Background
Many dentists or hygienists scale and polish patients at regular intervals, even if these patients are considered to be at low risk for developing periodontal disease. There is debate about the clinical and cost-effectiveness of "systematic scaling and polishing," as well as the "optimal" frequency at which it should be performed in healthy adults.
"Systematic scaling and polishing" treatment is defined as scaling and polishing, or both, of the crown and root surfaces of teeth to remove local irritating factors (plaque, tartar, debris, and staining), which does not include periodontal surgery or other forms of adjunctive periodontal treatment, such as the use of pharmacological agents or root planing. Systematic scaling and polishing treatments are routinely provided in general dental practice settings. The technique may also be called prophylaxis, professional mechanical plaque removal, or periodontal instrumentation.
This revision updates a version published in 2013.
Goals
1. Determine the beneficial and harmful effects of systematic scaling and polishing on periodontal health.
2. Determine the beneficial and harmful effects of systematic scaling and polishing at different intervals on periodontal health.
3. Determine the beneficial and harmful effects of systematic scaling and polishing on periodontal health when treatment is provided by dentists compared to dental care professionals (odontotherapists or dental hygienists).
Search methods
The Cochrane Oral Health’s Information Specialist searched the following databases: Cochrane Oral Health’s Trials Register (up to 10 January 2018), Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, issue 12), MEDLINE Ovid (1946 to January 10, 2018), and Embase Ovid (1980 to January 10 2018). We searched the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No language or publication date restrictions were imposed in the electronic database search.
Selection criteria
Randomized controlled trials of systematic scaling and polishing treatments, with or without oral hygiene instruction, in healthy dentate adults without severe periodontitis. Split-mouth trials were excluded.
Data collection and analysis
Two review authors analyzed the search results against the inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. Mean differences (MD) (or standardized mean differences [SMD] when different scales were reported) and 95% confidence intervals (CI) were calculated for continuous data. Relative risks (RR) and 95% CIs were calculated for dichotomous data.
For meta-analyses, a fixed effects model was used. He contacted study authors when necessary to obtain missing information. The certainty of the evidence was assessed using the GRADE criteria.
Main results
Two studies with 1711 participants were included in the analyses. Both studies were conducted in general dental practice settings in the United Kingdom and included adults without severe periodontitis who regularly attended dental surgeries. One study measured outcomes at 24 months and the other at 36 months. No studies measured adverse effects, changes in attachment level, tooth loss or halitosis.
Comparison 1: Systematic scaling and polishing versus no scheduled scaling and polishing
Two studies compared planned scaling and polishing treatments at regular intervals (every six and 12 months) versus no scheduled treatment. Little or no difference was found between groups over a period of two to three years in gingivitis, probing depths, oral health-related quality of life (high-certainty evidence), and plaque (low-certainty evidence). . The SMD for gingivitis when comparing the semiannual scale and polishing treatment versus no scheduled treatment was -0.01 (95% CI -0.13 to 0.11; two trials, 1087 participants), and for semiannual scale and polishing treatment versus no scheduled treatment was -0.04 (95% CI -0.16 to 0.08; two trials, 1091 participants).
Regularly planned scaling and polishing treatments produced a small reduction in tartar levels over two to three years compared to no scheduled scaling and polishing treatments (high-certainty evidence). The SMD for semiannual scaling and polishing versus no scheduled treatment was -0.32 (95% CI -0.44 to -0.20; two trials, 1088 participants) and for semiannual scaling and polishing versus no scheduled treatment was -0.19 (95% CI -0.31 to -0.07; two trials, 1088 participants). The clinical significance of these small reductions is unclear.
Participants’ self-reported levels of oral grooming were higher when receiving scaling and polishing treatments every six and 12 months compared to no scheduled treatment, but the certainty of the evidence is low.
Comparison 2: Systematic scraping and polishing at different intervals
Two studies compared systematic scaling and polishing treatments every six months versus treatments every 12 months. Little or no difference was found between groups over two to three years in gingivitis outcomes, probing depths, oral health-related quality of life (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; I2 = 0%). Scaling and polishing treatments every six months produced a small reduction in tartar levels over the two to three year period compared to treatments every 12 months (SMD –0.13 95% CI –0.25 to –0.01; two trials, 1086 participants; high-certainty evidence). The clinical significance of this small reduction is unclear.
The comparative effects of 6- and 12-month scaling and polishing treatments on patient self-reported levels of oral cleanliness were unclear (very low-certainty evidence).
Comparison 3: Systematic scaling and polishing provided by dentists compared to dental care professionals (dental therapists or hygienists)
No study evaluated this comparison.
The results of the review regarding costs were unclear (very low-certainty evidence).
Authors’ conclusions In adults without severe periodontitis who have regular access to routine dental care, routine scaling and polishing treatment makes little or no change in gingivitis, probing depths, and oral health-related quality of life for two to three years follow-up compared with no scheduled scaling and polishing treatment (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 tartar levels compared to no routine scaling and polishing, and treatments every six months are found to reduce tartar more than treatments every 12 months over two to three years of follow-up (high-certainty evidence) , although the clinical significance of these small reductions is unclear. The available evidence on the costs of treatments is also unclear. The studies did not evaluate adverse effects. |
