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HERRERA ET AL .
(Continued) Additional question raised by the WG
Balance of benefit and harm Evidence suggests that the frequency of recall intervals for SPC may be set according to a patient's risk status, with high-risk individuals benefit- ting from 3-monthly SPC and lower-risk patients remaining largely sta- ble with a frequency of 6 – 12 months. An overall consideration of the benefit versus harm of risk factor control to influence recall intervals of SPC supports the strength of the statement.
R11.4: Expert consensus-based recommendation b. Delivery by a variety of oral healthcare professionals , under the supervision of a suitably trained general dentist or a specialist , as appropriate to case complexity . c. Clear two-way communication between the oral healthcare team and the patient , and between healthcare professionals (medical or dental) . Supporting literature Expert Opinion. Quality of evidence Not applicable Grade of recommendation GradeA — "" Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
Overall certainty of the evidence Not applicable.
From evidence to recommendation — additional considerations
Background
Acceptability Little is known about patients' preferences in relation to frequency of recall visits. Oral healthcare professionals are increasingly collaborating with other healthcare providers and health authorities to raise aware- ness of and manage risk factors for the treatment of periodontitis. Feasibility Little is known about the implementation of risk-driven recall intervals for SPC; however, experience of oral healthcare professionals suggests that 3-monthly SPC intervals are feasible and acceptable to patients at high risk of recurrence of periodontitis and associated tooth loss. Ethical considerations It would seem appropriate to recommend more regular (3 – 4monthly) SPC visits for those with a higher grade/risk of periodontitis than those with a lower grade/risk. Economic considerations Some barriers may exist for patients at high risk due to the need for more frequent recall visits and the associated costs. This is likely to increase health inequalities in countries with no or limited public healthcare funding for periodontitis.
Intervention
SPC is the fourth step of therapy (Sanz, Herrera, et al., 2020). It is a com- plex intervention that elicits key questions relevant to both oral healthcare providers and patients and is crucial to the long-term stability of the periodontium. Important aspects of SPC are documented below: (a) Specific interventions to include in an SPC programme. In designing an SPC programme, it is important to regularly con- sider a number of components which include: • Interview : elicit information on periodontal health symptoms, med- ical and social history, risk factors including tobacco use, stress, diabetes and reported plaque control regime, patient motivation towards continuous risk factor control and PMPR/subgingival instrumentation; • Assessment : plaque and calculus deposits, periodontal health including inflammation, PPDs, and bleeding pockets; • Evaluation : of intervention needs, including risk factor manage- ment, oral hygiene and re-treatment; • Communicating : findings to patients to enhance their ownership of periodontal health and agreement on required interventions • Practical Intervention : oral hygiene coaching, instrumentation of supra- and sub-gingival plaque and calculus, treatment of sites with recurrence or residual periodontitis. • Planning : interval before next SPC visit. (b) The specific oral healthcare professional that undertakes/ oversees the SPC programme. A variety of qualified and trained oral healthcare professionals can carry out the components of an SPC programme. Nine prospec- tive cohort studies included in the systematic review (Leow et al., 2021) utilized undergraduate dental students, dental hygienists and periodontists. The SPC programme should be overseen by a suitably qualified and trained general dentist or specialist. Effective
Legal considerations Not applicable.
R11.4. What are the important components to consider when designing a successful SPC programme?
Additional question raised by the WG
R11.4: Expert consensus-based recommendation We recommend a number of important components when designing an SPC programme , including : a. Specific interventions include interview , assessment , evaluation , practical intervention and planning (see introduction) .
(Continues)
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