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OUTCOME MEASURES IN PERIODONTAL MANAGEMENT AT PRIMARY CARE DENTAL
CLINIC: A RANDOMIZED CONTROLLED TRIAL
NMRR-17-108-33964

Nuryastri M, Zamros Yuzadi MY, Asma’ M, Ishak AR

Introduction: Periodontal disease is a highly prevalent and the most common oral disease
affecting adults. An overwhelming body of evidence shows that personal and professional
plaque control are essential for the prevention and treatment of the disease. Despite the
evidence, there is an absence of a simplified task-oriented approach or a clinical pathway
for managing patients with periodontal disease at primary care dental clinics in Malaysia.
Objectives: 1) To develop a clinical pathway for managing patients with periodontal
disease at primary care dental clinics in Malaysia, 2) To assess and compare between
patients treated according to the clinical pathway and current practice in terms of
improvement in oral hygiene practice, bleeding on probing, plaque scores, probing pocket
depth (PPD), and oral health-related quality of life (OHRQoL) after 10 weeks, and 3) To
determine the distribution of cost for managing patients with periodontal disease
between the two methods. Materials and Methods: The steps for evidence-based
practice were used in the development of the clinical pathway. The effectiveness of the
clinical pathway in treating periodontal disease in adults was evaluated using a
randomised controlled trial (RCT) with 124 participants randomly allocated to the clinical
pathway (intervention) and current practice (control) groups. The effect of the clinical
pathway on oral hygiene practice, clinical, and OHRQoL outcomes (using OHIP-14) were
compared with the current practice at baseline and after 10 weeks. Intention To Treat
(ITT) analysis was used in data analysis. A cost analysis was carried out using the top down
and bottom-up methods for both groups. Finally, the proposed consensus-based clinical
pathway was developed and used in this clinical trial. Results: Sixty-two participants were
analysed in each group. Both groups were not statistically significance at baseline. There
was a significant difference in the number of participants who reported interdental
cleaning (p<0.001) and confidence in performing effective tooth brushing (p<0.05) after
10 weeks compared to baseline in the intervention group. Both groups had significant
reductions in bleeding scores and plaque scores (p<0.001) after 10 weeks with greater
reductions in the intervention group. The between-group difference in mean decrement
for bleeding score was 8.7% (95%CI:14.54-2.92; p=0.004), for plaque score it was 5.2%
(95%CI:10.60-0.18; p=0.058). The reduction of sites with PPD 4-5mm was not significant
in both groups after 10 weeks. A significant improvement in quality of life was observed
in the intervention group after 10 weeks associated with the self-conscious domain
(p=0.039). The total provider cost for the clinical pathway was RM86.30 while in the
current practice it was RM30.00.

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