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Quick Alert: Routine Scale and Polish has Little or No Effect on Gingivitis

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In an effort to inform the debate concerning the overall effectiveness of scaling and polishing and the best interval time to observe between treatments, authors at Cochrane Oral Health completed a literature review of randomized control trials. Our quick alert highlights key details and insights and provides an overview of this study and what it means for dentists. 

STUDY: A systematic review to assess the effects of routine scale and polish S&P treatment.

PURPOSE: To assess the effects of routine scale and polish treatments for healthy adults; to establish whether different time intervals between treatments influence these effects; and to compare the effectiveness of the treatment when given by a dentist compared to a dental therapist or hygienist.

TEAM: Carried out by authors working with Cochrane Oral Health, the research was conducted by a team led by Thomas Lamont of the University of Dundee, UK on behalf of Cochrane Oral Health. Helen V. Worthington, Janet E. Clarkson, and Paul V. Beirne. 

DEFINITION OF ROUTINE SCALE AND POLISHThe scaling and polishing of both the tooth and the root of the tooth to remove plaque deposits, and calculus. 

INCLUSION CRITERIA: Scaling above and below the gum level.

EXCLUSION CRITERIA: Any surgical procedure on the gums, any chemical washing of the space between gum and tooth and root planing.

STUDIES INCLUDED: Two randomised controlled trials (RCTs) for a total of 1,711 participants. 

About the RCTs:

  • Both involved adults without severe periodontitis who were regular attenders at dental        appointments in the UK. Both were conducted in general dental practices.
  • One study measured outcomes at 24-months and one study at 36-months.
  • The studies did not assess the adverse effects of S&P treatments and available evidence on the costs of the treatments is uncertain.   

Results Recap

  1. Found little or no difference between regular planned scale and polish treatments compared with no scheduled scale and polish for the early signs of gum disease (gingivitis or bleeding gums; plaque deposits; and probing depths or gum-pockets).
  2. Participants receiving six-monthly and 12-monthly scale and polish treatments reported feeling that their teeth were cleaner than those who were scheduled to receive no treatment.
  3. Available evidence on the costs of the treatments was uncertain as neither of the studies measured side effects, changes in attachment level, tooth loss, or halitosis; nor did they compare scale and polish treatments provided by different dentists, dental therapists, and hygienists.

Implications for Dentists

According to the authors, implications, “For adults without severe periodontitis accessing routine dental care, there is little or no difference in gingivitis, probing depths or quality of life over two to three years between routinely provided six-monthly scale and polish (S&P) treatments, 12-monthly S&P treatments and no scheduled S&P treatments (high-certainty evidence).

There may also be little or no difference in plaque levels over two years (low-certainty evidence). Although routine S&P treatments produce a small reduction in calculus levels over two to three years when compared to no scheduled S&P treatments, with six-monthly treatments reducing calculus more than 12-monthly treatments (high-certainty evidence), the importance of these reductions for patients and clinicians is unclear.”

To read the full article, Routine scale and polish for periodontal health in adults, visit the Cochrane Library.

Visit the Cochrane Oral Health Editorial Base Blog for an overview of this literature review.

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Until next time!

CDA Oasis Team

2 Comments

  1. Dr. Paul Belzycki, DDS January 18, 2019

    Let me start by saying I did not waste my time reading the Cochrane report. Reminds me of caffufle a year ago when flossing was poopooed.

    I am entering my fortieth year of full time solo practice. Here are my findings.

    1). Those patients that comply with routine cleaning appointments have the fewest problems. Note I run a practice where folks have been with me for decades.

    2). Those patients that come in sporadically over the years have the most problems. And by the time they present, the problems are more extensive.

    3). For myself, as a busy dentist around hygienist, somehow my cleanings get stretched to a year. I may not exhibit gingivitis, but my teeth do accumulate calculus. Feels so different when they are cleaned.

    4). This may be heretical, but gingivitis ain’t such a big deal. It can be resolved. But periodontitis is a huge deal. When symptoms do motivate a patient to action, the problems are advanced. Seeing patients regularly for “routine cleanings”, helps us catch these problems early on.

    I provide gum surgery. Often elbow deep in blood, I say to myself and sometimes the patient “Why the f**k didn’t you come in regularly?”

    5). And I am sure studies from Cochrane claim perio-surgery is of little value in treating gum disease.

    6). So what to do? Manage and manipulate biofilm with yogurt? Yes I attended that seminar too. At the university level I might add. Dragged a department head all the way from Denmark to make his case. “Restorative and perio-surgery is a crime”. “Yogurt is the Panacea”. He too mentioned Cochrane studies with reverence.

    I laughed to myself. The day before, I opened into a stained pit on a molar without local anesthetics thinking it was a tiny defect at worse. It wasn’t. Yep, should have stuffed yogurt into it.

    7). So I fall back on Common Sense. We struggle to get folks in as regularly as possible, recognizing that most put this off too. Typically everyone is bit overdue. And when they come in…it shows with increased bleeding. It may be subtle…but it is noted.

    As Plato claimed…”Good decisions are based on experience and not numbers”

    And Mark Twain…”there 3 types of lies….lies…then damn lies…and then there’s statistics”

    Sincerely…In The Trenches

    Dr. Paul Belzycki, DDS

    Reply
    1. Vasant Ramlaggan. January 22, 2019

      Here here! This review flies in the face of common sense experience. Are we waiting for “low certainty evidence” to guide us? I think not.

      Neither study seemed to NOT measure a lot of things. Visual experience says otherwise as do radiographic evidence over time.

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