{
 "name": "Preventio Hub evidence answers",
 "url": "https://preventiohub.com/evidence/",
 "updated": "2026-10-20",
 "license": "Cite as: Preventio Hub, Evidence answers, with the page URL.",
 "disclaimer": "Informational summaries of indexed peer-reviewed literature and guidelines. Not clinical advice.",
 "api": "https://preventiohub.com/openapi.json",
 "items": [
  {
   "question": "Is air polishing safe for enamel and dentine?",
   "topic": "Air polishing",
   "url": "https://preventiohub.com/evidence/air-polishing-safe-enamel-dentine/",
   "answer": "Air polishing safety differs between enamel and dentine, and depends heavily on the powder used. For dentine and cementum, glycine powder causes significantly less hard tissue modification than sodium bicarbonate or calcium carbonate powders, and may be safely applied to root surfaces [1]. Erythritol powder on exposed root dentine produces a slight but statistically significant increase in average surface roughness, which subsequent polishing with a cup and paste does not reduce [2]. In terms of substance loss, air polishing with low-abrasive powders (glycine or erythritol) results in a mean loss of around 8.65 µm, and substance loss per second is highest with air polishing devices compared to ultrasonic scalers, even when using these gentler powders [3]. Most studies report higher substance loss with hand curettes than with ultrasonic scalers, placing air polishing in an intermediate position depending on the metric used [3]. The indexed literature does not contain passages specifically addressing air polishing effects on intact enamel surfaces, so a direct safety statement for enamel cannot be drawn from this evidence base. Overall, the available evidence suggests that low-abrasive powders such as glycine represent a safer choice for hard tissues than conventional sodium bicarbonate or calcium carbonate powders, but some degree of surface alteration on dentine should still be anticipated [1][2].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "A systematic review on the effects of air polishing devices on oral tissues.",
     "journal": "International journal of dental hygiene",
     "year": 2016,
     "url": "https://doi.org/10.1111/idh.12120",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Impact of air-polishing with erythritol on exposed root dentin: A randomized clinical trial.",
     "journal": "International journal of dental hygiene",
     "year": 2025,
     "url": "https://doi.org/10.1111/idh.12835",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "The Effect of Mechanical Instrumentation on Dental Hard Tissue In Vitro: A Systematic Review.",
     "journal": "International journal of dental hygiene",
     "year": 2026,
     "url": "https://doi.org/10.1111/idh.70107",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "Does air polishing damage composite restorations or ceramic surfaces?",
   "topic": "Air polishing",
   "url": "https://preventiohub.com/evidence/air-polishing-damage-composite-restorations-ceramic-surfaces/",
   "answer": "Air polishing can adversely affect both composite restorations and ceramic surfaces, though the degree of damage varies by material and powder type. Ultrasonic instrumentation and air polishing both negatively impacted surface roughness and marginal quality across restorations, with resin-based composites and resin-modified glass ionomer cements being particularly vulnerable to increased roughness from ultrasonic scaling [1]. For ceramic surfaces, zirconia and lithium disilicate were less affected than resin-based materials, suggesting ceramics offer somewhat greater resistance to instrumentation damage [1].\n\nRegarding powder choice, sodium bicarbonate and calcium carbonate powders caused significantly greater surface roughness compared to lower-abrasive alternatives [1][2]. On hard tissues such as cementum and dentine, defect depths and volumes from sodium bicarbonate or calcium carbonate were significantly greater than those produced by glycine powder [2]. Erythritol and glycine powders were identified as the least abrasive options and are recommended when air polishing is used near restorations to help preserve surface smoothness and marginal integrity [1].\n\nIn practical terms, clinicians should select the debridement method and powder type based on the restoration material present, favouring low-abrasive powders such as erythritol or glycine to minimise iatrogenic damage [1][2]. The authors of the systematic review note that methodological limitations in available laboratory studies mean clinical translation still requires careful judgement [1].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Adverse Effects of Ultrasonic Instrumentation and Air Polishing on Dental Restorations: A Systematic Review of Laboratory Studies.",
     "journal": "Journal of esthetic and restorative dentistry : official publication of the American Academy of Esthetic Dentistry ... [",
     "year": 2025,
     "url": "https://doi.org/10.1111/jerd.13428",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "A systematic review on the effects of air polishing devices on oral tissues.",
     "journal": "International journal of dental hygiene",
     "year": 2016,
     "url": "https://doi.org/10.1111/idh.12120",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Does air polishing produce more aerosol than ultrasonic scaling?",
   "topic": "Air polishing",
   "url": "https://preventiohub.com/evidence/air-polishing-produce-more-aerosol-ultrasonic-scaling/",
   "answer": "The indexed literature does not directly compare aerosol production between air polishing and ultrasonic scaling in a head-to-head manner. What the evidence does address is aerosol generated specifically by ultrasonic scalers: a systematic review and meta-analysis found a significant increase in airborne bacteria in the dental environment during ultrasonic scaling, with bioaerosol reaching up to 2 m from the patient's mouth [1]. The use of low-volume or high-volume evacuation, or a combination of devices, can be effective in reducing that airborne contamination, with no significant difference found between suction types [1].\n\nThe remaining studies in this context focus on clinical outcomes of air polishing versus ultrasonic instrumentation - such as bleeding on probing, pocket depth reduction, and patient comfort - rather than on aerosol generation from air polishing itself [2][3][4]. Therefore, a direct evidence-based comparison of aerosol output between the two modalities cannot be made from the available indexed literature.\n\nWe found no a passage in the indexed literature that directly answers whether air polishing produces more or less aerosol than ultrasonic scaling.",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Concern about the risk of aerosol contamination from ultrasonic scaler: a systematic review and meta-analysis.",
     "journal": "BMC oral health",
     "year": 2024,
     "url": "https://doi.org/10.1186/s12903-024-03996-2",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Use of air polishing for supra- and subgingival biofilm removal for treatment of residual periodontal pockets and supportive periodontal care: a systematic review.",
     "journal": "Clinical oral investigations",
     "year": 2021,
     "url": "https://doi.org/10.1007/s00784-020-03762-y",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Erythritol airpolishing in the non-surgical treatment of peri-implantitis: A randomized controlled trial.",
     "journal": "Clinical oral implants research",
     "year": 2021,
     "url": "https://doi.org/10.1111/clr.13757",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "Clinical evaluation of air polishing with erythritol powder followed by ultrasonic calculus removal versus conventional ultrasonic debridement and rubber cup polishing for the treatment of gingivitis: A split-mouth randomized controlled clinical trial.",
     "journal": "International journal of dental hygiene",
     "year": 2022,
     "url": "https://doi.org/10.1111/idh.12537",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "How can aerosols be reduced during air polishing and ultrasonic scaling?",
   "topic": "Air polishing",
   "url": "https://preventiohub.com/evidence/aerosols-reduced-during-air-polishing-ultrasonic-scaling/",
   "answer": "Based on the indexed literature, several complementary strategies can reduce aerosol and droplet contamination during ultrasonic scaling (evidence on air polishing specifically is limited in these passages).\n\nFor evacuation, combining high-volume evacuation (HVE) with an intraoral suction device produces significant reductions in colony-forming units (CFUs) compared with either device used alone during oral prophylaxis procedures [1]. Extraoral suction (EOS) devices positioned close to the patient's mouth are also effective, with one chairside EOS system achieving statistically significant CFU reductions at the patient's chest area where aerosol concentration is highest [2]. A separate RCT found that an EOS performed comparably to HVE and was superior to a saliva ejector alone at the operator's and patient's chest surfaces [3]. Positioning an extraoral high-volume evacuator (eHVE) within 10 cm of the mouth renders bacterial contamination from aerosols negligible; moving it to 20 cm allows more detectable contamination to reach the dentist's and patient's chest areas [4].\n\nPreprocedural mouth rinsing adds a further layer of protection: povidone-iodine 0.5% reduced viable bacterial counts by 31–38% and essential oil rinse by 22–33% compared with water, particularly useful when the evacuator cannot be held very close to the mouth [4]. Meta-analysis confirms that ultrasonic scalers significantly increase airborne bacteria up to 2 m away, and that LVE, HVE, or combinations of devices can all reduce this contamination, though no single suction type showed a statistically significant advantage over another in that meta-analysis [5]. In summary, the most evidence-supported approach is combining close-proximity extraoral or intraoral evacuation with preprocedural antiseptic rinsing [4][1][3].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "A clinical investigation of dental evacuation systems in reducing aerosols.",
     "journal": "Journal of the American Dental Association (1939)",
     "year": 2021,
     "url": "https://doi.org/10.1016/j.adaj.2021.02.013",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "Efficacy of a chairside extraoral suction system in the reduction of aerosol contamination.",
     "journal": "General dentistry",
     "year": 2023,
     "url": "https://pubmed.ncbi.nlm.nih.gov/37083608/",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "Effect of an extraoral scavenging device on eliminating droplets and aerosols generated in ultrasonic supragingival scaling: A randomised clinical trial.",
     "journal": "International journal of dental hygiene",
     "year": 2025,
     "url": "https://doi.org/10.1111/idh.12823",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "Efficacy of Combining an Extraoral High-Volume Evacuator with Preprocedural Mouth Rinsing in Reducing Aerosol Contamination Produced by Ultrasonic Scaling.",
     "journal": "International journal of environmental research and public health",
     "year": 2022,
     "url": "https://doi.org/10.3390/ijerph19106048",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 5,
     "title": "Concern about the risk of aerosol contamination from ultrasonic scaler: a systematic review and meta-analysis.",
     "journal": "BMC oral health",
     "year": 2024,
     "url": "https://doi.org/10.1186/s12903-024-03996-2",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Can air polishing cause subcutaneous emphysema or gingival damage?",
   "topic": "Air polishing",
   "url": "https://preventiohub.com/evidence/air-polishing-cause-subcutaneous-emphysema-gingival-damage/",
   "answer": "Yes, air polishing carries risks for both subcutaneous emphysema and gingival damage, though the magnitude of risk varies by powder type.\n\nRegarding subcutaneous emphysema (SE), air-driven handpieces are implicated in 51% of SE cases identified in a systematic review of 135 cases, and air syringes account for a further 9% [1]. While that review focuses on handpieces used during extractions, the underlying mechanism - pressurised air forcing into soft tissue planes - is relevant to any air-driven device used intraorally. Dental extractions in the posterior mandible carried the highest risk, and use of air-driven handpieces in those sites is specifically cautioned against [1].\n\nRegarding gingival damage, the choice of powder matters significantly. Studies assessing soft tissue effects found that sodium bicarbonate powder causes greater harm to gingival tissue compared to glycine powder, and that glycine powder air polishing produces less soft tissue modification even compared to instrumentation with curettes [2]. Subgingival use of air-polishing devices with appropriate powders such as glycine has the potential to enhance patient comfort and mitigate damage to periodontal structures, supporting better tissue healing [3]. Overall, air polishing devices used in supportive periodontal therapy appear capable of removing biofilm efficiently without causing significant damage to periodontal soft tissues when the correct powder is selected [4].\n\nIn summary, SE is a recognised, though uncommon, risk associated with pressurised air intraorally [1], and gingival harm is largely powder-dependent, with glycine being better tolerated than sodium bicarbonate or calcium carbonate formulations [2][3].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Causes of subcutaneous emphysema following dental procedures: a systematic review of cases 1993-2020.",
     "journal": "British dental journal",
     "year": 2021,
     "url": "https://doi.org/10.1038/s41415-021-3564-0",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "A systematic review on the effects of air polishing devices on oral tissues.",
     "journal": "International journal of dental hygiene",
     "year": 2016,
     "url": "https://doi.org/10.1111/idh.12120",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Subgingival Use of Air-Polishing Powders: Status of Knowledge: A Systematic Review.",
     "journal": "Journal of clinical medicine",
     "year": 2023,
     "url": "https://doi.org/10.3390/jcm12216936",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "The efficacy of air polishing devices in supportive periodontal therapy: A systematic review and meta-analysis.",
     "journal": "Quintessence international (Berlin, Germany : 1985)",
     "year": 2018,
     "url": "https://doi.org/10.3290/j.qi.a40341",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Is air polishing more comfortable for patients than conventional instrumentation?",
   "topic": "Air polishing",
   "url": "https://preventiohub.com/evidence/air-polishing-more-comfortable-patients-conventional-instrumentation/",
   "answer": "Yes, the evidence consistently supports that air polishing is more comfortable for patients than conventional instrumentation. A systematic review found that reported discomfort during non-surgical periodontal therapy was consistently equal or lower when glycine or erythritol powders were used compared with hand instruments or ultrasonic devices, with glycine appearing to be associated with less discomfort [1]. In a randomized controlled trial comparing air polishing followed by ultrasonic calculus removal versus conventional ultrasonic scaling and rubber cup polishing, superior patient comfort was reported for the air polishing protocol [2]. Similarly, in a split-mouth RCT evaluating subgingival air polishing with a conical-shaped tip during supportive periodontal therapy, pain perception was significantly lower for the air polishing group compared to sonic scaling (mean VAS 12.56 vs. 28.8, p = 0.006) [3]. The majority of patients in several studies also rated subgingival air polishing as more comfortable compared to hand instruments or sonic scaling [3]. These findings apply across both supragingival and subgingival applications, and across different low-abrasiveness powders such as erythritol, glycine, and trehalose [1][2][3].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "A systematic review on the patient perception of periodontal treatment using air polishing devices.",
     "journal": "International journal of dental hygiene",
     "year": 2016,
     "url": "https://doi.org/10.1111/idh.12119",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Clinical evaluation of air polishing with erythritol powder followed by ultrasonic calculus removal versus conventional ultrasonic debridement and rubber cup polishing for the treatment of gingivitis: A split-mouth randomized controlled clinical trial.",
     "journal": "International journal of dental hygiene",
     "year": 2022,
     "url": "https://doi.org/10.1111/idh.12537",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "Subgingival air polishing with trehalose powder during supportive periodontal therapy: use of a conical shaped tip during a randomized clinical trial.",
     "journal": "BMC oral health",
     "year": 2022,
     "url": "https://doi.org/10.1186/s12903-022-02109-1",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "Does air polishing reduce treatment time compared with conventional prophylaxis?",
   "topic": "Air polishing",
   "url": "https://preventiohub.com/evidence/air-polishing-reduce-treatment-time-compared-conventional-prophylaxis/",
   "answer": "Yes, the evidence consistently supports that air polishing reduces treatment time compared with conventional prophylaxis methods.\n\nIn a split-mouth randomized controlled trial, the marginal mean treatment time for air polishing was significantly shorter at 325 seconds per quadrant compared with 407 seconds for rubber cup polishing [1]. A separate trial evaluating air polishing followed by targeted ultrasonic calculus removal versus conventional ultrasonic scaling and rubber cup polishing also identified time-saving as one of the principal benefits of the air polishing protocol [2]. A systematic review of 14 RCTs in supportive periodontal therapy similarly concluded that air polishing devices are a faster option compared with conventional techniques, including hand and ultrasonic instrumentation [3]. Another systematic review reinforced that air polishing can serve as an effective alternative to conventional instrumentation for biofilm control, with patient comfort and efficiency noted among its advantages [4].\n\nIt is worth noting that the absolute time savings may vary depending on the clinical context, the powder used, and whether adjunctive ultrasonic calculus removal is still required after air polishing. Clinical judgement should guide how these time-efficiency findings are applied in individual patient care.",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Conventional versus comprehensive dental prophylaxis: comparing the clinical outcomes between rubber cup and air polishing and the importance of plaque disclosure.",
     "journal": "Quintessence international (Berlin, Germany : 1985)",
     "year": 2021,
     "url": "https://doi.org/10.3290/j.qi.a45602",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "Clinical evaluation of air polishing with erythritol powder followed by ultrasonic calculus removal versus conventional ultrasonic debridement and rubber cup polishing for the treatment of gingivitis: A split-mouth randomized controlled clinical trial.",
     "journal": "International journal of dental hygiene",
     "year": 2022,
     "url": "https://doi.org/10.1111/idh.12537",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "The efficacy of air polishing devices in supportive periodontal therapy: Clinical, microbiological and patient-centred outcomes. A systematic review.",
     "journal": "International journal of dental hygiene",
     "year": 2023,
     "url": "https://doi.org/10.1111/idh.12635",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "Use of air polishing for supra- and subgingival biofilm removal for treatment of residual periodontal pockets and supportive periodontal care: a systematic review.",
     "journal": "Clinical oral investigations",
     "year": 2021,
     "url": "https://doi.org/10.1007/s00784-020-03762-y",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Does air polishing remove extrinsic stain better than rubber cup polishing?",
   "topic": "Air polishing",
   "url": "https://preventiohub.com/evidence/air-polishing-remove-extrinsic-stain-better-rubber-cup-polishing/",
   "answer": "The indexed literature I have available does not directly compare air polishing versus rubber cup polishing specifically for extrinsic stain removal as a primary outcome. The studies in context focus on plaque/biofilm removal [1][2] and on whether the prophylaxis method affects subsequent tooth bleaching outcomes [3], rather than measuring stain removal efficacy as a standalone endpoint.\n\nWhat can be said from the available evidence is that air polishing was significantly faster than rubber cup polishing for plaque removal (325 vs 407 seconds per quadrant) and achieved lower post-treatment plaque scores when combined with prior disclosure [1]. In the bleaching study, both techniques produced similar color change immediately after bleaching, though air polishing showed slightly greater color change at one week, suggesting it may support better bleaching outcomes [3] - but this is not the same as directly measuring extrinsic stain removal.\n\nI could not find a direct comparison of stain removal efficacy between these two modalities in the indexed literature. A specific study measuring extrinsic stain reduction as the primary outcome would be needed to answer this question definitively, and clinical judgement should guide practice in the meantime.",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Conventional versus comprehensive dental prophylaxis: comparing the clinical outcomes between rubber cup and air polishing and the importance of plaque disclosure.",
     "journal": "Quintessence international (Berlin, Germany : 1985)",
     "year": 2021,
     "url": "https://doi.org/10.3290/j.qi.a45602",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "A randomized controlled trial on the plaque-removing efficacy of a low-abrasive air-polishing system to improve oral health care.",
     "journal": "Quintessence international (Berlin, Germany : 1985)",
     "year": 2021,
     "url": "https://doi.org/10.3290/j.qi.b1763661",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "Effects of preoperative air-powder polishing and rubber-cup prophylaxis on tooth bleaching: randomized controlled split-mouth clinical study.",
     "journal": "Clinical oral investigations",
     "year": 2021,
     "url": "https://doi.org/10.1007/s00784-021-04023-2",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "How do erythritol and glycine air polishing powders compare?",
   "topic": "Powders",
   "url": "https://preventiohub.com/evidence/erythritol-glycine-air-polishing-powders-compare/",
   "answer": "Based on this systematic review and network meta-analysis of nine RCTs involving 462 patients, erythritol and glycine showed no statistically significant difference across the primary outcomes of PPD, CAL, and BOP in non-surgical periodontal treatment [1][2]. However, in the network meta-analysis SUCRA rankings for PPD reduction, erythritol scored higher (84.1) than glycine (28.5), suggesting a probabilistic advantage for erythritol in pocket depth reduction, though this did not reach statistical significance [1][2].\n\nFrom a physicochemical standpoint, erythritol has a smaller particle size (14 μm) compared to glycine (25–65 μm), making it less abrasive, and it exerts antimicrobial effects by altering the microstructure and metabolic profile of P. gingivalis biofilm in vitro [1]. Glycine is biocompatible and highly soluble, reduces subgingival P. gingivalis, A. actinomycetemcomitans, and F. nucleatum, but some studies indicate it may enhance pro-inflammatory gene expression (TNFα, IL-8, CCL2) via NF-κB activation and delay wound healing in vitro [1]. Both powders have been reported to have no adverse events [1].\n\nThe authors recommend prioritising erythritol over glycine when selecting a subgingival air-polishing powder, while noting that powder selection should also account for disease severity, patient oral hygiene habits, treatment tolerance, and the chemical properties of each powder [1][2]. Clinicians should interpret these findings cautiously given the small number of included RCTs and heterogeneity in study design, parameters, and follow-up duration [1].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "\"Clinical effects of erythritol, glycine and trehalose as subgingival air-polishing powders on non-surgical periodontal treatment: a systematic review with meta-analysis of randomized controlled trials\"",
     "journal": "Frontiers in Physiology",
     "year": 2025,
     "url": "https://doi.org/10.3389/fphys.2025.1593204",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Clinical effects of erythritol, glycine and trehalose as subgingival air-polishing powders on non-surgical periodontal treatment:a systematic review with meta-analysis of randomized controlled trials.",
     "journal": "Frontiers in physiology",
     "year": 2025,
     "url": "https://doi.org/10.3389/fphys.2025.1593204",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Is sodium bicarbonate powder safe for subgingival use?",
   "topic": "Powders",
   "url": "https://preventiohub.com/evidence/sodium-bicarbonate-powder-safe-subgingival-use/",
   "answer": "Sodium bicarbonate is not among the powders evaluated for subgingival use in the indexed literature. The systematic reviews and meta-analyses in the context focus specifically on glycine, erythritol, and trehalose as the powders studied for subgingival air-polishing [1][2][3]. Glycine has a particle size of 25–65 μm, trehalose 25–35 μm, and erythritol 14 μm, and all three are described as having no significant adverse events in subgingival applications [2]. Sodium bicarbonate, which has a much larger and more abrasive particle size, is not discussed in the subgingival context in any of the indexed passages, so no evidence-based statement about its subgingival safety can be drawn from this literature. For that specific question, The indexed literature does not directly address this.",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "\"Subgingival Use of Air-Polishing Powders: Status of Knowledge: A Systematic Review\"",
     "journal": "Journal of Clinical Medicine (MDPI)",
     "year": 2023,
     "url": "https://doi.org/10.3390/jcm12216936",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "\"Clinical effects of erythritol, glycine and trehalose as subgingival air-polishing powders on non-surgical periodontal treatment: a systematic review with meta-analysis of randomized controlled trials\"",
     "journal": "Frontiers in Physiology",
     "year": 2025,
     "url": "https://doi.org/10.3389/fphys.2025.1593204",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Subgingival Use of Air-Polishing Powders: Status of Knowledge: A Systematic Review.",
     "journal": "Journal of clinical medicine",
     "year": 2023,
     "url": "https://doi.org/10.3390/jcm12216936",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "Is trehalose powder effective for air polishing?",
   "topic": "Powders",
   "url": "https://preventiohub.com/evidence/trehalose-powder-effective-air-polishing/",
   "answer": "Based on the indexed literature, trehalose is an effective subgingival air-polishing powder, though with some nuances worth noting.\n\nTrehalose is a non-cariogenic disaccharide with a particle size of 25–35 μm, giving it a similar grinding effect on dental materials to glycine [1]. It can produce a statistically significant reduction in total bacterial load, though it is considered less antibacterial than glycine, and importantly has no significant impact on wound healing [1].\n\nIn the network meta-analysis of nine RCTs (462 patients), there was no statistically significant difference among erythritol, glycine, and trehalose when comparing PPD, CAL, and BOP outcomes [1][2]. However, when ranked by SUCRA values for PPD reduction, trehalose (SUCRA = 48.0) ranked second after erythritol (SUCRA = 84.1) and ahead of glycine (SUCRA = 28.5) [1][2]. Based on this ranking, the authors recommended a priority order of erythritol, then trehalose, then glycine [2].\n\nIt is worth noting that the evidence base is limited - only nine RCTs with 462 patients were included, making publication bias testing difficult, and most data came from the 3-month time point, limiting conclusions about long-term efficacy [1]. Powder selection should ultimately consider disease severity, patient oral hygiene habits, treatment tolerance, and the physicochemical properties of each powder [1].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "\"Clinical effects of erythritol, glycine and trehalose as subgingival air-polishing powders on non-surgical periodontal treatment: a systematic review with meta-analysis of randomized controlled trials\"",
     "journal": "Frontiers in Physiology",
     "year": 2025,
     "url": "https://doi.org/10.3389/fphys.2025.1593204",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Clinical effects of erythritol, glycine and trehalose as subgingival air-polishing powders on non-surgical periodontal treatment:a systematic review with meta-analysis of randomized controlled trials.",
     "journal": "Frontiers in physiology",
     "year": 2025,
     "url": "https://doi.org/10.3389/fphys.2025.1593204",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Does erythritol powder have an antimicrobial effect on oral biofilm?",
   "topic": "Powders",
   "url": "https://preventiohub.com/evidence/erythritol-powder-have-antimicrobial-effect-oral-biofilm/",
   "answer": "Yes, erythritol powder demonstrates antimicrobial properties relevant to oral biofilm management. It is described as a non-metabolized, non-cariogenic sugar alcohol that is safe and well-tolerated in the oral cavity, with documented antimicrobial properties, though it is limited in removing large or firm calculus deposits [1]. With a particle size of 14 μm, it is less abrasive than glycine, and can remove biofilm while exhibiting antibacterial effects during periodontal treatment [2].\n\nEvidence from a clinical microbiome study supports a direct impact on subgingival pathogens: in patients with stage III-IV periodontitis, the addition of subgingival erythritol-chlorhexidine air-polishing led to a statistically significant decrease in several periodontal pathogens - including Filifactor alocis, Porphyromonas endodontalis, Selenomonas sputigena, Tannerella forsythia, Treponema denticola, and Treponema socranskii - along with an increase in health-associated species such as Abiotropha defectiva, Capnocytophaga sputigena, and Lautropia mirabilis [3]. This shift was more pronounced than in the control group receiving conventional treatment alone, suggesting that subgingival erythritol air-polishing helps re-establish a more eubiotic microbiome in deep bleeding periodontal pockets [3]. Both erythritol and glycine air-polishing powders have been reported to have no adverse events [2].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "\"Subgingival Use of Air-Polishing Powders: Status of Knowledge: A Systematic Review\"",
     "journal": "Journal of Clinical Medicine (MDPI)",
     "year": 2023,
     "url": "https://doi.org/10.3390/jcm12216936",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "\"Clinical effects of erythritol, glycine and trehalose as subgingival air-polishing powders on non-surgical periodontal treatment: a systematic review with meta-analysis of randomized controlled trials\"",
     "journal": "Frontiers in Physiology",
     "year": 2025,
     "url": "https://doi.org/10.3389/fphys.2025.1593204",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Efficacy of the additional use of subgingival air-polishing with erythritol powder in the treatment of periodontitis patients: a randomized controlled clinical trial. Part II: effect on sub-gingival microbiome.",
     "journal": "Clinical oral investigations",
     "year": 2023,
     "url": "https://doi.org/10.1007/s00784-022-04811-4",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "Which air polishing powders are recommended around dental implants?",
   "topic": "Powders",
   "url": "https://preventiohub.com/evidence/which-air-polishing-powders-recommended-around-dental-implants/",
   "answer": "Based on the indexed literature, erythritol and glycine are the two powders most investigated and discussed for use around dental implants.\n\nErythritol air polishing has shown promising results for professional oral hygiene at implant-supported restorations, appearing significantly more effective in reducing biofilm compared to other treatments without causing significant damage to implant surfaces or peri-implant tissues [1]. It is considered a promising treatment method for peri-implant disease management [2]. However, in a randomized controlled trial of surgical peri-implantitis treatment, erythritol air polishing was not more effective than saline irrigation for clinical, radiographic, or microbiological outcomes, and both therapies resulted in low overall treatment success [3]. In non-surgical peri-implantitis treatment, erythritol air polishing has also been investigated as an alternative to glycine, though complete disease resolution remains difficult to achieve with non-surgical approaches [2].\n\nGlycine powder air polishing, when combined with mechanical submucosal debridement, produced significantly greater reductions in bleeding index and suppuration on probing compared to mechanical debridement alone, particularly for peri-implant mucositis, though PPD reductions were comparable between groups [4]. For treating peri-implant mucositis more broadly, air polishing showed effects comparable to ultrasonic scaling in reducing bleeding on probing and probing pocket depth [5].\n\nOverall, neither powder has been shown to produce clearly superior clinical outcomes over alternative modalities, and the literature does not designate one powder as definitively preferred over the other [5][2].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Efficacy and safety of erythritol air-polishing in implant dentistry: A systematic review.",
     "journal": "International journal of dental hygiene",
     "year": 2025,
     "url": "https://doi.org/10.1111/idh.12836",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Erythritol airpolishing in the non-surgical treatment of peri-implantitis: A randomized controlled trial.",
     "journal": "Clinical oral implants research",
     "year": 2021,
     "url": "https://doi.org/10.1111/clr.13757",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "Erythritol air polishing in the surgical treatment of peri-implantitis: A randomized controlled trial.",
     "journal": "Clinical oral implants research",
     "year": 2022,
     "url": "https://doi.org/10.1111/clr.13881",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "[Efficacy of combined application of glycine powder air-polishing in non-surgical treatment of peri-implant diseases].",
     "journal": "Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences",
     "year": 2022,
     "url": null,
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 5,
     "title": "Effect of Air Polishing on the Treatment of Peri-Implant Diseases: A Systematic Review and Meta-Analysis.",
     "journal": "The Journal of oral implantology",
     "year": 2023,
     "url": "https://doi.org/10.1563/aaid-joi-D-23-00114",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Is subgingival air polishing effective in periodontal pockets?",
   "topic": "Periodontal therapy",
   "url": "https://preventiohub.com/evidence/subgingival-air-polishing-effective-periodontal-pockets/",
   "answer": "Subgingival air polishing (SubGAP) appears to be clinically effective in periodontal pockets, with outcomes comparable to conventional hand or ultrasonic instrumentation. A systematic review of 13 clinical studies confirmed comparable efficacy in biofilm control and reduction of periodontal inflammation when air polishing was compared to hand or ultrasonic instruments [1]. A further systematic review found that most studies showed no statistically significant difference in pocket-depth reduction between SubGAP and ultrasonic debridement during periodontal maintenance, though neither modality was shown to be clearly superior [2].\n\nIn randomised controlled trials, both subgingival air polishing and sonic scaling produced significant reductions in probing depth, clinical attachment level, and bleeding on probing, with no statistically significant intergroup differences [3]. When erythritol powder air polishing was used as an adjunct to conventional instrumentation during initial non-surgical therapy, a significantly larger proportion of initially deep pockets (PPD ≥ 5.5 mm) were reduced to shallow pockets, and greater attachment gain was observed at 6 months compared to instrumentation alone [4]. At the microbiome level, the addition of subgingival erythritol air polishing produced a broader shift toward health-related species and a greater reduction of periodontal pathogens compared to conventional treatment alone [5].\n\nPatient comfort is consistently more favourable with air polishing than with sonic or hand instrumentation [3][2][1]. Overall, current evidence supports SubGAP as a viable alternative or adjunct for subgingival biofilm removal, though long-term data beyond one year remain limited [2][1].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Use of air polishing for supra- and subgingival biofilm removal for treatment of residual periodontal pockets and supportive periodontal care: a systematic review.",
     "journal": "Clinical oral investigations",
     "year": 2021,
     "url": "https://doi.org/10.1007/s00784-020-03762-y",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "The Clinical Efficacy of Subgingival Debridement by Ultrasonic Instrumentation Compared With Subgingival Air Polishing During Periodontal Maintenance: A Systematic Review.",
     "journal": "The journal of evidence-based dental practice",
     "year": 2019,
     "url": "https://doi.org/10.1016/j.jebdp.2019.02.001",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Subgingival air polishing with trehalose powder during supportive periodontal therapy: use of a conical shaped tip during a randomized clinical trial.",
     "journal": "BMC oral health",
     "year": 2022,
     "url": "https://doi.org/10.1186/s12903-022-02109-1",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "The efficacy of the adjunct use of subgingival air-polishing therapy with erythritol powder compared to conventional debridement alone during initial non-surgical periodontal therapy.",
     "journal": "Journal of clinical periodontology",
     "year": 2022,
     "url": "https://doi.org/10.1111/jcpe.13623",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 5,
     "title": "Efficacy of the additional use of subgingival air-polishing with erythritol powder in the treatment of periodontitis patients: a randomized controlled clinical trial. Part II: effect on sub-gingival microbiome.",
     "journal": "Clinical oral investigations",
     "year": 2023,
     "url": "https://doi.org/10.1007/s00784-022-04811-4",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "Can subgingival air polishing replace ultrasonic debridement in supportive periodontal therapy?",
   "topic": "Periodontal therapy",
   "url": "https://preventiohub.com/evidence/subgingival-air-polishing-replace-ultrasonic-debridement-supportive-pe/",
   "answer": "Based on the indexed literature, subgingival air polishing (SubAP) can serve as an effective alternative to ultrasonic debridement in supportive periodontal therapy (SPT), but \"replace\" requires some nuance.\n\nMultiple systematic reviews and meta-analyses consistently show no significant difference between air polishing and ultrasonic or hand instrumentation for key clinical outcomes including probing depth, clinical attachment level, bleeding on probing, and plaque index [1][2][3][4]. One meta-analysis of 12 RCTs specifically confirmed equivalence across these parameters [1], and another review of 14 RCTs reached the same conclusion [4].\n\nAir polishing does appear to offer some advantages over conventional debridement: patients report less discomfort [1][4], treatment is faster and less labour-intensive [4][5], and there is evidence of improved antimicrobial outcomes [4]. Repeated conventional instrumentation over the long SPT process can cause cementum damage and sensitivity, which air polishing may mitigate [6][5].\n\nHowever, important caveats apply. Most included studies carry varying degrees of risk of bias [1][2][3], follow-up periods are often short [2], and industry funding is a noted concern in some trials [2]. Evidence for single- and multi-rooted teeth without furcation involvement is more established; generalisation beyond this is less certain [3]. For deeper pockets specifically, tip design affects efficacy, with specialised subgingival nozzles needed to reach pocket depths effectively [7].\n\nIn summary, the literature supports using subgingival air polishing as a clinically equivalent alternative to ultrasonic debridement in SPT, particularly where patient comfort and tissue preservation are priorities, but clinicians should exercise judgement given the methodological limitations of available evidence [1][2][3][4].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "The efficacy of subgingival air polishing and subgingival debridement in periodontal support therapy: a meta-analysis.",
     "journal": "Evidence-based dentistry",
     "year": 2023,
     "url": "https://doi.org/10.1038/s41432-023-00910-7",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Use of air polishing for supra- and subgingival biofilm removal for treatment of residual periodontal pockets and supportive periodontal care: a systematic review.",
     "journal": "Clinical oral investigations",
     "year": 2021,
     "url": "https://doi.org/10.1007/s00784-020-03762-y",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "The efficacy of air polishing devices in supportive periodontal therapy: A systematic review and meta-analysis.",
     "journal": "Quintessence international (Berlin, Germany : 1985)",
     "year": 2018,
     "url": "https://doi.org/10.3290/j.qi.a40341",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "The efficacy of air polishing devices in supportive periodontal therapy: Clinical, microbiological and patient-centred outcomes. A systematic review.",
     "journal": "International journal of dental hygiene",
     "year": 2023,
     "url": "https://doi.org/10.1111/idh.12635",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 5,
     "title": "Efficacy of glycine powder air-polishing in supportive periodontal therapy: a systematic review and meta-analysis.",
     "journal": "Journal of periodontal & implant science",
     "year": 2021,
     "url": "https://doi.org/10.5051/jpis.1902340117",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 6,
     "title": "Subgingival Use of Air-Polishing Powders: Status of Knowledge: A Systematic Review.",
     "journal": "Journal of clinical medicine",
     "year": 2023,
     "url": "https://doi.org/10.3390/jcm12216936",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 7,
     "title": "Subgingival air polishing with trehalose powder during supportive periodontal therapy: use of a conical shaped tip during a randomized clinical trial.",
     "journal": "BMC oral health",
     "year": 2022,
     "url": "https://doi.org/10.1186/s12903-022-02109-1",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "Does adjunctive air polishing improve the outcomes of non-surgical periodontal therapy?",
   "topic": "Periodontal therapy",
   "url": "https://preventiohub.com/evidence/adjunctive-air-polishing-improve-outcomes-non-surgical-periodontal-the/",
   "answer": "Based on the indexed literature, the evidence is nuanced and depends on pocket depth and context.\n\nIn a split-mouth RCT of 21 patients with Stages 2 and 3 grade B periodontitis, adjunctive erythritol powder air-polishing (EPAP) added to conventional hand and ultrasonic instrumentation produced a significantly greater number of initially deep pockets (PPD ≥ 5.5 mm) reduced to shallow depth, and greater attachment gain at 6 months compared to conventional instrumentation alone [1]. However, no statistically significant microbiological differences were found between the adjunctive EPAP group and the control group, suggesting the clinical benefit does not extend to the microbial level [1]. A systematic review of RCTs on erythritol air-polishing confirmed these findings across active and supportive periodontal therapy contexts, noting improvements in probing depth, CAL, and BOP in several included trials [2].\n\nFor supportive periodontal therapy specifically, multiple systematic reviews and a meta-analysis found no significant difference between subgingival air polishing as monotherapy and conventional scaling in terms of PD, CAL, BOP, and plaque index [3][4][5]. Air polishing devices did, however, show better patient comfort, faster treatment times, and possibly improved antimicrobial behaviour compared to hand or ultrasonic instrumentation [6][5].\n\nIn summary, adjunctive air polishing during initial non-surgical therapy may offer a meaningful clinical benefit in deeper pockets (PPD ≥ 5.5 mm), but as a standalone or adjunct approach in maintenance, outcomes appear equivalent to conventional debridement [1][3][4][5].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "The efficacy of the adjunct use of subgingival air-polishing therapy with erythritol powder compared to conventional debridement alone during initial non-surgical periodontal therapy.",
     "journal": "Journal of clinical periodontology",
     "year": 2022,
     "url": "https://doi.org/10.1111/jcpe.13623",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "Effectiveness and Clinical Performance of Erythritol Air-Polishing in Non-Surgical Periodontal Therapy: A Systematic Review of Randomized Clinical Trials.",
     "journal": "Medicina (Kaunas, Lithuania)",
     "year": 2022,
     "url": "https://doi.org/10.3390/medicina58070866",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "The efficacy of air polishing devices in supportive periodontal therapy: A systematic review and meta-analysis.",
     "journal": "Quintessence international (Berlin, Germany : 1985)",
     "year": 2018,
     "url": "https://doi.org/10.3290/j.qi.a40341",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "Use of air polishing for supra- and subgingival biofilm removal for treatment of residual periodontal pockets and supportive periodontal care: a systematic review.",
     "journal": "Clinical oral investigations",
     "year": 2021,
     "url": "https://doi.org/10.1007/s00784-020-03762-y",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 5,
     "title": "The efficacy of subgingival air polishing and subgingival debridement in periodontal support therapy: a meta-analysis.",
     "journal": "Evidence-based dentistry",
     "year": 2023,
     "url": "https://doi.org/10.1038/s41432-023-00910-7",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 6,
     "title": "The efficacy of air polishing devices in supportive periodontal therapy: Clinical, microbiological and patient-centred outcomes. A systematic review.",
     "journal": "International journal of dental hygiene",
     "year": 2023,
     "url": "https://doi.org/10.1111/idh.12635",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "How deep into a periodontal pocket can subgingival air polishing reach?",
   "topic": "Periodontal therapy",
   "url": "https://preventiohub.com/evidence/deep-into-periodontal-pocket-subgingival-air-polishing-reach/",
   "answer": "The indexed literature does not provide a precise, universally agreed millimetre depth of penetration for subgingival air polishing across all tip designs, but several passages offer relevant clinical data. Early work using a conventional air-polishing device with glycine powder directed into the pocket showed sufficient biofilm removal in pockets of 3–5 mm, with adequate results observed in pockets ≤3 mm when the beam was pointed apically [1]. A triangular-shaped nozzle with sideways orientations for water and the air-powder beam was subsequently introduced specifically to reach deeper periodontal pockets and reduce the risk of emphysema [1]. The clinical trials included in this body of literature treated pockets ranging from 3 mm up to 9 mm with subgingival air polishing, suggesting devices are used across this range in practice [1][2][3].\n\nIt is worth noting that effectiveness appears to diminish with increasing pocket depth. One study found that air polishing alone in untreated pockets ≥6 mm produced short-term CAL gain comparable to conventional scaling and root planing, but the sequential two-step combination did not further enhance long-term outcomes [4]. Another trial found no significant advantage of adding subgingival air polishing over ultrasonic instrumentation alone for pockets of 7–9 mm [2]. Tip geometry matters considerably, as conical and sideways-oriented nozzles were developed precisely to improve access to deeper sites [1]. Long-term data on repeated subgingival use across all pocket depths remain limited [1].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Subgingival air polishing with trehalose powder during supportive periodontal therapy: use of a conical shaped tip during a randomized clinical trial.",
     "journal": "BMC oral health",
     "year": 2022,
     "url": "https://doi.org/10.1186/s12903-022-02109-1",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "Efficacy of the additional use of subgingival air polishing with erythritol powder in the treatment of periodontitis patients: a randomized controlled clinical trial.",
     "journal": "Clinical oral investigations",
     "year": 2021,
     "url": "https://doi.org/10.1007/s00784-020-03648-z",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "The efficacy of the adjunct use of subgingival air-polishing therapy with erythritol powder compared to conventional debridement alone during initial non-surgical periodontal therapy.",
     "journal": "Journal of clinical periodontology",
     "year": 2022,
     "url": "https://doi.org/10.1111/jcpe.13623",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "Impact of a two-stage subgingival instrumentation scheme involving air polishing on attachment gain after active periodontal therapy.",
     "journal": "Journal of periodontology",
     "year": 2022,
     "url": "https://doi.org/10.1002/JPER.21-0351",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "Does air polishing reduce bleeding on probing in periodontal maintenance?",
   "topic": "Periodontal therapy",
   "url": "https://preventiohub.com/evidence/air-polishing-reduce-bleeding-probing-periodontal-maintenance/",
   "answer": "In patients undergoing supportive periodontal therapy (SPT), air polishing devices (APDs) produce reductions in bleeding on probing (BOP) that are comparable to those achieved with conventional hand or ultrasonic instrumentation, with no statistically significant differences detected between the two approaches [1][2][3]. Across 14 RCTs analysed in one systematic review, APDs and conventional periodontal therapy yielded identical results on BOP as a primary outcome [1]. A meta-analysis likewise found no statistically significant difference in the percentage of BOP between repeated APD interventions and conventional treatments in SPT (p = 0.08) [2]. A further systematic review of 13 clinical studies confirmed no differences between air polishing and hand or ultrasonic instruments in reducing periodontal inflammation, of which BOP is a key indicator [3]. For implant maintenance specifically, APDs were associated with a reduction in BOP percentage compared to conventional interventions, though the evidence remains limited [2]. One systematic review did note that the clinical efficacy of subgingival air polishing versus ultrasonic debridement for BOP specifically remains inconclusive due to limited high-quality evidence and short follow-up periods across studies [4]. Overall, the current evidence supports air polishing as a clinically equivalent option to conventional debridement for BOP reduction during periodontal maintenance, while also offering advantages in patient comfort [1][2][5].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "The efficacy of air polishing devices in supportive periodontal therapy: Clinical, microbiological and patient-centred outcomes. A systematic review.",
     "journal": "International journal of dental hygiene",
     "year": 2023,
     "url": "https://doi.org/10.1111/idh.12635",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Efficacy of air polishing in comparison with hand instruments and/or power-driven instruments in supportive periodontal therapy and implant maintenance: a systematic review and meta-analysis.",
     "journal": "BMC oral health",
     "year": 2022,
     "url": "https://doi.org/10.1186/s12903-022-02120-6",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Use of air polishing for supra- and subgingival biofilm removal for treatment of residual periodontal pockets and supportive periodontal care: a systematic review.",
     "journal": "Clinical oral investigations",
     "year": 2021,
     "url": "https://doi.org/10.1007/s00784-020-03762-y",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "The Clinical Efficacy of Subgingival Debridement by Ultrasonic Instrumentation Compared With Subgingival Air Polishing During Periodontal Maintenance: A Systematic Review.",
     "journal": "The journal of evidence-based dental practice",
     "year": 2019,
     "url": "https://doi.org/10.1016/j.jebdp.2019.02.001",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 5,
     "title": "The efficacy of air polishing devices in supportive periodontal therapy: A systematic review and meta-analysis.",
     "journal": "Quintessence international (Berlin, Germany : 1985)",
     "year": 2018,
     "url": "https://doi.org/10.3290/j.qi.a40341",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "How often should supportive periodontal therapy visits be scheduled?",
   "topic": "Periodontal therapy",
   "url": "https://preventiohub.com/evidence/often-should-supportive-periodontal-therapy-visits-scheduled/",
   "answer": "The evidence does not support a single fixed interval for all patients; instead, risk-based scheduling is more appropriate. A systematic review found that evidence for a specific recall interval (e.g., every 3 months) for all patients is weak, and that the merits of risk-based recommendations over fixed regimens should be explored [1]. A large cohort study identified minimum thresholds below which tooth loss risk rose significantly: approximately one visit every 7.4 months for stage I-II periodontitis, and every 6.7 months for stage III-IV or grade C disease [2]. Stage III-IV patients who skip more than one year of maintenance in a five-year period face an odds ratio of 2.55 for periodontitis-related tooth loss compared to those who miss only one year [2].\n\nSeveral patient factors should push the interval shorter. Former and current smokers, diabetics, and elderly patients warrant more frequent visits than these minimum thresholds suggest [2]. Smoking and residual deep pockets have also been shown to negatively influence bleeding on probing reduction during supportive care [3]. The systematic review on recurrence notes that regular supportive periodontal care appears important for reducing tooth loss over the long term, though no superior method of managing recurrence has been identified [4].\n\nIn practical terms, the current evidence supports individualising recall frequency based on staging, grading, and systemic/behavioural risk factors rather than prescribing a uniform three-month interval for every patient [1][2].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Appropriate Recall Interval for Periodontal Maintenance: A Systematic Review.",
     "journal": "The journal of evidence-based dental practice",
     "year": 2015,
     "url": "https://doi.org/10.1016/j.jebdp.2015.10.001",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Maintenance visit regularity has a different impact on periodontitis-related tooth loss depending on patient staging and grading.",
     "journal": "Journal of clinical periodontology",
     "year": 2021,
     "url": "https://doi.org/10.1111/jcpe.13489",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "Effectiveness of two supportive periodontal care protocols and outcome predictors during periodontitis: A randomized controlled trial.",
     "journal": "Journal of periodontology",
     "year": 2026,
     "url": "https://doi.org/10.1002/jper.70007",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "Recurrence and progression of periodontitis and methods of management in long-term care: A systematic review and meta-analysis.",
     "journal": "Journal of clinical periodontology",
     "year": 2022,
     "url": "https://doi.org/10.1111/jcpe.13553",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "What happens to residual pockets during supportive periodontal therapy?",
   "topic": "Periodontal therapy",
   "url": "https://preventiohub.com/evidence/happens-residual-pockets-during-supportive-periodontal-therapy/",
   "answer": "During supportive periodontal care (SPC), residual pockets represent a persistent clinical challenge and a recognised risk factor for periodontitis progression [1]. Repeated subgingival instrumentation of these pockets leads to significant improvements in probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing over time, and pocket closure rates increase progressively with each re-evaluation cycle [2]. However, poor plaque control significantly impedes pocket closure, with plaque presence shown to increase the odds of a site remaining diseased nearly eightfold [2].\n\nWhen re-instrumentation alone is performed, outcomes can be modest, which has driven investigation into adjunctive strategies. Locally delivered antimicrobials such as chlorhexidine chip and tetracycline fibre have shown small but statistically significant additional PPD reductions of around 0.64-0.65 mm over six months compared to instrumentation alone [3]. Evidence for other adjuncts - including photodynamic therapy, antiseptics, hyaluronic acid, and probiotics - is currently insufficient or inconsistent to draw firm conclusions about their routine use in SPC [4][2]. For deep residual pockets unresponsive to repeated non-surgical care, surgical access or endoscopic-assisted debridement are options, with endoscopic re-instrumentation shown to be non-inferior to papilla preservation flap surgery in terms of CAL gain and pocket resolution at 12 months [5].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Efficacy of scaling and root planning with periodontal endoscopy for residual pockets in the treatment of chronic periodontitis: a randomized controlled clinical trial.",
     "journal": "Clinical oral investigations",
     "year": 2022,
     "url": "https://doi.org/10.1007/s00784-021-04029-w",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "Repeated local delivery of hyaluronic acid gel as adjunctive treatment of residual pockets in periodontitis patients undergoing supportive periodontal care. A randomized controlled clinical trial.",
     "journal": "Clinical oral investigations",
     "year": 2024,
     "url": "https://doi.org/10.1007/s00784-024-05505-9",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "Adjunctive local treatments for patients with residual pockets during supportive periodontal care: A systematic review and network meta-analysis.",
     "journal": "Journal of clinical periodontology",
     "year": 2020,
     "url": "https://doi.org/10.1111/jcpe.13379",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "The efficacy of adjunctive periodontal therapies during supportive periodontal care in patients with residual pockets. A systematic review and meta-analysis.",
     "journal": "Journal of periodontal research",
     "year": 2022,
     "url": "https://doi.org/10.1111/jre.13001",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 5,
     "title": "Endoscopic Re-Instrumentation of Intrabony Defect-Associated Deep Residual Periodontal Pockets Is Non-Inferior to Papilla Preservation Flap Surgery: A Randomized Trial.",
     "journal": "Journal of clinical periodontology",
     "year": 2025,
     "url": "https://doi.org/10.1111/jcpe.14075",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "Does local antimicrobial therapy improve outcomes in residual periodontal pockets?",
   "topic": "Periodontal therapy",
   "url": "https://preventiohub.com/evidence/local-antimicrobial-therapy-improve-outcomes-residual-periodontal-pock/",
   "answer": "Yes, local antimicrobial therapy does provide statistically significant, though modest, improvements in residual periodontal pockets during supportive care.\n\nIn patients with residual pockets during supportive periodontal care, adjunctive locally delivered antimicrobials achieve small additional probing pocket depth (PPD) reductions and clinical attachment level (CAL) gains over a follow-up of up to 6 months [1]. The chlorhexidine chip and tetracycline fibre showed the most consistent benefit, with PPD reductions of approximately 0.65 mm and 0.64 mm respectively over controls, while other agents did not reach statistical significance compared to scaling and root planing alone [1]. Across the broader periodontitis population, meta-analyses confirm statistically significant PPD reductions (weighted mean difference around 0.37 mm) and CAL gains at 6-9 months with adjunctive local antimicrobials, without relevant adverse effects [2]. In persistent or recurrent localised deep sites specifically, sustained-delivery devices may offer an additional benefit of roughly 0.4 mm in pocket depth reduction and 0.3 mm in CAL gain [3].\n\nAntimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing also showed significant improvements in PPD reduction (MD 0.69 mm) and CAL gain (MD 0.60 mm) for residual pockets in maintenance patients, though this benefit was not significant in smokers [4]. In contrast, a systematic review of non-antimicrobial adjunctive therapies during supportive care found only non-significant benefits from PDT, with insufficient evidence for other physical adjuncts [5].\n\nClinically, these gains are statistically significant but numerically modest, and the decision to use adjunctive local agents should weigh this limited benefit alongside considerations of antibiotic stewardship [3].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Adjunctive local treatments for patients with residual pockets during supportive periodontal care: A systematic review and network meta-analysis.",
     "journal": "Journal of clinical periodontology",
     "year": 2020,
     "url": "https://doi.org/10.1111/jcpe.13379",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Adjunctive effect of locally delivered antimicrobials in periodontitis therapy: A systematic review and meta-analysis.",
     "journal": "Journal of clinical periodontology",
     "year": 2020,
     "url": "https://doi.org/10.1111/jcpe.13230",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Antibiotics/antimicrobials: systemic and local administration in the therapy of mild to moderately advanced periodontitis",
     "journal": "Periodontology 2000",
     "year": 2016,
     "url": "https://doi.org/10.1111/prd.12121",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "Clinical effectiveness of adjunctive antimicrobial photodynamic therapy for residual pockets during supportive periodontal therapy: A systematic review and meta-analysis.",
     "journal": "Photodiagnosis and photodynamic therapy",
     "year": 2017,
     "url": "https://doi.org/10.1016/j.pdpdt.2016.11.011",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 5,
     "title": "The efficacy of adjunctive periodontal therapies during supportive periodontal care in patients with residual pockets. A systematic review and meta-analysis.",
     "journal": "Journal of periodontal research",
     "year": 2022,
     "url": "https://doi.org/10.1111/jre.13001",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Do lasers improve the outcomes of non-surgical periodontal therapy?",
   "topic": "Periodontal therapy",
   "url": "https://preventiohub.com/evidence/lasers-improve-outcomes-non-surgical-periodontal-therapy/",
   "answer": "Based on the indexed literature, adjunctive laser therapy generally provides some clinical benefit over scaling and root planing (SRP) alone, though the magnitude and durability of that benefit vary by laser type, pocket depth, and follow-up period.\n\nA systematic review of 20 RCTs found that 70% reported significantly better outcomes in at least some clinical parameters when a laser was used adjunctively, while 30% showed no significant difference compared to conventional treatment alone [1]. A meta-analysis of 16 RCTs confirmed that laser-assisted SRP was superior to SRP alone across most clinical parameters in non-smoking chronic periodontitis patients, with no treatment-related adverse events reported [2].\n\nRegarding specific laser types, the combination of Nd:YAG and Er:YAG lasers produced additional average reductions in pocket depth and clinical attachment level of approximately 1.01 mm and 0.77 mm respectively compared to controls [3]. Nd:YAG laser adjunct showed selective efficacy in deep pockets (≥7 mm) in stage III periodontitis, reducing inflammatory mediators such as IL-6 and TNF-α, but minimal impact on shallower pockets (4–6 mm) [4]. High-intensity diode laser therapy demonstrated consistently superior clinical attachment level gains compared to both low-intensity diode laser and SRP alone [5]. Erbium lasers and low-level laser therapy (LLLT) appear to offer mainly short-term benefits at 1–3 months, with no significant additional benefit demonstrated at 6 months or beyond [6][7].\n\nIn summary, lasers can improve short-term periodontal outcomes as adjuncts to SRP, particularly in deeper pockets, but long-term benefits remain uncertain and further well-designed RCTs with standardised protocols are needed [1][2][6][7].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Do Lasers Have an Adjunctive Role in Initial Non-Surgical Periodontal Therapy? A Systematic Review.",
     "journal": "Dentistry journal",
     "year": 2020,
     "url": "https://doi.org/10.3390/dj8030093",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "Clinical and biochemical effect of laser as an adjunct to non-surgical treatment of chronic periodontitis.",
     "journal": "Oral diseases",
     "year": 2022,
     "url": null,
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Combination of Nd:YAG and Er:YAG lasers in non-surgical periodontal therapy: a systematic review of randomized clinical studies.",
     "journal": "Lasers in medical science",
     "year": 2022,
     "url": "https://doi.org/10.1007/s10103-022-03548-6",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "Clinical effect of Nd:YAG laser-assisted non-surgical periodontal treatment on stage II/III periodontitis.",
     "journal": "Journal of dentistry",
     "year": 2025,
     "url": "https://doi.org/10.1016/j.jdent.2025.106056",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 5,
     "title": "Clinical efficacy of high versus low intensity diode laser as an adjunct to non-surgical periodontal therapy in periodontitis: randomized controlled clinical trial.",
     "journal": "Scientific reports",
     "year": 2026,
     "url": "https://doi.org/10.1038/s41598-026-40879-8",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 6,
     "title": "The effectiveness of low-level laser therapy as an adjunct to non-surgical periodontal treatment: a meta-analysis.",
     "journal": "Journal of periodontal research",
     "year": 2017,
     "url": "https://doi.org/10.1111/jre.12361",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 7,
     "title": "Erbium lasers in non-surgical periodontal therapy: an umbrella review and evidence gap map analysis.",
     "journal": "Lasers in medical science",
     "year": 2022,
     "url": "https://doi.org/10.1007/s10103-022-03504-4",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Are probiotics effective as an adjunct to periodontal therapy?",
   "topic": "Periodontal therapy",
   "url": "https://preventiohub.com/evidence/probiotics-effective-as-adjunct-periodontal-therapy/",
   "answer": "The evidence suggests probiotics offer modest but inconsistent clinical benefits as an adjunct to non-surgical periodontal therapy (NSPT). Several meta-analyses report statistically significant reductions in probing pocket depth (PPD) and gains in clinical attachment level (CAL) compared to NSPT alone, particularly at 3 and 12 months of follow-up [1][2], and significant reductions in plaque index and bleeding on probing have also been demonstrated in periodontitis patients [3]. However, the magnitude and durability of these benefits vary considerably across studies, with one well-designed randomised controlled trial finding no statistically significant additional clinical benefit over NSPT alone [4], and another meta-analysis noting CAL gains were significant in the short and medium term but not long term [5].\n\nThe strain, form, frequency, and duration of probiotic administration appear to influence outcomes. L. reuteri delivered as lozenges twice daily was associated with the most consistently favourable results for PPD reduction [5], and sensitivity analyses suggest greater benefit in patients with more severe baseline disease (mean PPD ≥5 mm) [1]. At a microbiological level, adjunctive probiotics - particularly L. reuteri used as a single strain - appear to reduce counts of key periodontopathogens such as Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola in subgingival plaque [6]. When compared directly to antibiotics, probiotics showed comparable PPD and CAL reductions, though antibiotics were more effective for plaque and gingival indices, and a combination of both outperformed either alone [7].\n\nOverall, high heterogeneity across trials and limited immunological and microbiological data mean that current evidence is insufficient to issue firm clinical recommendations, and further standardised, high-quality RCTs are needed [1][3].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "A Systematic Review and Meta-analysis of Clinical, Immunological, and Microbiological Shift in Periodontitis After Nonsurgical Periodontal Therapy With Adjunctive Use of Probiotics.",
     "journal": "The journal of evidence-based dental practice",
     "year": 2020,
     "url": "https://doi.org/10.1016/j.jebdp.2020.101397",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Role of probiotics in adjunct to non-surgical periodontal therapy in patients with chronic periodontitis: a systematic review and meta-analysis.",
     "journal": "Journal of biological regulators and homeostatic agents",
     "year": 2021,
     "url": "https://doi.org/10.23812/21-2supp1-6",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Clinical effects of probiotics on the treatment of gingivitis and periodontitis: a systematic review and meta-analysis.",
     "journal": "BMC oral health",
     "year": 2025,
     "url": "https://doi.org/10.1186/s12903-025-05888-5",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "A double-blind, paralleled-arm, placebo-controlled and randomized clinical trial of the effectiveness of probiotics as an adjunct in periodontal care.",
     "journal": "Journal of clinical periodontology",
     "year": 2019,
     "url": "https://doi.org/10.1111/jcpe.13191",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 5,
     "title": "Clinical, microbiological and immunological short, medium and long-term effects of different strains of probiotics as an adjunct to non-surgical periodontal therapy in patients with periodontitis. Systematic review with meta-analysis.",
     "journal": "The Japanese dental science review",
     "year": 2023,
     "url": "https://doi.org/10.1016/j.jdsr.2023.02.001",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 6,
     "title": "What are microbiological effects of the adjunctive use of probiotics in the treatment of periodontal diseases? A systematic review.",
     "journal": "Beneficial microbes",
     "year": 2021,
     "url": "https://doi.org/10.3920/BM2020.0143",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 7,
     "title": "Effectiveness of probiotics compared to antibiotics to treat periodontal disease: Systematic review.",
     "journal": "Oral diseases",
     "year": 2024,
     "url": "https://doi.org/10.1111/odi.14781",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "How should peri-implant mucositis be treated?",
   "topic": "Implants",
   "url": "https://preventiohub.com/evidence/should-peri-implant-mucositis-treated/",
   "answer": "Peri-implant mucositis should be treated primarily with nonsurgical mechanical debridement, which alone produces meaningful reductions in bleeding on probing (BOP), probing pocket depth, and plaque indices [1][2]. Several mechanical/physical approaches are documented - curettes, ultrasonic scalers, air-polishing, lasers, and rotating brushes - but none has been shown to be superior to the others [3]. Treatment success rates (defined as absence of BOP) after mechanical/physical instrumentation range from roughly 30-35% at 3 months and fall to 8-17% at 6 months, meaning complete resolution is uncommon and should not be expected in all patients [3][2].\n\nOral hygiene instructions (OHI) alone can achieve resolution in a meaningful proportion of compliant patients (around 39% at 3 months at patient level), but adding mechanical instrumentation to OHI improves success rates substantially (56% at patient level, 67% at implant level), making the combination preferable [4]. Patient compliance is a strong positive predictor of success, while a history of periodontitis, posterior implant location, heavy smoking, and the presence of periodontal pathogens such as Porphyromonas gingivalis and Tannerella forsythia negatively influence outcomes [5][4].\n\nThe routine adjunctive use of chlorhexidine (CHX) is debated. Two meta-analyses found that CHX does not significantly improve probing depth reduction compared to mechanical debridement alone [1][6]; however, one placebo-controlled RCT found that combining nonsurgical instrumentation with CHX mouthwash, subgingival irrigation, and tongue brushing produced significantly greater BOP and plaque index reduction at 6 months compared to placebo [5]. Similarly, laser therapy as an adjunct to nonsurgical treatment may offer modest short-term BOP reduction but provides minimal benefit in probing depth or attachment level [7]. Overall, the current evidence supports mechanical debridement as the core treatment, with adjuncts yielding only minor additional improvements [2].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Nonsurgical treatment for peri-implant mucositis: A systematic review and meta-analysis.",
     "journal": "International journal of oral implantology (Berlin, Germany)",
     "year": 2020,
     "url": "https://pubmed.ncbi.nlm.nih.gov/32424380/",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Effectiveness of nonsurgical therapy of peri-implant mucositis: A systematic review.",
     "journal": "Periodontology 2000",
     "year": 2026,
     "url": "https://doi.org/10.1111/prd.70047",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "Non-surgical therapy of peri-implant mucositis-Mechanical/physical approaches: A systematic review.",
     "journal": "Journal of clinical periodontology",
     "year": 2023,
     "url": "https://doi.org/10.1111/jcpe.13789",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "Impact of Oral Hygiene Instructions in the Resolution of Peri-Implant Mucositis. A Randomized Controlled Trial.",
     "journal": "Clinical oral implants research",
     "year": 2026,
     "url": "https://doi.org/10.1111/clr.70098",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 5,
     "title": "Effect of Nonsurgical Mechanical Debridement With or Without Chlorhexidine Formulations in the Treatment of Peri-Implant Mucositis. A Randomized Placebo-Controlled Clinical Trial.",
     "journal": "Clinical oral implants research",
     "year": 2025,
     "url": "https://doi.org/10.1111/clr.14405",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 6,
     "title": "Does chlorhexidine improve outcomes in non-surgical management of peri-implant mucositis or peri-implantitis?: a systematic review and meta-analysis.",
     "journal": "Medicina oral, patologia oral y cirugia bucal",
     "year": 2020,
     "url": "https://doi.org/10.4317/medoral.23633",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 7,
     "title": "Laser therapy for treatment of peri-implant mucositis and peri-implantitis: An American Academy of Periodontology best evidence review.",
     "journal": "Journal of periodontology",
     "year": 2018,
     "url": null,
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Is air polishing effective for treating peri-implantitis?",
   "topic": "Implants",
   "url": "https://preventiohub.com/evidence/air-polishing-effective-treating-peri-implantitis/",
   "answer": "Air polishing for peri-implantitis shows modest and inconsistent clinical benefits compared to conventional mechanical debridement. In non-surgical treatment, erythritol air polishing was as effective as piezoelectric ultrasonic scaling for reducing bleeding on probing (BOP), suppuration, plaque scores, and probing pocket depth, but neither therapy reliably resolved peri-implantitis, with only 18.4% of patients achieving treatment success at 3 months [1]. Similarly, a meta-analysis found airflow produced a statistically significant reduction in BOP compared to mechanical debridement, but differences in pocket depth, bone level changes, and patient-reported outcomes were not statistically significant [2]. In surgical treatment, erythritol air polishing was not more effective than saline-soaked gauze for implant surface cleansing during resective surgery, with only 19.2% of implants meeting success criteria at 1 year [3]. A broader systematic review confirmed that air polishing did not result in more favorable outcomes than comparative modalities overall, and statistical differences between air polishing and other treatments were not detected [4]. An earlier 2015 systematic review did suggest a possible benefit of glycine powder air polishing over mechanical debridement at peri-implantitis sites in BOP reduction, but noted that complete disease resolution was rarely achieved [5]. A 2023 systematic review of non-surgical submarginal instrumentation found only one study reporting a statistically significant BOP reduction favoring an air-polishing device over control, and overall evidence remains limited by heterogeneity and small study numbers [6]. In summary, air polishing appears comparable to, but not superior to, conventional approaches, and peri-implantitis frequently requires surgical intervention regardless of the decontamination method used [4][1][3].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Erythritol airpolishing in the non-surgical treatment of peri-implantitis: A randomized controlled trial.",
     "journal": "Clinical oral implants research",
     "year": 2021,
     "url": "https://doi.org/10.1111/clr.13757",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "Airflow for initial nonsurgical treatment of peri-implantitis: A systematic review and meta-analysis.",
     "journal": "Clinical implant dentistry and related research",
     "year": 2022,
     "url": "https://doi.org/10.1111/cid.13072",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Erythritol air polishing in the surgical treatment of peri-implantitis: A randomized controlled trial.",
     "journal": "Clinical oral implants research",
     "year": 2022,
     "url": "https://doi.org/10.1111/clr.13881",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "Effect of Air Polishing on the Treatment of Peri-Implant Diseases: A Systematic Review and Meta-Analysis.",
     "journal": "The Journal of oral implantology",
     "year": 2023,
     "url": "https://doi.org/10.1563/aaid-joi-D-23-00114",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 5,
     "title": "Efficacy of air polishing for the non-surgical treatment of peri-implant diseases: a systematic review.",
     "journal": "Journal of clinical periodontology",
     "year": 2015,
     "url": "https://doi.org/10.1111/jcpe.12454",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 6,
     "title": "Efficacy of mechanical/physical approaches for implant surface decontamination in non-surgical submarginal instrumentation of peri-implantitis. A systematic review.",
     "journal": "Journal of clinical periodontology",
     "year": 2023,
     "url": "https://doi.org/10.1111/jcpe.13762",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Does air polishing damage titanium implant surfaces?",
   "topic": "Implants",
   "url": "https://preventiohub.com/evidence/air-polishing-damage-titanium-implant-surfaces/",
   "answer": "Air polishing with certain powders can cause surface changes to titanium implants, but the degree of damage depends heavily on the powder used. Harder powders such as sodium bicarbonate tend to damage the surface more than softer powders such as glycine, while erythritol and calcium phosphate-based powders appear even gentler [1]. Overall, air abrasion was considered \"almost safe,\" particularly for nonmodified titanium surfaces, and produced surface changes comparable to those caused by plastic curettes or Er:YAG lasers [1].\n\nErythritol air polishing specifically has shown promising safety data: systematic review evidence indicates it does not cause significant damage to the implant surface or peri-implant tissues, and it promotes a good biological response [2]. Among the powders studied, erythritol- and osteoinductive powder-based air abrasion was also more successful in preserving surface biocompatibility compared to harder abrasives [1].\n\nIt is worth noting that while cleaning efficacy is generally good, a key limitation identified across in vitro studies is that air abrasion may not reliably restore the biological biocompatibility of a contaminated implant surface, regardless of the powder used [1]. Clinically, erythritol air polishing used during surgical treatment of peri-implantitis did not result in significantly different outcomes compared to saline irrigation at 12 months, suggesting surface cleansing method alone may not be the dominant factor in clinical success [3].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Effects of air abrasive decontamination on titanium surfaces: A systematic review of in vitro studies.",
     "journal": "Clinical implant dentistry and related research",
     "year": 2019,
     "url": "https://doi.org/10.1111/cid.12747",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Efficacy and safety of erythritol air-polishing in implant dentistry: A systematic review.",
     "journal": "International journal of dental hygiene",
     "year": 2025,
     "url": "https://doi.org/10.1111/idh.12836",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Erythritol air polishing in the surgical treatment of peri-implantitis: A randomized controlled trial.",
     "journal": "Clinical oral implants research",
     "year": 2022,
     "url": "https://doi.org/10.1111/clr.13881",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "How often should implant patients have professional maintenance?",
   "topic": "Implants",
   "url": "https://preventiohub.com/evidence/often-should-implant-patients-have-professional-maintenance/",
   "answer": "Based on the indexed literature, a definitive universal frequency cannot be stated, but several findings help guide clinical decisions.\n\nA minimum recall interval of 5 to 6 months is supported by meta-analytic data showing that peri-implant maintenance therapy (PIMT) interval significantly influences the incidence of peri-implantitis, and that implants under PIMT have a lower rate of failure compared to those without it [1]. Supportive peri-implant care every 6 months is also the practical recommendation drawn from a systematic review of full-arch prosthesis patients, with prosthesis removal at least once per year [2].\n\nFor patients who have already been treated for peri-implantitis, a 3-month recall interval was generally associated with a slightly lower percentage of disease recurrence, though recurrence still tended to increase over time regardless of interval [3]. This underscores that higher-risk patients likely warrant shorter recall intervals.\n\nAcross all the evidence, the consistent message is that frequency should be tailored to the individual patient's risk profile, including history of periodontitis, oral hygiene compliance, and prosthesis design [2][1][4]. SPT has been shown to significantly improve implant survival rates and reduce both peri-implantitis and peri-implant mucositis compared to no SPT [4], making a structured recall programme essential regardless of the exact interval chosen.",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Impact of Maintenance Therapy for the Prevention of Peri-implant Diseases: A Systematic Review and Meta-analysis.",
     "journal": "Journal of dental research",
     "year": 2016,
     "url": "https://doi.org/10.1177/0022034515622432",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "How often should implant-supported full-arch dental prostheses be removed for supportive peri-implant care to maintain peri-implant health? A systematic review.",
     "journal": "International journal of oral implantology (Berlin, Germany)",
     "year": 2024,
     "url": "https://pubmed.ncbi.nlm.nih.gov/38501398/",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Effect of Supportive Peri-implant Care After Treatment of Peri-implant Diseases: A Systematic Review.",
     "journal": "The International journal of periodontics & restorative dentistry",
     "year": 2026,
     "url": "https://doi.org/10.11607/prd.7217",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "The effect of supportive care in preventing peri-implant diseases and implant loss: A systematic review and meta-analysis.",
     "journal": "Clinical oral implants research",
     "year": 2019,
     "url": "https://doi.org/10.1111/clr.13496",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Which instruments are safe for cleaning dental implant surfaces?",
   "topic": "Implants",
   "url": "https://preventiohub.com/evidence/which-instruments-safe-cleaning-dental-implant-surfaces/",
   "answer": "Based on the indexed literature, several instrument categories have been evaluated for implant surface safety.\n\nFor titanium implants, air-powder abrasive (APA) devices using erythritol or glycine powder caused no significant damage to implant surfaces and showed strong biofilm removal efficacy [1][2]. PEEK-tipped ultrasonic scalers are also considered safe for titanium surfaces [1][2]. Er:YAG and Er,Cr:YSGG lasers at specific settings produced minimal surface alterations [2]. Electrolytic cleaning likewise showed minimal surface changes [2]. In contrast, titanium or stainless steel curettes, metal-tipped ultrasonic scalers, titanium brushes, and implantoplasty induced significant surface alterations and thread peak flattening and should be avoided [2].\n\nFor zirconia implants, air-abrasive devices with glycine powder, prophylaxis cups, and ultrasonic scalers with non-metal tips caused minimal to no surface damage [3]. Hand instruments and metal-tipped ultrasonic scalers carry a risk of major damage to zirconia surfaces and should be used with caution [3]. Diode lasers appeared promising for zirconia with no reported surface alterations, though evidence remains heterogeneous [3].\n\nOne important caveat: plastic and carbon curettes, PEEK ultrasonic tips, and APA devices have been noted to leave material remnants on implant surfaces, which is worth considering when selecting an instrument [2]. Overall, mechanical decontamination generally yielded more favourable results than chemical or laser methods alone, and combination approaches may offer the best clinical outcomes [4].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Efficacy and safety of erythritol air-polishing in implant dentistry: A systematic review.",
     "journal": "International journal of dental hygiene",
     "year": 2025,
     "url": "https://doi.org/10.1111/idh.12836",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Efficacy of Decontamination Methods for Biofilm Removal from Dental Implant Surfaces and Reosseointegration: An AAP/AO Systematic Review on Peri-implant Diseases and Conditions.",
     "journal": "The International journal of oral & maxillofacial implants",
     "year": 2025,
     "url": "https://doi.org/10.11607/ jomi.2025suppl4",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "The effects of physical decontamination methods on zirconia implant surfaces: a systematic review.",
     "journal": "Journal of periodontal & implant science",
     "year": 2021,
     "url": "https://doi.org/10.5051/jpis.2005080254",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "Titanium Surface Decontamination: A Systematic Review of In Vitro Comparative Studies.",
     "journal": "The International journal of oral & maxillofacial implants",
     "year": 2022,
     "url": "https://doi.org/10.11607/jomi.8969",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Does supportive peri-implant therapy reduce the risk of peri-implantitis?",
   "topic": "Implants",
   "url": "https://preventiohub.com/evidence/supportive-peri-implant-therapy-reduce-risk-peri-implantitis/",
   "answer": "Yes, supportive peri-implant therapy (SPIT/SPT) consistently reduces the risk of peri-implantitis across multiple systematic reviews and meta-analyses.\n\nA meta-analysis of five trials (1,570 implants, 617 patients) found significantly reduced rates of peri-implantitis with SPIT compared to no SPIT at both implant and patient levels, along with significantly reduced marginal bone loss [1]. A larger systematic review of 25 studies similarly found that SPIT, particularly with individualized risk-based recall intervals, consistently improved clinical outcomes compared with standard or no maintenance [2]. A separate meta-analysis of nine controlled clinical trials quantified this benefit, showing that SPT was associated with a markedly lower prevalence of peri-implantitis (risk ratio 0.25, p < 0.001) and higher implant survival rates compared to the non-SPT group [3]. Studies also show that lack of SPT or poor adherence to it results in significantly higher frequencies of deepened peri-implant pockets, mucosal bleeding, alveolar bone loss, and implant loss [4].\n\nHowever, SPIT does not eliminate risk entirely. Even with regular supportive care following peri-implantitis treatment, disease recurrence tends to increase over time, with mean recurrence rising from approximately 28.5% at one year post-treatment to 47.2% after two years of follow-up [5]. This underscores that while SPIT is effective at reducing risk, individualized protocols accounting for patient-specific factors such as history of periodontitis, smoking, and systemic health should be integrated into routine implant care [2].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Outcome of supportive peri-implant therapy on the rates of peri-implant diseases and marginal bone loss: a systematic review and meta-analysis.",
     "journal": "Quintessence international (Berlin, Germany : 1985)",
     "year": 2021,
     "url": "https://doi.org/10.3290/j.qi.a45428",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Efficacy of supportive peri-implant therapy in the management of peri-implant mucositis and peri-implantitis: A systematic review.",
     "journal": "Journal of the American Dental Association (1939)",
     "year": 2026,
     "url": "https://doi.org/10.1016/j.adaj.2025.08.015",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "The effect of supportive care in preventing peri-implant diseases and implant loss: A systematic review and meta-analysis.",
     "journal": "Clinical oral implants research",
     "year": 2019,
     "url": "https://doi.org/10.1111/clr.13496",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "The Efficacy of Supportive Peri-Implant Therapies in Preventing Peri-Implantitis and Implant Loss: a Systematic Review of the Literature.",
     "journal": "Journal of oral & maxillofacial research",
     "year": 2016,
     "url": "https://doi.org/10.5037/jomr.2016.7312",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 5,
     "title": "Effect of Supportive Peri-implant Care After Treatment of Peri-implant Diseases: A Systematic Review.",
     "journal": "The International journal of periodontics & restorative dentistry",
     "year": 2026,
     "url": "https://doi.org/10.11607/prd.7217",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "What is Guided Biofilm Therapy?",
   "topic": "Protocols and instrumentation",
   "url": "https://preventiohub.com/evidence/guided-biofilm-therapy/",
   "answer": "Guided Biofilm Therapy (GBT) is a treatment protocol that combines a disclosing agent to visualise biofilm with air-abrasive powder (erythritol) delivered via an air-polishing device and ultrasonic piezoelectric instrumentation for subgingival debridement [1][2]. It was developed as an alternative to conventional mechanical approaches such as scaling and root planing (SRP) or scaling and root debridement (SRD) for both non-surgical periodontal therapy and supportive periodontal treatment [2][3].\n\nIn the non-surgical periodontal therapy setting, the GBT sequence has been described as staining, air-polishing, ultrasonic scaling, and then air-polishing again, adapted to the patient's clinical conditions [3]. The rationale is systematic biofilm detection followed by targeted removal, rather than empirical mechanical instrumentation alone [1][2].\n\nClinically, studies show GBT achieves comparable reductions in plaque scores, bleeding on probing, and pocket probing depths to conventional approaches, but the evidence on primary periodontal outcomes such as BOP, CAL, and PPD is inconsistent across studies [2][3][4]. Patient-centred advantages that have been reported include shorter chair time and more favourable patient perception compared with conventional methods, though these findings are not uniform across all trials [1][2][4]. The current evidence does not support clinical superiority of GBT over conventional therapy [2].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "A novel biofilm removal approach (Guided Biofilm Therapy) utilizing erythritol air-polishing and ultrasonic piezo instrumentation: A randomized controlled trial.",
     "journal": "International journal of dental hygiene",
     "year": 2022,
     "url": "https://doi.org/10.1111/idh.12533",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "Clinical efficacy of Guided Biofilm Therapy in the management of periodontal disease - a systematic review.",
     "journal": "BMC oral health",
     "year": 2026,
     "url": "https://doi.org/10.1186/s12903-026-08418-z",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Guided biofilm therapy versus conventional protocol-clinical outcomes in non-surgical periodontal therapy.",
     "journal": "BMC oral health",
     "year": 2024,
     "url": "https://doi.org/10.1186/s12903-024-04898-z",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "Clinical evaluation of a novel protocol for supportive periodontal care: A randomized controlled clinical trial.",
     "journal": "Journal of periodontology",
     "year": 2024,
     "url": "https://doi.org/10.1002/jper.23-0527",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "Is Guided Biofilm Therapy more effective than scaling and root planing?",
   "topic": "Protocols and instrumentation",
   "url": "https://preventiohub.com/evidence/guided-biofilm-therapy-more-effective-scaling-root-planing/",
   "answer": "Based on the available evidence, GBT does not consistently outperform conventional scaling and root planing (SRP) or scaling and root debridement (SRD) in primary clinical periodontal outcomes.\n\nA systematic review of five RCTs found that GBT showed advantages in patient satisfaction, reduced pain, and shorter treatment time, but its effects on bleeding on probing (BOP), clinical attachment level (CAL), and probing pocket depth (PPD) were inconsistent across studies, and the current evidence does not support clinical superiority of GBT [1]. This is reinforced by an RCT in supportive periodontal treatment patients where GBT required approximately 15% less chair-time than SRP but demonstrated equivalent biofilm removal and similar reductions in plaque score and gingival bleeding index [2].\n\nIn non-surgical periodontal therapy for stage III-IV periodontitis, GBT and conventional instrumentation produced comparably good clinical results - PPD reduction was achieved in 57.0% of GBT sites versus 58.7% for conventional treatment, with no statistically significant differences in most outcomes, though treatment time was significantly shorter for GBT [3]. In supportive periodontal care over 12 months, SRP actually produced a statistically significant reduction in BOP whereas GBT did not reach significance, though both groups showed similar improvements in PPD and other parameters [4].\n\nIn summary, GBT appears equivalent - not superior - to conventional approaches for clinical outcomes, while offering meaningful patient-centered benefits such as reduced treatment time and improved comfort [1][3][2][4]. Clinical judgement should guide protocol selection based on individual patient needs.",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Clinical efficacy of Guided Biofilm Therapy in the management of periodontal disease - a systematic review.",
     "journal": "BMC oral health",
     "year": 2026,
     "url": "https://doi.org/10.1186/s12903-026-08418-z",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "A novel biofilm removal approach (Guided Biofilm Therapy) utilizing erythritol air-polishing and ultrasonic piezo instrumentation: A randomized controlled trial.",
     "journal": "International journal of dental hygiene",
     "year": 2022,
     "url": "https://doi.org/10.1111/idh.12533",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "Guided biofilm therapy versus conventional protocol-clinical outcomes in non-surgical periodontal therapy.",
     "journal": "BMC oral health",
     "year": 2024,
     "url": "https://doi.org/10.1186/s12903-024-04898-z",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "Clinical evaluation of a novel protocol for supportive periodontal care: A randomized controlled clinical trial.",
     "journal": "Journal of periodontology",
     "year": 2024,
     "url": "https://doi.org/10.1002/jper.23-0527",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "Does biofilm disclosing improve plaque removal during prophylaxis?",
   "topic": "Protocols and instrumentation",
   "url": "https://preventiohub.com/evidence/biofilm-disclosing-improve-plaque-removal-during-prophylaxis/",
   "answer": "Based on the indexed literature, the evidence is mixed and context-dependent.\n\nWhen plaque disclosure is used as an adjunct during professionally delivered prophylaxis, it does appear to enhance outcomes. In a split-mouth RCT, air polishing with prior plaque disclosure achieved a significantly lower post-treatment plaque score (21.7%) compared to air polishing without disclosure (33.5%) or rubber cup polishing without disclosure (34.5%), and treatment time with air polishing was also shorter [1]. This suggests disclosure helps the clinician identify and target residual biofilm more effectively during the appointment.\n\nFor self-performed plaque removal with oral hygiene instruction, the benefit is less clear. A systematic review of seven RCTs found that 11 out of 13 relevant comparisons showed no significant difference in plaque outcomes between standard oral hygiene instruction with versus without disclosing methods, though three comparisons did show a positive effect on gingival inflammation scores [2]. A more recent RCT in dental students with high baseline oral hygiene proficiency similarly found no significant between-group difference in Plaque Index change at one week or one month when disclosure was added to standardized instruction [3].\n\nTaken together, disclosure appears more beneficial when used chairside during prophylaxis to guide instrumentation [1], while its added value over standard instruction alone for self-care may be more pronounced in populations with lower oral health literacy or in orthodontic patients [3][2]. Clinicians should consider patient profile when deciding how to incorporate disclosing agents into their protocol [2].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Conventional versus comprehensive dental prophylaxis: comparing the clinical outcomes between rubber cup and air polishing and the importance of plaque disclosure.",
     "journal": "Quintessence international (Berlin, Germany : 1985)",
     "year": 2021,
     "url": "https://doi.org/10.3290/j.qi.a45602",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "Are oral hygiene instructions with aid of plaque-disclosing methods effective in improving self-performed dental plaque control? A systematic review of randomized controlled trials.",
     "journal": "International journal of dental hygiene",
     "year": 2021,
     "url": "https://doi.org/10.1111/idh.12491",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Effect of plaque-disclosing agents on biofilm removal: single-center randomized trial in fourth-year dental students.",
     "journal": "Head & face medicine",
     "year": 2026,
     "url": "https://doi.org/10.1186/s13005-026-00596-z",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "Is ultrasonic scaling as effective as hand instrumentation?",
   "topic": "Protocols and instrumentation",
   "url": "https://preventiohub.com/evidence/ultrasonic-scaling-as-effective-as-hand-instrumentation/",
   "answer": "Based on the indexed literature, ultrasonic and manual scaling produce broadly similar clinical outcomes, though some nuances exist depending on pocket depth and the outcome measured.\n\nMultiple systematic reviews and meta-analyses found no statistically significant differences in clinical attachment level (CAL) gain between hand and sonic/ultrasonic instruments at either 3 or 6 months after periodontal therapy [1][2]. Similarly, for deep pockets at 3-month follow-up, no statistical differences in PPD or CAL reduction were found between ultrasonic and manual groups [3].\n\nHowever, pocket depth does appear to matter. At medium initial PPD (4–6 mm) and at 6-month follow-up, PPD reduction favoured manual scaling, though CAL results still showed no statistically significant difference between the two approaches [3]. For deep initial PPD (≥6 mm), both PPD and CAL reductions suggested manual scaling was superior at 6 months, and BOP reduction at deep pockets also favoured hand instrumentation [3].\n\nOne practical advantage of sonic/ultrasonic instruments is that they spend significantly less treatment time compared to manual instrumentation [2]. Regarding tissue effects, most in vitro studies report higher root substance loss per stroke with hand curettes compared to ultrasonic scalers [4], and ultrasonic instrumentation produces effects on root surface roughness broadly similar to hand instrumentation [5].\n\nOverall, the evidence suggests comparable outcomes for most clinical parameters, but further studies with lower risk of bias are still warranted before firm conclusions can be drawn [2].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Comparing the Effectiveness of Ultrasonic Instruments Over Manual Instruments for Scaling and Root Planing in Patients With Chronic Periodontitis: A Systematic Review and Meta-Analysis.",
     "journal": "Cureus",
     "year": 2022,
     "url": "https://doi.org/10.7759/cureus.31463",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "Comparison Between Hand and Sonic/ Ultrasonic Instruments for Periodontal Treatment: Systematic Review with Meta-Analysis.",
     "journal": "Journal of the International Academy of Periodontology",
     "year": 2020,
     "url": "https://pubmed.ncbi.nlm.nih.gov/32980832/",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Treating periodontitis-a systematic review and meta-analysis comparing ultrasonic and manual subgingival scaling at different probing pocket depths.",
     "journal": "BMC oral health",
     "year": 2020,
     "url": "https://doi.org/10.1186/s12903-020-01117-3",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "The Effect of Mechanical Instrumentation on Dental Hard Tissue In Vitro: A Systematic Review.",
     "journal": "International journal of dental hygiene",
     "year": 2026,
     "url": "https://doi.org/10.1111/idh.70107",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 5,
     "title": "Calculus Removal and Root Surface Roughness When Using the Er:YAG or Er,Cr:YSGG Laser Compared with Conventional Instrumentation Method: A Literature Review.",
     "journal": "Photobiomodulation, photomedicine, and laser surgery",
     "year": 2019,
     "url": "https://doi.org/10.1089/photob.2018.4465",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Are there clinical differences between piezoelectric and magnetostrictive ultrasonic scalers?",
   "topic": "Protocols and instrumentation",
   "url": "https://preventiohub.com/evidence/there-clinical-differences-between-piezoelectric-magnetostrictive-ultr/",
   "answer": "Based on the indexed literature, there are meaningful clinical and in vitro differences between the two scaler types, though each has distinct advantages.\n\nRegarding efficiency and surface outcomes, magnetostrictive scalers removed calculus faster (mean 24 s vs 53.87 s per area) and produced smoother root surfaces after scaling (Ra 0.349 µm vs 0.496 µm) compared to piezoelectric scalers in vitro [1]. SEM analysis also showed less dental material loss with magnetostrictive instruments [1].\n\nRegarding patient experience, piezoelectric scalers caused significantly less discomfort in terms of pain, noise, and vibration during supragingival scaling than magnetostrictive scalers in the clinical trial [1]. This finding aligns with evidence that tip design and oscillation characteristics influence pain perception, with slim piezoelectric tips producing less patient discomfort than wider conventional tips [2].\n\nRegarding surface roughness comparisons more broadly, one source notes that piezoelectric scaler tips have been reported to produce rougher root surfaces than magnetostrictive tips [2], which is consistent with the in vitro findings in the 2024 study [1].\n\nIn summary, magnetostrictive scalers appear more efficient and less damaging to root structure, while piezoelectric scalers are associated with greater patient comfort [1]. The choice between them in clinical practice should account for both the clinical situation and patient tolerance [1].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Effects of a new magnetostrictive ultrasonic scaler and a traditional piezoelectric ultrasonic scaler on root surfaces and patient complaints.",
     "journal": "Scientific reports",
     "year": 2024,
     "url": "https://doi.org/10.1038/s41598-024-57037-7",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "Influence of scaler tip design on root surface roughness, tooth substance loss and patients' pain perception: an in vitro and a randomised clinical trial.",
     "journal": "BMC oral health",
     "year": 2021,
     "url": "https://doi.org/10.1186/s12903-021-01540-0",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "Does full-mouth disinfection give better results than quadrant-wise scaling?",
   "topic": "Protocols and instrumentation",
   "url": "https://preventiohub.com/evidence/full-mouth-disinfection-give-better-results-quadrant-wise-scaling/",
   "answer": "The evidence comparing full-mouth disinfection (FMD) and quadrant-wise scaling and root planing (Q-SRP) is mixed, and any advantages of FMD appear modest. A 2016 meta-analysis found FMD produced statistically significant but clinically small additional benefits over Q-SRP, specifically a 0.25 mm greater probing pocket depth (PPD) reduction and 0.33 mm greater clinical attachment level (CAL) gain in moderate pockets of single-rooted teeth, while no significant differences were found in other subanalyses [1]. The 2022 Cochrane review, including 20 RCTs and 944 participants, found no clear evidence that FMD provides additional clinical benefit over conventional Q-SRP for change in PPD, CAL gain, or BOP reduction at 6-8 months, rating the certainty of evidence as low to very low [2].\n\nSome individual studies do report advantages for FMD. A 2024 RCT found FM-SI significantly outperformed Q-SI in PPD reduction and periodontal pathogen reduction at 6 months, with higher baseline PPD and Porphyromonas gingivalis levels negatively influencing FM-SI outcomes [3]. In stage III/IV periodontitis, FMD with adjunctive erythritol air-polishing showed significantly greater PPD reduction and pocket closure than Q-SRP over 6 months, and full-mouth protocols as a group were more time-efficient (6-17 min per closed pocket) than Q-SRP [4]. In patients with generalized aggressive periodontitis, FMD demonstrated significantly higher pocket closure and greater reductions in bacterial load compared to both Q-SRP and full-mouth scaling without antiseptic [5].\n\nRegarding the role of chlorhexidine in FMD, one study suggested the additional clinical and microbiological benefits stem primarily from completing all instrumentation within 24 hours rather than from the chlorhexidine adjunct itself [6]. Overall, all three approaches are effective and safe, and the Cochrane review recommends that the choice between them should incorporate patient preference and scheduling convenience [2].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Comparison of full-mouth disinfection and quadrant-wise scaling in the treatment of adult chronic periodontitis: a systematic review and meta-analysis.",
     "journal": "Journal of periodontal research",
     "year": 2016,
     "url": "https://doi.org/10.1111/jre.12326",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Full-mouth treatment modalities (within 24 hours) for periodontitis in adults.",
     "journal": "The Cochrane database of systematic reviews",
     "year": 2022,
     "url": "https://doi.org/10.1002/14651858.CD004622.pub3",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Effect of quadrantwise versus full-mouth subgingival instrumentation on clinical and microbiological parameters in periodontitis patients: A randomized clinical trial.",
     "journal": "Journal of periodontal research",
     "year": 2024,
     "url": "https://doi.org/10.1111/jre.13279",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "Comparison of three full-mouth concepts for the non-surgical treatment of stage III and IV periodontitis: A randomized controlled trial.",
     "journal": "Journal of clinical periodontology",
     "year": 2021,
     "url": "https://doi.org/10.1111/jcpe.13548",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 5,
     "title": "Different scaling and root planing strategies in Turkish patients with aggressive periodontitis: A randomized controlled clinical trial.",
     "journal": "International journal of dental hygiene",
     "year": 2022,
     "url": "https://doi.org/10.1111/idh.12592",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 6,
     "title": "The rôle of chlorhexidine in the one‐stage full‐mouth disinfection treatment of patients with advanced adult periodontitis",
     "journal": "Journal Of Clinical Periodontology",
     "year": 2000,
     "url": "https://doi.org/10.1034/j.1600-051x.2000.027008578.x",
     "evidence_level": "Study"
    }
   ]
  },
  {
   "question": "Is coronal polishing after scaling necessary?",
   "topic": "Protocols and instrumentation",
   "url": "https://preventiohub.com/evidence/coronal-polishing-after-scaling-necessary/",
   "answer": "Based on the indexed literature, coronal polishing after scaling is not considered a routine necessity for all patients.\n\nThe current view is that polishing should be done selectively based on patient need rather than as a universal component of prophylaxis [1]. Overzealous polishing can wear superficial tooth structure, promote local deposit accumulation, and delay reformation of the fluoride-rich enamel layer [1].\n\nFrom a clinical outcomes perspective, the Cochrane review found little or no difference in gingivitis, probing depths, plaque, and oral health-related quality of life between patients receiving routine scale and polish versus no scheduled treatment over two to three years in adults without severe periodontitis [2]. The rapid review similarly concluded there is no evidence that dental polishing specifically is effective [3].\n\nWhen polishing is performed, prior plaque disclosure has been shown to significantly improve plaque removal effectiveness regardless of the polishing modality used, and air polishing required less treatment time than rubber cup polishing [4].\n\nIn summary, the evidence supports selective polishing based on individual patient need rather than routine coronal polishing after every scaling appointment [1], and any decision should incorporate clinical judgement about the patient's risk profile and periodontal status [3].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Tooth polishing: The current status.",
     "journal": "Journal of Indian Society of Periodontology",
     "year": 2015,
     "url": "https://doi.org/10.4103/0972-124x.154170",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "Routine scale and polish for periodontal health in adults.",
     "journal": "The Cochrane database of systematic reviews",
     "year": 2018,
     "url": "https://doi.org/10.1002/14651858.CD004625.pub4",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Benefits of Dental Scaling and Polishing in Adults: A Rapid Review and Evidence Synthesis.",
     "journal": "JDR clinical and translational research",
     "year": 2025,
     "url": "https://doi.org/10.1177/23800844241271684",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "Conventional versus comprehensive dental prophylaxis: comparing the clinical outcomes between rubber cup and air polishing and the importance of plaque disclosure.",
     "journal": "Quintessence international (Berlin, Germany : 1985)",
     "year": 2021,
     "url": "https://doi.org/10.3290/j.qi.a45602",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "How should professional prophylaxis be adapted for patients with fixed orthodontic appliances?",
   "topic": "Patient groups",
   "url": "https://preventiohub.com/evidence/should-professional-prophylaxis-adapted-patients-fixed-orthodontic-app/",
   "answer": "The evidence consistently shows that fixed appliances promote generalised plaque accumulation and gingivitis, making periodontal monitoring at every appointment essential [1]. Because brackets, archwires, and elastics create additional plaque retention areas and limit access for conventional cleaning, professional prophylaxis visits should include careful assessment of plaque index, gingival bleeding, and probing depth, with reinforcement of oral hygiene instruction tailored to the appliance [1][2].\n\nConventional toothbrushing alone is insufficient for these patients, so clinicians should counsel on adjunctive mechanical aids [2][3]. Both water jet flossing and interdental flossing have been shown to significantly reduce plaque index and gingival bleeding index in orthodontic patients over a two-week period, with no statistically significant difference between the two methods, though water jet flossing showed a slight numerical advantage [2][3]. Interproximal brushes and orthodontic-specific brushes are also described in the literature as adjuncts, though results have generally been modest [3].\n\nCaries risk should also be factored into each prophylaxis visit, as fixed appliances increase plaque retention and can shift the oral microbiome toward cariogenic species, particularly in adult patients [4][3]. While fluoride mouthrinses are commonly recommended, a 2025 meta-analysis found only a small risk difference in initial enamel caries adjacent to brackets compared with fluoride toothpaste alone, and concluded there is insufficient evidence for a general recommendation; individual risk assessment should guide this decision [5]. Finally, clinicians should be aware that although most periodontal parameters tend to normalise after debonding, some values may remain elevated relative to baseline for months to years, underscoring the importance of continued monitoring into the post-treatment period [1].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Orthodontic Fixed Appliance and Periodontal Status: An Updated Systematic Review.",
     "journal": "The open dentistry journal",
     "year": 2018,
     "url": "https://doi.org/10.2174/1745017901814010614",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "The effectiveness of water jet flossing and interdental flossing for oral hygiene in orthodontic patients with fixed appliances: a randomized clinical trial.",
     "journal": "BMC oral health",
     "year": 2024,
     "url": "https://doi.org/10.1186/s12903-024-04166-0",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "Effectiveness of Waterpik® for oral hygiene maintenance in orthodontic fixed appliance patients: A randomised controlled trial.",
     "journal": "Journal of orthodontics",
     "year": 2023,
     "url": "https://doi.org/10.1177/14653125231173708",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "Fixed appliances orthodontic therapy as a risk factor for caries development: Systematic review.",
     "journal": "Advances in clinical and experimental medicine : official organ Wroclaw Medical University",
     "year": 2024,
     "url": "https://doi.org/10.17219/acem/174444",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 5,
     "title": "Fluoride mouthrinses for prevention of initial caries in orthodontic patients - a systematic review and meta-analysis.",
     "journal": "BMC oral health",
     "year": 2025,
     "url": "https://doi.org/10.1186/s12903-025-06374-8",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Is professional dental prophylaxis safe during pregnancy?",
   "topic": "Patient groups",
   "url": "https://preventiohub.com/evidence/professional-dental-prophylaxis-safe-during-pregnancy/",
   "answer": "Based on the indexed literature, professional dental prophylaxis and nonsurgical periodontal therapy are considered safe during pregnancy.\n\nA systematic review of 19 RCTs concluded that nonsurgical periodontal therapy is safe during pregnancy, and while it does not completely prevent adverse outcomes, it can be recommended as part of antenatal care [1]. A separate systematic review and meta-analysis examining scaling and root planing combined with mouthwash during pregnancy further supports the use of mechanical periodontal interventions in pregnant women [2].\n\nRegarding anesthesia concerns that might arise during prophylaxis appointments, a systematic review of five studies involving nearly 2,000 patients found no significant differences in adverse pregnancy outcomes - including gestational age at delivery, birth weight, preterm birth, or fetal anomalies - among pregnant women who received local anesthetics (primarily lidocaine with epinephrine) for dental procedures [3]. That review explicitly concluded there are no grounds to avoid dental care or local anesthetics during pregnancy [3].\n\nDespite this evidence, unfavourable beliefs remain common among pregnant patients - notably that \"dental treatments are not safe and harm the fetus,\" identified in 17 of 39 studies in one systematic review [4]. Clinicians are therefore encouraged to proactively address these misconceptions, as low oral health knowledge and reliance on social networks contribute to avoidance of needed care [4].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "The influence of nonsurgical periodontal therapy on the occurrence of adverse pregnancy outcomes: A systematic review of the current evidence.",
     "journal": "Journal of Indian Society of Periodontology",
     "year": 2020,
     "url": "https://doi.org/10.4103/jisp.jisp_228_19",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "The impact of scaling and root planning combined with mouthwash during pregnancy on preterm birth and low birth weight: a systematic review and meta-analysis.",
     "journal": "BMC pregnancy and childbirth",
     "year": 2024,
     "url": "https://doi.org/10.1186/s12884-024-06905-1",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "The Use of Different Local Anesthetics in Pregnant Women in Dentistry: A Systematic Review.",
     "journal": "Current reviews in clinical and experimental pharmacology",
     "year": 2025,
     "url": "https://doi.org/10.2174/0127724328349965250407082245",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "Unfavourable beliefs about oral health and safety of dental care during pregnancy: a systematic review.",
     "journal": "BMC oral health",
     "year": 2023,
     "url": "https://doi.org/10.1186/s12903-023-03439-4",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "How does diabetes affect periodontal treatment and maintenance?",
   "topic": "Patient groups",
   "url": "https://preventiohub.com/evidence/diabetes-affect-periodontal-treatment-maintenance/",
   "answer": "Diabetes increases the risk of periodontitis onset and progression by approximately 86% compared to non-diabetic individuals, driven primarily by the degree of hyperglycemia rather than simply having a diabetes diagnosis [1][2]. However, the good news for clinicians is that diabetes mellitus with HbA1c at or below 8.5% does not appear to significantly affect short-term clinical periodontal outcomes - studies show no significant difference in probing depth reduction or clinical attachment level gain between diabetic and non-diabetic patients following non-surgical periodontal therapy [3].\n\nRegarding the bidirectional relationship, periodontal therapy appears to modestly improve glycemic control. Meta-analyses consistently show HbA1c reductions of approximately 0.27-0.48% at three months following scaling and root planing in diabetic patients, though the effect at six months is less consistent across studies [4][5][6]. Notably, the large randomized DPTT trial found no significant HbA1c improvement at six months with non-surgical periodontal therapy, which tempers some of the more optimistic estimates [7].\n\nFor maintenance, poorly controlled diabetes is associated with greater tooth loss in long-term post-periodontal treatment programs, reinforcing that glycemic control is a key variable affecting maintenance outcomes [2]. Mechanistic links between the two conditions involve elevated inflammatory mediators including IL-1β, TNF-α, and IL-6, which likely perpetuate both diseases simultaneously [4]. Clinicians should therefore integrate glycemic status monitoring into periodontal maintenance planning and consider co-management with the patient's physician, particularly when HbA1c is poorly controlled [4][2].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Does diabetes increase the risk of periodontitis? A systematic review and meta-regression analysis of longitudinal prospective studies.",
     "journal": "Acta diabetologica",
     "year": 2018,
     "url": "https://doi.org/10.1007/s00592-018-1120-4",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Periodontal complications of hyperglycemia/diabetes mellitus: Epidemiologic complexity and clinical challenge",
     "journal": "Periodontology 2000",
     "year": 2018,
     "url": "https://doi.org/10.1111/prd.12235",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Impact of diabetes on clinical periodontal outcomes following non-surgical periodontal therapy.",
     "journal": "Journal of clinical periodontology",
     "year": 2019,
     "url": "https://doi.org/10.1111/jcpe.13044",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "Scientific evidence on the links between periodontal diseases and diabetes: Consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology.",
     "journal": "Journal of clinical periodontology",
     "year": 2018,
     "url": "https://doi.org/10.1111/jcpe.12808",
     "evidence_level": "Guideline / consensus"
    },
    {
     "n": 5,
     "title": "An update of the evidence on the potential impact of periodontal therapy on diabetes outcomes.",
     "journal": "Journal of clinical periodontology",
     "year": 2018,
     "url": "https://doi.org/10.1111/jcpe.12836",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 6,
     "title": "The effect of periodontal therapy on glycemic control and fasting plasma glucose level in type 2 diabetic patients: systematic review and meta-analysis.",
     "journal": "BMC oral health",
     "year": 2016,
     "url": "https://doi.org/10.1186/s12903-016-0249-1",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 7,
     "title": "The Effect of Nonsurgical Periodontal Therapy on Hemoglobin A<sub>1c</sub>Levels in Persons With Type 2 Diabetes and Chronic Periodontitis",
     "journal": "JAMA",
     "year": 2013,
     "url": "https://doi.org/10.1001/jama.2013.282431",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "Does smoking reduce the response to periodontal therapy?",
   "topic": "Patient groups",
   "url": "https://preventiohub.com/evidence/smoking-reduce-response-periodontal-therapy/",
   "answer": "Yes, smoking consistently and significantly reduces the response to periodontal therapy across multiple study designs and treatment modalities.\n\nIn a 6-year longitudinal study, smokers showed significantly less probing depth reduction and less clinical attachment level (CAL) gain than non-smokers following both non-surgical and surgical therapy, and these differences persisted at every yearly maintenance visit, with effects most pronounced in pockets of 7 mm or deeper [1]. A 2021 systematic review and meta-analysis of 17 studies confirmed this finding, reporting that smokers achieved 0.33 mm less probing depth reduction and 0.20 mm less CAL gain than non-smokers after non-surgical periodontal therapy [2]. At the biological level, smokers showed significantly higher GCF IL-1β levels after periodontal therapy compared to non-smokers, suggesting that smoking impairs the host immune resolution response even after treatment [3].\n\nImportantly, cessation appears to reverse much of this impairment. Quitters achieved up to 0.2 mm greater CAL gain and 0.32 mm greater pocket depth reduction compared to non-quitters after 12-24 months, and their risk of periodontitis progression became comparable to that of never-smokers [4]. Former smokers also showed no increased risk of tooth loss compared to never-smokers, whereas current smokers had 2.6 times the risk [5]. Adding systemic antibiotics as an adjunct to scaling and root planing in smokers produced modest but statistically significant additional PD reduction and CAL gain, though the clinical relevance of these gains was considered limited [6]. Collectively, the evidence strongly supports integrating smoking cessation counselling as a routine component of periodontal care [4].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "The effect of smoking on the response to periodontal therapy",
     "journal": "Journal Of Clinical Periodontology",
     "year": 1994,
     "url": "https://doi.org/10.1111/j.1600-051x.1994.tb00285.x",
     "evidence_level": "Study"
    },
    {
     "n": 2,
     "title": "The impact of smoking on non-surgical periodontal therapy: A systematic review and meta-analysis.",
     "journal": "Journal of clinical periodontology",
     "year": 2021,
     "url": "https://doi.org/10.1111/jcpe.13384",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "The impact of smoking on periodontitis patients' GCF/serum cytokine profile both before and after periodontal therapy: a meta-analysis.",
     "journal": "BMC oral health",
     "year": 2023,
     "url": "https://doi.org/10.1186/s12903-023-02768-8",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "Impact of Smoking Cessation on Periodontitis: A Systematic Review and Meta-analysis of Prospective Longitudinal Observational and Interventional Studies.",
     "journal": "Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco",
     "year": 2019,
     "url": "https://doi.org/10.1093/ntr/nty147",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 5,
     "title": "Effect of smoking cessation on tooth loss: a systematic review with meta-analysis.",
     "journal": "BMC oral health",
     "year": 2019,
     "url": "https://doi.org/10.1186/s12903-019-0930-2",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 6,
     "title": "Antibiotic therapy as an adjunct to scaling and root planing in smokers: a systematic review and meta-analysis.",
     "journal": "Brazilian oral research",
     "year": 2017,
     "url": "https://doi.org/10.1590/1807-3107BOR-2017.vol31.0067",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "How can pain and anxiety during periodontal instrumentation be reduced?",
   "topic": "Patient groups",
   "url": "https://preventiohub.com/evidence/pain-anxiety-during-periodontal-instrumentation-reduced/",
   "answer": "Several complementary strategies can reduce pain and anxiety during periodontal instrumentation.\n\nRegarding anesthesia delivery, needleless jet anesthesia systems produce significantly lower pain scores (VAS and VRS both p < 0.05) and less post-operative soreness compared to conventional syringe injection, and patients report lower anxiety and greater comfort with this approach [1].\n\nAddressing anxiety directly is important because dental anxiety is a consistent predictor of expected pain, pain during treatment, and post-treatment pain across all types of dental procedures and treatment stages, so identifying anxious patients early is a critical step in pain control for all patients, not just those with high anxiety [2].\n\nNon-pharmacological interventions - including muscle relaxation, guided imagery, biofeedback, hypnosis, acupuncture, distraction techniques, and desensitization - can modify the patient's experience with minimal or negligible side effects [3]. Meta-analytic data confirm that non-pharmacological interventions produce a significant reduction in anxiety levels (SMD = -0.32; 95% CI -0.57 to -0.07; p = 0.01) [4].\n\nPharmacological options such as nitrous oxide, oral sedation, or conscious intravenous sedation are also available, though they carry potential side effects, risks, contraindications, and increased cost [3]. Evidence supports that combining pharmacological and non-pharmacological methods yields superior outcomes compared to either approach alone [5]. For patients with mild to moderate anxiety, behavioural interventions including effective communication and relaxation techniques are particularly appropriate, while pharmacological sedation is better suited to moderate-to-severe dental fear [6].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "A Comparison in Patient Comfort Using Conventional Syringe and Needleless Jet Anesthesia Technique in Periodontal Surgery-A Split-Mouth Randomized Clinical Trial.",
     "journal": "Medicina (Kaunas, Lithuania)",
     "year": 2022,
     "url": "https://doi.org/10.3390/medicina58020278",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "Association between Anxiety and Pain in Dental Treatment: A Systematic Review and Meta-analysis.",
     "journal": "Journal of dental research",
     "year": 2017,
     "url": "https://doi.org/10.1177/0022034516678168",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Management strategies for adult patients with dental anxiety in the dental clinic: a systematic review.",
     "journal": "Australian dental journal",
     "year": 2022,
     "url": "https://doi.org/10.1111/adj.12926",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "Non-Pharmacological Interventions for Reducing Fear and Anxiety in Patients Undergoing Third Molar Extraction under Local Anesthesia: Systematic Review and Meta-Analysis.",
     "journal": "International journal of environmental research and public health",
     "year": 2022,
     "url": "https://doi.org/10.3390/ijerph191811162",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 5,
     "title": "Anxiety and Pain Management in Dental Patients: A Systematic Review of Pharmacological and Non-Pharmacological Approaches.",
     "journal": "Journal of pharmacy & bioallied sciences",
     "year": 2025,
     "url": "https://doi.org/10.4103/jpbs.jpbs_1454_24",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 6,
     "title": "Pharmacological vs. non-pharmacological interventions for anxiety control in dental implant surgery: a systematic review.",
     "journal": "Frontiers in dental medicine",
     "year": 2026,
     "url": "https://doi.org/10.3389/fdmed.2026.1891238",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Is chlorhexidine mouthwash effective as an adjunct to scaling and root planing?",
   "topic": "Home care and adjuncts",
   "url": "https://preventiohub.com/evidence/chlorhexidine-mouthwash-effective-as-adjunct-scaling-root-planing/",
   "answer": "Chlorhexidine (CHX) mouthwash as an adjunct to scaling and root planing (SRP) does produce measurable benefits, though the clinical magnitude is modest. A meta-analysis found that adjunctive CHX mouthrinse resulted in significantly greater probing depth (PD) reduction than SRP alone at 40-60 days (0.33 mm) and 180 days (0.24 mm), though the authors noted these differences, while statistically significant, could be considered clinically slight, and the effect on clinical attachment level (CAL) was negligible [1][2]. A Cochrane review similarly confirmed high-quality evidence of a large reduction in dental plaque and a reduction in gingivitis with CHX mouthrinse used adjunctively over 4-6 weeks and 6 months, though the gingivitis reduction was not considered clinically relevant in individuals with mild inflammation [3].\n\nFor locally delivered CHX forms, subgingival xanthan-based CHX gel as an adjunct to SRP at selected sites showed a slight but significant improvement in PPD reduction (mean difference 0.15 mm), with no significant difference in CAL gain [4]. CHX chips showed some gingival index benefit over other local antimicrobials at three months, though other antimicrobials outperformed CHX chips on probing depth reduction at one and three months [5].\n\nClinicians should weigh these modest clinical gains against well-documented adverse effects including extrinsic tooth staining, taste disturbance, mucosal irritation, and potential calculus build-up, all of which may affect patient compliance [1][3][6]. There is currently no evidence that one concentration of CHX rinse is more effective than another [3].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Chlorhexidine mouthwash as an adjunct to mechanical therapy in chronic periodontitis: A meta-analysis.",
     "journal": "Journal of the American Dental Association (1939)",
     "year": 2017,
     "url": "https://doi.org/10.1016/j.adaj.2017.01.021",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Adjunctive Use of Chlorhexidine Mouthwash to Nonsurgical Periodontal Therapy May Enhance Periodontal Pocket Depth Reduction.",
     "journal": "The journal of evidence-based dental practice",
     "year": 2018,
     "url": "https://doi.org/10.1016/j.jebdp.2018.10.004",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Chlorhexidine mouthrinse as an adjunctive treatment for gingival health.",
     "journal": "The Cochrane database of systematic reviews",
     "year": 2017,
     "url": "https://doi.org/10.1002/14651858.CD008676",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "Adjunctive subgingival application of Chlorhexidine gel in nonsurgical periodontal treatment for chronic periodontitis: a systematic review and meta-analysis.",
     "journal": "BMC oral health",
     "year": 2020,
     "url": "https://doi.org/10.1186/s12903-020-1021-0",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 5,
     "title": "Effectiveness of chlorhexidine gels and chips in Periodontitis Patients after Scaling and Root Planing: a systematic review and Meta-analysis.",
     "journal": "BMC oral health",
     "year": 2023,
     "url": "https://doi.org/10.1186/s12903-023-03241-2",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 6,
     "title": "Effectiveness of Different Commercial Chlorhexidine-Based Mouthwashes After Periodontal and Implant Surgery: A Systematic Review.",
     "journal": "Implant dentistry",
     "year": 2019,
     "url": "https://doi.org/10.1097/ID.0000000000000854",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Are interdental brushes more effective than dental floss?",
   "topic": "Home care and adjuncts",
   "url": "https://preventiohub.com/evidence/interdental-brushes-more-effective-dental-floss/",
   "answer": "The evidence suggests interdental brushes (IDBs) may have an edge over dental floss for reducing gingivitis, though overall certainty is low. A Cochrane review found low-certainty evidence that IDBs reduce gingivitis more than floss at one and three months, though evidence for plaque outcomes was inconsistent [1]. A withdrawn Cochrane review similarly reported low-certainty evidence of a 52% reduction in gingivitis (Eastman Bleeding Index) favouring IDBs over floss at one month, but found insufficient evidence to claim a benefit for either device for plaque reduction [2].\n\nFor plaque removal specifically, narrative evidence notes that studies have shown better plaque removal with IDBs compared to floss, though patient compliance with flossing is often poor - roughly one third of patients floss daily, and about one quarter reportedly lie to their dentist about their flossing habits [3]. A randomised trial around implant-supported crowns found both methods improved plaque control, though notably only the IDB group showed a statistically significant change in IL-6 levels [4].\n\nIt is worth noting that the overall evidence quality across comparisons is rated low to very low, and effect sizes observed may not always be clinically meaningful [1]. Device choice should also remain site-specific, as not all interdental tools suit every patient or anatomical situation [3].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries.",
     "journal": "The Cochrane database of systematic reviews",
     "year": 2019,
     "url": "https://doi.org/10.1002/14651858.CD012018",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "WITHDRAWN: Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults.",
     "journal": "The Cochrane database of systematic reviews",
     "year": 2019,
     "url": "https://doi.org/10.1002/14651858.CD009857.pub3",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "Efficacy of power-driven interdental cleaning tools: A systematic review and meta-analysis.",
     "journal": "Clinical and experimental dental research",
     "year": 2023,
     "url": "https://doi.org/10.1002/cre2.691",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "Efficacy of Three Interdental Cleaning Methods for Peri-Implant Health Maintenance of Single Implant-Supported Crowns: A Randomised Clinical Trial.",
     "journal": "Oral health & preventive dentistry",
     "year": 2024,
     "url": "https://doi.org/10.3290/j.ohpd.b4854607",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  },
  {
   "question": "Do powered toothbrushes remove more plaque than manual toothbrushes?",
   "topic": "Home care and adjuncts",
   "url": "https://preventiohub.com/evidence/powered-toothbrushes-remove-more-plaque-manual-toothbrushes/",
   "answer": "Yes, the overall evidence consistently supports that powered toothbrushes remove more plaque than manual toothbrushes, though the magnitude varies by population and study design.\n\nIn adults, a network meta-analysis found a statistically significant difference in post-brushing plaque scores favouring oscillating-rotating (OR) powered toothbrushes over manual toothbrushes (SMD = -0.43), with high certainty for a small effect [1]. A separate meta-analysis of single brushing exercises confirmed a significant benefit for powered toothbrushes regardless of plaque index used, with moderate certainty [2]. For sonic powered toothbrushes used in everyday brushing over four weeks to three months, combined results from 18 studies showed significantly greater plaque removal (SMD = -0.89) compared to manual toothbrushes [3]. A further meta-analysis reported powered toothbrushes were approximately 9% more effective at removing plaque, with OR, sonic, and ultrasonic modes all outperforming manual brushing, though counter-oscillation and ionic types did not show a significant benefit [4].\n\nIn children, a meta-analysis of nine randomised controlled trials found a statistically significant plaque reduction benefit for powered toothbrushes (combined mean difference = 0.590, moderate quality evidence) [5]. However, in adults aged 55 and older, current evidence did not reach statistical significance (SMD = -0.10, p = .38), suggesting the advantage may be less clear in this age group and that more targeted research is needed [6].\n\nOne important clinical note from the literature is that the advantage of powered toothbrushes may diminish in adequately instructed and motivated patients, highlighting the importance of individualised oral hygiene education [4].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "The efficacy of powered toothbrushes: A systematic review and network meta-analysis.",
     "journal": "International journal of dental hygiene",
     "year": 2022,
     "url": "https://doi.org/10.1111/idh.12563",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "How effective is a powered toothbrush as compared to a manual toothbrush? A systematic review and meta-analysis of single brushing exercises.",
     "journal": "International journal of dental hygiene",
     "year": 2020,
     "url": "https://doi.org/10.1111/idh.12401",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "The Effectiveness of Manual versus High-Frequency, High-Amplitude Sonic Powered Toothbrushes for Oral Health: A Meta-Analysis.",
     "journal": "The Journal of clinical dentistry",
     "year": 2017,
     "url": "https://pubmed.ncbi.nlm.nih.gov/28422461/",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "[Evaluation of the efficacy of powered and manual toothbrushes in preventing oral diseases (Systematic review with meta-analysis)].",
     "journal": "Fogorvosi szemle",
     "year": 2016,
     "url": "https://pubmed.ncbi.nlm.nih.gov/27188156/",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 5,
     "title": "Plaque Removal by a Powered Toothbrush Versus a Manual Toothbrush in Children: A Systematic Review and Meta-Analysis.",
     "journal": "Pediatric dentistry",
     "year": 2020,
     "url": "https://pubmed.ncbi.nlm.nih.gov/32847667/",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 6,
     "title": "Powered versus manual toothbrushes for plaque removal and gingival health amongst 55 and older individuals: A systematic review and meta-analysis.",
     "journal": "Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentis",
     "year": 2024,
     "url": "https://doi.org/10.1111/scd.12974",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Does professional fluoride varnish application reduce caries in adults?",
   "topic": "Home care and adjuncts",
   "url": "https://preventiohub.com/evidence/professional-fluoride-varnish-application-reduce-caries-adults/",
   "answer": "Professional fluoride varnish application does appear to reduce caries in adults, though the evidence is nuanced. A meta-analysis of 13 RCTs (n = 4,784 participants) found fluoride varnish reduced caries with a 95% CI of 0.28 to 0.43, with quarterly applications associated with a 54% reduction, particularly in high-risk populations [1]. In older adults specifically, monthly 5% sodium fluoride (NaF) varnish combined with professional brushing significantly improved caries outcomes versus standard fluoride toothpaste and oral hygiene instructions alone (RR = 1.63, p = 0.002) [2]. However, when quarterly professional cleaning and oral hygiene instructions were already provided, adding 5% NaF varnish showed no significant additional benefit, suggesting that regular professional care itself is a strong preventive factor [2].\n\nFor non-cavitated proximal lesions in moderate-to-high caries-risk adults, fluoride varnish achieved a 98% arresting success rate over 18 months, comparable to resin infiltration [3]. A separate systematic review of incipient lesions in permanent teeth found mixed results - some RCTs supported fluoride varnish for reversing early lesions, but studies comparing it to routine home care with fluoride toothpaste did not show a clear advantage [4]. The ADA recommends 2.26% fluoride varnish for patients at caries risk aged 6 years and older, with recommendation strength ranging from \"in favor\" to \"expert opinion\" depending on the agent [5]. Overall, evidence quality is moderate with notable heterogeneity across studies, and clinical judgement regarding patient risk profile and care setting remains important [2][1].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Effectiveness of Fluoride Varnish in Preventing Dental Caries: Systematic Review and Meta-Analysis.",
     "journal": "Current drug research reviews",
     "year": 2026,
     "url": "https://doi.org/10.2174/0125899775431211260206140819",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Efficacy of Dental Varnishes and Gels for the Prevention and Management of Dental Caries in Older Adults-A Systematic Review and Meta-Analysis.",
     "journal": "Gerodontology",
     "year": 2026,
     "url": "https://doi.org/10.1111/ger.70075",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "Comparative evaluation of resin infiltration and fluoride varnish treatment for moderate to high caries risk adults: A randomized controlled trial.",
     "journal": "American journal of dentistry",
     "year": 2023,
     "url": "https://pubmed.ncbi.nlm.nih.gov/38092748/",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "Is professionally applied topical fluoride effective in treating incipient caries? A systematic review.",
     "journal": "Brazilian oral research",
     "year": 2022,
     "url": "https://doi.org/10.1590/1807-3107bor-2022.vol36.0083",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 5,
     "title": "Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systematic review.",
     "journal": "Journal of the American Dental Association (1939)",
     "year": 2013,
     "url": null,
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Does dentine hypersensitivity increase after scaling, and how is it managed?",
   "topic": "Home care and adjuncts",
   "url": "https://preventiohub.com/evidence/dentine-hypersensitivity-increase-after-scaling-managed/",
   "answer": "Dentin hypersensitivity (DH) is a recognised consequence of non-surgical periodontal therapy, including scaling and root planing (SRP), which exposes dentinal tubules through removal of deposits and disruption of the smear layer [1][2]. All desensitizing treatment modalities tested post-SRP have shown meaningful reductions in sensitivity compared to untreated controls [1][2].\n\nFor in-office management after SRP, several agents have demonstrated efficacy. Bioactive glass (BAG), Nd:YAG laser, fluoride varnish, bioactive ceramic solution, universal self-etching adhesive, and PRG filler-based varnish have all been shown to reduce DH scores over follow-up periods of up to 8 weeks [2][3]. When BAG and Nd:YAG laser were combined in sequence, with BAG applied before laser irradiation, the most pronounced and sustained reduction in VAS scores was observed across the study period [2].\n\nFor home-use management, agents including arginine, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), Novamin, potassium nitrate, propolis, and strontium chloride-containing toothpastes have all shown statistically significant improvements compared to baseline [4][5]. CPP-ACP demonstrated the greatest reduction in DH symptoms by week 8 across multiple measurement scales [5].\n\nA consensus panel has emphasised that a structured clinical decision tree, moving from diagnosis through staged treatment selection to prognosis, should guide management of DH, with elimination of etiological causes as the first step before applying desensitizing therapies [6][7]. The overall certainty of evidence supporting specific agents post-SRP remains low to very low, so clinical judgement remains essential when selecting a protocol [1].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Effect of desensitizing agents on dentin hypersensitivity after non-surgical periodontal therapy: A systematic review and meta-analysis.",
     "journal": "Journal of dentistry",
     "year": 2020,
     "url": "https://doi.org/10.1016/j.jdent.2020.103498",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 2,
     "title": "Clinical outcome of Nd:YAG laser and bioactive glass combined use for dentin hypersensitivity after scaling and root planning: a short-term comparative study.",
     "journal": "European journal of medical research",
     "year": 2025,
     "url": "https://doi.org/10.1186/s40001-025-03249-0",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 3,
     "title": "Efficacy of different in-office treatments for dentin hypersensitivity: randomized and parallel clinical trial.",
     "journal": "Brazilian dental journal",
     "year": 2024,
     "url": "https://doi.org/10.1590/0103-6440202405487",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 4,
     "title": "A randomized clinical trial for comparing the efficacy of desensitizing toothpastes on the relief of dentin hypersensitivity.",
     "journal": "Scientific reports",
     "year": 2023,
     "url": "https://doi.org/10.1038/s41598-023-31616-6",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 5,
     "title": "Home-use agents in the treatment of dentin hypersensitivity: clinical effectiveness evaluation with different measurement methods.",
     "journal": "Clinical oral investigations",
     "year": 2025,
     "url": "https://doi.org/10.1007/s00784-025-06155-1",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 6,
     "title": "Efficacy of bioactive glass-based desensitizer compared to other desensitizing agents or techniques in dentin hypersensitivity: a systematic review.",
     "journal": "BMC oral health",
     "year": 2025,
     "url": "https://doi.org/10.1186/s12903-025-06288-5",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 7,
     "title": "The Decision Tree for Clinical Management of Dentin Hypersensitivity. A Consensus Report.",
     "journal": "Oral health & preventive dentistry",
     "year": 2022,
     "url": "https://doi.org/10.3290/j.ohpd.b2572997",
     "evidence_level": "Systematic review / meta-analysis"
    }
   ]
  },
  {
   "question": "Does motivational interviewing or oral hygiene instruction improve plaque control?",
   "topic": "Home care and adjuncts",
   "url": "https://preventiohub.com/evidence/motivational-interviewing-oral-hygiene-instruction-improve-plaque-cont/",
   "answer": "Both motivational interviewing (MI) and traditional oral hygiene instruction (OHI) appear capable of improving plaque control, though the evidence on which approach is superior is mixed and overall limited in quality.\n\nIn a 12-month RCT, both traditional OHI and brief MI groups showed significant reductions in plaque score over time, with the OHI group actually showing a statistically greater improvement in plaque score at visits three and four [1]. However, pooled data from a 2024 meta-analysis found no significant difference in plaque levels between MI and control groups overall [2], and a 2024 community-level meta-analysis similarly found only a marginal, non-significant summary effect favouring MI for plaque index (-3.59 percentage points, CI crossing zero) [3].\n\nAn earlier 2017 systematic review noted that in two of five included studies MI did show a significant positive effect on plaque values, while two studies showed no influence, highlighting inconsistency across trials [4]. A 3-year follow-up of a single-MI-session RCT found that both test and control groups maintained similarly desirable plaque scores over time, and the single MI session could not be shown to add long-term benefit beyond conventional therapy alone [5].\n\nAt the 3-year longitudinal follow-up of the brief MI trial, the time-by-group interaction for plaque score did not reach statistical significance (p=0.12) between MI and OHI groups [6]. Overall, both approaches can support plaque reduction, but current evidence does not consistently demonstrate that MI is superior to traditional OHI for plaque control, and additional high-quality, standardised trials are needed before firm conclusions can be drawn [2][4].",
   "last_checked": "2026-10-20",
   "sources": [
    {
     "n": 1,
     "title": "Impact of Brief Motivational Interviewing on Periodontal Clinical Outcomes: A randomized clinical trial.",
     "journal": "Journal of dental hygiene : JDH",
     "year": 2022,
     "url": "https://pubmed.ncbi.nlm.nih.gov/36224090/",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 2,
     "title": "Motivational Interviewing on Periodontal Treatment Outcomes: A Meta-Analysis.",
     "journal": "International dental journal",
     "year": 2024,
     "url": "https://doi.org/10.1016/j.identj.2024.01.003",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 3,
     "title": "Motivational interviewing for preventing oral morbidities in adults: Systematic review and meta-analysis.",
     "journal": "Community dentistry and oral epidemiology",
     "year": 2024,
     "url": "https://doi.org/10.1111/cdoe.12904",
     "evidence_level": "Systematic review / meta-analysis"
    },
    {
     "n": 4,
     "title": "Motivational Interviewing As an Adjunct to Periodontal Therapy-A Systematic Review.",
     "journal": "Frontiers in psychology",
     "year": 2017,
     "url": "https://doi.org/10.3389/fpsyg.2017.00279",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 5,
     "title": "A brief motivational interviewing as an adjunct to periodontal therapy-A potential tool to reduce relapse in oral hygiene behaviours. A three-year study.",
     "journal": "International journal of dental hygiene",
     "year": 2018,
     "url": "https://doi.org/10.1111/idh.12308",
     "evidence_level": "Peer-reviewed study"
    },
    {
     "n": 6,
     "title": "Longitudinal Impact of Brief Motivational Interviewing on Periodontal Clinical Outcomes and Patient Perceptions: A 3-year follow-up study.",
     "journal": "Journal of dental hygiene : JDH",
     "year": 2025,
     "url": "https://pubmed.ncbi.nlm.nih.gov/40514080/",
     "evidence_level": "Peer-reviewed study"
    }
   ]
  }
 ]
}