Is there a case for routine scale and polish?

ScalingScaling and polishing of the teeth may help to reduce deposits such as plaque (bacteria)  and hardened plaque (calculus or tartar). It may also reduce bleeding and inflammation of the gums. Many dentists and hygienists provide scaling and polishing for most patients at regular intervals, even if they are at low risk of developing gum disease.  For this review, scaling and polishing was defined as the scaling and polishing of the crown and root surfaces to remove deposits of plaque and calculus. Calculus is so hard that it cannot be removed by toothbrushing alone, and it is generally removed by the scale and polish treatment. Removal of hardened deposits is done with specially designed dental instruments or ultrasonic scalers, and polishing is done mechanically with special pastes.

Is there evidence that this practice is effective? This review considers the data from randomized controlled trials.

What was the research?

A systematic review of the evidence to find out whether undergoing scaling and polishing of the teeth on a routine basis leads to less periodontal or gum disease in healthy individuals.

Who conducted the research?

The research was conducted by a team led by Helen Worthingon, on behalf of the Cochrane Oral Health Group. Jan Clarkson, Gemma Bryan and Paul V Beirne were also on the team.

What evidence was included in the review?

Data was extracted from 3 randomised controlled trials, only one of which was conducted in general practice.  A total of 836 people participated in the trials. The participants either received:

  1. Scale and polish treatments with or without oral hygiene instruction delivered at planned regular intervals by a dentist or hygienist, or
  2. No scale and polish, or scale and polish in response to signs and symptoms of developing periodontal disease

What did the evidence say?

One study was based in General Practice, and did not show either a benefit or a harm for regular six or 12-month scale and polish treatments when compared to no scale and polish. However, a study on young air force cadets compared scale and polish treatments at different time intervals and did find some differences for gum disease, plaque and calculus.

How good was the evidence?

Only three studies met the eligibility criteria for this review, and the risk of bias for all the studies was unclear due to inadequate reporting. The evidence was generally of low quality.

What are the implications for dentists and the general public?

Considering the resources that are involved in providing routine scale and polish treatments for adults in many countries, the reviewers found the lack of well-conducted randomized controlled trials on this topic disappointing. There was insufficient evidence to come to a conclusion on the efficacy of routine scale and polish.

What should researchers look at in the future?

There is a need for well-conducted trials in this area which include a sufficient number of patients to detect a true difference. The trials should be at least five years duration, and should be conducted in primary care settings.

Link

Worthington HV, Clarkson JE, Bryan G, Beirne PV. Routine scale and polish for periodontal health in adults. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD004625. DOI: 10.1002/14651858.CD004625.pub4.