IQuaD dental trial; improving the quality of dentistry: 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

BMC Oral Health

Linda Young^1,10  Helen V Worthington⁴  Pauline D Watt⁵  Martin Tickle⁴  Moira Swan⁹  James G Steele⁹  Margaret K Ross³  David NJ Ricketts¹  Marjon van der Pol⁷  Nigel B Pitts⁶  John DT Norrie²  Fiona E Mitchell⁵  Lorna E Macpherson⁵  Gladys McPherson²  Alison M McDonald²  Giles I McCracken⁹  Wendy McCombes^1,10  Isobel Madden^1,10  Laura A Lovelock⁵  Thomas J Lamont⁵  Marilyn Laird⁵  Clare Jones⁴  Penny J Hodge⁸  Peter A Heasman⁹  Lynne Heasman⁹  Andrew F Hall¹  Jill Gouick⁵  Andrew Elders²  Anne Duncan²  Graham R Chadwick¹  Louise Campbell²  Dwayne Boyers⁷  Debbie Bonetti⁵  Paul Averley⁹  Craig R Ramsay²  Jan E Clarkson^1,10 

[1]Dundee Dental School, University of Dundee, Dundee, UK

[2]Health Services Research Unit, University of Aberdeen, Aberdeen, UK

[3]University of Edinburgh, Edinburgh, UK

[4]School of Dentistry, University of Manchester, Manchester, UK

[5]Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee DD1 4HN, UK

[6]Kings College London Dental Institute, London, UK

[7]Health Economics Research Unit, University of Aberdeen, Aberdeen, UK

[8]School of Medicine, University of Glasgow Dental School, Glasgow, UK

[9]Newcastle University, Newcastle Upon Tyne, UK

[10]NHS Education for Scotland, Edinburgh, UK

关键词: Primary care;    RCT;    Periodontal instrumentation;    Toothbrushing advice;    Prevention;    Scale and polish;    Oral hygiene advice;   

Others  :  1125883
DOI  :  10.1186/1472-6831-13-58

 received in 2013-06-11, accepted in 2013-07-22,  发布年份 2013

【 摘 要 】

Background

Periodontal disease is the most common oral disease affecting adults, and although it is largely preventable it remains the major cause of poor oral health worldwide. Accumulation of microbial dental plaque is the primary aetiological factor for both periodontal disease and caries. Effective self-care (tooth brushing and interdental aids) for plaque control and removal of risk factors such as calculus, which can only be removed by periodontal instrumentation (PI), are considered necessary to prevent and treat periodontal disease thereby maintaining periodontal health. Despite evidence of an association between sustained, good oral hygiene and a low incidence of periodontal disease and caries in adults there is a lack of strong and reliable evidence to inform clinicians of the relative effectiveness (if any) of different types of Oral Hygiene Advice (OHA). The evidence to inform clinicians of the effectiveness and optimal frequency of PI is also mixed. There is therefore an urgent need to assess the relative effectiveness of OHA and PI in a robust, sufficiently powered randomised controlled trial (RCT) in primary dental care.

Methods/Design

This is a 5 year multi-centre, randomised, open trial with blinded outcome evaluation based in dental primary care in Scotland and the North East of England. Practitioners will recruit 1860 adult patients, with periodontal health, gingivitis or moderate periodontitis (Basic Periodontal Examination Score 0–3). Dental practices will be cluster randomised to provide routine OHA or Personalised OHA. To test the effects of PI each individual patient participant will be 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) will be 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.

Discussion

IQuaD will provide evidence for the most clinically-effective and cost-effective approach to managing periodontal disease in dentate adults in Primary Care. This will support general dental practitioners and patients in treatment decision making.

Trial registration

Protocol ID: ISRCTN56465715

【 授权许可】

   
2013 Clarkson et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Papapanou PN: Epidemiology of periodontal diseases: an update. J Int Acad Periodontol 1999, 1:110-116.
• [2]Neely AL, Holford TR, Löe H, Ånerud Å, Boysen H: The natural history of periodontal disease in man. Risk factors for progression of attachment loss in individuals receiving no oral health care. J Periodontol 2001, 72(8):1006-1015.
• [3]Ekstrand KR, Bruun G, Bruun M: Plaque and gingival status as indicators for caries progression on approximal surfaces. Caries Res 1998, 32(1):41-45.
• [4]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: The Stationary Office; 2000.
• [5]Axelsson P, Nystrom B, Lindhe J: The long-term effect of a plaque control program on tooth mortality, caries, and periodontal disease in adults. J Clin Periodontol 2004, 31:749-757.
• [6]Watt RG, Marinho VC: Does oral health promotion improve oral hygiene and gingival health? Periodontol 2005, 37:35-47.
• [7]Renz A, Ide M, Newton T, Robinson P, Smith D: Psychological interventions to improve adherence to oral hygiene instructions in adults with periodontal diseases. Cochrane Database Syst Rev 2007. Issue 2. Art. No.: CD005097. doi: 10.1002/14651858.CD005097.pub2
• [8]Kay E, Locker DA: A systematic review of the effectiveness of oral health promotion aimed at improving oral health. Community Dent Health 1998, 15:132-144.
• [9]Sprod AJ, Anderson R, Treasure ET: Effective oral health promotion: literature review. Technical Report 20. Cardiff: Health Promotion Wales and University of Wales College of Medicine; 1996.
• [10]Elley K, Gold L, Burls A, Gray M: Scale and Polish for chronic periodontal disease. WMHTAC, Department of Public Health & Epidemiology, University of Birmingham; 2000. [Report 22] ISBN: 07044 21739
• [11]Beirne PV, Worthington HV, Clarkson JE: Routine scale and polish for periodontal health in adults. Cochrane Database Syst Rev 2007. Issue 4. Art. No.: CD004625. doi: 10.1002/14651858.CD004625.pub3
• [12]Gaunt F, Devine M, Pennington M, Vernazza C, Gwynnett E, Steen N, Heasman P: The cost-effectiveness of supportive periodontal care for patients with chronic periodontitis. J Clin Periodontol 2008, 35(Suppl. 8):67-82.
• [13]Bandura A: Health promotion from the perspective of social cognitive theory. Psychol Health 1998, 13:623-649.
• [14]Gollwitzer PM: Implementation intentions: strong effects of simple plans. Am Psychol 1999, 54:493-503.
• [15]Chapple ILC, Hill K: Getting the message across to periodontitis patients: the role of personalised biofeedback. Int Dent J 2008, 58(5 Supplement 1):294-306.
• [16]Löe H: The gingival index, the plaque index and the retention index systems. J Periodontol 1967, 36:610-616.
• [17]Slade GD: Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997, 25:284-290.
• [18]Ajzen I: The theory of planned behaviour. Organ Behav Hum Decis Process 1991, 50:179-211.
• [19]Goldstein H: Multilevel Statistical Models. London: Arnold; 1996.
• [20]Fielding S, Fayers PM, Ramsay CR: Investigating the missingness mechanism in quality of life data: a comparison of approaches. Health Qual Life Outcome [Online] 2009., 7(57) doi:10.1186/1477-7525-7-57. Available from: http://www.hqlo.com/content/pdf/1477-7525-7-57.pdf webcite
• [21]Carpenter JR, Kenward MG: Missing data in randomised controlled trials – a practical guide. 2007. [http://www.pcpoh.bham.ac.uk/publichealth/methodology/docs/invitations/Final_Report_RM04_JH17_mk.pdf webcite]
• [22]Ryan M, Gerard K: Using discrete choice experiments to value health care: current practice and future prospects. Appl Health Econ Policy Anal 2003, 2:55-64.
• [23]Louviere JJ, Hensher DA, Swait JD: Stated Choice Methods. Analysis and Application. Cambridge: Cambridge University Press; 2000.
• [24]Maddala G: Limited dependent and qualitative variables in econometrics. Cambridge: Cambridge University Press; 1983.
• [25]Pearmain D, Swanson J, Kroes E, Bradley M: Stated preferences techniques: guide to practice. The Hague: Steer Davies Gleave and Hague Consulting Group; 1991.
• [26]McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, et al.: Systematic review of the clinical effectiveness and cost-effectiveness of laparoscopic surgery for inguinal hernia repair. Health Technol Assess 2005, 9:14.
• [27]Clarkson JE, Young L, Ramsay CR, Bonner BC, Bonetti D: How to influence patient oral hygiene behaviour effectively. J Dent Res 2009, 88(10):933-937.