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
Open accessAbstract
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
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A recently completed UK trial demonstrated no clinical benefit in providing either 6 or 12 monthly scale and polishes.
“A recently completed UK trial demonstrated no clinical benefit in providing either 6 or 12 monthly scale and polishes.68”
From Ending the neglect of global oral health: time for radical action. (2019) · cites this paper as [68]
The Methods/Design section describes a UK trial comparing no periodontal instrumentation with six- and twelve-monthly instrumentation. But it describes planned interventions and future outcome measurement, not a completed trial, and reports no finding that either schedule lacked clinical benefit. (LLM, conf=0.88)
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Ending the neglect of global oral health: time for radical action.
Watt, R. G., Daly, B., Allison, P., Macpherson, L. M. D., Venturelli, R., Listl, S., Weyant, R. J., Mathur, M. R., Guarnizo-Herreño, C. C., Celeste, R. K., et al. (2019) · The Lancet · doi:10.1016/s0140-6736(19)31133-x · Cited by 1,029 · see citing works
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- Authors
- Clarkson, J. E., Ramsay, C. R., Averley, P., Bonetti, D., Boyers, D., Campbell, L., Chadwick, G. R., Duncan, A., Elders, A., Gouick, J., Hall, A. F., Heasman, L., Heasman, P. A., Hodge, P. J., Jones, C., Laird, M., Lamont, T. J., Lovelock, L. A., Madden, I., McCombes, W., McCracken, G. I., McDonald, A. M., McPherson, G., Macpherson, L. E., Mitchell, F. E., Norrie, J. D., Pitts, N. B., van der Pol, M., Ricketts, D. N., Ross, M. K., Steele, J. G., Swan, M., Tickle, M., Watt, P. D., Worthington, H. V., & Young, L.
- Affiliations
- University of Dundee (GB)
- University of Aberdeen (GB)
- Newcastle University (GB)
- University of Glasgow (GB)
- University of Manchester (GB)
- NHS Education for Scotland (GB)
- King's College London (GB)
- University of Edinburgh (GB)
- Corresponding author
- Lamont, Thomas J
- ORCID
- Clarkson, Jan E
- Ramsay, Craig R
- Bonetti, Debbie
- Boyers, Dwayne
- Campbell, Louise
- Duncan, Anne
- Elders, Andrew
- Gouick, Jill
- Hall, Andrew F
- Heasman, Lynne
- Heasman, Peter A
- Lamont, Thomas J
- McCracken, Giles I
- McDonald, Alison M
- McPherson, Gladys
- Macpherson, Lorna E
- Mitchell, Fiona E
- Norrie, John DT
- Pitts, Nigel B
- Ricketts, David NJ
- Steele, James G
- Tickle, Martin
- Worthington, Helen V
- Young, Linda
- Venue
- BMC Oral Health
- Published
- 2013-10-26
- Volume
- 13
- Issue
- 1
- Pages
- 58-58
- ISSN
- 1472-6831 (ISSN-L)
- PMC
- PMC4015981
- OpenAlex
- W2165641369
- Cited by
- 26
- References
- 1
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2022: 1 · 2021: 5 · 2020: 1 · 2019: 1 · 2018: 4 · 2017: 5 · 2015: 3 · 2014: 2
- FWCI
- 1.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Oral Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (publishedVersion)
- Research Portal (King's College London) (publishedVersion, other-oa)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity) (cc-by)
- Funders
- University of Dundee
- Scottish Government
- National Institute for Health and Care Research (09/01/45)
- Health Technology Assessment Programme (09/01/45)
- NIHR Evaluation Trials and Studies Coordinating Centre
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
- Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
- Keywords
- periodontal disease, oral hygiene advice, periodontal instrumentation, gingivitis, periodontitis, plaque control, dental calculus, oral hygiene self-efficacy, gingival bleeding on probing, primary dental care, dental caries prevention
- MeSH terms
- Adult, Aged, Counseling, Dental Calculus, Dental Care, Dental Plaque, Dental Prophylaxis, Follow-Up Studies, Gingival Hemorrhage, Gingivitis, Humans, Health Knowledge, Attitudes, Practice, Middle Aged, Oral Hygiene, Periodontal Diseases, Periodontal Pocket, Periodontitis, Primary Health Care, Quality of Health Care, Quality of Life, Self Care, Toothbrushing, Health Behavior, Single-Blind Method, Treatment Outcome, Self Efficacy, Precision Medicine
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