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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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Characteristics of included studies [ordered by study ID]
Jones 2011

MethodsRandomised controlled trial conducted in: UK

Number of centres: 3 dental practices

Recruitment period: Not stated

Design: Parallel group 3-arm RCT


ParticipantsAdults (18-60 years) attending practice for scheduled dental check-up appointment. Generally fit and well with minimum of 20 natural teeth. All participants had scale and polish at baseline

Number of participants: 369 allocated, 305 analysed


InterventionsGroup 1: Scale and polish every 6 months
n = 125 allocated; n = 106 in analysis

Group 2: Scale and polish every 12 months

n = 122 allocated; n = 100 in analysis

Group 3: No scale and polish

n = 122 allocated; n = 99 in analysis

9 hygienists and therapists performed the interventions in this study

Oral hygiene advice was given every 6 months to all participants


OutcomesSee Additional  Table 1 for further details of indices used to measure outcomes
Plaque: Visual presence of plaque on 6 Ramfjord teeth (dichotomised)
Gingivitis: Gingival bleeding on 6 Ramfjord teeth (dichotomised)
Calculus: 1 measurement in mm confined to the lingual surfaces of the mandibular incisor and canine teeth
2 independent examiners undertook the outcome assessment in this study

Outcomes measured at 24-month follow-up


NotesSample size calculation: Yes

Funding source: Oral Health Unit, The University of Manchester

Consort flow diagram recording reasons for loss to follow-up


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskQuote: "randomised, 3 arm parallel clinical trial"

Quote: "Treatment allocation was by minimization and carried out by the trial manager using MINIM, an MS-DOS program"

Comment: Probably done

Allocation concealment (selection bias)Low riskComment: Central method of randomisation

Comment: Probably adequate

Blinding of outcome assessment (detection bias)
All outcomes
Low riskQuote: "Participants were asked not to disclose their allocation group to their dentist or to the outcome examiner"

Quote: "the same two examiners carried out all of the follow-up examinations blind to the allocation"

Comment: Possibility of accidental disclosure by patient

Incomplete outcome data (attrition bias)
All outcomes
Low risk369 patients were randomised. Consort diagram and text explanation of withdrawals/drop-outs

Selective reporting (reporting bias)Low riskAll outcomes stated in the methods presented in the results

Other biasUnclear riskPatients who had BPE > 3 at any interim exam were withdrawn and the outcome data for these patients not collected (total numbers varied in months 15, 17 and 19, but more in the no scale and polish group). Authors note an overall deterioration in gingival health of the trial population, which the authors suggest may be a result of inter-examiner variation

Lightner 1971

MethodsRandomised controlled trial conducted in: USA

Number of centres: 1 US Air Force Academy

Recruitment period: 1965/1966

Design: Parallel group 4-arm RCT


ParticipantsYoung male US Air Force Academy cadets (mean age at final examination was 22 years)

Number of participants: 713 recruited, 470 in analysis


InterventionsGroup 1: Scale and polish every 12 months without OHI

Subdivided further into Groups 1A and 1B. 1 50-minute preventive treatment (scale and polish) per year with no instruction in toothbrushing. Groups (1A and 1B) were treated 1 month apart. In this review when testing for treatment effects, a single group mean was employed for Groups 1A and 1B. Number of participants in analysis is 108

Group 2: Scale and polish every 12 months with OHI

1 preventive treatment per year given in 2 30-minute appointments, 5 to 11 days apart and 10 minutes of toothbrushing instruction at each of their 2 appointments. Number of participants in analysis is 121

Group 3: Scale and polish every 6 months with OHI

2 scale and polish treatments per year, given 6 months apart: the first given in 2 30-minute appointments, 5 to 11 days apart, with an additional 10 minutes of toothbrushing instruction at each session; the second given in 1 30-minute appointment, plus 10 minutes of brushing instruction. Number of participants in analysis is 110

Group 4A: Scale and polish every 3 months with OHI

Group 4B: Scale and polish every 3 months without OHI

Individuals in groups receiving toothbrushing instruction received the instruction at each appointment prior to preventive treatment. Disclosing solution was used to disclose plaque. If only small plaque accumulation was noted, patients were instructed how to modify their technique to clean teeth effectively. If patient had no effective technique, they were instructed to use modified Roll technique in all areas, with the exception of the lingual surface of the mandibular molars, for which they were instructed to use the Bass technique

Toothbrushes were provided to all participants throughout the course of the study. Each participant received 2 brushes every 90 days, either at a scheduled appointment or via postal delivery

Due to graduation of participants in June 1969, the treatment schedule for the final year of the study had to be revised for Groups 3, 4A and 4B. However, the participants in Group 1A, 1B and 2 received their regular treatments at the customary times. Participants in Group 3 received their second preventive treatment after only 4 months instead of 6 months. The participants in Groups 4A and 4B received 3 instead of 4 preventive treatments. Number of participants in analysis is 64 in 4A and 67 in 4B

All treatment was provided by 3 dental hygienists


OutcomesSee Additional  Table 1 for further details of indices used to measure outcomes

Plaque: 0-3 scale
Gingivitis: 0-3 scale
Calculus: 0-3 scale


NotesSample size calculation: Not stated

Funding source: Not stated


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskQuote: "randomly assigned to one of four treatment groups"

Comment: Random component not described

Allocation concealment (selection bias)Unclear riskInsufficient information

Blinding of outcome assessment (detection bias)
All outcomes
Low riskQuote: "the dentist was unaware of the treatment groups to which the participants were assigned"

Comment: Dentist unaware of treatment allocations at initial and follow-up examinations. Probably done

Incomplete outcome data (attrition bias)
All outcomes
Unclear risk712 participants entered the trial and 121, 74 and 42 participants lost in years 1, 2 and 3 respectively. Patients withdrew because they were moved to a different airbase. Total rate of withdrawal was 33%. However, this was unlikely to be related to intervention group

Selective reporting (reporting bias)Low riskPlanned outcomes of plaque, gingivitis and calculus reported

Other biasUnclear riskBaseline imbalance: Calculus scores at baseline were lower in the control group

Listgarten 1985

MethodsRandomised controlled study conducted in: USA

Number of centres: 1 (the Dental Hygiene Clinic at the University of Pennsylvania School of Dental Medicine)

Recruitment period: Not stated

Design: Parallel group 2-arm RCT


ParticipantsHealthy adults, at least 18 years of age, in good general health, recruited from the Dental Hygiene Clinic at the University of Pennsylvania School of Dental Medicine
Mean age of participants:
Group 1 (control): 36 years (range 20-67)
Group 2 (test): 38 years (range 20-73)

Sex:
Group 1: Male n = 14; female n = 17
Group 2: Male n = 13; female n = 17

All subjects had at least 5 teeth per quadrant, but no periodontal pockets probable to a depth of 6 mm or more. They had varying degrees of gingivitis but no evidence of alveolar bone loss. Some, but not all subjects, had been receiving periodontal prophylaxes at intervals of 3 to 6 months (no further information given in the report on the latter point)
61 (of original 69) participants completed the 3-year study

Number of participants: 69 randomised, 61 in analysis


InterventionsGroup 1: Scale and polish every 6 months

Clinical examination (every 6 months), periodontal prophylaxis every 6 months (after every examination). Number of participants in analysis is 31
Group 2: Scale and polish at variable schedule based on DDFM tests

Clinical examination (every 6 months). Prophylaxes administered according to a variable schedule, based on the outcome of differential dark-field microscopy (DDFM) tests. For negative DDFM tests (less than 15% spirochetes or motile rods, or less than 20% spirochetes plus motile rods) recall intervals were gradually increased from 1 to 2, to 3, to 6, to 12, to 24 months. 1 month after the baseline examination, the test was negative the recall interval was extended to 2 months and no prophylaxis was given. If at that time the test was still negative the interval was increased to 3 months, and so on. By the time a 12-month interval was assigned, a subject may already have gone 12 months without a prophylaxis. If at a given recall (e.g. 3 months) a test was positive, a prophylaxis was given and the patient kept on the same recall interval (in this case, 3 months). If 3 months later the test was still positive, the prophylaxis was repeated and the patients recall interval reduced to the next lower interval, in this case 2 months. No patients were assigned recall intervals of less than 1 month. (Note: the latter description of the DDFM test was given in an earlier paper by the authors (Listgarten 1982 (for full reference see 'Additional references')). In the experimental group, the authors state that 25 out of 30 subjects achieved recall intervals of 12 to 24 months within the 3-year experimental period. 11 subjects in the experimental group reached the end of the study without receiving a single prophylaxis over the 3-year duration of the trial. Number of participants in analysis is 30
Provider characteristics: Dental therapist/hygienist


OutcomesSee Additional  Table 1 for further details of indices used to measure outcomes
Plaque: Modified Plaque Index (Loe 1967)
Gingivitis: Modified Gingival Index (Loe 1967)
Probing depth: Mean probing depth recorded in mm
Attachment change: Gingival recession recorded to the nearest mm
Mean percentages of motile rods, spirochetes (this outcome was not used as it was deemed not relevant to this review)
It is unclear who (dentist, hygienist, other) performed the outcome assessment in this study


NotesFunding source: NIDR grant DE-02623 to the Centre for Oral Health Research and a grant from the Colgate-Palmolive company

Sample size calculation: Not stated


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskQuote: "Assignment to the C or T group was randomised"

Comment: Random component not described

Allocation concealment (selection bias)Unclear riskInsufficient information

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskInsufficient information

Incomplete outcome data (attrition bias)
All outcomes
Unclear risk69 patients randomised. 61 patients completed the study (31 in the intervention arm and 30 in the control arm). No reasons given for withdrawal or drop-outs

Selective reporting (reporting bias)Low riskPlaque index, gingival index, probing depth recession, recall interval and microbiology outcomes planned and reported

Other biasUnclear riskQuote: "despite randomisation of the patients... into two groups some differences were observed at baseline"

Comment: Baseline imbalances

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Adachi 2002None of the primary outcomes specified in our review were measured in this study. This study evaluated the effectiveness of professional tooth cleaning once a week for 24 months in a group of elderly subjects living in 2 nursing homes. Outcomes: fevers of 37.8º C >, prevalence of aspiration pneumonia, numbers of Staphylococcus species and Candida albicans in oral swab samples and the amount of methylmercaptan exhaled.

Addy 1988Not routine scale and polish. Antimicrobial strips were used in 3 out of 4 treatment groups. The remaining treatment group received root planing.

Aldridge 1995Length of follow-up less than 6 months. Data from 2 studies presented in this paper. In study 1, 41 patients were randomly allocated to receive oral hygiene instruction (small loop flossing, Bass technique brushing, scaling and adjustment of restorative margins) or no treatment. Patients in the intervention group returned for re-enforcement 1 month later. This study was excluded as it employed less than 6 months follow-up (follow-up was 2 months). In study 2, 23 patients were randomised to receive non-surgical treatment (Bass technique brushing, flossing, scaling and root planing under local anaesthesia) or no-treatment control. This study was excluded due to the use of root planing (not routine scale and polish).

Ashley 1981Children with mixed dentition at baseline. This study recruited schoolgirls aged between 11 and 12 years old at baseline. Girls in the intervention arm were randomly assigned by class to visit the hygienist every 2 weeks during term time for 3 years for oral hygiene reinforcement and professional prophylaxis. Girls in the control group received the oral hygiene instruction normally given at the school.

Axelsson 1975Unclear if randomised. This study examined the effect of fluoride on caries in a programme involving meticulous plaque control. 82 patients of both genders were recruited (41 in each arm). Prophylactic treatment was administered once every 2 weeks. During these sessions an abrasive paste containing 5% sodium monofluorophosphate was used in the control group. While in the test group, a paste which did not contain fluoride was used.

Axelsson 1977Children with mixed dentition at baseline. In this study 216 Swedish schoolchildren aged between 7 and 14 years old were divided into test and control groups. Once monthly children in the control group brushed their teeth with a 0.2% sodium fluoride solution under the supervision of a dental nurse. While patients in the treatment group received detailed information on the prevention of gingivitis, periodontitis and caries. During the first 2 years of the trial, patients in the treatment group also received detailed oral hygiene instruction and professional prophylaxis (including the application of sodium monoflurophosphate) at a dental nurse clinic every 2 weeks.

Axelsson 1981Not a randomised controlled trial. 90 patients referred for treatment of advanced periodontal disease were recruited by the authors. For the first 2 months after surgery (Widman flap technique), the patients were recalled once every 2 weeks for professional tooth cleaning. Every third patient was then referred back to the care of their dentist for maintenance. While the remaining 2 out of 3 were enrolled in a maintenance care programme at a university clinic (patients were recalled every 2-months and received oral health instruction, scaling and tooth cleaning). Patients were re-examined 3 years and 6 years after baseline examination.

Axelsson 1987Not routine scale and polish. This study involved 2 treatment groups (Groups 1 and 2) and 1 control group (Group 3). Group 1: received oral hygiene instruction, professional mechanical tooth cleaning including tongue scraping and chlorhexidine mouthrinse followed by application of 1% chlorhexidine gel (excluded from review due to adjunctive use of chlorhexidine). The entire prophylactic regimen was performed on days 1, 3, 5 and 8, followed by 1 single treatment every 6 months throughout the experimental period. Group 2 received only oral hygiene instructions - given on days 1, 3, 5 and 8 for approximately 10 minutes on each occasion (excluded from review as no scale and polish provided). The instructions were repeated every 6 months. The 'control' group (Group 3) did not receive any treatment additional to the one based on individual needs given by the local dental health officers.

Axelsson 2004Not a randomised controlled trial. The authors refer to an earlier paper (Axelsson 1978) for further details of the study participants. This paper was retrieved by the review team. Participants were recruited using the recall list of 3 general private practitioners and the waiting list of 3 large public dental health clinics. Potential participants for the test group were informed by letter of the purpose of the study and asked to volunteer for the trial. Potential members for the control group were informed that if they agreed to receive a very detailed oral examination they would be recalled for dental treatment to the public dental health clinic once a year during the next 3 years. Only those volunteers who had sought and received dental treatment annually during the last 5 years were selected.

Badersten 1984Unclear if randomised. In this study the incisors, cuspids and premolars received plaque control and supra and subgingival debridement using hand or ultrasonic scaling in a split-mouth design.

Bellini 1981Children with mixed dentition at baseline. This study examined the effect of monthly professional tooth cleaning on gingivitis in children aged between 7 and 11 years old.

Bonner 2005Not routine scale and polish. Study compared 2 different methods of scaling (manual versus ultrasonic scaling).

Brown 2002Not routine scale and polish. This study evaluated the effects of routine and intensified dental care and disease prevention in persons with human immunodeficiency virus (HIV). Study involved 1 control group ('standard care group') and 1 treatment group ('enhanced care group'). The standard care group received free professional dental treatment as needed and desired, including semi-annual professional prophylaxes and checkups (3 per subject, at baseline, 6 months and 1 year). The enhanced care group received standard care plus additional free professional prophylaxes (every 2 months) and twice-daily chlorhexidine antiseptic mouthrinses (excluded from review due to adjunctive use of chlorhexidine).

Budtz-Jorgensen 2000Not a randomised controlled trial. Study examined the effects of an oral health programme on the occurrence of oral candidosis in residents in a long-term care facility. 2 groups of residents were formed in this study. The authors state that random allocation was 'ruled out' and all the residents of each ward were assigned to 1 of the 2 groups. The study appears to have been carried out in the same long-term care facility as Mojon 1998.

Chapple 1995Not routine scale and polish. Split-mouth design: full power versus half power ultrasonic scaling.

Chawla 1975Randomisation not mentioned. One of the study authors was contacted by the review team but failed to respond to a second e-mail request for further information.

Cutress 1991Not a randomised controlled trial. This study was a field trial of a community-based periodontal disease prevention programme in a developing nation. The authors state that allocation of villages to periodontal disease prevention programmes was on an 'arbitrary basis' and was also dependent on the facilities available.

Feldman 1988Not a randomised controlled trial. This study examined the long-term impact of 2 dental delivery systems on children's oral health. It was not possible to determine any differences in the provision of scale and polish treatments to both groups. On reviewing an earlier paper (Bentley 1983) describing the procedure for forming the 2 study groups, it became evident that the randomisation procedure used was compromised. After first siblings were randomly assigned, their brothers or sisters or both were removed from the subsequent assignment process and given the same assignment.

Glavind 1977Study included periodontal patients in maintenance phase.

Godin 1976Not routine scale and polish. Patients randomised to receive the intervention were taught to self scale using a dentiscope, a large plane mouth mirror and a scaler. The control group received scaling and oral hygiene instruction limited to 3 hours over 4 or 5 visits.

Greenwell 1985Not routine scale and polish. This study compared the effectiveness of 2 oral hygiene regimens ('Keyes' method' versus 'conventional oral hygiene instruction').

Grimm 1986Not a randomised controlled trial. In this study the treatment and control groups were formed according to the age of participants.

Gunay 1998Not a randomised controlled trial. This study was a 3-phase prospective study examining the effects of a long-term preventive programme for mothers and children starting during pregnancy - there were no randomised comparison groups.

Hellström 1996All patients received a scale and polish. No control group.

Hill 1981Not routine scale and polish. In this study each quadrant of a participating patient's dentition was randomly assigned to 1 of 4 treatment types: Quadrant 1 (surgical pocket elimination); Quadrant 2 (modified Widman flap surgery); Quadrant 3 (subgingival curettage); Quadrant 4 (thorough scaling and root planing by the periodontist as a principally 'non-surgical' control area).

Hoffman 2005Not routine scale and polish. This study compared the use of a Vector™ scaling system and a piezo-electric scaler.

Hou 1989Not a randomised controlled trial. In this study only 1 group of patients was formed and all received the same level of treatment (ultrasonic scaling and root planing).

Huber 1987Not a randomised controlled trial. Study used a split-mouth experimental design. However, allocation to 'test' and 'control' sides was not random.

Hugoson 2007Interventions confounded by other things. 1 group had a scale and polish on 2 quadrants so a split-mouth design.

Kaldahl 1988Not routine scale and polish. In this study coronal scaling was used as a 'control' in 1 quadrant (Quadrant A) for 3 'treatment' quadrants: Quadrant B: coronal and subgingival scaling and root planing; Quadrant C: coronal and subgingival scaling and root planing followed by modified Widman surgery; Quadrant D: coronal and subgingival scaling and root planing followed by flap with osseous resection surgery.

Katay 1990Patients had partial dentures.

Ketomaki 1993Not a randomised controlled trial. In this study participants were assigned (not a random assignment) either to 'individualised recall' or to 'annual recall' examinations.

Kinane 2000Not routine scale and polish. In this study participants were randomised to 4 treatment groups: 1) scaling and root planing alone, 2) scaling and root planing plus antimicrobial therapy (minocycline gel), 3) scaling and root planing plus antimicrobial therapy (tetracycline fibres), and 4) scaling and root planing plus antimicrobial therapy (metronidazole gel).

Klein 1985Not a randomised controlled trial. This study examined the cost and effectiveness of various types and combinations of school-based preventive dental care procedures. Schools (rather than individual children) were assigned to regimens in a way that balanced baseline decay level, numbers of children and racial mix across treatment regimens.

Knöfler 2007Not routine scale and polish. This study compared scaling and root planing to full mouth scaling in a sample of 37 male subjects with moderate chronic periodontitis.

Kwan-Yat 2006Not routine scale and polish. This study compared oral hygiene instructions alone or in combination with metronidazole 25% gel or subgingival scaling with or without metronidazole gel in the treatment of new, residual or recurrent periodontal pockets in patients previously treated for periodontitis.

Lee 2009Not a randomised controlled trial. Pseudo-randomised: order of outpatient visits used to randomly assign patients to intervention and control groups.

Lembariti 1998Randomised split-mouth design on contralateral quadrants, single intervention given once.

Lim 1996Unclear if randomised. 550 employees of both sexes aged between 25 and 44 were selected using "stratified random sampling criteria". Patients were then "divided" into 4 groups. Group A: oral hygiene group (n = 195), group B: scaling (n = 148), Group C: scaling and oral hygiene (n = 145), group D: control (n = 62).

Listgarten 1986Study included patients with treated periodontal disease and were on different maintenance schedules.

Loesche 2002Not routine scale and polish. Patients were randomly assigned (following debridement) to receive either metronidazole or doxycycline or placebo.

Lopez 2005Not routine scale and polish. This study randomised 870 pregnant women with gingivitis to periodontal treatment before 28 weeks gestation or a control group who received periodontal treatment after delivery. Periodontal therapy consisted of plaque control, scaling and daily rinsing with 0.12% chlorhexidine. Maintenance therapy was provided every 2 or 3 weeks until delivery. Excluded due to the use of chlorhexidine.

Lunder 1994Not a randomised controlled trial. Participants were allocated to treatment (18-month recall) and control (12-month recall) groups alphabetically according to their surname. Authors also state that "when allocating the children into the 2 groups geography and caries-activity was taken into consideration."

Mishkin 1986Not routine scale and polish. Split-mouth. Scale and polish versus waterjet.

Moimaz 2000Randomisation not mentioned (abstract). This study divided patients into 2 groups. Group 1 received prophylaxis and maintained usual oral hygiene while group 2 carried out usual oral hygiene only.

Mojon 1998Not a randomised controlled trial. The aim of this study was to evaluate the effectiveness of a comprehensive oral health programme for residents of a long-term care facility. 2 groups were formed: 1 group comprised of residents from 5 wards; the other group comprised of residents from 7 wards. The assignment of wards to each group took into account the location of the ward. 1 of the groups was then randomly selected as the experimental group. The study appears to have been carried out in the same long-term care facility as Budtz-Jorgensen 2000.

Moëne 2010Not routine scale and polish. This study compared the subgingival application of amino acid glycerine powder to scaling and root planing.

Nyman 1975Study included patients post-periodontal surgery.

Poulsen 1976Children with mixed dentition at baseline. This study randomised 7-year old children to 2 groups: the intervention group received mechanical tooth cleaning every 2 weeks while the control group were untreated.

Powell 1999Not routine scale and polish. In this study subjects were randomly assigned to 1 of 4 experimental groups or a control group. The control group (Group 1) received 'usual care' from a public health department or private practitioner. Group 2 received an educational programme of 2 hours duration implemented twice a year. Group 3 received the educational programme plus a chlorhexidine rinse weekly. Group 4 received the education and chlorhexidine interventions and a fluoride varnish application by a dental hygienist twice a year. Group 5 received all of the above interventions as well as scaling and root planing by a dental hygienist every 6 months throughout the 3-year study.

Rask 1988Interventions not relevant. This randomised controlled trial was designed to test the effectiveness (in high caries risk patients) of an intensified preventative regimen. The effects of scaling and polishing were not examine in this trial.

Rosen 2004Not a randomised controlled trial. In this study, following the initial examination, 391 subjects were divided into 4 experimental groups. First, 3 age groups were formed and within each of these age groups equal numbers of individuals were matched into the 4 experimental groups based on the number of remaining teeth, number of decayed and filled tooth surfaces, number of decayed surfaces, full mouth plaque scores and mean probing depth.

Rosling 1976Study included patients with advanced periodontal disease.

Rosling 1983Not routine scale and polish. 2 studies. In study 1 (2-year clinical study), 75 patients were randomly distributed into intervention (professional cleaning) and control groups. Patients were additionally randomly distributed to receive 1 of 5 surgical procedures: the apically repositioned flap operation including elimination of bony fragments, the apically repositioned flap operation including curettage of bony defects but without removal of bone, the Widman flap technique including elimination of bony defects, the Widman flap technique including curettage of bony defects but without removal of bone and gingivectomy. After surgery, the teeth of patients in the intervention arm were professionally cleaned once a fortnight during a 2-year period. The patients in the control arm were recalled once a year for supragingival scaling and polishing. No data from this study are reported in this article. Only the 50 patients in the treatment arm of the 2-year clinical study progressed to the 6-year clinical study, while the 25 control patients were withdrawn.

Saliba 1997Randomisation not mentioned (abstract). In this study 45 schoolchildren were divided into 3 groups. Group A received toothbrushing and dental floss use under supervision. Group B received professional prophylaxis. Group C received non-supervised toothbrushing.

Sandig 1981Unclear if study was randomised (paper in German). This study was partially translated (Material and methods section) with a view to determining its eligibility. However, we were unable to ascertain if it was a randomised trial. The authors state that "2 comparable groups of 18 or 20 patients were studied. A year ago those patients were treated with cast removable partial dentures at the department of Stomatology of the medical academy Erfurt."

Sato 2008No scale and polish. This study compared professional oral care performed by a hygienist (15 minutes of instructions on mouth cleaning and on Bass toothbrushing method) with toothbrushing and mouth rinsing by patients themselves.

Schlagenhauf 1989Not routine scale and polish. The purpose of this study was to evaluate the effect of subgingival scaling versus subginigival pocket irrigation with 0.1% chlorhexidine or saline controls.

Schulz 1989Unclear if study was randomised. Unable to contact authors to determine if the study was a randomised controlled trial (paper in German).
This study was fully translated with a view to determining its eligibility. However, we were unable to ascertain if it was a randomised trial. In addition the interventions and comparison groups were poorly described. The authors state that "55 test persons participated in this study. They had gingivitis caused by plaque at the age 15 and 25 years (17.7 years on average). Not included were pregnant women, patients with internal diseases, with prosthetic restorations and untreated caries. 15 test persons took part in 3 different programmes, over a period of 3 months that had the following objectives: oral hygiene instructions and motivation (dental nurse) as well as professional tooth cleaning (dentist). 1 group made up of 10 test persons (group IV) served as the control group. The programme of group III with 1 motivation session without teeth cleaning training was designed to check which results the frequent examination with an oral hygiene pass/check book produces. From the results of the test group we expected indications of the motivating effect of the professional teeth cleaning and of the importance for the reduction of gingivitis as such."

Serrano 2011Not routine scale and polish. The purpose of this study was to compare three protocols for non-surgical periodontal therapy. Patients were randomised to receive either scaling and root planing quadrant by quadrant at weekly intervals (control group), full mouth scaling and root planing performed over 2 consecutive days (FM group), or full mouth scaling and root planing performed over 2 consecutive days combined with the administration of antibiotics (FMa group).

Shaw 19914 centres randomised to 4 interventions. Cluster randomised controlled trial with single cluster per intervention so unable to use data at all.

Smulow 1983Not routine scale and polish. Patients were randomised to 4 groups. Group 1 received initial scaling and daily polishing, group 2 received daily polishing without initial scaling, group 3 received initial scaling without daily polishing and group 4 received no treatment.

Suomi 1971Not a randomised controlled trial. This study was carried out "to test the hypothesis that the development and progression of gingival inflammation and destructive periodontal disease are retarded in an oral environment in which high levels of hygiene are maintained." 2 groups (experimental and control) were matched on the basis of periodontal and oral hygiene status, past caries experience, age and sex. The experimental group were given a series of frequent oral prophylaxes combined with oral hygiene instruction and dental health education. Subjects in the control groups received no attention from the study team except for annual examinations.

Suomi 1973Unclear how groups were formed, unlikely to be randomised.

Tan 1978Follow-up less than 6 months. In this study 120 Dutch army recruits in 2 camps were randomised to receive no treatment (group A), professional prophylaxis (group B), dental health instruction (group C) or both prophylaxis and dental health instruction (group D). Patients were examined at initiation of the study, after 1 month and 3 months.

Tsuboi 2003Not a randomised controlled trial (after translation from Japanese).

Van der Weijden 1994No scale and polish. This study looked at the effect of pre-experimental maintenance on the development of gingivitis.

Wang 1992Interventions not relevant. In this randomised controlled trial participants were randomly allocated to recall examination at either 12 months or 24 months. Scale and polish treatments (if any) provided at recall were not reported in this paper. Outcomes reported were clinical examination time, treatment time and the DMFS increment during the 2-year study period.

Wennström 2011Not routine scale and polish. This study compared air polishing to ultrasonic instruments in a split-mouth study.

Westfelt 1983Included patients had periodontal surgery.

Westfelt 1998Not routine scale and polish. Split-mouth study. 2 quadrants of each patient were designated test group, while the other 2 were identified as control. Patients in the test arm received supragingival plaque control. While patients in the control arm received subgingival scaling and root planing.

White 1996Length of follow-up less than 6 months. Single episode of scaling. Participant characteristics not presented. This study examined the efficiency of 2 professionals (1 dentist, 1 dental hygienist) in removing supragingival calculus. Participants were concomitantly participating in a tartar control dentifrice trial. Outcomes: total developed force, average force per stroke, total strokes and Volpe-Manhold-Index (VMI) grading.

Zanatta 2011Length of follow-up less than 6 months. Split-mouth study. 67 patients received supragingival scaling on the 6 mandibular teeth. Quadrants were then randomly selected to be polished or not with a rubber cup and pumice. Outcomes assessed at 1, 2 and 3 weeks post-treatment.

Zee 2006Not routine scale and polish. Split-mouth study. Active treatment included subgingival scaling, metronidazole 25% gel and subgingival scaling plus metronidazole 25% gel. A control group was also employed.

Zimmerman 1993All patients received scale and polish.This study examined the effectiveness of 1 versus 2 preventive advice sessions. Both treatment and control groups were given 30-minute scale and polish treatments.

 
Characteristics of ongoing studies [ordered by study ID]
IQUAD

Trial name or titleIQUAD: Improving the Quality of Dentistry

MethodsA 5-year multicentre, randomised, open trial with blinded outcome evaluation based in dental primary care in Scotland and the North East of England. Dental practices are cluster randomised to provide routine oral hygiene advice or personalised oral hygiene advice. Both dentists and DCPs will undertake the scale and polish treatments. To test the effects of Periodontal Instrumentation each participant will be randomised to 1 of 3 groups: no periodontal instrumentation, 6-monthly periodontal instrumentation (current practice), or 12-monthly periodontal instrumentation

ParticipantsDentate adults with BPE <= 3

InterventionsNo periodontal instrumentation, 6-monthly periodontal instrumentation (current practice), or 12-monthly periodontal instrumentation

OutcomesPrimary outcomes: Clinical: gingival inflammation/bleeding on probing at the gingival margin measured by the Gingival Index of Loe. Patient-centred: oral hygiene self efficacy

Economic: net benefits (mean willingness to pay minus mean costs). Measured at 3 years

Starting date2012

Contact informationj.e.clarkson@dundee.ac.uk

NotesHTA funded ISRCTN56465715. A multicentre randomised controlled trial comparing oral hygiene advice and periodontal instrumentation for the prevention and management of periodontal disease in dentate adults attending dental primary care

 
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]

 
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.

Routine scale and polish at different frequencies for periodontal health

Patient or population: Healthy dentate young adults

Settings: Air Force Academy

Intervention: Routine scale and polish every 6 months with oral hygiene instruction

Comparison: Routine scale and polish every 12 months with oral hygiene instruction

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

Gingivitis different indices usedSMD -0.08 (-0.27 to 0.10)2 studies1

(438 participants)
⊕⊕⊝⊝
low
The results for comparing 3 versus 12 months are significant but based on only 1 study

Calculus different indices usedSMD -0.25 (-0.44 to -0.06)2 studies1

(438 participants)
⊕⊕⊝⊝
low
The results for comparing 3 versus 12 months are significant but based on only 1 study

Plaque different indices usedSMD -0.16 (-0.35 to 0.03)2 studies1

(438 participants)
⊕⊕⊝⊝
low
The results for comparing 3 versus 12 months are generally not significant

CI: confidence interval; MD: mean difference; SMD: standardised 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.

 12 studies at unclear risk of bias
 
Summary of findings 3.

Routine scale and polish with and without oral hygiene instruction for periodontal health

Patient or population: Healthy dentate young adults

Settings: Air Force Academy

Intervention: Routine scale and polish with oral hygiene instruction

Comparison: Routine scale and polish without oral hygiene instruction

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

Gingivitis (mean on 0-3 scale) at 24 months

3-monthly scale and polish

Mean gingivitis score (0-3 scale) in control group is 1.40
MD -0.07 (-0.18 to 0.04)1 study1

(131 participants)
⊕⊕⊝⊝
low
Results for 12-monthly scale and polish was significant

Calculus (mean on 0-3 scale) at 24 months

3-monthly scale and polish

Mean calculus score (0-3 scale) in control group is 0.29 mm
MD -0.02 (-0.16 to 0.12)1 study1

(131 participants)
⊕⊕⊝⊝
low
Results for 12-monthly scale and polish was similar

Plaque (mean on 0-3 scale) at 24 months

3-monthly scale and polish

Mean plaque score (0-3 scale) in control group is 1.99
MD -0.17 (-0.31 to -0.03)1 study1

(131 participants)
⊕⊕⊝⊝
low
Results for 12-monthly scale and polish was 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 4.

Routine scale and polish undertaken by dentist or dental care professional for periodontal health

Patient or population: Healthy dentate adults

Settings: General dental practice

Intervention: Routine scale and polish by dental professional

Comparison: Routine scale and polish by dentist

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

Gingivitis No studies

Calculus No studies

Plaque No studies

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.

 
Table 1. Indices used in trials

StudyNotes/referencesPlaqueCalculusGingivitis/bleedingPocket depthAttachment changePeriodontal indices

Jones 2011For references to index teeth used in trial see Ramfjord 1959Visual presence of any plaque on the 6 (Ramfjord) index teeth according to a dichotomous scale: plaque present/not presentMeasurement of calculus in mm: 1 measurement,
confined to the lingual surfaces of the mandibular incisor and canine teeth. A PCP-10
probe was used to measure along the vertical axis of
the tooth with the most calculus
Bleeding from the gingival margin of 6 (Ramfjord) index teeth. Bleeding was detected by running a blunt-ended (PCP-10) probe gently around the gingival margin of the tooth at a 60°
angle, in contact with the sulculur epithelium. After approximately 30 seconds, any bleeding elicited was
recorded according to a dichotomous scale for each tooth: present/not present
Not reportedNot reportedNot reported

Lightner 1971For references to indices used in trial see O' Leary 1967. The examination system used was the Periodontal Screening Examination (O' Leary 1967). The mouth is divided into 6 segments. The highest score found for any tooth in a segment is recorded as the score for the segmentPlaque index (no description of the precise criteria used). Plaque scores range from 0 to 3. Data reported as mean plaque index scoresHard deposit index. Hard deposit scores range from 0 to 3 (precise criteria not described). Data presented as mean hard deposit index scoresGingival index (precise criteria not described). Gingival scores range from 0 to 3. Data reported as mean gingival index scoresNot reportedLoss of epithelial attachment. Data reported as mean attachment loss (mm). Reported data not used in this review as no standard deviations providedPeriodontal index. Possible scores of 0, 4, 5 or 6 (criteria described in full in the paper). To simplify the statistical handling of data, scores 4, 5 and 6 were transformed to 1, 2 and 3 respectively. Reported data were not used in this review as presented in an inappropriate format

Listgarten 1985For references to indices used in trial see Loe 1967Modified plaque index. Index based on a 0-3 score (Loe 1967). Each tooth was scored on the mid-buccal and mid-lingual surfaces as well as on the mesial buccal surface. The mean values for the whole mouth obtained by adding all mid-buccal and mid-lingual and the doubled value of the mesial buccal scores and dividing by the number of surfaces at risk. Data reported as mean plaque index scores for control and test groupsNot reportedModified gingival index (Loe 1967). Index is based on a 0-3 score. Data reported as mean gingival index scores for control and test groups for all surfaces measured at each examinationProbing depth. Data reported as mean probing depth (mm). Probing depth recorded to the nearest mm with uniform probes calibrated in mm, with a tip diameter of 0.35 mmRecession recorded to the nearest mm as the distance from the gingival margin to the cemento-enamel junction (only when a distinct cemento-enamel junction was identifiable)Not reported

 mm = millimetre
 
Table 2. Comparison 1: Scale and polish versus no scale and polish (outcomes, data points, scale and polish frequency)

Frequency of scale and polishData pointsPlaqueCalculusGingivitis/bleedingPocket depthAttachment change

6 months24Jones 2011Jones 2011Jones 2011

12 months24Jones 2011Jones 2011Jones 2011

 
Table 3. Comparison 2: Scale and polish versus scale and polish in response to gingivitis/periodontitis (outcomes, data points, scale and polish frequency)

Frequency of scale and polishData pointsPlaqueCalculusGingivitis/bleedingPocket depthAttachment change

6 months6Listgarten 1985Listgarten 1985Listgarten 1985

12Listgarten 1985Listgarten 1985Listgarten 1985

18Listgarten 1985Listgarten 1985Listgarten 1985

24Listgarten 1985Listgarten 1985Listgarten 1985

30Listgarten 1985Listgarten 1985Listgarten 1985

36Listgarten 1985Listgarten 1985Listgarten 1985

 
Table 4. Comparison 3: Scale and polish versus scale and polish at different intervals (outcomes, data points, scale and polish frequency)

Frequency of scale and polishData pointsPlaqueCalculusGingivitis/bleedingPocket depthAttachment changePeriodontal indices

3 months versus 6 months12Lightner 1971Lightner 1971Lightner 1971

24Lightner 1971Lightner 1971Lightner 1971

36Lightner 1971Lightner 1971Lightner 1971

46Lightner 1971Lightner 1971Lightner 1971


3 months versus 12 months24Lightner 1971Lightner 1971Lightner 1971

36Lightner 1971Lightner 1971Lightner 1971

46Lightner 1971Lightner 1971Lightner 1971


6 months versus 12 months24Lightner 1971

Jones 2011
Lightner 1971

Jones 2011
Lightner 1971

Joners 2011

36Lightner 1971Lightner 1971Lightner 1973

46Lightner 1971Lightner 1971Lightner 1971

 
Table 5. Comparison 2: Results for scale and polish at fixed interval (6 months) versus in response to signs/symptoms

Outcome measured
(months)
Variable intervalFixed interval





MeanSDnMeanSDn MD (95% CI) P value

Gingivitis

6 months0.30.26300.290.26310.01 (-0.12, 0.14)0.88

120.40.26300.420.2631-0.02 (-0.15, 0.11)0.76

180.520.26300.590.2631-0.07 (-0.20, 0.06)0.29

240.670.26300.620.26310.05 (-0.08, 0.18)0.45

300.70.26300.70.26310.00 (-0.13, 0.13)1.00

360.630.26300.670.2631-0.04 (-0.17, 0.09)0.55

 

Plaque  

6 months0.430.24300.530.2431-0.10 (-0.22, 0.02)0.10 

120.550.24300.620.2431-0.07 (-0.19, 0.05)0.25 

180.60.24300.70.2431-0.10 (-0.22, 0.02)0.10

240.590.24300.690.2431-0.10 (-0.22, 0.02)0.10

300.680.24300.740.2431-0.06 (-0.18, 0.06)0.33

360.60.24300.680.2431-0.08 (-0.20, 0.04)0.19

 

Pocket depth        

6 months1.650.19301.70.1931-0.05 (-0.15, 0.05)0.19

121.650.19301.70.1931-0.05 (-0.15, 0.05)0.19

181.650.17301.70.1731-0.05 (-0.14, 0.04)0.17

241.650.17301.70.1731-0.05 (-0.14, 0.04)0.17

301.650.18301.70.1731-0.05 (-0.14, 0.04)0.18

361.650.17301.70.1731-0.05 (-0.14, 0.04)0.17 

 CI = confidence interval; MD = mean difference; SD = standard deviation
 
Table 6. Comparison 3: Results from Lightner 1971 and Jones 2011 for scale and polish comparing different time intervals (48 months)

ComparisonOutcome measured
(months)
Variable intervalFixed intervalMD (95% CI)P value






3 versus 6 months GingivitisMeanSDnMeanSDn  

Lightner 1971121.580.31641.630.31110-0.05 (-0.15, 0.05)0.30

Lightner 1971241.330.31641.430.31110-0.10 (-0.20, -0.00)0.04

Lightner 1971361.270.31641.340.31110-0.07 (-0.17, 0.03)0.15

Lightner 1971481.250.31641.340.31110-0.09 (-0.19, 0.01)0.06

 

 Calculus        

Lightner 1971120.260.41640.30.41110-0.04 (-0.17, 0.09)0.53

Lightner 1971240.270.41640.270.411100.00 (-0.13, 0.13)1.00

Lightner 1971360.220.41640.230.41110-0.01 (-0.14, 0.12)0.88

Lightner 1971480.130.41640.150.41110-0.02 (-0.15, 0.11)0.76


 Plaque        

Lightner 1971121.850.41641.840.411100.01 (-0.12, 0.14)0.88

Lightner 1971241.820.41641.770.411100.05 (-0.08, 0.18)0.44

Lightner 1971361.530.41641.580.41110-0.05 (-0.18, 0.08)0.44

Lightner 1971481.480.41641.470.411100.01 (-0.12, 0.14)0.88

 

3 versus 12 months (with OHI)Gingivitis        

Lightner 1971241.330.31641.470.31121-0.14 (-0.23, -0.05)0.003

Lightner 1971361.270.31641.390.31121-0.12 (-0.21, -0.03)0.01

Lightner 1971481.250.31641.40.31121-0.15 (-0.24, -0.06)0.002

 

 Calculus        

Lightner 1971240.270.41640.40.41121-0.13 (-0.25, -0.01)0.04

Lightner 1971360.220.41640.320.41121-0.10 (-0.22, 0.02)0.11

Lightner 1971480.130.41640.260.41121-0.13 (-0.25, -0.01)0.04

 

 Plaque        

Lightner 1971241.820.41641.840.41121-0.02 (-0.14, 0.10)0.75

Lightner 1971361.530.41641.680.41121-0.15 (-0.27, -0.03)0.02

Lightner 1971481.480.41641.530.41121-0.05 (-0.17, 0.07)0.43

          

3 versus 12 months (without OHI)Gingivitis        

Lightner 1971241.40.31671.610.31108-0.21 (-0.30, -0.12)< 0.001

Lightner 1971361.410.31671.560.31108-0.15 (-0.24, -0.06)0.002

Lightner 1971481.340.31671.550.31108-0.21 (-0.30, -0.12)< 0.001

 

 Calculus        

Lightner 1971240.290.41670.470.41108-0.18 (-0.30, -0.06)0.005

Lightner 1971360.290.41670.450.41108-0.16 (-0.28, -0.04)0.01

Lightner 1971480.190.41670.330.41108-0.14 (-0.26, -0.02)0.03

 

 Plaque        

Lightner 1971241.990.41672.140.41108-0.15 (-0.27, -0.03)0.02

Lightner 1971361.90.41672.040.41108-0.14 (-0.26, -0.02)0.03

Lightner 1971481.750.41671.930.41108-0.18 (-0.30, -0.06)0.005

 

6 versus 12 monthsGingivitis        

Jones 2011240.3790.3031070.3880.307100-0.01 (-0.09, 0.07)0.03

Lightner 1971241.430.311101.470.31121-0.04 (-0.12, 0.04)0.33

Lightner 1971361.340.311101.390.31121-0.05 (-0.13, 0.03)0.22

Lightner 1971481.340.311101.40.31121-0.06 (-0.14, 0.02)0.14

 

 Calculus        

Jones 2011240.711.01070.890.99100-0.18 (-0.45, 0.09)0.19

Lightner 1971240.270.411100.40.41121-0.13 (-0.24, -0.02)0.02

Lightner 1971360.230.411100.320.41121-0.09 (-0.20, 0.02)0.10

Lightner 1971480.150.411100.260.41121-0.11 (-0.22, -0.00)0.04

 

 Plaque        

Jones 2011240.3940.3421070.4350.347100-0.04 (-0.13, 0.05)0.39

Lightner 1971241.770.411101.840.41121-0.07 (-0.18, 0.04)0.19

Lightner 1971361.580.411101.680.41121-0.10 (-0.21, 0.01)0.06

Lightner 1971481.470.411101.530.41121-0.06 (-0.17, 0.05)0.27

 CI = confidence interval; MD = mean difference; OHI = oral hygiene instruction; SD = standard deviation
 
Table 7. Comparison 4: Results from Lightner 1971 comparing scale and polish (at 3 and 12 months) with and without OHI at different time intervals 

ComparisonOutcome measured (months)OHIWithout OHIMD (95% CI)P value






Scale and polish every 3 monthsGingivitisMeanSDnMeanSDn  

Lightner 1971121.580.31641.650.3167-0.07 (-0.18, 0.04)0.20

Lightner 1971241.330.31641.40.3167-0.07 (-0.18, 0.04)0.20

Lightner 1971361.270.31641.410.3167-0.14 (-0.25, -0.03)0.01

Lightner 1971481.250.31641.340.3167-0.09 (-0.20, 0.02)0.10

 

 Calculus        

Lightner 1971120.260.41640.310.4167-0.05 (-0.19, 0.09)0.49

Lightner 1971240.270.41640.290.4167-0.02 (-0.16, 0.12)0.78

Lightner 1971360.220.41640.290.4167-0.07 (-0.21, 0.07)0.33

Lightner 1971480.130.41640.190.4167-0.06 (-0.20, 0.08)0.40

 

 Plaque        

Lightner 1971121.850.41642.120.4167-0.27 (-0.41, -0.13)< 0.001

Lightner 1971241.820.41641.990.4167-0.17 (-0.31, -0.03)0.02

Lightner 1971361.530.41641.90.4167-0.37 (-0.51, -0.23)< 0.001

Lightner 1971481.480.41641.750.4167-0.27 (-0.41, -0.13)< 0.001

 

Scale and polish every 12 monthsGingivitis        

Lightner 1971241.470.311211.610.31108-0.14 (-0.22, -0.06)< 0.001

Lightner 1971361.390.311211.560.31108-0.17 (-0.25, -0.09)< 0.001

Lightner 1971481.40.311211.550.31108-0.15 (-0.23, -0.07)< 0.001


 Calculus        

Lightner 1971240.40.411210.470.41108-0.07 (-0.18, 0.04)0.20

Lightner 1971360.320.411210.450.41108-0.13 (-0.24, -0.02)0.02

Lightner 1971480.260.411210.330.41108-0.07 (-0.18, 0.04)0.20

 

 Plaque        

Lightner 1971241.840.411212.140.41108-0.30 (-0.41, -0.19)< 0.001

Lightner 1971361.680.411212.040.41108-0.36 (-0.47, -0.25)< 0.001

Lightner 1971481.530.411211.930.41108-0.40 (-0.51, -0.29)< 0.001

 CI = confidence interval; MD = mean difference; OHI = oral hygiene instruction; SD = standard deviation