Knowledge Translation Among General Dental Practitioners in the Field of Periodontics.

INTRODUCTION: Evidence-based practice (EBP) is an expectation of medical professionals and is positively received in the dental community. Investigations of evidence-based dentistry (EBD) have discussed its use in broad terms and daily clinical practice, but there is only limited information about its use and barriers with respect to particular dental specialities. METHODS: A cross-sectional questionnaire was developed to survey implementation and obstacles to EBP; EBD specific to periodontics; and preferences for types of dissemination of evidence. The target population was active general dentists in Nova Scotia (n = 446). An email link to the questionnaire was distributed to dentists, and reminders were sent 4 and 10 days later. RESULTS: The response rate was limited (16.6%). Most respondents were comfortable evaluating the growing body of research, although many reported use of low-level evidence, including that from other health professionals or expert opinion. A common barrier to use was insufficient time. Respondents who found strong evidence for certain periodontal procedures were more likely to refer these procedures, which included tissue regeneration and periodontics related to endodontics. On-site lecture-based dissemination was preferred by most respondents. CONCLUSION: General evidence-based concepts and use were similar to EBD results reported elsewhere, although external validity is limited by our low response rate and narrow target population. Specific data related to periodontics may be useful in directing a modified questionnaire to a broader target population. Respondents who are truly interested in EBD and responded to our questionnaire may ultimately benefit the most from our results, where further educational opportunities can be tailored to overcome the identified barriers and aid in more effective translation of evidence-based periodontal decisions in a general dental practice.

Patterns of opioid prescribing by dentists in a pediatric population: a retrospective observational study.

BACKGROUND: Dentists are regular prescribers of opioid analgesic medications; however, there are few published data on their prescribing practices for children. The aim of this study was to assess opioid prescribing practices of dentists for pediatric patients. METHODS: We conducted a retrospective study (2011/12 to 2017/18) using administrative health data of opioid prescribing practices of dentists in Nova Scotia for children and adolescents (age < 18 yr). The main variables of interest were opioid "type" and "load" dentists prescribed (number of dispensed prescriptions/yr, days supplied/prescription and dosage/d per prescription in milligrams of morphine equivalents [MME]). RESULTS: Dentists accounted for a mean of 18.3% (standard deviation 1.5%) of all opioid prescribers for the pediatric population annually but were responsible for 59.9% of all opioid prescriptions and 48.6% of total MME dispensed during the 7-year study period. Oral and maxillofacial surgeons were responsible for 80.7% of all dental-related opioids dispensed. Codeine was most frequently prescribed (78.6% of total MME), followed by oxycodone (11.1%). There were significant downward trends over the study period in the total amount of opioid analgesics dispensed (r = -0.903, p < 0.01), primarily due to a reduction in the total amount of codeine dispensed and number of days supplied per prescription (r = -0.837, p < 0.05). Few opioids were dispensed to children less than 12 years. INTERPRETATION: Dentists in Nova Scotia reduced prescriptions of opioids in the pediatric population between 2011/12 and 2017/18, which may indicate that current opioid prescribing principles are influencing dentists' prescribing habits. Nonetheless, patients and parents should receive appropriate counselling as to the proper use, risks, storage and potential for misuse of opioids when prescribed.

PRACTICE PROFILE OF PERIODONTISTS IN CANADA: A NATIONAL SURVEY.

OBJECTIVE: To document the profile of periodontists in private practice in Canada in terms of services provided and referral patterns. METHODS: An online survey consisted on 45 questions in 3 categories: demographics, referral patterns and periodontal procedures performed. The sampling frame consisted of all active members of the Canadian Academy of Periodontology (n= 280). Letters and email containing links to the online survey were used to invite participants and to send reminders to non-respondents on days 7, 21 and 49. RESULTS: The response rate was 164/280 (58.6%); 135 respondents completed the entire survey. Of the respondents who noticed changes in referral dynamics in the last 10 years (68.1%), most (61.9%) perceived an overall decrease in the number of referrals, and 74.0% reported that general dentists were referring patients later in the disease progression. The most common referrals (71.6%) were for limited treatment. Most respondents placed dental implants (93.7%) and performed maxillary sinus lifts (81.6%). All performed surgical debridement, esthetic and prerestorative crown lengthening and connective tissue grafts. Only 13.7% provided photodynamic therapy. Fewer years in practice (<20 years), more recent graduation (after 1990) and younger age (<45 years) were correlated with greater use of single-implant placement, sinus lifts and procedures requiring intravenous sedation. Men were more likely than women to use lasers (p=0.020). CONCLUSION: Periodontal specialists perceived a change in referral dynamics over the last 10 years with most reporting both a decrease in number and delayed timing of referrals. Practice patterns have changed, with younger periodontists performing more advanced surgical procedures. These findings may guide periodontal residency programs and create awareness among general dentists of the role of the periodontist and their repertoire of treatment options.

Success and Survival Rates of Dental Implants Restored at an Undergraduate Dental Clinic: A 13-Year Retrospective Study with a Mean Follow-up of 5.8 Years.

PURPOSE: The purpose of this study was to evaluate the clinical, radiographic, and patient-based outcomes of dental implants placed at an undergraduate student dental clinic. MATERIALS AND METHODS: A retrospective study was performed to determine the success and survival rates of dental implants placed at the undergraduate dental clinic at Dalhousie University between January 1999 and January 2012. Only patients with a minimum of 1-year follow-up were included. Clinical and radiographic assessments determined implant success and survival rates. Questionnaires recorded patients' satisfaction with esthetics, comfort, and ease of hygiene. RESULTS: Of the 352 patients (n = 591 implants) who received implants over 13 years, 165 patients completed the clinical and radiographic examinations. By the end of the study period, demographic information and implant characteristics were collected for 111 (n = 217 implants; 47.5% in the maxilla, 52.6% in the mandible) of these patients. Of those assessed clinically, 36.4% were males and 63.6% females, with a mean age of 56.1 ± 14.15 years (range, 17 to 86 years) at the time of implant placement. The mean follow-up period was 5.8 years (range, 1 to 13 years). The overall implant success and survival rates were 88.0% and 97.2%, respectively. No observable bone loss was evident in 88.0% of the surviving implants. There were no implant fractures. Most patients (91.2%) were very satisfied with the implant restoration appearance, 88.0% were very comfortable with the implant, 92.6% were very satisfied with their ability to chew, and 84.8% reported easy hygiene maintenance at the implant sites. CONCLUSION: Implant success and survival in an undergraduate student clinic were comparable to those reported in the literature. It seems that inexperienced students were able to provide restorations that were very satisfying to the patients.

Prevention and treatment of periodontal diseases in primary care.

SCOPE AND PURPOSE: The aim of this guidance is to support the dental team to; manage patients with periodontal diseases in primary care appropriately; improve the quality of decision making for referral to secondary care; improve the overall oral health of the population. It focuses on the prevention and non-surgical treatment of periodontal diseases and implant diseases in primary care. The surgical treatment of periodontal and implant diseases and the management of patients by periodontal specialists or in a secondary care setting are outwith the scope of this guidance and are not discussed in detail. The guidance is based on existing guidelines, including those from the British Society of Periodontology, relevant systematic reviews, research evidence and the opinion of experts and experienced practitioners. METHODOLOGY: The methodological approach is based on the international standards set out by the Appraisal of Guidelines Research and Evaluation (AGREE) Collaboration (www.agreetrust.org). The guiding principle for developing guidance within SDCEP is to first source existing guidelines, policy documents, legislation or other recommendations. Similarly, relevant systematic reviews are also initially identified. These documents are appraised for their quality of development, evidence base and applicability to the remit of the guidance under development. In the absence of these documents or when supplementary information is required, other published literature and unpublished work may be sought.Review and updating. The guidance will be reviewed in three years and updated accordingly. RECOMMENDATIONS: Recommendations are provided for assessment and diagnosis; changing patient behaviour; treatment of gingival conditions; periodontal conditions; long term maintenance; management of patients with dental implants; referral and record keeping. The key recommendations highlighted are: Assess and explain risk factors for periodontal diseases to patients. Screen all patients for periodontal diseases at every routine examination. Carry out a full periodontal examination for patients with BPE scores 3, 4 and (*)Use the Oral Hygiene TIPPS (talk, instruct, practise, plan, support) behaviour change strategy to address inadequate plaque removal. Raise the issue of smoking cessation where appropriate. Encourage patients to modify other lifestyle factors that may impact on their oral health. Ensure the patient is able to perform optimal plaque removal. Remove supra-gingival plaque, calculus and stain and sub-gingival deposits. Ensure that local plaque retentive factors are corrected. Remove supra-gingival plaque, calculus and stain and correct any local plaque retentive factors. Carry out root surface instrumentation at sites ≥ 4 mm probing depth where sub-gingival deposits are present or which bleed on probing. Do not use antimicrobial medication to treat chronic periodontitis. Remove supra-gingival plaque, calculus and stain and sub-gingival deposits and ensure that local plaque retentive factors are corrected. Assign an individual's risk level based on the patient's medical history and oral health status and schedule recall appointments accordingly. Ensure the patient is able to perform optimal plaque removal around the dental implant(s)Examine the peri-implant tissues for signs of inflammation and bleeding on probing and/or suppuration and remove supra- and sub- mucosal plaque and calculus deposits and excess residual cement. Perform radiographic examination only where clinically indicated. Consult any locally produced referral guidelines and the BSP 'Referral Policy and Parameters of Care' to determine if the patient is a suitable candidate for referral. Carry out initial therapy to address inadequate plaque removal, smoking status (if applicable) and to remove supra- and sub-gingival deposits. Provide supportive periodontal therapy and monitoring for patients who have been discharged from secondary care. Record the results of the periodontal examinations (basic and/or full) carried out and the current standard of oral hygiene. Record the diagnosis, suggested treatment plan and details of costs. Document any discussions you have with the patient, for example, treatment options, risks and benefits of treatment, oral hygiene advice, smoking cessation, alcohol consumption and/or other lifestyle factors. RESEARCH RECOMMENDATIONS: There is a need for high-quality research carried out within an appropriate governance framework to improve the evidence base in the following areas: barriers and facilitators to the delivery of oral hygiene interventions in primary care;behaviour change interventions to improve inadequate oral hygiene;optimal timescales for provision of routine supra-gingival debridement (dental prophylaxis) and supportive periodontal therapy;effectiveness of supportive periodontal therapy regimens;effectiveness of supportive therapy regimens to maintain peri-implant tissues;effectiveness of interventions to treat peri-implant mucositis and peri-implantitis.Consensus is urgently required on the importance and validity of surrogate periodontal outcomes (eg bleeding on probing, changes in clinical probing depth and clinical attachment level and bone levels) and their relationship to true outcomes (eg tooth loss and patient-centred outcomes) so that consistency can be achieved across studies. There is also a need for independent research into the effectiveness of oral hygiene tools such as toothbrushes, interdental aids, toothpastes and mouthwashes and gels containing antibacterial agents.

Adoption issues associated with a new periodontal screening tool: an online survey of Canadian dentists.

OBJECTIVE: To determine barriers and facilitators associated with the acceptance of a new diagnostic screening tool for periodontitis. METHODS: As part of a larger study to examine factors that affect the adoption of new technology by dentists, we piloted an online survey of Canadian dentists through an electronic newsletter produced by the Journal of the Canadian Dental Association. A new oral rinse that screens for the presence of periodontitis by estimating neutrophil abundance in saliva was used for illustrative purposes. The survey included questions about the types of patients for which the test would be beneficial, how the test might be incorporated into practice and how much the dentist would be willing to pay for the test. RESULTS: As the survey was delivered through a new communication tool, the response rate was low. Nonetheless there appeared to be interest in new periodontal screening tools to complement existing diagnostic tests for periodontitis. The test was seen as a valuable educational tool for patients; however, the cost to administer the test was determined to be an issue. CONCLUSIONS: Despite the low response rate, dentists were interested in new screening tests for periodontitis. A larger study with a more representative sample could provide valuable information for scientists who are interested in taking their research from the bench to chairside.

The oral health status of recent immigrants and refugees in Nova Scotia, Canada.

There are no published reports on the oral health status of adult immigrants and refugees in Canada. An oral health interview and clinical oral examination were conducted on 45 recent immigrants and 41 recent Bhutanese refugees, aged 18-67, in Nova Scotia, Canada. Over half (53%) of the immigrants and 85% of the refugees had untreated decay. Most (89% of immigrants; 98% of refugees) had moderate to severe gingivitis and the majority (73% of immigrants; 85% of refugees) had moderate to severe periodontitis. Despite these, 64% of immigrants and 49% of refugees rated their oral health as good, very good or excellent, and most believed they did not need fillings or periodontal treatment. Oral disease among the study sample was higher than the Canadian average and there was a striking discrepancy between self-reported and clinically determined need for dental care.

The oral health of ageing baby boomers: a comparison of adults aged 45-64 and those 65 years and older.

OBJECTIVES: To compare the oral health status of adults aged 45-64 (baby boomers) and those aged 65 and older. METHODS: An observational, cross-sectional survey of adults living independently in rural and urban settings in Nova Scotia, Canada was conducted. Using random digit dialing, calibrated interviewers completed a telephone survey, and clinicians calibrated to WHO standards conducted clinical examinations. Weighting was used to correct for sampling bias. RESULTS: 747 community dwelling adults completed both the clinical exam and the questionnaire (n=411, age 45-64; n=336, age 65 or older). Rates of edentulism were low (2.6% aged 45-64; 15.7% aged 65+; p<0.001). Untreated root caries was greater in the older dentate group (19.7 vs. 10.1%; p<0.001). Being 65 years of age or older was identified as a predictor of increased decayed, missing, filled teeth, presence of decayed and/or filled roots and presence of attachment loss≥4 mm, but was not a significant predictor of presence of untreated coronal caries. CONCLUSIONS: A falling rate of edentulism and a higher risk for root caries with increasing age may predict the need for more complex dental care as our population ages.

A practitioner's guide to developing critical appraisal skills: observational studies.

BACKGROUND: and Overview. Observational investigations provide an opportunity to document the distribution of diseases in various populations and to explore correlations between exposures and outcomes. Interpreting such correlations as causal is challenging and can lead to more harm than good when used as a basis for advising lifestyle changes or interventions to healthy people. The aim of this review is to provide a brief introduction to observational study designs and describe some of their strengths and weaknesses. CONCLUSIONS AND PRACTICE IMPLICATIONS: Observational findings can be useful to guide clinical research, but often they do not provide a reliable basis for clinical decision making. Caution in applying observational findings to clinical practice is particularly important when caring for healthy people.

Periodontal practice and referral profile of general dentists in Nova Scotia, Canada.

BACKGROUND: In contrast to an expected increase in demand for periodontal services with aging of the population, it appears that referrals to periodontists are declining. OBJECTIVE: To determine the extent to which general dentists in Nova Scotia, Canada, provide periodontal and surgical implant therapies and to determine the factors influencing a dentist's decision to provide treatment or refer patients to a specialist. METHODS: A cross-sectional survey study was performed. The survey questionnaire was mailed to all 443 general dentists practising in Nova Scotia in summer 2009. The questionnaire presented several clinical scenarios and asked respondents whether they would treat the patient in the office or refer to a specialist. The data were analyzed by logistic regression. RESULTS: Of the 279 (63.0%) dentists responding to the survey, 272 (61.4% of the total) were eligible for inclusion in the analysis. The majority of dentists reported rendering nonsurgical periodontal therapy, including scaling (98.5%; 262/266), periodontal maintenance (95.9%; 255/266), and treatment for bruxism (95.1%; 252/265). The most common surgical procedures performed by dentists were frenectomy (29.4%; 78/265), gingivectomy (29.3%; 77/263) and crown-lengthening procedures (17.0%; 46/271). Eleven factors significantly influenced dentists' decisions to treat or refer patients. The most common criteria used in selecting a periodontist were satisfaction of previous patients, previous success with the treatment, and the personality of and good communications with the periodontist. CONCLUSIONS: In this study, dentists reported rendering nonsurgical periodontal therapy on a wide scale, whereas their involvement in oral or periodontal and implant surgical therapies was limited.

Oral health-related quality of life in an aging Canadian population.

BACKGROUND: The purpose of the study is to describe the impact of oral health-related quality of life (OHRQoL) on the lives of pre-seniors and seniors living in Nova Scotia, Canada. METHODS: This cross-sectional study involved 1461 participants, grouped by age (pre-seniors [45-64] and seniors [65+]) and residential status (long-term care facility [LTC] or community). OHRQoL was measured using the 14-item Oral Health Impact Profile questionnaire (OHIP-14) in a random digit dialing telephone survey (for community residents) or a face-to-face interview (for LTC residents). Intra-oral examinations were performed by one of six dentists calibrated to W.H.O. standards. RESULTS: Approximately one in four pre-seniors and seniors reported at least one OHRQoL impact 'fairly/very often'. The most commonly reported impacts were within the dimensions 'physical pain' and 'psychological discomfort'. It was found that 12.2% of LTC residents found it uncomfortable to eat any foods 'fairly/very' often compared to 7.7% in the community, and 11.6% of LTC residents reported being self-conscious 'fairly/very often' compared to 8.2% in the community. Of those residing in the community, pre-seniors (28.8%) reported significantly more impacts than seniors (22.0%); but there were no significant differences in OHRQoL between pre-seniors (21.2%) and seniors (25.3%) in LTC. Pre-seniors living in the community scored significantly higher than community dwelling seniors on prevalence, extent and severity of OHIP-14 scores. Logistic regression revealed that for the community dwelling sample, individuals living in rural areas in addition to those being born outside of Canada were approximately 2.0 times more likely to report an impact 'fairly/very often', whereas among the LTC sample, those having a high school education or less were 2.3 times more likely to report an impact. CONCLUSIONS: Findings indicate that the oral health and OHRQoL of both pre-seniors and seniors in LTC residents is poor. Community dwelling pre-seniors have the highest prevalence rate of oral impacts.

Action planning for daily mouth care in long-term care: the brushing up on mouth care project.

Research focusing on the introduction of daily mouth care programs for dependent older adults in long-term care has met with limited success. There is a need for greater awareness about the importance of oral health, more education for those providing oral care, and organizational structures that provide policy and administrative support for daily mouth care. The purpose of this paper is to describe the establishment of an oral care action plan for long-term care using an interdisciplinary collaborative approach. Methods. Elements of a program planning cycle that includes assessment, planning, implementation, and evaluation guided this work and are described in this paper. Findings associated with assessment and planning are detailed. Assessment involved exploration of internal and external factors influencing oral care in long-term care and included document review, focus groups and one-on-one interviews with end-users. The planning phase brought care providers, stakeholders, and researchers together to design a set of actions to integrate oral care into the organizational policy and practice of the research settings. Findings. The establishment of a meaningful and productive collaboration was beneficial for developing realistic goals, understanding context and institutional culture, creating actions suitable and applicable for end-users, and laying a foundation for broader networking with relevant stakeholders and health policy makers.

Oral health status of long-term care residents-a vulnerable population.

OBJECTIVE: To conduct an observational, cross-sectional survey of the oral health status of adults ≥ 45 years of age in rural and urban long-term care (LTC) facilities in Nova Scotia, Canada. METHODS: Residents capable of informed consent were recruited by LTC staff in a stratified random sample of LTC facilities. Calibrated personnel administered standard clinical and quality-of-life instruments. RESULTS: Of the 335 adults (74% female) surveyed (mean age 80.8 ± 11.6 years), only 25% reported having regular dental care. Although 76% described their oral health as good or excellent, 41% were edentulous, 41% had some mucosal abnormality, 36% reported xerostomia and 25% had perceived or self-reported untreated dental conditions. Most mandibular dentures were nonretentive (59%) and almost half were unstable (49%). Among the dentate, 51% had untreated coronal caries, 44% had untreated root caries and 67% had attachment loss of ≥ 4 mm at ≥ 1 site. Predictors of coronal decay were a debris score ≥ 2 (adjusted odds ratio [adj OR] = 2.12; p = 0.045) or a history of smoking (adj OR = 1.02 per year of smoking; p = 0.024). Predictors of root caries were participants' perceiving a need for dental treatment (adj OR = 2.56; p = 0.015) or a history of smoking (adj OR = 1.02 per year of smoking; p = 0.026). CONCLUSIONS: This epidemiologic study of the oral health of LTC residents revealed a high prevalence of untreated oral disease and low use of oral care services, highlighting the need for better access to oral care for this population.

Assessing the oral health of an ageing population: methods, challenges and predictors of survey participation.

OBJECTIVES: To examine predictors of participation and to describe the methodological considerations of conducting a two-stage population-based oral health survey. METHODS: An observational, cross-sectional survey (telephone interview and clinical oral examination) of community-dwelling adults aged 45-64 and ≥65 living in Nova Scotia, Canada was conducted. RESULTS: The survey response rate was 21% for the interview and 13.5% for the examination. A total of 1141 participants completed one or both components of the survey. Both age groups had higher levels of education than the target population; the age 45-64 sample also had a higher proportion of females and lower levels of employment than the target population. Completers (participants who completed interview and examination) were compared with partial completers (who completed only the interview), and stepwise logistic regression was performed to examine predictors of completion. Identified predictors were as follows: not working, post-secondary education and frequent dental visits. CONCLUSION: Recruitment, communications and logistics present challenges in conducting a province-wide survey. Identification of employment, education and dental visit frequency as predictors of survey participation provide insight into possible non-response bias and suggest potential for underestimation of oral disease prevalence in this and similar surveys. This potential must be considered in analysis and in future recruitment strategies.

Journal clubs most effective if tailored to learner needs.

DATA SOURCES: The search strategy was developed using Medline and adapted for the requirements of other databases. The strategy included all study types, enabling the retrieval of qualitative research. Databases searched were; Australian Education Index, ACP Journal Club, British Education Index, Cochrane Library, CINAHL, Embase, Eric, LISA Medline, metaRegister of Controlled Trials, National Research Register, Psychinfo, REFER, Sociological Abstracts, Web of Knowledge. Bibliographies of relevant publications and review articles were scanned and relevant references were retrieved. No language restrictions were applied. Information on databases searched provided by original authors as not included in published article. STUDY SELECTION: All study designs which evaluated whether clubs promote changes in learner reaction, attitudes, knowledge, skills, behaviour or patient outcomes in undergraduate, postgraduate and practice settings. Studies evaluating video/internet meetings or single meetings were excluded. DATA EXTRACTION AND SYNTHESIS: Each article was reviewed by two authors independently with pilot-tested data collection forms. No quality assessment was pre-specified. RESULTS: Eighteen studies were included. Studies reported improvements in reading behaviour (N=5/11), confidence in critical appraisal (N=7/7), critical appraisal test scores (N=5/7) and ability to use findings (N=5/7). No studies reported on patient outcomes. Sixteen studies used self-reported measures, but only four studies used validated tests. Interventions were too heterogeneous to allow pooling. Realist synthesis identified potentially 'active educational ingredients', including mentoring, brief training in clinical epidemiology, structured critical appraisal tools, adult-learning principles, multifaceted teaching approaches and integration of the JC with other clinical and academic activities. CONCLUSIONS: The effectiveness of JCs in supporting evidence-based decision making is not clear. Better reporting of the intervention and a mixed methods approach to evaluating active ingredients are needed in order to understand how JCs may support evidence-based practice.

Multifaceted strategy needed to improve dentists' adherence to evidence-based guidelines.

DESIGN: This was a cluster-randomised clinical trial (RCT) of incomplete block design. INTERVENTION: The interventions comprised an online 'patient-simulated clinical case' assessment, guideline dissemination, an interactive educational meeting, and flow chart reminders. All participants received feedback on individual as well as group scores for the patient-simulated clinical case assessment. Reminders with particular information and guideline-algorithm flow diagrams were provided 2 months before post-intervention measurements. OUTCOME MEASURE: The primary outcome measure was guideline-adherent recall interval assignment, and the secondary outcome measure was guideline-adherent bitewing frequency prescription. RESULTS: For low-risk patients, guideline-adherent recall increased in the intervention group (+8%), which differed from the control group (-6.1%; P 0.01). Guideline-adherent bitewings showed mixed results. CONCLUSIONS: Multifaceted intervention had a moderate but relevant effect on the performance of general dental practitioners, which is consistent with other findings in primary care.

Seeing the Light--the truth about soft tissue lasers and nonsurgical periodontal therapy.

Although laser treatment has generated considerable interest among dentists and the public, there is no evidence that any laser system adds clinical value over and above scaling and root planing and conventional surgical treatment for periodontitis. Following a brief explanation of the mechanism behind soft tissue lasers, the evidence on the use of laser therapy in addition to traditional nonsurgical periodontal treatment in the management of periodontal diseases is reviewed.

No difference between full-mouth and quadrant-wise treatment of chronic periodontitis.

DATA SOURCES: Medline and Embase, along with reference lists from retrieved papers, were used to source relevant studies. STUDY SELECTION: Only English-language randomised controlled clinical trials (RCT) with at least 6 months followup; that used the patient as the unit of analysis; included patients with chronic periodontitis who had not used antibiotics for 3 months prior to the start of the study; and compared full-mouth debridement or full-mouth disinfection with conventional quadrant root planing were included. OUTCOME MEASURE: Measures considered were reductions in probing pocket depths, probing attachment levels and bleeding on probing. Study quality was assessed based on randomisation methods, allocation concealment, examiner blinding and completeness of followup. DATA EXTRACTION AND SYNTHESIS: Data were extracted by two reviewers independently and meta-analysis was performed. RESULTS: Seven RCT were included. There were no statistically significant differences between the full-mouth debridement and quadrant approaches. CONCLUSIONS: The review suggests that mechanical or nonsurgical periodontal treatment is effective but showed no difference in the periodontal clinical outcome measures between the full-mouth debridement and quadrant approaches.

Powered toothbrush plus triclosan only as effective as manual brush and fluoride toothpaste for periodontal maintenance patients.

DESIGN: This randomised, controlled and single-masked clinical trial was carried out in specialist clinics in Sweden and the US. INTERVENTION: The test group were instructed to use an rotation-oscillation action (ROA) powered toothbrush (Oral-B; Gillette, Boston, Massachusetts, USA) and a triclosan/ copolymer/ fluoride-containing dentifrice (Total; Colgate, Piscataway, New Jersey, US). The control group were instructed to brush using the modified Bass technique and a conventionally designed, multitufted, soft, manual toothbrush using a standard fluoride-containing dentifrice (Protection Caries; Colgate). Both groups were to brush twice a day and clean interdentally daily with dental floss, toothpicks and/ or interdental brushes. OUTCOME MEASURE: Measurements were taken at baseline, and 1, 2 and 3 years for the following parameters: number of teeth, plaque, bleeding on probing (BoP), probing pocket depth (PPD) and level of the gingival margin (GM). GM was assessed as the distance between the soft tissue margin and the cemento-enamel junction or the border of a restoration. Relative attachment level (RAL) was calculated as PPD minus GM. Subgingival plaque samples were taken and analysed for their content of 40 bacterial species at each examination interval. RESULTS: Both groups showed significant reduction in BoP, PPD and in mean total counts of the 40 bacterial species between baseline and 3 years, whereas plaque score and RAL remained almost unchanged. No significant differences between the two prevention programmes were found for any of the clinical outcome variables or in mean counts of the various bacterial species. CONCLUSIONS: The study failed to demonstrate superior clinical and microbiological effects of powered toothbrush and triclosan dentifrice compared with manual toothbrush and standard fluoride-dentifrice in periodontitis-susceptible subjects undergoing regular maintenance therapy.