Major Assignment Part A - PICO PDF

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Major Assignment on PICO Questions and Research
Involves the discussion of prophy polish and air polish methods...

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Major Assignment Part A Ms. Morneau Alexia Cirino October 16, 2019

Introduction The issue I chose that is relevant to me and to dental hygiene practice is rubber cup polishing compared to air polishing techniques. Rubber cup polishing has been the go-to polishing method for extrinsic stain and plaque biofilm removal for many years now and is still very often used in practice today, including the St. Clair dental clinic. In the recent years, air polishing has been introduced to dental hygiene practice and many offices are picking up this method of polishing over the rubber cup method, including my family dentist office that I go to. This topic has relevance and value to me because I have not only experienced both rubber cup polish and air polish as a client, but I am also a dental hygiene student who is learning about these methods and I am interested in if there is a substantial difference between the two. Background Rubber cup polish and paste have been used for many years as an effective method in removing extrinsic stain and plaque biofilm. This technique requires a rubber cup shaped headpiece that attaches to a slow speed, a dental hygienist will fill the rubber cup with pumice and as the slow speed spins, the pumice will polish a client’s teeth. Air polishing was introduced to dental professionals just under 50 years ago and is essentially an alternative to rubber cup polishing. Typically, air polishing uses a mixture of water, abrasive powder (like baking soda), and high-pressure air to effectively remove extrinsic stain and plaque biofilm. (1) PICO Question In clients who receive a polish, will air polishing methods, as compared to rubber cup polishing methods, be more effective in removing extrinsic stain and plaque biofilm?

Article Process My search process for the two articles I have found so far was to first identify the main points of my PICO question which were rubber cup polishing, air polishing, and dental/dental hygiene. The database I used to find both of these articles was the St. Clair database under “dental” so I could specifically find what I needed on this topic. I then originally searched for the topics together, and slowly started to notice that I wasn’t getting as many articles as I hoped. After realizing that searching “rubber cup polishing”, “air polishing” and “dental hygiene” as one search together wasn’t giving me many articles, I tried to separate them. To find my first article, I searched “rubber cup polishing” and “dental” together which presented me with more articles to choose from. Finding the second article was a little bit more of a challenge considering there isn’t very many good articles on this topic. For the second article I searched “air polishing” and “dental hygiene” together. Conclusion Currently, I think I am making good progress in gathering initial information about this topic to further my knowledge in answering the PICO question. The next steps in answering the PICO question is to find more articles to further study on, maybe focus on each individual method of polishing instead of finding articles that compare the two. Once I gather the articles that I need, the next step for me would be to gather all the important information and outcomes from each article as a whole to answer the PICO question.

Reference List 1. Air polishing has changed—so why hasn't the dental hygiene curriculum? [Internet]. StackPath. [cited 2019Oct13]. Available from: https://www.dentistryiq.com/products/article/16352185/air-polishing-haschangedso-why-hasnt-the-dental-hygiene-curriculum 2. Patil SS, Rakhewar PS, Limaye PS, Chaudhari NP. A comparative evaluation of plaqueremoving efficacy of air polishing and rubber-cup, bristle brush with paste polishing on oral hygiene status: A clinical study. Journal of International Society of Preventive & Community Dentistry [Internet]. 2015 Nov [cited 2019 18];5(6):457–62. Available from: direct=true&db=ddh&AN=111478512&si

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3. Sircar T, Debnath K, Chatterjee A. A Comparative Evaluation of Different Polishing Aids After Scaling and Root Planing a Split Mouth Clinical Trial. Guident [Internet]. 2018 Jan [cited 2019 Sep 18];11(2):42–6. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=ddh&AN=127653322&si te=eho st-live

PART A - ARTICLE CRITIQUE ARTICLE #1

ARTICLE #2

1. Title of the article (Vancouver Style format)

2. What was the identified purpose of the study or the research question? What are the central concepts (variables) being studied?

3. What type of study is it?  Qualitative? What type?  Quantitative? What type?  Mixed method? Describe what ones.  Systematic review? 4. Describe the population being studied. How was the study sample obtained? How was bias controlled?

Patil SS, Rakhewar PS, Limaye PS, Chaudhari NP. A comparative evaluation of plaque-removing efficacy of air polishing and rubber-cup, bristle brush with paste polishing on oral hygiene status: A clinical study. Journal of International Society of Preventive & Community Dentistry [Internet]. 2015 Nov [cited 2019Sep18];5(6):457-62. -The purpose of the study is to identify if there is a clinical difference between rubber cup polishing and air polishing when removing plaque and stain -The central concepts being studied are efficacy of air polishing (test) versus rubber cup polishing (control) -This article is a quantitative continuous study because it uses graphs and charts to display their findings and the data being recorded uses multiple measurements like PI, GI, and SBI

-The study consisted of 35 individuals originally as 5 individuals dropped out during the study (18 males and 17 females) and they ranged from 18-65 years of age. The individuals had to have all teeth (not including 3rd molars) and a highest probe depth of 3mm. Each individual had to also be diagnosed with chronic marginal or papillary gingivitis.

Sircar T, Debnath K, Chatterjee A. A Comparative Evaluation of Different Polishing Aids After Scaling and Root Planing a Split Mouth Clinical Trial. Guident [Internet]. 2018 Jan [cited 2019 Sep 18];11(2):42-6.

-The purpose of the study is to compare the efficacy of both air polishing and rubber cup polishing aids after scaling and root planning -The central concepts being studied are efficacy of air polishing (test) versus rubber cup polishing (control) -This article is a quantitative continuous study. This article is very similar to the first article I critiqued. It uses graphs and charts to display their findings and the data being recorded uses Plaque Score, Extrinsic Stain Score, and Sulcular Bleeding Index -The study consisted of 100 individuals (69 males and 31 females). Their age range was the same as the first article critique (18-65). The individuals had to have >20 teeth except 3rd molars and a highest probe depth of 5mm. Each individual had to be diagnosed with chronic marginal or papillary gingivitis as well as localized periodontitis. This study also included individuals who

5. Describe the method used. What type of data was collected and how was it analyzed?

6. What were the main findings of the study? Were the findings

-The study sample was obtained by excluding anyone with a medical condition or chronic illness/disease, anyone who has taken prophylaxis one month prior, and anyone with orthodontic appliances/braces. -Bias control was not clearly stated but from reading the article I would assume that randomly assigning separate quads to either test or control using coin toss method without the individuals knowing would control bias -Before any procedures, the individuals underwent scaling to remove any calculus they may have. Next, each quadrant of the individuals’ mouth was randomly assigned to either test or control using a coin toss method. A splitmouth design was used to assess supragingival plaque, gingival bleeding, and gingivitis -A plaque index disclosing agent was used to assess the plaque on the individuals’ teeth and the sulcus bleeding index and gingival index were used to assess the severity of gingival bleeding and gingivitis. The data as a whole was obtained from all 3 time intervals and was put in a statistical analysis software (SPSS) which would give the mean, standard deviation, standard error, and paired ttest to interpret the results -When evaluating PI, GI, and SBI alone at the 3 separate stages (at baseline,

smoke as well as nonsmokers -The study sample was obtained by excluding the same factors as the first article critique -Bias control was also not clearly stated but each quadrant was randomly assigned with either test or control using a coin toss method.

-The individuals underwent scaling for removing any deposits. A split-mouth design was used and again each quadrant was randomly assigned a polishing method -Plaque index, gingival bleeding, and extrinsic stain index were recorded. The data as a whole was obtained at baseline, after 7 days, and after 21 days. The data was analyzed with the SPSS software which provided the mean, standard deviation, standard error, and t-test which interpreted the results

-When evaluating plaque index, there was significant improvement from baseline to

significant?

7. What are strengths and/or limitations of the study? What recommendations were made?

immediately after, and 15 days after), showed a significant difference in the stats. -When evaluating the main purpose of the study between APP and RCP using the 3 separate stages, the stats did not show any significant difference between the two

-Some strengths of the study were the equal number of males to females, and the system used to analyze the data once recorded from baseline, immediately after, and 15 days after using SPSS software package -Some weaknesses/limitations of the study were that they scaled each individuals’ mouths before performing the study which caused some temporary gingival trauma.

day 7 which even further progressed at day 21 (65.83% of population increased). Gingival bleeding also showed significant improvement from baseline to day 7 and day 21 which increasingly progressed overtime (82.09% of the population increased). Stain index showed a significant improvement as well which progressed overtime (87.69% of population increased) -When evaluating the main purpose of the study between APP and RCP, APP showed more improvement than other quadrants in the plaque index portion of the study. All quadrants showed improvements regarding stain index and gingival bleeding index. Overall when looking at the data/graphs and charts, all quadrants showed improvements, but air polishing showed significant improvements in plaque index, gingival bleeding, and stain index compared to the other quadrants -The strengths of this study are that the sampling size was significantly larger than the first article I critiqued (100 individuals). This article is very similar to the first article critique but there is a difference between the results, and I think the significant increase in sampling size may have made the results differ since the first article was only 35 individuals. This article also references the first article

This could have been avoided if they did not perform scaling or maybe did a supragingival scale avoiding the gingiva entirely. The gingival trauma previously to the study, and the trauma caused by the polishing methods made the GI and SBI scores increase which was partly not caused by the study itself. Another limitation to the study would be the lack of negative control which goes hand in hand with recommendations that were made -Recommendations to future research were made by including randomized controlled trials that not only compare air polishers and rubber cup polishers, but also ultrasonic and piezo-scalers

8. Is this information useful for answering the PICO question? Explain why/why not.

-This information is useful in answering the PICO question, but more research has to be done on my part to see if any studies I come across have different responses instead of no difference between the two (APP and RCP)

I critiqued by Patil in 2015 but they state that this present study is not in accordance with the first study done. Another advantage to this study is that the wait period to assess the results was longer (21 days) which shows the long-term effects of the polishing methods -The weaknesses/limitations of this study are similar if not the same as the first study. This study scaled the individuals’ teeth before performing the study which again caused some temporary trauma to the gingiva as well as trauma from the polishing methods. This again could have been avoided if they did not perform scaling before the study was done -There were no recommendations made in this study -This information is useful in answering the PICO question because they did find evidence of one polishing agent over the other. This article, as said before, is very similar to the first article so finding separate articles not as related to each other might help me answer the PICO question more successfully...