An Element of Doubt
I am about to use this blog posting to play `devils advocate`, by questioning one of the pillars of general dental practice, and it does have a serious side. The simple `scale and polish` or `S&P` is one of the most common treatments provided in general practice. Sometimes we provide it out of habit, but more commonly through patient demand. However, we should be aware that there is very little, if any, evidence base to support it`s use. A recent study, succinctly titled `Clinical outcomes of single-visit oral prophylaxis: a practice-based randomised controlled trial`, published by Jones,CL et al, yet again throws doubt on what, and why, we do some things to patients and charge them for it.
Historically, there was a meta-analysis of research data concerning this subject in 2002, which found that there was no clinical benefit from three-monthly scaling compared to twelve-monthly scaling. That somewhat blows a hole in our custom and practice. Similarly, a Cochrane Review of current data in 2008 found “The research evidence is of insufficient quality to reach any conclusions regarding the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals. High quality clinical trials are required to address the basic questions posed in this review.”
This most recent research by C L Jones was in response to the need for better quality work in this field. And only adds doubt to what has become a mainstay of clinical practice. This is where we need to recognise the difference between treatment for periodontal health and treatment for cosmetic and `feel-good` benefit. Note that the studies have concentrated on scaling, alone, as an intervention. We do know that working with patients to increase standards of oral hygiene has a beneficial effect, but somewhere this has got sidelined. We need to re-establish the need for patients to take responsibility for their oral health.
There is a need to provide patients with appropriate information and this includes the fact that a simple `routine scale` is not of much help with their periodontal problem. They do need more definitive professional intervention in the form of root planing (or RSD) and certainly time with a dental professional dealing with detailed home care techniques. However, for people with no appreciable gum problem an S&P is not a clinical treatment.
Dr John Shapter – QCS Dental Expert Contributor
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