Translational studies to evaluate plaque control interventions

Abstract

Clinical research should aim to broaden and translate the understanding of health and disease by designing and successfully implementing interventions to achieve healthcare improvement. This thesis reports clinical research that moves from laboratory to clinic and investigates the potential challenges of dissemination and adoption into clinical practice. Initially an established gingivitis was used as a model to evaluate a personalised plaque control intervention. The evaluation used traditional clinical monitoring techniques and pioneering laboratory technologies. Subsequently the personalised plaque control intervention was developed further and applied to a new clinical situation, the gingival manifestations of oral lichen planus. The personalised plaque control intervention was then evaluated as part of a randomised controlled trial using traditional clinically observed, patient-centred and health-economic outcome measures. Finally, a qualitative study investigated the potential barriers in disseminating research through continuing education to general dental practitioners. The research findings showed that in the established gingivitis model, sequential plaque control interventions, comprising powered toothbrushing and professional prophylaxis, were effective in reducing the clinical signs of established gingivitis. Changes in clinical signs were associated with a shift in bacterial species, and transient changes were observed in host inflammatory biomarker concentrations. Personalised plaque control was cost-effective and reduced clinical signs of inflammation and brought about improvements in quality of life for patients with gingival manifestations of oral lichen planus. The qualitative study identified barriers to the successful translation and implementation of contemporary clinical research. The plaque control intervention evaluated in the established gingivitis model and successfully implemented in a new clinical situation. Personalised plaque control should form part of the initial management phase for patients with gingival manifestations of oral lichen planus. Researchers should investigate alternative methods for engaging with general dental practitioners in disseminating research to ensure that relevant findings are translated into improvements in healthcare.