Targeting high risk patients

A recent assessment from the Cochrane Reports concluded that regular hygiene visits for scaling and polishing (a routine procedure for preventing gum disease and tooth decay) had no clinical benefit. Here’s the data which supports this conclusion:

“Healthy” patients with no scaling and polishing over 3 years had 39.3% of their teeth with bleeding gums.

“Healthy” patients with scaling and polishing once a year or twice a year had 38.2% and 39.3% of their teeth with bleeding gums, respectively, over the same three year period.

This is a harsh assessment of a mainstay service by the hygienist.

And I think it is misleading.

The response to any clinical treatment depends on the level of disease or need at the start of the study, and on the mix of patients in the study. The rule of thumb is the bigger the level of disease or the more aggressive the disease in most of the patients, the better the treatment effect.

Scaling “healthy” patients won’t show much effect.

Scaling patients with severe forms of periodontal disease will, by all accounts, show significant reduction in bleeding.

And blending both “healthy” patients and diseased patients to find a mean effect, will mute any treatment.

My guess is that among those patients with bleeding gums at the start of the study, this hygiene procedure was effective.

So the conclusion which should be reached is not to stop scaling and polishing, but rather to target this procedure to those at high risk.