Periodic Health Examination, 1993 Update: 3. Periodontal Diseases

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Abstract

Objective

To review the 1979 Canadian Task Force on the Periodic Health Examination recommendations on the diagnosis and prevention of periodontal disease.

Options

Self-care at home, professional care, treatment with antimicrobial agents and management of patients at high risk.

Outcomes

Maintaining the gingiva, alveolar bone and periodontal ligament in a healthy state (absence of gingival bleeding and no loss of epithelial attachment).

Evidence

A literature search for articles published from 1980 to 1993 was conducted. Selected studies published before 1980 were also reviewed if there were no recent updates. Evidence was evaluated and classified as good, fair or poor according to the criteria of the task force.

Values

The task force's evidence-based rules for recommendations were used. In addition, whenever feasible, and on the basis of advice from the reviewers and experts, recommendations were modified in the interest of maintaining oral health (e.g., dental flossing in children).

Benefits, harms and costs

The recommendations are not expected to increase the costs of preventing periodontal diseases for the general population. They could benefit dental patients and reduce costs because they are based on the periodontal needs of patients rather than on the current universal application approach.

Recommendations

There is good evidence to recommend personal toothbrushing and flossing to prevent gingivitis in adults. In children there is good evidence to support toothbrushing only; however, flossing is recommended to develop the necessary skills and establish a habit. There is weak scientific evidence to recommend oral hygiene for the prevention of periodontitis; however, brushing and flossing are strongly recommended to prevent gingival inflammation and reduce the level of supragingival bacteria. There is fair evidence to recommend professional scaling and plaque removal in periodontally healthy individuals. There is good evidence to recommend professional scaling every 3 to 4 months in patients with periodontitis or after periodontal surgery. There is also good evidence to recommend the use of chlorhexidine oral rinse as an adjunct to self-care in the prevention of gingivitis. Listerine is less effective than chlorhexidine. There are no long-term studies of the effectiveness of other antimicrobial rinses marketed for home use. Anticalculus dentifrices are recommended for people with high levels of calculus formation to reduce the accumulation of supragingival calculus. Antibiotics are not recommended for the prevention of gingivitis or periodontitis. There is fair evidence to recommend smoking cessation to reduce the risk of developing periodontitis.

Validation

The report was reviewed by members of the task force and three external reviewers selected to represent different areas of expertise in the management of periodontal disease. Changes recommended by the experts were incorporated if there was published scientific evidence.

Sponsor

These guidelines were developed and endorsed by the task force. Funding was provided by the Faculty of Dentistry, Dalhousie University, and the Faculty of Dentistry, University of Toronto.

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