title: 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.
abstract: 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
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Protocol ID: ISRCTN56465715.
authors.forename: Jan E
authors.initials: JE
authors.lastname: Clarkson
authors.forename: Craig R
authors.initials: CR
authors.lastname: Ramsay
authors.forename: Paul
authors.initials: P
authors.lastname: Averley
authors.forename: Debbie
authors.initials: D
authors.lastname: Bonetti
authors.forename: Dwayne
authors.initials: D
authors.lastname: Boyers
authors.forename: Louise
authors.initials: L
authors.lastname: Campbell
authors.forename: Graham R
authors.initials: GR
authors.lastname: Chadwick
authors.forename: Anne
authors.initials: A
authors.lastname: Duncan
authors.forename: Andrew
authors.initials: A
authors.lastname: Elders
authors.forename: Jill
authors.initials: J
authors.lastname: Gouick
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Hall
authors.forename: Lynne
authors.initials: L
authors.lastname: Heasman
authors.forename: Peter A
authors.initials: PA
authors.lastname: Heasman
authors.forename: Penny J
authors.initials: PJ
authors.lastname: Hodge
authors.forename: Clare
authors.initials: C
authors.lastname: Jones
authors.forename: Marilyn
authors.initials: M
authors.lastname: Laird
authors.affiliation: Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee DD1 4HN, UK. t.lamont@dundee.ac.uk.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Lamont
authors.forename: Laura A
authors.initials: LA
authors.lastname: Lovelock
authors.forename: Isobel
authors.initials: I
authors.lastname: Madden
authors.forename: Wendy
authors.initials: W
authors.lastname: McCombes
authors.forename: Giles I
authors.initials: GI
authors.lastname: McCracken
authors.forename: Alison M
authors.initials: AM
authors.lastname: McDonald
authors.forename: Gladys
authors.initials: G
authors.lastname: McPherson
authors.forename: Lorna E
authors.initials: LE
authors.lastname: Macpherson
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Mitchell
authors.forename: John Dt
authors.initials: JD
authors.lastname: Norrie
authors.forename: Nigel B
authors.initials: NB
authors.lastname: Pitts
authors.forename: Marjon
authors.initials: M
authors.lastname: van der Pol
authors.forename: David Nj
authors.initials: DNj
authors.lastname: Ricketts
authors.forename: Margaret K
authors.initials: MK
authors.lastname: Ross
authors.forename: James G
authors.initials: JG
authors.lastname: Steele
authors.forename: Moira
authors.initials: M
authors.lastname: Swan
authors.forename: Martin
authors.initials: M
authors.lastname: Tickle
authors.forename: Pauline D
authors.initials: PD
authors.lastname: Watt
authors.forename: Helen V
authors.initials: HV
authors.lastname: Worthington
authors.forename: Linda
authors.initials: L
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling; D003728:Dental Calculus / Q000517:prevention & control; D003729:Dental Care / Q000191:economics / Q000592:standards*; D003773:Dental Plaque / Q000517:prevention & control; D003777:Dental Prophylaxis / Q000191:economics / Q000592:standards; D005500:Follow-Up Studies; D005884:Gingival Hemorrhage / Q000517:prevention & control; D005891:Gingivitis / Q000517:prevention & control; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D009910:Oral Hygiene / Q000191:economics / Q000193:education*; D010510:Periodontal Diseases / Q000517:prevention & control*; D010514:Periodontal Pocket / Q000517:prevention & control; D010518:Periodontitis / Q000517:prevention & control; D057285:Precision Medicine; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D011788:Quality of Life; D012648:Self Care; D020377:Self Efficacy; D016037:Single-Blind Method; D014099:Toothbrushing / Q000379:methods; D016896:Treatment Outcome