A COMPARISON OF THE EFFECTIVENESS OF THE “TOOTHKEEPER’ AND A TRADITIONAL DENTAL HEALTH EDUCATION PROGRAM

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66303/1/j.1752-7325.1975.tb04031.x.pd

Attrition, occlusion, (dys)function, and intervention: a systematic review.

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Cost-effectiveness of personalized plaque control for managing the gingival manifestations of oral lichen planus: a randomized controlled study.

AIM: To undertake cost-effectiveness and cost-benefit analyses of an intervention to improve oral health in patients presenting with the gingival manifestations of oral lichen planus (OLP). MATERIALS & METHODS: Eighty-two patients were recruited to a 20-week randomized controlled trial. The intervention was personalized plaque control comprising powered tooth brushing and inter-dental cleaning advice. The primary outcome measure was the oral health impact profile (OHIP) with secondary outcomes of pain, plaque index, mucosal disease score and cost-effectiveness. Private cost data and stated willingness-to-pay (WTP) values for treatment were obtained from intervention patients at 20 weeks. RESULTS: Overall, 81% of intervention patients showed improvement in both plaque index and mucosal disease score at 20 weeks compared to 30% of controls that continued with their usual plaque control regimen. All intervention group patients stated a positive WTP value. The mean net value of the treatment was £172 compared to the incremental cost of the treatment estimated at £122.75. The cost-effectiveness analysis resulted in an incremental cost-effectiveness ratio of £13 per OHIP point. CONCLUSIONS: The tailored plaque control programme was more effective than control in treating the gingival manifestations of oral lichen planus. The programme is cost effective for modest values placed on a point on the OHIP scale and patients generally valued the treatment in excess of the cost

A Randomized Controlled Trial of Intensive Periodontal Therapy on Metabolic and Inflammatory Markers in Patients With ESRD: Results of an Exploratory Study

BACKGROUND: Periodontitis is a novel risk factor for inflammation and cardiovascular disease in the dialysis population. Limited information about the impact of periodontal therapy in patients receiving dialysis exists. STUDY DESIGN: Randomized, controlled trial to assess feasibility and gather preliminary data. SETTING & PARTICIPANTS: Dialysis patients with moderate/severe chronic periodontitis. INTERVENTION: Intensive treatment, consisting of scaling and root planing, extraction of hopeless teeth, and placement of local delivery antibiotics was performed at the baseline visit for treatment group patients and following study completion for control group patients. OUTCOMES: Outcomes were feasibility (screening, recruitment, enrollment, adverse events and study withdrawal/completion), clinical periodontal parameters [probing depth (PD), clinical attachment level, bleeding on probing, gingival index (GI), and plaque index] and serum albumin and interleukin 6 levels at 3 and 6 months postintervention. RESULTS: A total of 342 dialysis patients were approached for participation: 53 were randomized, with 26 participants assigned to immediate treatment and 27 to a control arm for treatment after 6 months. 51 patients completed baseline appointments; 46 were available for 3 month follow up and 45 were available for 6 month follow up examinations. 43 participants completed all visits. At 3 months, there was a statistically significant improvement for the treatment group compared to the control group for 3 periodontal parameters: mean PD (p=0.008), extent PD ≥ 4 mm (p=0.02), and extent GI ≥1 (p=0.01). By 6 months, however, the difference between groups was no longer present for any variable except PD ≥ 4 mm (p=0.04). There was no significant difference between the groups for serum albumin or high-sensitivity interleukin 6 at any time point, when adjusted for body mass index, diabetic status, and plaque index. LIMITATIONS: Small sample size and relatively healthy population. Imbalance in diabetes. CONCLUSIONS: This small trial demonstrates successful cooperation between dentists and nephrologists and successful recruitment, treatment and retention of dialysis patients with periodontitis. Larger studies with longer follow up are needed to determine whether treatment can improve markers of inflammation and morbidity