Showing papers by "Jan E Clarkson published in 2018"

Improving the Quality of Dentistry (IQuaD): a cluster factorial randomised controlled trial comparing the effectiveness and cost–benefit of oral hygiene advice and/or periodontal instrumentation with routine care for the prevention and management of periodontal disease in dentate adults attending dental primary care

Abstract: Background Periodontal disease is preventable but remains the most common oral disease worldwide, with major health and economic implications Stakeholders lack reliable evidence of the relative clinical effectiveness and cost-effectiveness of different types of oral hygiene advice (OHA) and the optimal frequency of periodontal instrumentation (PI) Objectives To test clinical effectiveness and assess the economic value of the following strategies: personalised OHA versus routine OHA, 12-monthly PI (scale and polish) compared with 6-monthly PI, and no PI compared with 6-monthly PI Design Multicentre, pragmatic split-plot, randomised open trial with a cluster factorial design and blinded outcome evaluation with 3 years’ follow-up and a within-trial cost–benefit analysis NHS and participant costs were combined with benefits [willingness to pay (WTP)] estimated from a discrete choice experiment (DCE) Setting UK dental practices Participants Adult dentate NHS patients, regular attenders, with Basic Periodontal Examination (BPE) scores of 0, 1, 2 or 3 Intervention Practices were randomised to provide routine or personalised OHA Within each practice, participants were randomised to the following groups: no PI, 12-monthly PI or 6-monthly PI (current practice) Main outcome measures Clinical – gingival inflammation/bleeding on probing at the gingival margin (3 years) Patient – oral hygiene self-efficacy (3 years) Economic – net benefits (mean WTP minus mean costs) Results A total of 63 dental practices and 1877 participants were recruited The mean number of teeth and percentage of bleeding sites was 24 and 33%, respectively Two-thirds of participants had BPE scores of ≤ 2 Under intention-to-treat analysis, there was no evidence of a difference in gingival inflammation/bleeding between the 6-monthly PI group and the no-PI group [difference 087%, 95% confidence interval (CI) –16% to 33%; p = 0481] or between the 6-monthly PI group and the 12-monthly PI group (difference 011%, 95% CI –23% to 25%; p = 0929) There was also no evidence of a difference between personalised and routine OHA (difference –25%, 95% CI –83% to 33%; p = 0393) There was no evidence of a difference in self-efficacy between the 6-monthly PI group and the no-PI group (difference –0028, 95% CI –0119 to 0063; p = 0543) and no evidence of a clinically important difference between the 6-monthly PI group and the 12-monthly PI group (difference –0097, 95% CI –0188 to –0006; p = 0037) Compared with standard care, no PI with personalised OHA had the greatest cost savings: NHS perspective –£15 (95% CI –£34 to £4) and participant perspective –£64 (95% CI –£112 to –£16) The DCE shows that the general population value these services greatly Personalised OHA with 6-monthly PI had the greatest incremental net benefit [£48 (95% CI £22 to £74)] Sensitivity analyses did not change conclusions Limitations Being a pragmatic trial, we did not deny PIs to the no-PI group; there was clear separation in the mean number of PIs between groups Conclusions There was no additional benefit from scheduling 6-monthly or 12-monthly PIs over not providing this treatment unless desired or recommended, and no difference between OHA delivery for gingival inflammation/bleeding and patient-centred outcomes However, participants valued, and were willing to pay for, both interventions, with greater financial value placed on PI than on OHA Future work Assess the clinical effectiveness and cost-effectiveness of providing multifaceted periodontal care packages in primary dental care for those with periodontitis Trial registration Current Controlled Trials ISRCTN56465715 Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol 22, No 38 See the NIHR Journals Library website for further project information

INTERVAL (investigation of NICE technologies for enabling risk-variable-adjusted-length) dental recalls trial: a multicentre randomised controlled trial investigating the best dental recall interval for optimum, cost-effective maintenance of oral health in dentate adults attending dental primary care.

Abstract: Traditionally, patients at low risk and high risk of developing dental disease have been encouraged to attend dental recall appointments at regular intervals of six months between appointments. The lack of evidence for the effect that different recall intervals between dental check-ups have on patient outcomes, provider workload and healthcare costs is causing considerable uncertainty for the profession and patients, despite the publication of the NICE Guideline on dental recall. The need for primary research has been highlighted in the Health Technology Assessment Group’s systematic review of routine dental check-ups, which found little evidence to support or refute the practice of encouraging 6-monthly dental check-ups in adults. The more recent Cochrane review on recall interval concluded there was insufficient evidence to draw any conclusions regarding the potential beneficial or harmful effects of altering the recall interval between dental check-ups. There is therefore an urgent need to assess the relative effectiveness and cost-benefit of different dental recall intervals in a robust, sufficiently powered randomised control trial (RCT) in primary dental care. This is a four year multi-centre, parallel-group, randomised controlled trial with blinded outcome assessment based in dental primary care in the UK. Practitioners will recruit 2372 dentate adult patients. Patient participants will be randomised to one of three groups: fixed-period six month recall, risk-based recall, or fixed-period twenty-four month recall. Outcome data will be assessed through clinical examination, patient questionnaires and NHS databases. The primary outcomes measure gingival inflammation/bleeding on probing and oral health-related quality of life. INTERVAL will provide evidence for the most clinically-effective and cost-beneficial recall interval for maintaining optimum oral health in dentate adults attending general dental practice. ISRCTN95933794 (Date assigned 20/08/2008).