ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Hydrogen Peroxide Gel May Be Beneficial As A Conjunctive Treatment To Scaling And Root Planing To Enhance Reduction Of Pockets Depths In An Adult With Periodontitis
Clinical Question In an adult patient with periodontitis, does using hydrogen peroxide gel treatments in conjunction with scaling and root planing enhance reduction of pocket depths after a month of therapy more than scaling and root planing alone?
Clinical Bottom Line One RCT, with remaining questions of validity, showed patients with moderate to advanced periodontitis using hydrogen peroxide in conjunction with scaling and root planing reduces pocket depths more than scaling and root planing along. This is a single trial of only 31 patients. More research is needed to conclusively state this is a viable treatment option.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22779217Putt/201231 subjects with moderate to advanced periodontitis. Randomized Control Trial
Key resultsChanges in clinical attachment levels were not reported. Statistically significant improvement in pocket probing depth and bleeding were seen in patients treated with 1.7% hydrogen peroxide gel delivered by customized trays in conjunction with scaling and root planing compared to scaling and root planing alone. At 13 weeks the mean reduction in pocket probing depths was examined at all sites showing a mean reduction in the treatment group of 0.77mm and a mean reduction of 0.13mm in the control group; giving a p-value of < 0.0001. The treatment group had a mean reduction in bleeding index of 0.14, while the control group had a mean reduction of 0.0, giving a p-value of 0.0014.
Evidence Search ("Hydrogen Peroxide"[Mesh] AND "Periodontal Diseases"[Mesh]) AND "Periodontal Pocket"[Mesh]
Comments on
The Evidence
Validity: This is an industry-sponsored study leaving some question regarding validity of results. Putt enrolled 31 subjects, and 28 subjects finished the study, giving a 90% completion rate and had adequate compliance. 13 subjects were in the treatment group who received scaling and root planing in conjunction with 1.7% hydrogen peroxide gel delivered via a customize tray. 15 subjects were in the control group who only received scaling and root planing. The levels of reduction in probing depths for control sites greater than 5mm seems to be less than that typically seen in clinical trials. Similarly, the lack of improvement in bleeding index following conventional treatment draws question to the effectiveness of the control therapy. Further, there is no evidence reporting the number of involved sites per patient. This information is critical to appreciating the benefits of therapies provided. All subjects received scaling and root planing, but only the test group used custom trays. Perspective: Given the best available evidence, there is little support for this clinical approach at this time. This study did not look at clinical attachment loss or bone loss, which would be helpful to see the long-term effects. The analysis of only probing depths and bleeding on probing, in the absence of clinical attachment levels (CAL) and the absence of improvements in bleeding index in the control group, suggests that any effects seen are likely due to changes in inflammation of the marginal gingival tissues rather than gains in the base of the pocket. It is suspicious that this study did not consider CAL measurements, and if so, that they did not present them. Also, the use of trays and vehicle in control patients would have allowed a better understanding of the effects of this therapy. More research is needed to prove this is a viable treatment option.
Applicability All subjects were between 30-70 years old with at least 12 or more natural teeth. To qualify they had to have moderate to severe periodontitis, defined by at least 2 pockets measuring greater than 6mm in different quadrants.
Specialty/Discipline (General Dentistry) (Periodontics)
Keywords Periodontitis, hydrogen peroxide
ID# 2370
Date of submission: 02/25/2013spacer
E-mail pezzotti@livemail.uthscsa.edu
Author Cheryl Pezzotti Hansen
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Thomas Oates Jr., DMD, PhD
Faculty mentor/Co-author e-mail OATES@uthscsa.edu
Basic Science Rationale
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