Routine scale and polish – is it effective?

Scaling and polishing removes deposits such as plaque and calculus (tartar) from tooth surfaces. Over time, the regular removal of these deposits may reduce gingivitis (a mild form of gum disease) and prevent progression to periodontitis (severe gum disease). Routine scale and polish treatment is sometimes referred to as “prophylaxis”, “professional mechanical plaque removal” or “periodontal instrumentation”. Many dentists or hygienists provide scaling and polishing for most patients at regular intervals even if the patients are considered to be at low risk of developing gum disease. There is debate about whether scaling and polishing is effective and the best interval between treatments. Scaling is an invasive procedure and has been associated with a number of negative side effects including damage to tooth surfaces and tooth sensitivity.

For the purposes of this review, a ‘routine scale and polish’ was scaling and polishing of both the tooth and the root of the tooth to remove plaque deposits (mainly bacteria), and calculus. Calculus is so hard it cannot be removed by toothbrushing alone and this along with plaque, other debris and staining on the teeth is removed by the scale and polish treatment. Scaling or removal of hardened deposits is done with specially designed dental instruments or ultrasonic scalers, and polishing is done mechanically with special pastes. In this review, we included scaling above and below the gum level; however, we excluded any surgical procedure on the gums, any chemical washing of the space between gum and tooth (pocket) and root planing, which is more intense scraping of the root than simple scaling.

What was the research?

A systematic review to assess the effects of routine scale and polish treatment. It was carried out by authors working with Cochrane Oral Health to assess the effects of routine scale and polish treatments for healthy adults; to establish whether different time intervals between treatments influence these effects; and to compare the effectiveness of the treatment when given by a dentist compared to a dental therapist or hygienist.

Who conducted the research?

The research was conducted by a team led by Thomas Lamont of the University of Dundee, UK on behalf of Cochrane Oral Health. Helen V. Worthington, Janet E. Clarkson, and Paul V. Beirne were also on the team.

What evidence was included in the review?

We included 2 randomised controlled trials, including 1,711 participants. Both studies involved adults without severe periodontitis who were regular attenders at dental appointments in the UK. The studies were conducted in general dental practices, which is the most appropriate setting to evaluate ‘routine scale and polish’ treatments. One study measured outcomes at 24 months and one study at 36 months.

What did the evidence say?

The studies found little or no difference between regular planned scale and polish treatments compared with no scheduled scale and polish for the early signs of gum disease (gingivitis or bleeding gums; plaque deposits; and probing depths or gum
pockets). There was a small reduction in calculus (tartar) levels, but it was uncertain if this is important for patients or their dentists.

Participants receiving six-monthly and 12-monthly scale and polish treatments reported feeling that their teeth were cleaner than those who were scheduled to receive no treatment. However, there did not seem to be a difference between groups in
terms of quality of life.

Available evidence on the costs of the treatments was uncertain. Neither of the studies measured side effects (such as damage to tooth surfaces and tooth sensitivity), changes in attachment level, tooth loss or halitosis (bad breath). Neither study compared scale and polish treatments provided by different professionals, e.g. dentists, dental therapists and hygienists.

How good was the evidence?

We judged the certainty of the evidence to be high for gingivitis, probing depths, calculus and quality of life, but low for plaque, and low to very low for patient perception of oral cleanliness. The certainty of evidence for costs was very low. The high-certainty evidence for gingivitis means that we can be confident that routine scale and polish does not significantly reduce the signs of mild gum disease when measured up to three years.

What are the implications for dentists and the general public?

For adults without severe periodontitis accessing routine dental care, there is little or no difference in gingivitis, probing depths or quality of life over two to three years between routinely provided six-monthly scale and polish (S&P) treatments, 12-monthly S&P treatments and no scheduled S&P treatments (high-certainty evidence). There may also be little or no difference in plaque levels over two years (low-certainty evidence). Although routine S&P treatments produce a small reduction in calculus levels over two to three years when compared to no scheduled S&P treatments, with six-monthly treatments reducing calculus more than 12-monthly treatments (high-certainty evidence), the importance of these reductions for patients and clinicians is unclear. The studies did not assess the adverse effects of S&P treatments and available evidence on the costs of the treatments is uncertain.

What should researchers look at in the future?

Further studies comparing routine S&P treatments (also known as prophylaxis, professional mechanical plaque removal or periodontal instrumentation) for regularly attending adults in primary care seem unnecessary, given the high certainty of the evidence for the review’s primary outcome. Future research could focus on assessment of the effects and cost-effectiveness of interventions to manage moderate-to-severe periodontal disease. This may include evaluating multifaceted periodontal care packages that combine advice, recommendations for oral care products and S&P primary dental care. Outcomes to be measured should include clinical, patient-reported and economic factors. A core outcome set for effectiveness trials investigating the prevention and management of periodontal disease is currently being developed. Researchers should assess these outcomes as a minimum, and should define the level of improvement they will consider clinically significant for each outcome. Such information is needed to help guide changes in dental practice. Any future trial should be reported according to CONSORT guidelines (www.consort-statement.org/).

Link

Citation example: Lamont T, Worthington HV, Clarkson JE, Beirne PV. Routine scale and polish for periodontal health in adults. Cochrane Database of Systematic Reviews 2018 , Issue 12 . Art. No.: CD004625. DOI: 10.1002/14651858.CD004625.pub5

This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at the Cochrane Oral Health Editorial Base.