Scale or Oral Hygiene Advice? Results From a Randomised Trial

Objectives: Introduction
Periodontal disease is preventable, but remains the most common oral disease affecting adults worldwide with major health and economic implications. Patients and clinicians lack strong and reliable evidence of the relative effectiveness of different types of oral hygiene advice (OHA) and the optimal frequency of periodontal instrumentation (PI) to inform their practice/care.

Objectives
The ‘Improving the Quality of Dentistry’ (IQuaD) randomised control trial primary objectives were to test the effectiveness and assess the economic value of the following dental management strategies:
a) personalised OHA versus routine OHA;
b) 12 monthly PI (scale and polish) versus 6 monthly PI;
c) no PI versus 6 monthly PI.

Methods: IQuaD is a National Institute for Health Research funded 5 year multi-centre, randomised, open trial with blinded outcome evaluation based in dental practices in the United Kingdom.
Adult patients, with periodontal health, gingivitis or moderate periodontitis (Basic Periodontal Examination Score 0–3) and no uncontrolled systemic diseases were eligible.
Dental practices were cluster randomised to provide routine OHA or Personalised OHA. To test the effects of PI each individual patient participant were randomised to one of three groups: no PI, 6 monthly PI (current practice), or 12 monthly PI.
Baseline measures and outcome data (during a three year follow-up) were assessed through clinical examination, patient questionnaires and NHS databases.
The primary outcome measures at 3 year follow up are gingival inflammation/bleeding on probing at the gingival margin; oral hygiene self-efficacy and net benefits.

Results: From 2206 screened participants, 2030 were eligible and 1877 consented to participate (92%) across 63 dental practices. 1328 (71%) participants attended for the final three year clinical outcome assessment and 1452 (77%) provided oral hygiene self-efficacy data through patient questionnaires.

Conclusions: This trial demonstrates that high quality research can be conducted in primary care and we will present the main trial results.