Examining the impact of oral hygiene advice and/or scale and polish on periodontal disease: the IQuaD cluster factorial randomised controlled trial

Benefits of Dental Scaling and Polishing in Adults: A Rapid Review and Evidence Synthesis

BACKGROUND

This rapid review assessed evidence to inform policy on the clinical effectiveness and optimal frequency of dental scaling and polishing (S&P) for adults, including those with low incomes eligible for the Canadian Dental Care Plan.

METHODS

A rapid review was conducted according to Cochrane Recommendations for Rapid Reviews. Populations included all adults, adults with periodontitis, and those with inequitable access to dental care. Primary outcomes included gingival inflammation, probing depths, and tooth loss. Secondary outcomes included oral health-related quality of life and economic impact. Four databases were searched for randomized clinical trials, systematic reviews, cohort studies, and practice guidelines. Risk of bias was evaluated using Cochrane Risk of Bias, Newcastle-Ottawa, ROBIS, and AGREE II tools. A qualitative synthesis was planned.

RESULTS

In total, 3,181 references were retrieved: 4 applied to "all adults" and 4 to those with periodontitis. All reports had low risk of bias. One systematic review and one multicenter trial of adults with regular dental care found no clinical benefit regardless of S&P interval; however, patients valued and were willing to pay for regular scaling. One claims-based study reported regular S&P reduced tooth loss, and 2 clinical practice guidelines found a reduced risk of future attachment and tooth loss, lower overall health care costs for diabetes, and reduced costs for and incidence of acute myocardial infarction in those with regular S&P. There were no studies of underserved populations.

CONCLUSIONS

For adults with no or early periodontal disease and regular access to dental care, routine S&P may have little clinical benefit but reduces tooth loss and some health care expenses. In patients with periodontitis, scaling intervals tailored to individual risk profile and periodontal status can maintain health. There is no evidence on the impact of routine S&P on patients with barriers accessing care.

KNOWLEDGE TRANSFER STATEMENT

In terms of the benefits of routine scaling and polishing in adults, this rapid review found mixed evidence with a high level of certainty due to minimal risk of bias in the appraised studies for "regular dental attenders" and those with a diagnosis of periodontal diseases. Tailored intervals for dental scaling are beneficial for those diagnosed with periodontitis but may not provide the clinical benefits previously expected for adults at low risk. There is no evidence that dental polishing is effective. No evidence was found to support recommendations about the clinical effectiveness of scaling or the most appropriate recall intervals for scaling for low-income Canadians eligible for dental services under the new Canadian Dental Care Plan.

Impact of public health and patient-centered prevention strategies on periodontitis and caries as causes of tooth loss in high-income countries

In high-income countries, the oral health of the population is influenced by public health interventions, widespread use of oral care products, dental practice measures, and the cost of dental treatment. We compiled information on changes of the prevalence of proximal and upstream determinants of periodontitis, caries, and tooth loss over the last three decades to outline their potential effects on changes of oral health during this period. Information was retrieved from repeated cross-sectional studies and from published literature. While both the prevalence of edentulism and the number of missing teeth (from the DMF-T index) decreased, the number of sound teeth as well as the total number of teeth increased. The prevalence of severe periodontitis was unchanged, whereas the prevalence of periodontal health and moderate periodontitis may have increased to a minor extent. Concerning oral health risk factors, the proportion of individuals with tertiary education increased, while smoking prevalence declined. More and more people used oral care products. Whether one reimbursement system worked better than another one in terms of tooth retention could not be elucidated. In tooth retention, population-wide use of fluoridated toothpastes had the greatest impact. To some extent, the higher number of teeth present may be related to the more frequent use of interdental cleaning aids and powered toothbrushes. Since there was no decrease in severe periodontitis in most cohorts, periodontal interventions probably contributed little to improved tooth retention.

Citizen science to improve patient and public involvement in GUideline Implementation in oral health and DEntistry (the GUIDE platform)

BACKGROUND

Citizen science is a way to democratise science by involving groups of citizens in the research process. Clinical guidelines are used to improve practice, but their implementation can be limited. Involving patients and the public can enhance guideline implementation, but there is uncertainty about the best approaches to achieve this. Citizen science is a potential way to involve patients and the public in improving clinical guideline implementation. We aimed to explore the application of citizen science methods to involve patients and the public in the dissemination and implementation of clinical guidelines in oral health and dentistry.

METHODS

We developed GUIDE (GUideline Implementation in oral health and DEntistry), a citizen science online platform, using a participatory approach with researchers, oral health professionals, guideline developers and citizens. Recruitment was conducted exclusively online. The platform focused on prespecified challenges related to oral health assessment guidelines, and asked citizens to generate ideas, as well as vote and comment on other citizens' ideas to improve those challenges. Citizens also shared their views via surveys and two online synchronous group meetings. Data were collected on participant's demographics, platform engagement and experience of taking part. The most promising idea category was identified by an advisory group based on engagement, feasibility and relevance. We presented quantitative data using descriptive statistics and analysed qualitative data using inductive and deductive thematic analysis.

RESULTS

The platform was open for 6 months and we recruited 189 citizens, from which over 90 citizens actively engaged with the platform. Most citizens were over 34 years (64%), female (58%) and had a university degree (50%). They generated 128 ideas, 146 comments and 248 votes. The challenge that led to most engagement was related to prevention and oral health self-care. To take this challenge forward, citizens generated a further 36 ideas to improve a pre-existing National Health Service oral care prevention leaflet. Citizens discussed motivations to take part in the platform (understanding, values, self-care), reasons to stay engaged (communication and feedback, outputs and impact, and relevance of topics discussed) and suggestions to improve future platforms.

CONCLUSION

Citizen science is an effective approach to generate and prioritise ideas from a group of citizens to improve oral health and dental services. Prevention and oral health self-care were of particular interest to citizens. More research is needed to ensure recruitment of a diverse group of citizens and to improve retention in citizen science projects.

PATIENT OR PUBLIC CONTRIBUTION

This project was inherently conducted with the input of public partners (citizen scientists) in all key aspects of its conduct and interpretation. In addition, two public partners were part of the research team and contributed to the design of the project, as well as key decisions related to its conduct, analysis, interpretation and dissemination and are co-authors of this manuscript.

A randomised controlled trial evaluating the impact of oral health advice on gingival health using intra oral images combined with a gingivitis specific toothpaste

OBJECTIVES

Does a complex intervention of oral hygiene advice (OHA) delivered with intra-oral scanner images, anti-gingivitis toothpaste and motivational reminders, improve oral health more than a standard of care control arm of fluoride toothpaste, with OHA without scanner images?

METHODS

Adult participants with pre-existing gingivitis were randomised to intervention or control. Following enrolment, baseline and each subsequent visit (V) (3-weeks, V2; 3-months, V3; 6-months, V4) followed the same schedule. Bleeding on Probing (BOP) was assessed and Intra Oral Scan IOS(1) recorded. Plaque was disclosed, scored and re-scanned (IOS(2)). The intervention group received OHA with IOS images, control group receiving OHA without IOS images. Participants brushed with their allocated toothpaste (fluoride, control; anti-gingivitis, intervention), IOS(3) was recorded. Between visits participants brushed with their allocated toothpaste, intervention group received motivational reminders.

RESULTS

BOP scores from baseline were significantly improved in the intervention group compared to control at all visits for all surfaces (p<0.001); differences at V4 were 0.292 (all), 0.211 (buccal/labial) and 0.375 (lingual/palatal). Plaque scores from baseline pre-brushing to each visit pre- and post-brushing also favoured the intervention group, the difference always significant on lingual/palatal surfaces (p<0.05), significant for all but pre-brushing-V4 (p<0.05) on all surfaces, but only significant for pre-brushing-V3 (p<0.05) buccally/labially. Differences from baseline to post-brushing at V4 were: 0.200 (all), 0.098 (buccal/labial) and 0.291 (lingual/palatal).

CONCLUSION

A complex intervention comprising OHA delivered with IOS-images, anti-gingivitis toothpaste and motivational reminders improved gingival health more than existing standard of care-OHA together with a standard fluoride toothpaste over a 6-month period.

CLINICAL SIGNIFICANCE STATEMENT

Intra-oral scans (IOS) are now frequently used in general dental practice for a variety of purposes. IOS use, in combination with motivational texts and an anti-gingivitis toothpaste, could be further deployed to promote oral hygiene behaviour change in patients and improve gingival health, in a cost-effective manner.

Behavioral Interventions on Periodontitis Patients to Improve Oral Hygiene: A Systematic Review

This systematic review aimed to investigate the impact of different psychological models, strategies, and methods to improve plaque control and/or gingival inflammation in patients with periodontal diseases. Methods: The PubMed/MEDLINE, Cochrane Library, and Embase online databases were explored to identify relevant studies published before October 2022. Articles investigating the effects of different psychological approaches and intervention strategies on periodontitis patients’ oral hygiene (OH) behavioral change were screened. Results: 5460 articles were identified, and 21 fulfilled the inclusion criteria. In total, 2 studies tested audio-visual modalities, and the remaining 19 publications involved six psychological models of health-related behavioral interventions, including Social Cognitive Theory, the Theory of Planned Behavior, the Health Action Process Approach, Leventhal’s self-regulatory theory, Motivational Interviewing, and Cognitive Behavioral Therapy. A meta-analysis of the results was not carried out due to the high heterogeneity among the interventions. Conclusions: Considering the limitations of the available studies, psychological interventions based on social cognitive models that combine some of the techniques of this model (goal setting, planning, self-monitoring, and feedback) may improve OH in periodontitis patients, having a positive impact on periodontal clinical outcomes. Delivering cognitive behavioral therapy in combination with motivational interviewing may result in an improvement in OH as evaluated by decreasing plaque and bleeding scores.