Lamont Thomas, Worthington Helen V, Clarkson Janet E, Beirne Paul V
University of Dundee, Dental School & Hospital, Park Place, Dundee, Tayside, UK, DD1 4HN.
Cochrane Database Syst Rev. 2018 Dec 27;12(12):CD004625. doi: 10.1002/14651858.CD004625.pub5.
Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even for those at low risk of developing periodontal disease. There is debate over the clinical and cost effectiveness of 'routine scaling and polishing' and the optimal frequency at which it should be provided for healthy adults.A 'routine scale and polish' treatment is defined as scaling or polishing, or both, of the crown and root surfaces of teeth to remove local irritational factors (plaque, calculus, debris and staining), which does not involve periodontal surgery or any form of adjunctive periodontal therapy such as the use of chemotherapeutic agents or root planing. Routine scale and polish treatments are typically provided in general dental practice settings. The technique may also be referred to as prophylaxis, professional mechanical plaque removal or periodontal instrumentation.This review updates a version published in 2013.
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 12), MEDLINE Ovid (1946 to 10 January 2018), and Embase Ovid (1980 to 10 January 2018). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
Randomised controlled trials of routine scale and polish treatments, with or without oral hygiene instruction, in healthy dentate adults without severe periodontitis. We excluded split-mouth trials.
Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MDs) (or standardised mean differences (SMDs) when different scales were reported) and 95% confidence intervals (CIs) for continuous data. We calculated risk ratios (RR) and 95% CIs for dichotomous data. We used a fixed-effect model for meta-analyses. We contacted study authors when necessary to obtain missing information. We rated the certainty of the evidence using the GRADE approach.
We included two studies with 1711 participants in the analyses. Both studies were conducted in UK general dental practices and involved adults without severe periodontitis who were regular attenders at dental appointments. One study measured outcomes at 24 months and the other at 36 months. Neither study measured adverse effects, changes in attachment level, tooth loss or halitosis.Comparison 1: routine scaling and polishing versus no scheduled scaling and polishingTwo studies compared planned, regular interval (six- and 12-monthly) scale and polish treatments versus no scheduled treatment. We found little or no difference between groups over a two- to three-year period for gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis when comparing six-monthly scale and polish treatment versus no scheduled treatment was -0.01 (95% CI -0.13 to 0.11; two trials, 1087 participants), and for 12-monthly scale and polish versus no scheduled treatment was -0.04 (95% CI -0.16 to 0.08; two trials, 1091 participants).Regular planned scale and polish treatments produced a small reduction in calculus levels over two to three years when compared with no scheduled scale and polish treatments (high-certainty evidence). The SMD for six-monthly scale and polish versus no scheduled treatment was -0.32 (95% CI -0.44 to -0.20; two trials, 1088 participants) and for 12-monthly scale and polish versus no scheduled treatment was -0.19 (95% CI -0.31 to -0.07; two trials, 1088 participants). The clinical importance of these small reductions is unclear.Participants' self-reported levels of oral cleanliness were higher when receiving six- and 12-monthly scale and polish treatments compared to no scheduled treatment, but the certainty of the evidence is low.Comparison 2: routine scaling and polishing at different recall intervalsTwo studies compared routine six-monthly scale and polish treatments versus 12-monthly treatments. We found little or no difference between groups over two to three years for the outcomes of gingivitis, probing depths, oral health-related quality of life (all high-certainty evidence) and plaque (low-certainty evidence). The SMD for gingivitis was 0.03 (95% CI -0.09 to 0.15; two trials, 1090 participants; I = 0%). Six- monthly scale and polish treatments produced a small reduction in calculus levels over a two- to three-year period when compared with 12-monthly treatments (SMD -0.13 (95% CI -0.25 to -0.01; 2 trials, 1086 participants; high-certainty evidence). The clinical importance of this small reduction is unclear.The comparative effects of six- and 12-monthly scale and polish treatments on patients' self-reported levels of oral cleanliness were uncertain (very low-certainty evidence).Comparison 3: routine scaling and polishing provided by dentists compared with dental care professionals (dental therapists or hygienists)No studies evaluated this comparison.The review findings in relation to costs were uncertain (very low-certainty evidence).
AUTHORS' CONCLUSIONS: For adults without severe periodontitis who regularly access routine dental care, routine scale and polish treatment makes little or no difference to gingivitis, probing depths and oral health-related quality of life over two to three years follow-up when compared with no scheduled scale and polish treatments (high-certainty evidence). There may also be little or no difference in plaque levels over two years (low-certainty evidence). Routine scaling and polishing reduces calculus levels compared with no routine scaling and polishing, with six-monthly treatments reducing calculus more than 12-monthly treatments over two to three years follow-up (high-certainty evidence), although the clinical importance of these small reductions is uncertain. Available evidence on the costs of the treatments is uncertain. The studies did not assess adverse effects.
许多牙医或口腔保健员会定期为患者进行洗牙和抛光，即使是那些患牙周病风险较低的患者。对于“常规洗牙和抛光”的临床效果和成本效益，以及为健康成年人提供该治疗的最佳频率，存在争议。“常规洗牙和抛光”治疗是指对牙齿的冠部和根部表面进行洗牙或抛光，或两者皆做，以去除局部刺激因素（牙菌斑、牙结石、碎屑和污渍），这不涉及牙周手术或任何形式的辅助牙周治疗，如使用化学治疗剂或根面平整。常规洗牙和抛光治疗通常在普通牙科诊所进行。该技术也可称为预防性治疗、专业机械性牙菌斑清除或牙周器械治疗。本综述更新了2013年发表的版本。
Cochrane口腔健康信息专家检索了以下数据库：Cochrane口腔健康试验注册库（截至2018年1月10日）、Cochrane对照试验中心注册库（CENTRAL）（Cochrane图书馆，2017年第12期）、MEDLINE Ovid（1946年至2018年1月10日）和Embase Ovid（1980年至2018年1月10日）。检索了美国国立卫生研究院试验注册库（ClinicalTrials.gov）和世界卫生组织国际临床试验注册平台，以查找正在进行的试验。检索电子数据库时，对语言或出版日期没有限制。
针对无严重牙周炎的健康有牙成年人进行的常规洗牙和抛光治疗的随机对照试验，无论是否有口腔卫生指导。我们排除了双侧对照试验。
两名综述作者根据纳入标准筛选检索结果，独立且重复地提取数据并评估偏倚风险。对于连续数据，我们计算了平均差（MDs）（当报告不同量表时为标准化平均差（SMDs））和95%置信区间（CIs）。对于二分数据，我们计算了风险比（RR）和95% CIs。我们使用固定效应模型进行荟萃分析。必要时联系研究作者以获取缺失信息。我们使用GRADE方法对证据的确定性进行评级。
我们纳入了两项研究，共1711名参与者进行分析。两项研究均在英国普通牙科诊所进行，涉及无严重牙周炎且定期就诊的成年人。一项研究在24个月时测量结果，另一项在36个月时测量。两项研究均未测量不良反应、附着水平变化、牙齿脱落或口臭情况。
比较1：常规洗牙和抛光与无定期洗牙和抛光
两项研究比较了计划好的、定期（每六个月和十二个月一次）的洗牙和抛光治疗与无定期治疗。我们发现，在两到三年的时间里，两组在牙龈炎情况、探诊深度、口腔健康相关生活质量（所有均为高确定性证据）和牙菌斑（低确定性证据）方面几乎没有差异。比较每六个月一次的洗牙和抛光治疗与无定期治疗时，牙龈炎的标准化平均差为-0.01（95% CI -0.13至0.11；两项试验，1087名参与者）；比较每十二个月一次的洗牙和抛光与无定期治疗时，标准化平均差为-0.04（95% CI -0.16至0.08；两项试验，1091名参与者）。
与无定期洗牙和抛光治疗相比，定期计划洗牙和抛光治疗在两到三年时间里使牙结石水平有小幅降低（高确定性证据）。比较每六个月一次的洗牙和抛光与无定期治疗时，标准化平均差为-0.32（95% CI -0.44至-0.20；两项试验，1088名参与者）；比较每十二个月一次的洗牙和抛光与无定期治疗时，标准化平均差为-0.19（95% CI -0.31至-0.07；两项试验，1088名参与者）。这些小幅降低的临床重要性尚不清楚。
与无定期治疗相比，接受每六个月和十二个月一次洗牙和抛光治疗的参与者自我报告的口腔清洁程度更高，但证据的确定性较低。
比较2：不同回访间隔的常规洗牙和抛光
两项研究比较了常规每六个月一次的洗牙和抛光治疗与每十二个月一次的治疗。我们发现，在两到三年的时间里，两组在牙龈炎情况、探诊深度、口腔健康相关生活质量（所有均为高确定性证据）和牙菌斑（低确定性证据）方面几乎没有差异。牙龈炎的标准化平均差为0.03（95% CI -0.09至0.15；两项试验，1090名参与者；I = 0%）。
与每十二个月一次的治疗相比，每六个月一次的洗牙和抛光治疗在两到三年时间里使牙结石水平有小幅降低（标准化平均差-0.13（95% CI -0.25至-0.01；2项试验，1086名参与者；高确定性证据）。这种小幅降低的临床重要性尚不清楚。
每六个月和十二个月一次洗牙和抛光治疗对患者自我报告的口腔清洁程度的比较效果不确定（极低确定性证据）。
比较3：牙医与口腔保健专业人员（口腔治疗师或口腔保健员）提供的常规洗牙和抛光
没有研究评估这一比较。
关于成本的综述结果不确定（极低确定性证据）。
对于定期接受常规牙科护理的无严重牙周炎成年人，与无定期洗牙和抛光治疗相比，在两到三年的随访中，常规洗牙和抛光治疗对牙龈炎、探诊深度和口腔健康相关生活质量几乎没有差异（高确定性证据）。在两年内牙菌斑水平可能也几乎没有差异（低确定性证据）。与无常规洗牙和抛光相比，常规洗牙和抛光可降低牙结石水平，在两到三年的随访中每六个月一次的治疗比每十二个月一次的治疗能更多地降低牙结石（高确定性证据），尽管这些小幅降低的临床重要性尚不确定。关于治疗成本的现有证据不确定。这些研究未评估不良反应。
