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Feasibility, ethical, economic, legal considerations Not applicable.
communication is essential should the operator carrying out the com- ponents of the SPC programme differ from the person overseeing the SPC programme. (c) Key communication steps to undertake for long-term patient benefit? • Oral healthcare professionals and the patient: communication between oral healthcare professionals delivering the SPC pro- gramme and the patient is crucial at each visit. The patient should have a clear understanding of his/her periodontal status, treatment needs (if any) and the recommended home-care regime. • Communication between healthcare professionals: the person overseeing the SPC programme may be different to that delivering the components of an SPC programme. Clear and transparent com- munication between these oral healthcare professionals should occur at each recall visit. Importantly, a number of healthcare pro- fessionals may be involved with a patient's care, particularly with regard to medical health and/or risk factor management. In order to work synergistically for long-term patient benefit, the person overseeing the SPC programme should initiate and maintain communications. • Oral healthcare professional overseeing the SPC programme and the patient: the person overseeing the SPC programme should communicate with the patient on a regular basis. Patients should be actively engaged in the decision-making process regarding long- termcare.
R11.5. What is the best approach, when treating the recurrence of periodontitis during SPC to reduce tooth loss and/or influence other outcomes (e.g., measures of periodontal health, quality of life, cost and accessibility of care and harms)?
PICOS question addressed by a SR
R11.5: Evidence-based recommendation We suggest not to use adjunctive approaches to subgingival instrumentation when treating recurrence of periodontitis during supportive periodontal care . Supporting literature (Leow et al., 2021) Quality of evidence Moderate Nine studies (seven randomized controlled trials, one controlled clinical trial and one prospective cohort) with ≥ 12 months follow- up. Risk of bias — 6 “ of some concern ” , 1 “ high ” , 2 “ serious ” . Grade of recommendation GradeB — # Strength of consensus Consensus (0% of the group abstained due to potential CoI)
Background
Intervention
Available evidence
Periodontitis may become unstable during long-term SPC and may present as disease recurrence, occurrence or progression.
Number and design of included studies None of the studies included addressed specific components that should be included in an SPC programme, who should undertake or oversee the SPC programme nor which key communications steps should be undertaken for long-term patient benefit.
• Recurrence refers to a finding of periodontitis at a site that was rendered periodontally healthy/stable through active treatment; • Occurrence refers to a diseased site arising within a periodontitis patient that did not previously exhibit signs of disease; • Progression is characterized by deterioration (e.g., clinical attach- ment loss) at a site that exhibited residual disease despite active treatment. It may be challenging to distinguish between these, particularly if the SPC programme has not been continuously delivered in a single dental practice/office setting. Sites with PPDs ≥ 4 mm and BOP require fur- ther treatment in order to reduce the risk of further deterioration and/or tooth loss.
Risk of bias, effect sizes and their clinical relevance, consistency, balance of benefit and harm Not applicable.
Overall certainty of the evidence Not applicable.
From evidence to recommendation — additional considerations
Available evidence
Acceptability Little is known about patient preferences with regard to design and delivery of SPC programmes. Clear and transparent communication between healthcare professionals and with the patient is essential for long-term patient benefit.
Number and design of included studies Nine studies, with ≥ 12 months follow-up, were included. Seven stud- ies were RCTs, one study was a controlled clinical trial and one study was a prospective cohort.
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