IQuaD dental trial; improving the quality of dentistry: a multicentre randomised controlled trial comparing oral hygiene advice and periodontal instrumentation for the prevention and management of periodontal disease in dentate adults attending dental primary care.

BACKGROUND: Periodontal disease is the most common oral disease affecting adults, and although it is largely preventable it remains the major cause of poor oral health worldwide. Accumulation of microbial dental plaque is the primary aetiological factor for both periodontal disease and caries. Effective self-care (tooth brushing and interdental aids) for plaque control and removal of risk factors such as calculus, which can only be removed by periodontal instrumentation (PI), are considered necessary to prevent and treat periodontal disease thereby maintaining periodontal health. Despite evidence of an association between sustained, good oral hygiene and a low incidence of periodontal disease and caries in adults there is a lack of strong and reliable evidence to inform clinicians of the relative effectiveness (if any) of different types of Oral Hygiene Advice (OHA). The evidence to inform clinicians of the effectiveness and optimal frequency of PI is also mixed. There is therefore an urgent need to assess the relative effectiveness of OHA and PI in a robust, sufficiently powered randomised controlled trial (RCT) in primary dental care. METHODS/DESIGN: This is a 5 year multi-centre, randomised, open trial with blinded outcome evaluation based in dental primary care in Scotland and the North East of England. Practitioners will recruit 1860 adult patients, with periodontal health, gingivitis or moderate periodontitis (Basic Periodontal Examination Score 0-3). Dental practices will be cluster randomised to provide routine OHA or Personalised OHA. To test the effects of PI each individual patient participant will be randomised to one of three groups: no PI, 6 monthly PI (current practice), or 12 monthly PI.Baseline measures and outcome data (during a three year follow-up) will be assessed through clinical examination, patient questionnaires and NHS databases.The primary outcome measures at 3 year follow up are gingival inflammation/bleeding on probing at the gingival margin; oral hygiene self-efficacy and net benefits. DISCUSSION: IQuaD will provide evidence for the most clinically-effective and cost-effective approach to managing periodontal disease in dentate adults in Primary Care. This will support general dental practitioners and patients in treatment decision making. TRIAL REGISTRATION: Protocol ID: ISRCTN56465715.

Association between interleukin-6 polymorphisms and periodontitis in Indian non-smokers.

AIM: Genetic polymorphisms (SNPs) in the interleukin-6 (IL-6) gene have been associated with the presence of periodontitis. The aim of this study was to investigate the association between five SNPs in the IL-6 promoter region and the periodontal status of a rural Indian population. MATERIALS AND METHODS: Two hundred and fifty-one systemically healthy volunteers were clinically assessed by a single calibrated examiner and divided into: healthy individuals and periodontitis patients based on the European Workshop on Periodontitis definitions and on a recently suggested definition, which takes into account age and clinical attachment levels. Their genomic DNA was analysed blindly using real-time polymerase chain reaction to study IL-6 variants. The association between genetic factors and the presence of periodontitis was assessed by logistic regression. RESULTS: The IL-6-174 GG genotype was associated with periodontitis in non-smokers and older subjects (>45 years old). No statistically significant associations were detected between IL-6 haplotypes and periodontal status, after adjusting for confounders. CONCLUSIONS: The IL-6-174 polymorphism showed some evidence of an association with the periodontal status in non-smokers and older subjects in this rural Indian population. This association might be mediated by the effect of IL-6 on inflammatory responses.

Motivating patients.

Patients who seek advice and treatment for periodontal conditions often find challenges in the personal involvement required for successful care. This paper reviews methods of advising and motivating patients to adhere to oral hygiene regimens and understand the necessity for long-term management of the condition.