Showing papers by "Nigel Pitts published in 2004"

Are we ready to move from operative to non-operative/preventive treatment of dental caries in clinical practice?

Abstract: This review focuses on the clinical interactions between patients and the dental team, not on caries prevention at a public health level. Many dentists no longer take a narrow surgical view seeking to apply interventive treatment as a one-off event at a certain trigger point of disease severity and the evidence that caries is an initially reversible, chronic disease with a known multi-factorial aetiology is being appreciated more widely. The caries process should be managed over time in an individualized way for each patient. Very few individuals can be considered to be truly 'caries free' when initial lesions as well as more advanced dentine lesions are considered. It is now very clear that, by itself, restorative treatment of the disease does not 'cure' caries. The caries process needs to be managed, in partnership with patients, over the changing challenges of a lifetime. The answer to the question posed in the title should be, in many cases, that we are ready to move to non-operative/preventive care (if we have not done so already). However, this should be for appropriate stages of lesion extent and in patients who respond to advice on recall frequency and preventive behaviours.

International Consensus Workshop on Caries Clinical Trials (ICW-CCT)--final consensus statements: agreeing where the evidence leads.

Abstract: the Workshop objectives, a brief summary of the context of the discussions is given. These are followed by the agreed consensus statements. In the aggregate, these sequential statements represent the consensus achieved by the Workshop participants. It is hoped that the ICW-CCT proceedings and consensus statements will provide increased understanding and guidance for the future conduct of caries clinical trials.

Modern concepts of caries measurement

Abstract: Following the consideration of several recent systematic and other reviews, there is a growing professional and scientific consensus that caries measurement methodology in caries clinical trials (CCT) should be updated to reflect progress made elsewhere in cariology. In this paper, therefore, "modern" means accepted in contemporary dental research and dental practice on the basis of sound research evidence--not necessarily new or requiring the use of new technology. Caries measurement should be seen in the context of the objectives of modern clinical caries management and the continuum of disease states, ranging from sub-surface carious changes through to more advanced lesions. Measurement concepts can be applied to at least three levels: the tooth surface, the individual, or the group/population. All are relevant to CCTs. Modern clinical caries management can be seen as comprised of seven discrete but linked steps (Steps 2, 3, and 4 are directly concerned with measurement.): (1) 'Caries detection' represents a yes/no decision as to whether caries is present; (2) lesion measurement assesses defined stages of the caries process, taking into account the histopatholgical morphology and appearance of different sizes and types of lesion and the diagnostic threshold(s) being used; (3) lesion monitoring by repeated measures at a series of examinations is used when lesions are less advanced than the stage judged to require operative intervention (A comparison of serial measurements permits the efficacy of preventive care aiming either to arrest or to reverse the lesion to be assessed.); (4) caries activity measures would be very valuable, but are relatively poorly developed and tested at present; (5) diagnosis, prognosis, and clinical decision-making are the important human processes in which all the information obtained from steps 1 to 4 is synthesised; (6) interventions/treatments, both preventive and operative, are now routinely used for caries management; and (7) outcome of caries control/management assesses caries management by examining evidence on the long-term outcomes. A challenge for the future is to define a range of optimal caries measurement methods--in use or in development in recent trials, in clinical practice, and/or in caries epidemiology--that will best contribute to more efficient, modern caries clinical trials.

Dental Recall. Recall Interval between Routine Dental Examinations

Abstract: Acknowledgements v Stakeholder Organisations vii Abbreviations used in Guideline ix 1 Introduction 1 1.1 Background 1 1.2 What is a guideline? 2 1.3 Remit of the Guideline 3 1.4 What the guideline covers 3 1.5 What the guideline does not cover 3 1.6 Who developed the guideline? 3 1.7 Guideline Methodology 4 1.7.1 Outline of methods used 4 1.7.2 Questions addressed in developing the guideline 4 1.7.3 Systematic Review Methods for Key Clinical Questions 5 1.7.4 Hierarchy of evidence 6 1.7.5 Health economics methods 6 1.7.6 Forming and grading the recommendations 7 2 Clinical effectiveness and cost-effectiveness of routine dental checks (HTA update) 9 2.1 Characteristics of the Included Studies 9 2.1.1 Characteristics of the study settings and study design 9 2.1.2 The accuracy of clinical oral examinations in detecting oral cancer and potentially malignant conditions 31 3.3.5 Toluidine blue dye 31 3.3.6 Potentially malignant lesions and conditions 31 3.4

Effectiveness of strategies to disseminate and implement clinical guidelines for the management of impacted and unerupted third molars in primary dental care, a cluster randomised controlled trial.

Abstract: Objective To investigate the effectiveness and cost-effectiveness of different guideline implementation strategies, using the Scottish Intercollegiate Guidelines Network (SIGN) Guideline 42 'Management of unerupted and impacted third molar teeth' (published 2000) as a model. Design A pragmatic, cluster RCT (2×2 factorial design). Subjects Sixty-three dental practices across Scotland. Clinical records of all 16—24-year-old patients over two, four-month periods in 1999 (pre-intervention) and 2000 (post-intervention) were searched by a clinical researcher blind to the intervention group. Data were also gathered on the costs of the interventions. Interventions Group 1 received a copy of SIGN 42 Guideline and had an opportunity to attend a postgraduate education course (PGEC). In addition to this, group 2 received audit and feedback (A and F). Group 3 received a computer aided learning (CAL) package. Group 4 received A and F and CAL. Principal outcome measurement The proportion of patients whose treatment complied with the guideline. Results The weighted t-test for A and F versus no A and F (P=0.62) and CAL versus no CAL (P=0.76) were not statistically significant. Given the effectiveness results (no difference) the cost effectiveness calculation became a cost-minimisation calculation. The minimum cost intervention in the trial consisted of providing general dental practitioners (GDPs) with guidelines and the option of attending PGEC courses. Routine data which subsequently became available showed a Scotland-wide fall in extractions prior to data collection. Conclusion In an environment in which pre-intervention compliance was unexpectedly high, neither CAL nor A and F increased the dentists' compliance with the SIGN guideline compared with mailing of the guideline and the opportunity to attend a postgraduate course. The cost of the CAL arm of the trial was greater than the A and F arm. Further work is required to understand dental professionals' behaviour in response to guideline implementation strategies.

Understanding the jigsaw of evidence-based dentistry: 1. Introduction, research and synthesis.

Abstract: Understanding the jigsaw of evidence-based dentistry: 1. Introduction, research and synthesis

Understanding the jigsaw of evidence-based dentistry. 2. Dissemination of research results.

Abstract: The first part of this three-part series provided an overview and a definition of evidence-based dentistry (EBD).1 Having introduced the EBD matrix, part one concentrated on the research synthesis part of the jigsaw puzzle. Now we focus on the middle row of this puzzle, the dissemination of research results. The final part of this series, to be published in a forthcoming issue, will consider the bottom row of the EBD matrix, the implementation of research findings in clinical practice.

Understanding the jigsaw of evidence-based dentistry. 3. Implementation of research findings in clinical practice

Abstract: Part one1 of this three-part series provided an overview of evidence-based dentistry (EBD), provided one definition of EBD and, having introduced the EBD matrix, concentrated on the research synthesis part of the jigsaw puzzle. Part two2 focused on the middle row of this puzzle, the dissemination of research results. This final article deals with perhaps the most vital but the most often overlooked element of the puzzle: implementation of research findings in clinical practice.

The dental caries experience of 14-year-old children in England and Wales. Surveys co-ordinated by the British Association for the Study of CommunityDentistry in 2002/2003

Abstract: Objective This paper reports the results of standardised clinical caries examinations of 77,693 14-year-old children from across England, Wales, Jersey and the Isle of Man. These 2002/3 coordinated surveys are the latest in a series which seeks to monitor the dental health of children and to assess the delivery of dental services. Method The criteria and conventions of the British Association for the Study of Community Dentistry were used. Representative samples were drawn from participating health authorities and boards and caries was diagnosed at the caries into dentine (D 3 ) threshold using a visual method without radiography or fibre-optic transillumination. Results These demonstrated, once again, a wide variation in prevalence across the area surveyed, with mean values for D 3 MFT for the current English government offices (of the National Health Service) and the local Health Boards in Wales ranging from 0.99 in the South East to 2.10 in Wales (2.41 in the Isle of Man). The mean value for across England and Wales was 1.48 (D 3 T=0.56, MT=0.10, FT=0.82). Overall 49 per cent of 14-year-old children in England and Wales had evidence of dentinal caries experience (D 3 MFT> 0), the regional / country means ranged between 37 per cent (South - East) and) and 60 percent in Wales (65 per cent, Isle of Man). The mean D 3 MFT for those with disease at this threshold was 3.03. Trends over time demonstrate an improvement of 4% in overall D 3 MFT for England and Wales, there has been only small improvement in mean MT since 1994/95, while FT and care index have fallen. The number of fillings provided in 2002/3 and thus the care index, remains low, on average across England and Wales, only 55% of the dentinal caries experience identified by survey examinations of permanent teeth was seen as fillings (range in individual areas: 28% to 83%). Conclusion these findings demonstrate a modest overall improvement in oral health, but a continuing need for more effective preventive strategies and treatment services for permanent teeth in this important age group. An average of half of the 14 year old children examined being affected by dentinal decay and a mean of three permanent teeth decayed into dentine for those children affected at this level of diagnosis is a poor start to charting oral health in the 21 s t Century in England and Wales.

Virtual centre for improving oral health — vC-IOH

Abstract: The virtual centre The virtual ‘Centre for Improving Oral Health through Evidence-Based Dentistry’ (vC-IOH) has been established by a unique non-competitive networking of four UK units that have a long history in the advocacy and use of evidence-based methods. The core groups are: K CEBD — the Centre for Evidence-Based Dentistry (Oxford): The CEBD provides training and disseminates information via both a website and this, the most widely distributed evidence-based dental journal, Evidence-Based Dentistry. K COHG — the Cochrane Oral Health Group (Manchester): The Oral Health Group of the Cochrane Collaboration is an international group that undertakes systematic reviews of literature, covering all randomised controlled trials of oral health. K DHSRU — the Dental Health Services Research Unit (Dundee, Scotland): Members of the unit have been involved in the development of evidence-based guidelines for the Scottish Intercollegiate Guidelines Network, the Faculty of General Dental Practitioners (FGDP) and the National Institute of Clinical Excellence. DHSRU currently leads the development of the National Health Service’s (NHS) Dental Clinical Care Pathways programme under the ‘Options for Change’ initiative in England. K WOHIU — the Welsh Oral Health Information Unit (Cardiff, Wales): Members of the unit have been involved in several high-profile systematic reviews, most notably the York review of water fluoridation. Currently WOHIU are responsible for leading development of the National Electronic Library for Health Oral Health Specialist Library.