ORAL HEALTH

Health Evidence Bulletins - Wales
Team Leader: Mr Tony Glenn

Date of completion: 5/2/1998

The contents of this bulletin are likely to be valid for approximately one year, by which time significantly new research evidence may become available


2. Periodontal Diseases

(Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation)

The Statements The Evidence
2a. There is good evidence on which to recommend correctly conducted toothbrushing and flossing in the prevention of gingivitis in adultsi.
(Health gain notation - 1 "beneficial")
i. Ismail AI, Lewis DW. Periodic health examination, 1993 update: 3. Periodontal diseases classification, diagnosis, risk factors and prevention. Canandian Medical Association Journal 1993; 149(10): 1409-1422
(Type I evidence - systematic review using Medline only)
2b. There is good evidence on which to recommend correctly conducted toothbrushing in the prevention of gingivitis in childreni.

(Health gain notation - 1 "beneficial")

i. Ismail AI, Lewis DW. Periodic health examination, 1993 update: 3. Periodontal diseases classification, diagnosis, risk factors and prevention. Canadian Medical Association Journal 1993; 149(10): 1409-1422
(Type I evidence - systematic review using Medline only)
2c. The primary aetiology of periodontal disease is bacterial plaque i.
(Health gain notation - 6 "likely to be harmful")
i. Caton JG, Quinones CR. Etiology of periodontal diseases. Current Opinion in Dentistry 1991; 1:17-28
(Type IV evidence - observational studies)
2d. There is weak evidence to recommend correctly conducted toothbrushing and flossing to prevent periodontitis in adults i.
(Health gain notation - 2 "likely to be beneficial")
i. Ismail AI, Lewis DW. Periodic health examination, 1993 update: 3. Periodontal diseases classification, diagnosis, risk factors and prevention. Canadian Medical Association Journal 1993; 149 (10): 1409-1422
(Type I evidence - systematic review using Medline only)
2e. A reduction in smoking will reduce periodontal disease i.
(Health gain notation - 1 "beneficial")
i. Ismail AI, Lewis DW. Periodic health examination, 1993 update: 3. Periodontal diseases classification, diagnosis, risk factors and prevention. Canadian Medical Association Journal 1993; 149 (10): 1409-1422
(Type III evidence - well designed non-randomised study)

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2f. There is good evidence to recommend use of chlorhexidine oral rinse over a short period as an adjunct to self care in the prevention of gingivitis although staining is a problem. Newer rinses and gum protection toothpastes have an increasing role to play i,ii.

(Health gain notation - 1 "beneficial")

i. Ismail AI, Lewis DW. Periodic health examination, 1993 update: 3. Periodontal diseases classification, diagnosis, risk factors and prevention. Canadian Medical Association Journal 1993; 149 (10): 1409-1422
(Type I evidence - systematic review using Medline only);
ii. Adams D, Addy M. Mouthrinses. Advances in Dental Research 1994; 8 (2): 291-301
(Type I evidence - systematic review)
2g. Community based oral health education programmes can lead to improved gingival health (reduced plaque and gingivitis)i but positive effects are short term ii.

(Health gain notation - 4"unknown").

i. Sprod A J, Anderson R, Treasure E T. Literature Review. Health Promotion Wales Technical Report 20. 1996
(Type I evidence - systematic review);
ii. Kay EJ, Locker D. Is dental education effective? A systematic review of current evidence. Community Dentistry and Oral Epidemiology 1996; 24(4): 231-235
(Type I evidence - systematic review using MEDLINE only)
2h. Guidelines are available on screening of patients to detect periodontal diseases i. i. Faculty of Dental Surgery. National Clinical Guidelines 1997. London: Royal College of Surgeons, 1997
(Recommendations classified according to type of evidence)
2i. The recall interval for dental examination, for individuals at risk of plaque associated periodontal disease, should differ between patients according to oral hygiene status, the severity of gingivitis and the status of the periodontal ligament i. Further research is recommended on suitable recall intervals.
(Health gain notation - 3 "trade-off between beneficial and adverse effects")
i. Ismail AI, Lewis DW. Periodic health examination, 1993 update: 3. Periodontal diseases classification, diagnosis, risk factors and prevention. Canadian Medical Association Journal 1993; 149 (10): 1409-1422
(Type V evidence - expert opinion)
2j. There is good evidence to recommend professional scaling and plaque removal every 3-4 months in patients with periodontitis to prevent the progression of the disease i.

(Health gain notation - 1 "beneficial")

i. Ismail AI, Lewis DW. Periodic health examination, 1993 update: 3. Periodontal diseases classification, diagnosis, risk factors and prevention. Canadian Medical Association Journal 1993; 149 (10): 1409-1422
(Type I evidence - systematic review using Medline only)
2k. Antibiotics are not generally recommended for the prevention of gingivitis or periodontitisi,ii.

(Health gain notation - 5 "unlikely to be beneficial")

However, acute specific infections such as acute necrotising ulcerative gingivitis and lateral periodontal abscess, together with more rare forms of periodontitis such as juvenile periodontitis are indications for usei,ii.

(Health gain notation - 2 "likely to be beneficial")

i. Ismail AI, Lewis DW. Periodic health examination, 1993 update: 3. Periodontal diseases classification, diagnosis, risk factors and prevention. Canadian Medical Association Journal 1993; 149 (10): 1409-1422
(Type I evidence - systematic review using Medline only);
ii. Rams TE, Slots J. Antibiotics in periodontal therapy: an update. Compendium of Continuing Education in Dentistry; XIII (12): 1130-1145
(Type I evidence - systematic review);
iii. Van Winkelhoff AJ, Rams TE, Slots J. Systemic antibiotic therapy in periodontics. Periodontology 2000 1996; 10: 45-78
(Type I evidence - systematic review)

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2l. A systematic review of systemic tetracycline use in chronic adult periodontitis is currently in progressi. i. Hayes C, Antczak-Bouckoms AA, Burdick E. Systematic review of systemic tetracycline use in chronic adult periodontitis. Cochrane Database of Systematic Reviews. Cochrane Library Review expected April 1998.
2m. There is no clear evidence to suggest that surgical interventions are more effective than non surgical approaches in the treatment of periodontal disease i,ii. Further research is recommended.

(Health gain notation - 4 "unknown")

i. Kaldahl WB, Kalkwarf KL, Patil KD. A review of longitudonal studies that compared periodontal therapies. Journal of Periodontology 1993; 64: 243-253
(Type I evidence - systematic review);
ii. Antczak-Bouckoms A, Joshipura K, Burdick E, Tulloch JFC. Meta-analysis of surgical versus non-surgical methods of treatment for periodontal disease. Journal of Clinical Periodontology. 1993; 20: 259-268
(Type I evidence - systematic review)
2n. Short term periodontal splinting techniques require further evaluation in their role in the continuing care of individuals who have undergone treatment for periodontal diseasei. Further research is recommended.
(Health gain notation - 4 "unknown")
i. Oral Health. Protocol for Investment in Health Gain. Welsh Health Planning Forum. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk