Table 1            Levels of evidence and classification of recommendations

 

            Levels of evidence

            I:            Evidence obtained from at least one properly randomized controlled trial.

            II-1:       Evidence obtained from well-designed controlled trials without randomization.

            II-2:       Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one centre or research group.

            II-3:      Evidence obtained from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be included in this category.

III:        Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees.

 

            Recommendations

A:         There is good evidence to support a recommendation for use of the manoeuvre in the management of adult periodontitis.

B:         There is fair evidence to support a recommendation for use of the manoeuvre in the management of adult periodontitis.

C:         There is poor evidence to support a recommendation for or against use of the manoeuvre in the management of adult periodontitis, but recommendations may be made on other grounds.

D:         There is fair evidence to support a recommendation against use of the manoeuvre in the management of adult periodontitis.

E:         There is good evidence to support a recommendation against use of the manoeuvre in the management of adult periodontitis.

 

* Adapted from Goldbloom and Battista7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 2            Summary of findings and recommendations

 

Practice

Effectiveness

Evidence

Recommendations

Tobacco use

 

 

 

Direct effect

Tobacco use is associated with and shows a dose–response relationship with deteriorating periodontal health.

II-2 Cohort29,30

Case-control26,27

 

III Descriptive8-25

There is fair evidence that tobacco use is a major factor in the progression and treatment outcome of adult periodontitis.

Response to therapy

Smokers respond less favourably to periodontal therapy.

 

II-2 Cohort31-37

 

Smoking cessation

Former smokers show periodontal health intermediate to that found in current smokers and individuals who have never smoked.

II-2 Cohort30

III Descriptive14,15,18

There is fair evidence that quitting tobacco use is beneficial to periodontal health.

Cessation counselling

Oral health professionals as counsellors

Oral health professionals are effective at increasing the proportion of dental patients who successfully quit using tobacco.

I - Meta-analysis5

I – RCT38-43

III Case series44-46

There is good evidence to recommend that oral health professionals provide cessation counselling for all patients who use tobacco. (A)

Cessation products

Nicotine replacement

Use of transdermal nicotine (the patch) more than doubles the quit rates obtained in smoking cessation programs (ORs 2.1 to 2.6).

I – Meta-analysis47-51

There is good evidence to recommend the use of transdermal nicotine as a smoking cessation adjunct for most tobacco users. (A)

 

Use of nicotine gum increases cessation rates by about 50% (ORs 1.4 to 1.6).

I – Meta-analysis47,51,52

There is good evidence to recommend the use of nicotine gum as a smoking cessation adjunct for most tobacco users. (A)

Bupropion

Use of bupropion nearly doubles smoking cessation success, with reported quit rates of 23.1 and 30.3% vs. 12.4 and 15.6% for placebo.

I – RCT53,54

There is good evidence to recommend the use of bupropion as a smoking cessation adjunct for most tobacco users. (A)