Priority 14 from the Oral and Dental Health PSP

UNCERTAINTY: What is the best way for dental teams to manage gum disease? (JLA PSP Priority 14)
Overall ranking 14
JLA question ID 0079/14
Explanatory note

Not available for this PSP


Evidence predominantly low quality (no high quality evidence)
“The evidence suggests that sub-gingival instrumentation of probing depths greater than 3 mm is effective in improving periodontal health”
“Evidence suggests that power driven RSI and hand RSI are equally effective in terms of improved clinical outcomes”
“There is currently no evidence of a difference in effectiveness between full mouth and quadrant debridement and both are therefore suitable for the treatment of chronic periodontitis.”
“Evidence does not support the adjunctive use of disinfectants during sub-gingival instrumentation “
“Current evidence does not support the use of local antimicrobials as a primary treatment for chronic periodontitis.” 
“The evidence suggests that adjunctive systemic antibiotic therapy may lead to statistically significant improvements in outcomes such as probing depth and clinical attachment level when compared with RSI alone. However, the clinical significance of these improvements, and the extent to which they may be influenced by the quality of the concurrent RSI, is unclear. Also, there is no evidence to suggest which antibiotic is most effective and the most effective dose.”
“There is insufficient evidence to support the routine use of antibiotics as an adjunct to RSI in periodontitis patients who smoke.”
“There is currently insufficient evidence to support the use of host modulation therapy as an adjunct to RSI in patients with chronic periodontitis.”
“There is currently insufficient evidence to determine the most effective regimen for supportive periodontal therapy.”

For full details of the evidence checked, please see the spreadsheet of data held on the JLA website.

Health Research Classification System category  Oral and gastrointestinal
Extra information provided by this PSP
Original uncertainty examples Original questions touched on options for the best and most cost-effective way to treat/ prevent gum disease, as well as the efficacy of deep cleaning procedures. In the case of chronic periodontal disease: is RSD an effective an effective treatment?   What is the role of different members of the dental team?
Submitted by  5 x patients, carers or members of public, 9 x health professionals, 3 x others
PSP information
PSP unique ID 0079
PSP name Oral and Dental Health
Total number of uncertainties identified by this PSP 38  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 12 December 2018