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
Authors: Clarkson Jan E , Ramsay Craig R , Averley Paul , Bonetti Debbie , Boyers Dwayne , Campbell Louise , Chadwick Graham R , Duncan Anne , Elders Andrew , Gouick Jill , Hall Andrew F , Heasman Lynne , Heasman Peter A , Hodge Penny J , Jones Clare , Laird Marilyn , Lamont Thomas J , Lovelock Laura A , Madden Isobel , McCombes Wendy , McCracken Giles I , McDonald Alison M , McPherson Gladys , Macpherson Lorna E , Mitchell Fiona E , Norrie John DT , Pitts Nigel B , van der Pol Marjon , Ricketts David NJ , Ross Margaret K , Steele James G , Swan Moira , Tickle Martin , Watt Pauline D , Worthington Helen V , Young Linda 
Published: October 2013

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/Design
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.

Discussion
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.

Trial registration
Protocol ID: ISRCTN56465715