (INREGISTER)
#3 (#1 and #2) AND (INREGISTER)

Searches previous to July 2013 were undertaken using the Procite software and the search strategy below:

(((scaling OR "scale and polish" OR "dental prophylaxis" OR "oral prophylaxis" OR periodont*) AND (periodic* OR routine* OR recall* OR six-month* OR three-month*)) OR (("periodic check-up*" OR "regular check-up" OR "regular examination" OR "regular care" OR "routine care" OR "routine* recall*" OR "six-month* check-up" OR "six-month* inspect*" OR "six-month* recall*" OR "6 month* check-up*" OR "6 month* inspect*" OR "6 month* recall*" OR "three-month* check-up*" OR "three-month* inspect*" OR "three month* recall*" OR "3 month* check-up" OR "3 month* inspect*" OR "3 month* recall*")))

 

Appendix 4. Cochrane Central Register of Controlled Trials (CENTRAL) search strategy

#1 MeSH descriptor Periodontal Diseases explode all trees
#2 (peridonti* in Title, Abstract or Keywords or (periodont* in Title, Abstract or Keywords near/3 disease* in Title, Abstract or Keywords) )
#3 gingivitis in Title, Abstract or Keywords
#4 ( (gingiva* in Title, Abstract or Keywords near/5 inflam* in Title, Abstract or Keywords) or (gingiva* in Title, Abstract or Keywords near/5 disease* in Title, Abstract or Keywords) or (gingiva* in Title, Abstract or Keywords near/5 bleed* in Title, Abstract or Keywords) or (gingiva* in Title, Abstract or Keywords near/5 swell* in Title, Abstract or Keywords) )
#5 ( (gum* in Title, Abstract or Keywords near/5 inflam* in Title, Abstract or Keywords) or (gum* in Title, Abstract or Keywords near/5 disease* in Title, Abstract or Keywords) or (gum* in Title, Abstract or Keywords near/5 bleed* in Title, Abstract or Keywords) or (gum* in Title, Abstract or Keywords near/5 swell* in Title, Abstract or Keywords) )
#6 MeSH descriptor Dental plaque this term only
#7 MeSH descriptor Dental calculus this term only
#8 ( (tooth in Title, Abstract or Keywords near/5 plaque in Title, Abstract or Keywords) or (teeth in Title, Abstract or Keywords near/5 plaque in Title, Abstract or Keywords) or (dental in Title, Abstract or Keywords near/5 plaque in Title, Abstract or Keywords) )
#9 ( (tooth in Title, Abstract or Keywords near/5 calculus in Title, Abstract or Keywords) or (teeth in Title, Abstract or Keywords near/5 calculus in Title, Abstract or Keywords) or (dental in Title, Abstract or Keywords near/5 calculus in Title, Abstract or Keywords) )
#10 (#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9)
#11 MeSH descriptor Dental prophylaxis explode all trees
#12 ( (dental in Title, Abstract or Keywords near/5 scal* in Title, Abstract or Keywords) or (tooth in Title, Abstract or Keywords near/5 scal* in Title, Abstract or Keywords) or (teeth in Title, Abstract or Keywords near/5 scal* in Title, Abstract or Keywords) or (dental in Title, Abstract or Keywords near/5 polish* in Title, Abstract or Keywords) or (tooth in Title, Abstract or Keywords near/5 polish* in Title, Abstract or Keywords) or (teeth in Title, Abstract or Keywords near/5 polish* in Title, Abstract or Keywords) or (dental in Title, Abstract or Keywords near/5 prophylax* in Title, Abstract or Keywords) or (tooth in Title, Abstract or Keywords near/5 prophylax* in Title, Abstract or Keywords) or (teeth in Title, Abstract or Keywords near/5 prophylax* in Title, Abstract or Keywords) )  
#13 (periodont* in Title, Abstract or Keywords near/5 scal* in Title, Abstract or Keywords)  
#14 (#11 or #12 or #13)
#15 (#10 and #14)

 

Appendix 5. The metaRegister of Controlled Trials and NLM Clinical Trials Register search strategy

The metaRegister of Controlled Trials (www.controlled-trials.com) and NLM Clinical Trials Register (www.clinicaltrials.gov) were searched using the following keyword searches:

scale or scaling
polish or polishing

 

What's new

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

Last assessed as up-to-date: 15 July 2013.


DateEventDescription

5 November 2013New citation required but conclusions have not changedNew methods including risk of bias implemented. Inclusion criteria modified to exclude patients with severe periodontitis, split-mouth studies and studies that included only a single visit for scale and polish treatment. 1 new study and only 2 of the original included studies now included in the review. Summary of findings tables added.

15 July 2013New search has been performedSearch strategy amended and updated to July 2013.



 

History

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

Protocol first published: Issue 1, 2004
Review first published: Issue 1, 2005


DateEventDescription

19 June 2008AmendedConverted to new review format.

10 August 2007New citation required and conclusions have changedSubstantive amendment. 1 new trial (Westfelt 1983) has been included in this update bringing the total number of included trials up to 9.



 

Contributions of authors

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

Paul Beirne (PB), Helen Worthington (HW), Jan Clarkson (JC) and Andrew Forgie (AF) wrote the protocol. For the initial review PB and AF decided which studies were eligible. All four current authors have been involved in the final decisions on inclusion/exclusion. Risk of bias assessments were made by Gemma Bryan (GB) and Helen Worthington (HW). Data extraction and analysis were undertaken by PB, JC and HW. The review update was written by HW, JC and GB.

 

Declarations of interest

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

Helen V Worthington: no interests to declare.
Jan E Clarkson: no interests to declare.
Gemma Bryan: no interests to declare.
Paul V Beirne: no interests to declare.

 

Sources of support

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms
 

Internal sources

  • The School of Dentistry, The University of Manchester, UK.
  • The University of Dundee, UK.
  • NHS Education for Scotland, UK.
  • University College Cork, Ireland.
  • Manchester Academic Health Sciences Centre (MAHSC), UK.
    The Cochrane Oral Health Group is supported by MAHSC and the NIHR Manchester Biomedical Research Centre.

 

External sources

  • National Institute for Health and Care Excellence, UK.
  • Cochrane Fellowship - Health Research Board, Ireland.
  • Department of Health Cochrane Review Incentive Scheme, UK.
  • Cochrane Oral Health Group Global Alliance, UK.
    All reviews in the Cochrane Oral Health Group are supported by Global Alliance member organisations (British Association of Oral Surgeons, UK; British Orthodontic Society, UK; British Society of Paediatric Dentistry, UK; British Society of Periodontology, UK; Canadian Dental Hygienists Association, Canada; National Center for Dental Hygiene Research & Practice, USA; Mayo Clinic, USA; New York University College of Dentistry, USA; and Royal College of Surgeons of Edinburgh, UK) providing funding for the editorial process (http://ohg.cochrane.org/).
  • National Institute for Health Research (NIHR), UK.
    CRG funding acknowledgement:
    The NIHR is the largest single funder of the Cochrane Oral Health Group.
    Disclaimer:
    The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health.

 

Differences between protocol and review

  1. Top of page
  2. Summary of findings    [Explanations]
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Differences between protocol and review
  18. Index terms

We have tightened up the inclusion criteria to exclude split-mouth studies, studies including participants with severe periodontal disease, participants who had been referred for specialist treatment, or who had undergone specialist periodontal treatment and were in the maintenance phase. We also excluded studies with only a single scale and polish treatment. In a previous version the search strategy was amended and the primary and secondary outcomes altered.

* Indicates the major publication for the study

References

References to studies included in this review

  1. Top of page
  2. AbstractRésumé scientifique
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. References to ongoing studies
  23. Additional references
  24. References to other published versions of this review
Jones 2011 {published data only}
  • Jones CL, Macfarlane TV, Milsom KM, Ratcliffe P, Wyllie A, Tickle M. Patient perceptions regarding benefits of single visit scale and polish: a randomised controlled trial. BMC Oral Health 2013;13:50.
  • Jones CL, Milsom KM, Ratcliffe P, Wyllie A, Macfarlane TV, Tickle M. Clinical outcomes of single-visit oral prophylaxis: a practice-based randomised controlled trial. BMC Oral Health 2011;11:35.
Lightner 1971 {published data only}
  • Lightner LM, O'Leary JT, Drake RB, Crump PP, Allen MF. Preventive periodontic treatment procedures: results over 46 months. Journal of Periodontology 1971;42(9):555-61.
Listgarten 1985 {published data only}

References to studies excluded from this review

  1. Top of page
  2. AbstractRésumé scientifique
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. References to ongoing studies
  23. Additional references
  24. References to other published versions of this review
Adachi 2002 {published data only}
  • Adachi M, Ishihara K, Abe S, Okuda K, Ishikawa T. Effect of professional oral health care on the elderly living in nursing homes. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics 2002;94(2):191-5.
Addy 1988 {published data only}
  • Addy M, Hassan H, Moran J, Wade W, Newcombe R. Use of antimicrobial containing acrylic strips in the treatment of chronic periodontal disease. A three month follow-up study. Journal of Periodontology 1988;59(9):557-64.
Aldridge 1995 {published data only}
Ashley 1981 {published data only}
Axelsson 1975 {published data only}
Axelsson 1977 {published data only}
Axelsson 1981 {published data only}
Axelsson 1987 {published data only}
  • Axelsson P, Kristoffersson K, Karlsson R, Bratthall D. A 30-month longitudinal study of the effects of some oral hygiene measures on streptococcus mutans and approximal dental caries. Journal of Dental Research 1987;66:761-5.
Axelsson 2004 {published data only}
Badersten 1984 {published data only}
Bellini 1981 {published data only}
Bonner 2005 {published data only}
  • Bonner BC, Young L, Smith PA, McCombes W, Clarkson JE. A randomised controlled trial to explore attitudes to routine scale and polish and compare manual versus ultrasonic scaling in the general dental service in Scotland (ISRCTN99609795). BMC Oral Health 2005;5:3.
Brown 2002 {published data only}
  • Brown JB, Rosenstein D, Mullooly J, O' Keeffe Rosetti M, Robinson S, Chiodo G. Impact of intensified dental care on outcomes in Human Immunodeficiency Virus Infection. AIDS Patient Care and STDs 2002;16(10):479-86.
Budtz-Jorgensen 2000 {published data only}
Chapple 1995 {published data only}
  • Chapple ILC, Walmsley DA, Saxby MS, Moscrop H. Effect of instrument power setting during ultrasonic scaling upon treatment outcome. Journal of Periodontology 1995;66:756-60.
Chawla 1975 {published data only}
  • Chawla TN, Nanda RS, Kapoor KK. Dental prophylaxis procedures in control of periodontal disease in Lucknow (rural) India. Journal of Periodontology 1975;46(8):498-503.
Cutress 1991 {published data only}
  • Cutress TW, Powell RN, Kilisimasi S, Tomiki S, Holborow D. A 3-year community-based periodontal disease prevention programme for adults in a developing nation. International Dental Journal 1991;41(6):323-34.
Feldman 1988 {published data only}
Glavind 1977 {published data only}
Godin 1976 {published data only}
  • Godin MC. The effect of visual feedback and self-scaling on plaque control behaviour. Journal of Periodontology 1976;47(1):34-7.
Greenwell 1985 {published data only}
Grimm 1986 {published data only}
  • Grimm WD, Curth K, Rumler KD, Walther C. Clinically controlled studies of the optimum recall interval of public health care patients [Klinisch-kontrollierte untersuchung uber den optimalen recallabstand dispensairebetreuter patienten]. Stomatologie der DDR 1986;36(12):728-32.
Gunay 1998 {published data only}
  • Gunay H, Dmoch-Bockhorn K, Gunay Y, Geurtsen W. Effect on caries experience of a long-term preventive program for mothers and children starting during pregnancy. Clinical Oral Investigations 1998;2(3):137-42.
Hellström 1996 {published data only}
Hill 1981 {published data only}
Hoffman 2005 {published data only}
Hou 1989 {published data only}
  • Hou GL, Chi-Cheng T. Clinical observations of the effects of nonsurgical periodontal therapy on human periodontal disease II: Ultrasonic scaling and root planing for 6 months. The Kaohsiung Journal of Medical Sciences 1989;5:72-86.
Huber 1987 {published data only}
  • Huber S, Vernino AR, Nanda RS. Professional prophylaxis and its effect on the periodontium of full-banded orthodontic patients. American Journal of Orthodontics and Dentofacial Orthopedics 1987;91(4):321-7.
Hugoson 2007 {published data only}
  • Hugoson A, Lundgren D, Asklöw B, Borgklint G. Effect of three different dental health preventive programmes on young adult individuals: a randomized, blinded, parallel group, controlled evaluation of oral hygiene behaviour on plaque and gingivitis. Journal of Clinical Periodontology 2007;34:407-15.
  • Hugoson A, Lundgren D, Asklöw B, Borgklint G. The effect of different dental health programmes on young adult individuals: a longitudinal evaluation of knowledge and behaviour including cost aspects. Swedish Dental Journal 2003;27(3):115-30.
Kaldahl 1988 {published data only}
  • Kaldahl WB, Kalkwarf KL, Patil K, Dyer JK, Bates RE. Evaluation of four modalities of periodontal therapy: mean probing depth, probing attachment level and recession changes. Journal of Periodontology 1988;59(12):783-93.
Katay 1990 {published data only}
  • Katay L. Intensive aftercare for patients with removable dentures. Results after four years [Intensivbetreuung von Patienten mit herausnehmbarem Zahnersatz]. Deutsche Zahnarztliche Zeitschrift 1990;45(7):410-3.
Ketomaki 1993 {published data only}
  • Ketomaki T, Luoma AR. Dental Caries and Use of Resources in Relation to Individual Inspection Interval in Systematic Oral Health Care [Jarjestelmallisen hammashuollon yksilollisen tutkimusvalin yhteys hammaskariekseen ja voimavarojen kayttoon - den individuella undersokningsfrekvensens inverkan pa tandkaries och resursering inom den systematiska tandvarden]. Helsinki: Vantaa National Research and Development Centre for Welfare and Health, 1993.
Kinane 2000 {published data only}
  • Kinane DF. Local antimicrobial therapies in periodontal disease. Annals of the Royal Australian College of Dental Surgeons 2000;15:57-60.
Klein 1985 {published data only}
Knöfler 2007 {published data only}
  • Knöfler GU, Purschwitz RE, Jentsch HFR. Clinical evaluation of partial and full mouth scaling in the treatment of chronic periodontitis. Journal of Periodontology 2007;78:2135-42.
Kwan-Yat 2006 {published data only}
  • Kwan-Yat Z, Dae-Hyun L, Corbet EF. Repeated oral hygiene instructions alone, or in combination with metronidazole dental gel with or without subgingival scaling in adult periodontitis patients: A one-year clinical study. Journal of International Academy of Periodontolgy 2006;8(4):125-35.
Lee 2009 {published data only}
  • Lee H-K, Choi S-H, Wong KC, Merchant AT, Song K-B, Jeong S-H, et al. The effect of intensive oral hygiene care in gingivitis and periodontal destruction in type-2 diabetics. Yonsei Medical Journal 2009;50(4):529-36.
Lembariti 1998 {published data only}
Lim 1996 {published data only}
Listgarten 1986 {published data only}
Loesche 2002 {published data only}
  • Loesche WJ, Giordano JR, Soehren S, Kaciroti N. The non-surgical treatment of patients with periodontal disease: results after 5 years. Journal of the American Dental Association 2002;133(3):311-20.
Lopez 2005 {published data only}
  • López NJ, De Silva I, Ipinza J, Gutiérrez J. Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. Journal of Periodontology 2005;76:2144-53.
Lunder 1994 {published data only}
  • Lunder N. Effects of extended recall intervals for children between the ages of 7 and 13 [Forlengede innkallingsintervaller: effeckter pa ressursbruk og tannhelse hos et arskull barn fra 7 til 13 ar]. Nor Tannlaegeforenings Tidende 1994;104:100-2.
Mishkin 1986 {published data only}
  • Mishkin DJ, Engler WO, Javed T, Darby TD, Cobb RL, Coffman MA. A clinical comparison of the effect on the gingiva of the Prophy-Jet and the rubber cup and paste techniques. Journal of Periodontology 1986;57(3):151-4.
Moëne 2010 {published data only}
Moimaz 2000 {published data only}
  • Moimaz SAS, Guimaräes LOC, Saliba NA, Saliba O. Effect of professional prophylaxis and usual toothbrushing on dental plaque. Journal of Dental Research 2000;79(5):A146.
Mojon 1998 {published data only}
  • Mojon P, Rentsch A, Budtz-Jorgensen E, Baehni PC. Effects of an oral health program on selected clinical parameters and salivary bacteria in a long-term care facility. European Journal of Oral Science 1998;106(4):827-34.
Nyman 1975 {published data only}
Poulsen 1976 {published data only}
Powell 1999 {published data only}
Rask 1988 {published data only}
  • Rask PI, Emilson CG, Krasse B, Sundberg H. Effect of preventitive measures in 50-60 with high risk of dental caries. Scandinavian Journal of Dental Research 1988;96(6):500-4.
Rosen 2004 {published data only}
  • Rosen B, Olavi G, Baderstein A, Ronstrom A, Soderholm G, Egelberg J. Effect of different frequencies of preventive maintenance treatments on periodontal conditions: 5 year observations in general dentistry patients. Journal of Clinical Periodontology 1999;26(4):225-33.
  • Rosen B, Olavi G, Birkhed D, Edvardsson S, Egelberg J. Effect of different frequencies of preventive maintenance treatment on dental caries: five-year observations in general dentistry patients. Acta Odontologica Scandinavica 2004;62(5):282-8.
Rosling 1976 {published data only}
Rosling 1983 {published data only}
Saliba 1997 {published data only}
  • Saliba CA, Saliba NA, Moimaz SAS. Comparison of the efficacy of supervised toothbrushing and periodic professional prophylaxis on dental plaque control. Journal of Dental Research 1997;76(5):970.
Sandig 1981 {published data only}
  • Sandig HC, Eismann H. Clinical studies on the efficacy of regular periodontal health check-up [Klinische Untersuchungen uber die Wirksamkeit der periodontalhygienischen Dispensairebetreuung von Patienten mit abnehmbaren gegossenen Teilprothesen]. Stomatologie der DDR 1981;31(8):569-72.
Sato 2008 {published data only}
  • Sato T, Abe T, Ichikawa M, Fukushima Y, Nakamoto N, Koshikiya N, et al. A randomised controlled trial assessing the effectiveness of professional oral care by dental hygienists. International Journal of Dental Hygiene 2008;6(1):63-7.
Schlagenhauf 1989 {published data only}
Schulz 1989 {published data only}
  • Schulz R, Seefeld G. Therapy of gingivitis. Investigations of the effectiveness of preventive care program in dental practice [Untersuchungen uber die Effektivitat von praventiven betreuungsprogrammen unter den bedingungen einer stomatiologischen praxis]. Stomatologie der DDR 1989;39(1):12-6.
Serrano 2011 {published data only}
  • Serrano C, Torres N, Bejarano A, Cavie-des M, Castellanos ME. Clinical and microbiological comparison of three non surgical protocols for the initial treatment of chronic periodontitis. Journal of the International Academy of Periodontology 2011;13(1):17-26.
Shaw 1991 {published data only}
  • Shaw M, Shaw L. The effectiveness of differing dental health education programmes in improving the oral health of adults with mental handicaps attending Birmingham adult training centres. Community Dental Health 1991;8(2):139-45.
Smulow 1983 {published data only}
  • Smulow JB, Turesky SS, Hill RG. The effect of supragingival plaque removal on anaerobic bacteria in deep periodontal pockets. The Journal of the American Dental Association 1983;107(5):737-42.
Suomi 1971 {published data only}
  • Suomi JD, Greene JC, Vermillion JR, Doyle J, Chang JJ, Leatherwood EC. The effect of controlled oral hygiene procedures on the progression of periodontal disease in adults: results after third and final year. Journal of Periodontology 1971;42(3):152-60.
Suomi 1973 {published and unpublished data}
  • Suomi JD, Smith LW, Chang JJ, Barbano JP. Study of the effect of different prophylaxis frequencies on the periodontium of young adult males. Journal of Periodontology 1973;44(7):406-10.
Tan 1978 {published data only}
Tsuboi 2003 {published data only}
  • Tsuboi S, Morita I, Nakagaki H, Uchibori N, Yasuda J, Kume H, et al. Effect of professional oral prophylaxis on the general health perceptions and lifestyles of workers of a worksite. San Ei Shi 2003;45:222-34.
Van der Weijden 1994 {published data only}
  • Van der Weijden GA, Timmerman MF, Danser MM, Nijboer A, Saxton CA, Van der Velden U. Effect of pre-experimental maintenance care duration on the development of gingivitis in a partial mouth gingivitis model. Journal of Periodontal Research 1994;29(3):168-73.
Wang 1992 {published data only}
Wennström 2011 {published data only}
Westfelt 1983 {published data only}
Westfelt 1998 {published data only}
White 1996 {published data only}
  • White DJ, Cox ER, Bacca L, Lanzalaco AC, Montgomery RM, Coyle-Rees M. A quanticalc clinical comparison of professional efficiency in manual supraginival calculus debridement. The Journal of Clinical Dentistry 1996;7:54-7.
Zanatta 2011 {published data only}
  • Zanatta FB, Pinto TM, Kantorski KZ, Rosing CK. Plaque, gingival bleeding and calculus formation after supragingival scaling with and without polishing: a randomised clinical trial. Oral Health and Preventive Dentistry 2011;9(3):275-80.
Zee 2006 {published data only}
  • Zee KY, Lee DH, Corbet EF. Repeated oral hygiene instructions alone, or in combination with metronidazole dental gel with or without subgingival scaling in adult periodontitis patients: a one year clinical study. Journal of the International Academy of Periodontology 2006;8(4):125-35.
Zimmerman 1993 {published data only}

Additional references

  1. Top of page
  2. AbstractRésumé scientifique
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. References to ongoing studies
  23. Additional references
  24. References to other published versions of this review
AAP 1992
  • American Academy of Periodontology. Glossary of Periodontal Terms. 3rd Edition. Chicago: American Academy of Periodontology, 1992.
AAP 2001
  • American Academy of Periodontology. Position paper: Guidelines for periodontal therapy. Journal of Periodontology 2001;72(11):1624-8.
AAP 2003
  • American Academy of Periodontology. Position paper: Diagnosis of periodontal diseases. Journal of Periodontology 2003;74:1237-47.
Albandar 2002
Bearne 2000
Beirne 2005a
  • Beirne P, Forgie A, Clarkson JE, Worthington HV. Recall intervals for oral health in primary care patients. Cochrane Database of Systematic Reviews 2005, Issue 2. [DOI: 10.1002/14651858.CD004346.pub3]
Bentley 1983
  • Bentley JM, Cormier P, Oler J. The rural dental health program: the effect of a school-based dental health education program on children's utilization of dental services. American Journal of Public Health 1983;73(5):500-5.
Bonito 2004
  • Bonito A, Lohr K, Lux L, Sutton S, Jackman A, Whitener L, et al. Effectiveness of antimicrobial adjuncts to scaling and root planing therapy for periodontitis. Evidence Report Technology Assessment. Agency for Healthcare Research and Quality, 2004; Vol. 88:1-4. [: AHRQ Publication No. 04-E014-3]
Brothwell 1998
  • Brothwell DJ, Jutai DK, Hawkins RJ. An update of mechanical oral hygiene practices: evidence-based recommendations for disease prevention. Journal of the Canadian Dental Association 1998;64(4):295-306.
Brown 1994
Corbet 2002
DoH 2000
  • Department of Health. Modernising NHS Dentistry - Implementing the NHS Plan. HMSO, 2000.
Egger 1997
  • Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple graphical test. BMJ 1997;315(7109):629-34.
Elley 2000
  • Elley K, Gold L, Burls A, Gray M. Scale and Polish for Chronic Periodontal Disease - A West Midlands Development and Evaluation Service Report. West Midlands Health Technology Assessment Group, Department of Public Health and Epidemiology, University of Birmingham 2000.
Frame 2000
  • Frame PS, Sawai R, Bowen WH, Meyerowitz C. Preventive dentistry: practitioners' recommendations for low-risk patients compared with scientific evidence and practice guidelines. American Journal of Preventive Medicine 2000;18(2):159-62.
Greenstein 1992
  • Greenstein G. Periodontal response to mechanical non-surgical therapy: A review. Journal of Periodontology 1992;63(2):118-30.
Haffajee 1991
Higgins 2011
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Ismail 1994
  • Ismail AI, Lewis DW, Dingle JL. Prevention of periodontal disease. Canadian Task Force on Preventive Health Care: Guide to Clinical Preventive Health Care. Ottowa: Health Canada, 1994:420-31.
Jenkins 2003
  • Jenkins B, Heasman P. The prevention and control of periodontal disease. In: Murray JJ, Nunn JH, Steele JG editor(s). The Prevention of Oral Disease. 4th Edition. Oxford: Oxford University Press, 2003.
Kay 1996
Kay 1998
  • Kay E, Locker D. A systematic review of the effectiveness of health promotion aimed at improving oral health. Community Dental Health 1998;15(3):132-44.
Kelly 2000
  • Kelly M, Steele J, Nuttall N, Bradnock G, Morris J, Nunn J, et al. Adult Dental Health Survey. Oral Health in the United Kingdom 1998. London: Her Majesty's Stationery Office, 2000.
Lindhe 1989
Loe 1967
Needleman 2002
Needleman 2004
O' Leary 1967
  • O' Leary TJ. The periodontal screening examination. Journal of Periodontology 1967;38:617.
Oxford Dict 1995
  • Concise Oxford Dictionary. The Concise Oxford Dictionary of Current English. 9th Edition. Oxford: Oxford University Press, 1995.
Pilot 1980
  • Pilot T. Analysis of the overall effectiveness of treatment of periodontal disease. In: D Shanley editor(s). Efficacy of Treatment Procedures in Periodontics. Berlin: Quintessence Publishing Company, 1980:213-30.
Pilot 1997
  • Pilot T. Periodontal diseases. In: Pine C editor(s). Community Oral Health. Oxford: Reed Educational and Professional Publishing Ltd, 1997:82-8.
Ramfjord 1959
  • Ramfjord SP. Indices for prevalence and incidence of periodontal disease. Journal of Periodontology 1959;30:51.
Sheiham 1986
Sheiham 2002
Sprod 1996
  • Sprod AJ, Anderson R, Treasure E. Effective Oral Health Promotion: a Literature Review. Technical Report 20. Cardiff: University of Wales: Health Promotion Wales, 1996.
Wennstrom 1990
WHO 2004
  • World Health Organization. Periodontal country profiles: an overview of CPITN data in the WHO Global Oral Data Bank for the age groups 15-19 years, 35-44 years and 65-74 years. http://www.dent.niigata-u.ac.jp/prevent/perio/contents.html.

References to other published versions of this review

  1. Top of page
  2. AbstractRésumé scientifique
  3. Summary of findings
  4. Background
  5. Objectives
  6. Methods
  7. Results
  8. Discussion
  9. Authors' conclusions
  10. Acknowledgements
  11. Data and analyses
  12. Appendices
  13. What's new
  14. History
  15. Contributions of authors
  16. Declarations of interest
  17. Sources of support
  18. Differences between protocol and review
  19. Characteristics of studies
  20. References to studies included in this review
  21. References to studies excluded from this review
  22. References to ongoing studies
  23. Additional references
  24. References to other published versions of this review
Beirne 2005b
  • Beirne P, Forgie A, Worthington HV, Clarkson JE. Routine scale and polish for periodontal health in adults. Cochrane Database of Systematic Reviews 2005, Issue 1. [DOI: 10.1002/14651858.CD004625.pub2]
Beirne 2007
Forgie 2004
  • Forgie A, Beirne P, Worthington HV, Clarkson JE. Routine scale and polish for periodontal health in adults. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD004625]