Showing papers in "Evidence-based Dentistry in 2004"

The TREND Statement

Abstract: Readers will be familiar with the CONSORT guidelines for the reporting of randomised controlled trials. These guidelines were designed to improve the reporting of RCTs and are of considerable use to researchers designing and reporting studies as well as to editors and to systematic reviewers. However, a major limitation of CONSORT is that they are limited to RCTs and there are far more research designs than RCTs. Some topics just cannot be investigated using RCTs and yet it may often be desirable to try to identify whether or not there is a causal link between two factors. It is therefore very welcome to see the development of the TREND statement (www.trend-statement.org/asp/trend.asp) — the Transparent Reporting of Evaluations with NonRandomised designs. As the authors state these guidelines are developing — there is room for alteration and improvement but their prime focus is to encourage the transparency or clarity of reporting. In view of the evolutionary state of these guidelines, I would encourage researchers, editors and reviewers to become familiar with them and to start using them. As they are used, areas, primarily of omission, will become apparent. The first area that needs expanding, in my opinion, is that more detail is required describing the characteristics of each population subgroup. I consider that more prominence of the potential for confounding factors needs to be acknowledged. As CONSORT has helped both investigators and reviewers improve the quality of RCTs and systematic reviews there is the possibility for TREND to do the same

10 years after

Abstract: On 14 December, 10 years ago, Alan Lawrence, the founding editor of Evidence-Based Dentistry, and I organised a workshop on evidence-based dental practice at Templeton College, Oxford. We were spurred on in our activities by David Sackett, who had recently arrived in Oxford to establish the Centre for Evidence-based Medicine, and Muir Gray, who was then the Director of Research and Development at Oxfordshire Regional Health Authority and is now the Programme Director of the UK National Health Service's National Electronic Library for Health (NeLH).

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.

The quality of systematic reviews in dentistry.

Abstract: DATA SOURCES Sources of reviews were the Database of Reviews of Effectiveness (DARE) and completed systematic reviews registered by the Cochrane Oral Health Group in the Cochrane Library. STUDY SELECTION All systematic reviews that examined the effectiveness of interventions for oral, dental and craniofacial disorders and diseases were eligible for inclusion. DATA EXTRACTION AND SYNTHESIS A quality assessment checklist was completed for each study. RESULTS A total of 115 studies were identified, of which 65 were relevant to the review. The area most frequently evaluated within the reviews was pain relief or prevention (20 out of 65, ie, 31%) followed by caries, and oral medicine. The quality assessment of the systematic reviews identified highlighted key areas where improvements could be made. One major weakness was that the search strategies employed in reviews were not always adequate: only 12 reviews (19%) demonstrated an attempt to identify all relevant studies. Other areas of weakness include the screening and quality assessment of primary studies, the pooling of data and examination of heterogeneity, and the interpretation of findings. CONCLUSIONS The quality of systematic reviews in dentistry could be improved. If future clinical decisions are to be based upon systematic reviews, it is imperative that reviews address clinically-relevant, focused questions, and follow a transparent, well-designed protocol.

Periodontal disease and cardiovascular disease

Abstract: Data sources Medline (1980–present) and bibliographic citations from each article were consulted to find relevant studies. Study selection Analyses were restricted to cohort studies published between 1980 and February 2001 so that any effects of secular trends could be minimised. Studies were included if sample size was over 100 and if the ascertainment of exposure before outcome provided relative risk (RR) and confidence intervals (CI), or enough information to calculate these. Data extraction and synthesis Studies were reviewed by two dentists and two physicians. The RR, CI and standard errors were extracted or calculated. The quality of studies was assessed with a combination of modified Liddle's criteria. Homogeneity was assessed with Q statistics and the data were analysed using a random-effects model. Results The summary RR was 1.19 (95% CI, 1.08–1.32), indicating a higher risk of future cardiovascular events in individuals who had periodontal disease than in those who did not. In an analysis stratified to individuals of ⩽65 years of age, the RR was 1.44 (95% CI, 1.20–1.73). Conclusions Periodontal disease appears to be associated with a 19% increase in the risk of future cardiovascular disease (CVD). This increase in RR is more prominent (44%) in individuals under 65 years of age. The increment of risk between subjects with or without periodontal disease in the general population is modest, at around 20%, because nearly 40% of population has periodontal disease. This modest increase may have a profound public health impact, however.

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 Oxford Pain Group League table of analgesic efficacy

Abstract: The two Canadian Collaboration on Clinical Practice Guidelines in Dentistry (CCCD) discussed in this issue of Evidence-Based Dentistry recommend the use of analgesics rather than antibiotic therapy for acute apical abscess where drainage cannot be achieved immediately, or in the treatment of acute apical periodontitis. Linked to this we have reproduced the Oxford League Table of Analgesic Efficacy: this is also freely available from the Oxford Pain Group internet site (www.jr2.ox.ac.uk/ bandolier/booth/painpag/index2.html) see Figure 1. Table 1 has been developed over many years by the Oxford Pain Research Group. The information in the table has been derived from a large number of systematic reviews of randomised, doubleblind, single-dose studies in patients who had moderate to severe pain. Each of the reviews has the same outcome measure, at least 50% pain relief over 4–6 h. The pain measurements were standardised, and have been validated. Numbers-needed-to-treat are calculated for the proportion of subjects who had at least 50% pain relief over 4–6 h compared with placebo in randomised, double-blind, and single-dose studies in people with moderate to severe pain. Drugs were oral, unless specified, and doses are given in milligrams. The relevance of this table to acute dental pain has been raised in this journal before in an editorial by Moore et al, when the author noted that dental pain is no different from other acute pain models.

Some evidence that fluoride during orthodontic treatment reduces occurrence and severity of white spot lesions

Abstract: Some evidence that fluoride during orthodontic treatment reduces occurrence and severity of white spot lesions

Hypotensive anaesthesia and blood loss in orthognathic surgery.

Abstract: Objective This trial aimed to determine whether hypotensive anaesthesia reduces blood loss during orthognathic surgery. Design Randomised trial. Intervention Subjects were allocated to hypotensive (24 patients) or normotensive (29 patients) groups, assigned by sealed envelope, before undergoing standard orthognathic procedure. Outcome measure Median blood loss was measured. Results A significant reduction in blood loss was seen with hypotensive anaesthesia (see Table 1). Conclusions There was pronounced reduction in blood loss during orthognathic procedures carried out under hypotensive anaesthesia.

Postal reminders can improve attendance at orthodontic clinics.

Abstract: Design A randomised controlled trial in an NHS hospital orthodontic clinic. Intervention Participants either received an appointment or an appointment plus a reminder at least 2 weeks before their appointment. The reminder letter was sent with a stamped addressed postcard, which the patient was asked to return, to confirm the appointment. Outcome measure Patient attendance at the clinic. Results A total of 231 patients were entered into the study. Patients who received a reminder and returned the confirmation were significantly less likely to fail the appointment than those who did not receive a reminder (see Table 1). 27% of girls failed appointments compared with 15% of boys. Those from areas of high social deprivation were more likely to fail to attend appointment than people who were more affluent. Conclusions The use of postal reminders for orthodontic consultation appointments appears to result in a useful increase of appointments that are kept or cancelled in advance but does not counteract the effect of social deprivation on attendance.

Benefits of topical fluorides firmly established.

Abstract: Data sources The Cochrane Oral Health Group’s Trials Register the Cochrane Centre Register of Controlled Trials (CENTRAL), Medline, EMbase, SciSearch, Social SciSearch (ISTP Index to Scientific and Technical Proceedings), Biosis, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ERIC (Educational Resources Information Centre) define, Dissertation Abstracts and LILACS/BBO (Latin American and Caribbean Health Science Information Database), databases were used, along with searches by hand of relevant journals and the reference lists of included articles. Selected authors and manufacturers were also contacted. Study selection Randomised or quasi-randomised controlled trials were chosen that had blind outcome assessment and compared fluoride varnish, gel, mouthrinse or toothpaste with placebo or no treatment in children aged up to 16 years over at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces [D(M)FS]. Data extraction and synthesis Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one-third of studies, and consensus was achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF), that is, the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. Random-effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random-effects metaregression analyses. Results Of the 144 studies included, 133 contributed data for meta-analysis (involving 65 169 children). The D(M)FS pooled PF estimate was 26% (95% confidence interval (CI), 24–29%; P<0.0001). There was substantial heterogeneity, which was confirmed statistically (P<0.0001), but the direction of effect was consistent. The effect of topical fluoride varied according to type of control group used, type of TFT, mode/setting of TFT use, initial caries levels and intensity of TFT application, but was not influenced by exposure to water fluoridation or other fluoride sources. The mean D(M)FS PF was on average 14% (95% CI, 5–23%; P=0.002) higher in non-placebo controlled trials, and likewise was 14% (95% CI, 2–26%; P=0.25) higher in fluoride varnish trials compared with all others. It was 10% lower (95% CI, −17 to −3%; P=0.003), in trials of unsupervised home use compared with self-applied supervised and operator-applied TFT. There was a 0.7% increase in the PF per unit increase in baseline caries (95% CI, 0.2–1.2%; P=0.004). The numbers needed to treat (NNT) in deciduous and permanent teeth are shown in Table 1 and pooled estimates of the treatment effects of different types of TFT in Table 2. Conclusions The benefits of topical fluorides have been firmly established on a sizeable body of evidence from randomised controlled trials. Although the formal examination of sources of heterogeneity between studies has been important in the overall conclusions reached, these should be interpreted with caution. No definite conclusions about any adverse effects that might result from the use of topical fluorides could be reached because such data from the trials are scarce.

Orthodontic treatment has little to do with temporomandibular disorders.

Abstract: Data sources Studies were sourced using Medline, reference lists of identified articles and a list of published and unpublished articles compiled by RG Behrents (Professor and head of orthodontics at St. Louis University).

Effectiveness of screening for oral cancer not proven.

Abstract: Data sources Electronic databases (Medline, Cancerlit, Embase, the Cochrane Central Register of Controlled Trials) from 1966 to September 2002 and the Cochrane Library up to issue 2 in 2002 were searched. Searches by hand of specific journals and bibliographies were also made and corresponding authors contacted to identify published and unpublished work. Study selection Studies were required to be randomised controlled trials (RCT) that screened for oral cancer or potentially premalignant oral lesions using visual examination, toluidine blue, fluorescence imaging or brush biopsy. Data extraction and synthesis Data were extracted independently by two reviewers. Results Only one RCT met the review's inclusion criteria. This one ongoing trial has 13 clusters of 153 708 eligible subjects and 130 799 included subjects. There was no difference in the age-standardised oral cancer mortality rates for the screened group (21.2/100 000 person–years) and the control group (21.3/100 000 person–years). This study has some methodological weaknesses, however. Conclusions Given the limited evidence (only one RCT) and the potential methodological weakness in that study, it is not possible to say whether there is evidence to support or refute the use of a visual examination as a method of screening for oral cancer in the general population. Furthermore, no robust evidence exists to suggest whether other methods of screening — toluidine blue, fluorescence imaging or brush biopsy — are either beneficial or harmful. Further cost-effective, high-quality studies to assess the efficacy and effectiveness of screening are required. In addition, studies to elucidate the natural history of oral cancer, prevention methods and the effectiveness of opportunistic screening in high-risk groups are needed.

The CCCD guidelines.

Abstract: Clinical practice guideline on emergency management of acute apical periodontitis (AAP) in adults

Does Splint Therapy Work for Temporomandibular Pain

Abstract: Data sources The Cochrane Oral Health Group’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Library Issue 2 from 2003, Medline and Embase were all data sources. Relevant journals were also searched by hand and the reference lists of chosen studies were screened. Experts in the field were contacted and there were no language restrictions. Study selection To be selected, the studies had to be randomised controlled trials (RCT) or quasi-RCT, in which splint therapy was compared concurrently with no treatment, other occlusal appliances or any other active intervention. Data extraction and synthesis Data extraction was carried out independently and in duplicate. Validity assessment of the chosen trials was carried out at the same time as data extraction. Discrepancies were discussed and a third reviewer consulted. The author of the primary study was contacted where necessary. The studies were grouped according to treatment type and duration of follow-up. Results Twenty potentially relevant RCT were identified. Eight were later excluded, leaving 12 trials for analysis. Stabilisation splint therapy (SS) was compared with: acupuncture, bite plates, biofeedback/stress management, visual feedback, relaxation, jaw exercises, non-occluding appliance and minimal/no treatment. There was no evidence of a statistically significant difference in the effectiveness of SS in reducing symptoms in patients with pain dysfunction syndrome (PDS) compared with other active treatments. There was weak evidence to suggest that the use of SS for the treatment of PDS may be beneficial for reducing pain severity, at rest and on palpation, compared with no treatment. Conclusions There is insufficient evidence either for or against the use of SS for the treatment of temporomandibular PDS. This review suggests the need for further, rigorous RCT that consider the method of allocation and outcome assessment, have large sample size and sufficient duration of follow-up. A standardisation of the outcomes of the treatment of PDS should be established in the RCT.

Third molars may double the risk of an angle fracture of the mandible

Abstract: Data sources Medline, Embase and references of relevant articles. Study selection Reports were selected if they were cohort studies reporting mandibular angle fractures in people with and without third molars. Case–control studies and case series that provided information about the proportion of people who had a third molar among the total suffering angle fractures and those without angle fractures were included. Data extraction and synthesis Odds ratios and 95% confidence intervals were calculated from study data and results summarised using Mantel–Haenszel fixed-effects models and DerSimonian and Laird random-effects model. Formal heterogeneity tests were also carried out. Results Six studies, all case series and involving 3002 patients with mandibular fractures, met the inclusion criteria (see Table 1). Crude relative risk estimates for an angle fracture, comparing patients with a third molar with those without, ranged from 1.2 to 12.7. There was significant heterogeneity across the six studies (P=0.001), but when two less methodologically rigorous studies were excluded this was no longer the case (P=0.22). Conclusions The presence of a lower third molar may double the risk of an angle fracture of the mandible. This could have a bearing on any clinical decision on whether to extract the molar.

Limited evidence supports use of oral appliances in obstructive sleep apnoea.

Abstract: Data sources Medline was searched for articles dated 1966–July 2003, along with the Cochrane Airways Group Sleep Apnoea Randomised Controlled Trials Register and reference lists of relevant articles. Study selection Studies were included if they were randomised trials that compared oral appliance (OA) with control or other treatments in adults who had sleep apnoea. Data extraction and synthesis Trial quality was assessed and two reviewers extracted data independently. Study authors were contacted for missing information. Results Twelve trials were included, involving 509 participants. All the studies had some methodological shortcomings. Overall, OA use improved the apnoea–hypopnoea index (AHI) more than inactive control. The AHI for the former was −13.17 (95% confidence interval (CI), −18.53 to −7.80) in parallel group data from four studies. Use of an OA reduced daytime sleepiness in two trials, giving a weighted mean difference (WMD) of −1.77 (95% CI, −2.91 to −0.62). OA use was less effective than continuous positive pressure in reducing the AHI (respectively giving a WMD of 13 (95% CI, 7.63−18.36) in parallel studies from two trials and of 6.75 (95% CI, 4.93−8.57) in crossover studies from six trials). No significant difference was observed on symptom scores (data from three trials), however. Nasal continuous positive airway pressure (nCPAP) was more effective at improving minimum arterial oxygen saturation during sleep compared with OA use. In two small crossover studies, participants preferred OA therapy to nCPAP. Conclusions There is limited evidence that suggests OA use improves subjective sleepiness and sleep-disordered breathing compared with control. nCPAP is apparently more effective in improving sleep-disordered breathing than OA use. Until there is more definitive evidence on the effectiveness of OA, it is probably appropriate to restrict OA therapy to patients who have sleep apnoea but are unwilling or unable to comply with nCPAP therapy.

Sealants recommended to prevent caries.

Abstract: Top of pageAbstract Data sources Sources of studies were the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials, Medline, Embase, Scisearch, SIGLE (System for Information on Grey Literature in Europe) CAplus¥, INSPEC*, JICST-EPLUS, NTIS, PASCAL, Database of Abstracts and Reviews (DARE), the UK National Health Service Economic Evaluation Database and Health Technology Assessment database. Reference lists from included articles and review articles were searched for additional relevant publications. All relevant studies in most languages were considered and translated. Study selection Articles were selected for inclusion in the review if they were randomised or quasi-randomised controlled trials of at least 12 months in duration and if sealants were used for preventing caries in children and adolescents of under 20 years of age. Both parallel group and split-mouth study designs were included. The primary outcome was the increment in the numbers of carious occlusal surfaces of premolars and molars. Data extraction and synthesis In the first phase, two reviewers independently examined whether a given study was likely to be relevant on the basis of the title, keywords and abstract. In the second phase, four of the reviewers independently classified whether studies would be included in final analyses. Study authors were contacted for additional information. In the split-mouth studies, relative risk (RR) ratios were calculated for the paired differences of tooth surfaces being carious or not. In studies that compared resin-based sealant with no treatment, fixed-effect meta-analyses were used to combine the estimates of RR ratios. In one parallel-group study, the effect-estimate was calculated from data of occlusal surfaces of teeth included in the test and control groups. Results Eight trials were included in this review, of which seven were split-mouth studies and one a parallel-group study. Six studies provided data for comparing sealant with no treatment and three studies compared glass ionomers (GI) with resin-based sealants. The overall effectiveness of resin-based sealants in preventing dental decay on first molars was high. Based on five split-mouth studies with 5–10-year-old children there were significant differences in favour of the second-generation resin sealant compared with no treatment. Pooled RR values were 0.14, 0.24, 0.30 and 0.43 at 12, 24, 36 and 48–54 months, respectively. The reductions in caries therefore ranged from 86% at 12 months to 57% at 48–54 months. The 24-month parallel group study that compared second-generation resin sealant with control in 12–13-year old children also found significantly more caries in the control group children with a DFS of 0.65 (95% confidence interval, 0.47–0.83). Allocation concealment was classified as adequate in three of these six studies. The information on background levels of caries in the population, however, was insufficient to conduct further analyses that would allow an estimate of the effect of resin-based sealants related to baseline caries prevalence. Only one study provided data for the comparison of GI sealant and control. Based on this, there is not enough information to say whether GI sealants are effective or not. The results of three studies comparing resin sealants with GI sealants were conflicting and the meta-analyses were not carried out. Conclusions Sealing with resin-based sealants is recommended to prevent caries of the occlusal surfaces of permanent molars but we recommend that the caries prevalence level of both the individual and population should be taken into account. In practice, the benefit of sealing should be considered locally and specific guidelines for clinicians should be used. The methodological quality of published studies concerning pit and fissure sealants was poorer than expected.

Centre for Health Information Quality.

Abstract: The Centre for Health Information Quality (CHIQ; www.hfht.org/chiq), was established in 1997 by the UK government's Department of Health. CHIQ acts as a clearing house for all aspects of patient information, providing practical advice to the UK National Health Service (NHS) and others about the production of good quality information for patients.

Early treatment with the twin-block appliance is effective in reducing overjet and severity of malocclusion

Abstract: Early treatment with the twin-block appliance is effective in reducing overjet and severity of malocclusion

Very few indications justify early treatment for severe Class II malocclusions

Abstract: Design This was a single-centre two-phased, parallel, randomised clinical trial (RCT) conducted over a period of more than 10 years. Intervention Children were enrolled who had severe (=7 mm overjet) Class II malocclusions and who were developmentally at least a year before their peak pubertal growth. During the first phase of the trial, the children were randomly assigned to either treatment starting in the mixed dentition (either combination headgear or a modified bionator) or to observation only. Phase-1 treatment was carried out by an orthodontist according to a standardised protocol. Records for all children were made again after 15 months. A second phase of comprehensive fixed-appliance treatment was planned for all the children when they had early permanent dentition. The children were then randomised, within their phase-1 treatment group, to one of four orthodontists for completion of orthodontic treatment (see Figure 1). Outcome measure Primary outcomes were a restricted set of 11 cephalometric measures used to describe the position and relationship of the maxillary and mandibular skeletal and dental units. Secondary outcomes included the alignment and occlusion of the teeth [peer assessment rating (PAR) scores], the duration of treatment, and the proportion of children who required more complex treatment involving extractions or orthognathic surgery. Results Of the 166 children who completed the first phase of the trial, 137 completed phase-2 with one of the four finishing clinicians. After the second phase, early treatment had little effect on the subsequent treatment outcomes — measured as skeletal change, alignment and occlusion of the teeth, or length and complexity of treatment. The differences created between the treated children and untreated control group by phase-1 treatment before adolescence disappeared when both groups received comprehensive fixed-appliance treatment. Conclusions This RCT suggested that two-phase treatment started before adolescence in the mixed dentition might not be any more clinically effective than a single-phase treatment started during adolescence in the early permanent dentition. Early treatment also appears to be less efficient, in that it produced no reduction in the average time a child is in fixed appliances during a second stage of treatment, and it did not decrease the proportion of complex treatments involving extractions or orthognathic surgery.

Studies suggest alternatives to amalgam as a retrograde filling material for apicectomy.

Abstract: Data sources Sources were Medline and the Cochrane Library. Study selection Studies included were in vivo with human subjects, had experimental and control groups, and gave quantitative results in English, German or French. Data extraction and synthesis Success and failure rates were derived from randomised controlled trials (RCT), clinical controlled trials (CCT), cohort studies (CS) and case-controlled studies (CCS). Qualitative synthesis of results was performed. Results Two RCT, six CCT and 14 CCS were identified. The two RCT suggest that glass ionomer may be more effective than amalgam, conversley one CCT showed amalgam to be more effective. CCTs also suggest that EBA (reinforced zinc oxide eugenol) cement, composite with GLUMA (Bayer AG., Leverkusen, Germany) and gold leaf retrograde filling may be more effective than amalgam. A further CCT suggested that gutta-percha used as a retrograde filing is less effective than when used following an orthograde approach. Conclusions Based on the outcome of two RCT, glass ionomer appears as effective as amalgam. EBA cement, composite with GLUMA and gold leaf and orthograde gutta-percha may also be as effective as amalgam. Evidence is limited, however, and further research is needed.

The effectiveness of fissure sealants.

Abstract: Data sources Sources were Medline, the Cochrane Library, reference lists of identified articles and selected textbooks. Study selection Selected studies were randomised clinical trials (RCT), quasi-RCT or controlled clinical trials that compared fissure sealing with no treatment or another preventive treatment, in children of up to 14 years of age at the beginning of study, with clearly described diagnostic criteria, and with at least 2 years follow-up. Studies reported in Danish, English, French, German, Italian, Norwegian, Spanish or Swedish were considered. Data extraction and synthesis Inclusion decisions and grading of the studies was done independently by two of the authors. The main outcome was caries increment and the measure of treatment effect was either relative risk (RR) reduction or prevented faction. A pooled estimate was calculated for studies using resin-based materials. Results Thirteen studies were included, eight of which used resin-based material and were selected for meta-analysis. The pooled estimate of effect for a single application of resin-based sealant on first permanent molars showed the RR of developing caries in sealed teeth relative to controls was 0.67 (95% confidence interval, 0.55–0.83), a reduction in RR of 33%. For repeated applications, the reduction in RR varied from 69 to 93%. Conclusions The review provides limited evidence that fissure sealing of first permanent molars with resin-based materials has a caries-preventive effect. The evidence is incomplete for second permanent molars, premolars and primary molars and for glass ionomer cements. Overall, there remains a need for further trials of high quality, particularly in child populations of both low and high caries risk.

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.

Functional appliances and mandibular growth--is there an effect?

Abstract: Data sources A MEDLINE search strategy for the years 1966 to 1999 was developed. The search was limited to randomised controlled trials (RCT) and meta-analyses, which were performed on humans and written in English. Study selection Articles retrieved were critically appraised for their validity. For inclusion, an article had to meet four of seven validity standards and also the following criteria: it pertained to functional appliance use in the early treatment of Class II malocclusions; it was an RCT; and it included measurable mandibular cephalometric values. Data extraction and synthesis Cephalometric values were used to assess mandibular growth in the horizontal and the vertical dimensions. The following linear measures were assessed: condylion–pogonion (Co–Pg), articulare–pogonion (Ar–Pg), condylion–gnathion (Co–Gn), articulare–gnathion (Ar–Gn), sella–gonion (S–Go), articulare–gonion (Ar–Go), and condylion–gonion (Co–Go). Two angular parameters, sella-nasion-B point (SNB) and lower incisal angle (LIA), were also measured. Three horizontal measurements were also used in some of the studies examined, namely: gonion–menton (Go–Me), pogonion–N (Pg–N), and gonion–pogonion (Go–Pg). Annualised changes (linear or angular) in specific cephalometric data were pooled from the selected articles and then compared and plotted. Statistical significance was tested through analysis of variance, the Student’s t-test for paired data and 95% confidence intervals. Results The search identified 17 articles of which six met the inclusion and validity criteria. There was a significant difference between the control and the treated groups for Ar–Pg and Ar–Gn. No other horizontal or vertical cephalometric measurements were statistically significant. Conclusions It is currently difficult to obtain definitive answers about efficacy of functional appliances on mandibular growth because of many inconsistencies in measuring the treatment outcome variables. There is still a need to conduct more RCT to reduce the methodological limitations.

Informed Health Online

Abstract: The Informed Health Online website www.informedhealthonline.org/ is produced by the Health Research and Education Foundation, a non-profit-making health-promotion charity based in Melbourne, Australia. It aims to provide information and tools that enable people to keep up-to-date with reliable, evidence-based information.

Common complications with implants and implant prostheses

Abstract: Data sources English language articles were sourced in MEDLINE. Study selection To be included in the review, published articles must have presented clinical data that identified the number of implants/ prostheses being evaluated, how long they had been in place, and how many were affected by complications. Data extraction and synthesis Publications were grouped according to each category of complication (surgical, implant loss, bone loss, peri-implant soft tissue, mechanical and aesthetic/phonetic). The types of complications in each category were identified. The raw data for a particular complication were combined and a mean incidence of complications was calculated. The mean values for each complication were compared for the purpose of establishing a trend, allowing ranking of complications. For a specific complication to be included in this, three or more studies must have reported data related to the incidence of that particular complication. Results The most common implant complications identified are shown in Table 1. Conclusions It was not possible to calculate an overall incidence of complications for implant prostheses because there were not multiple clinical studies that simultaneously evaluated all or most of the categories of complications. Although the implant data had to be obtained from different studies, they do indicate a trend toward a greater incidence of complications with implant prostheses than single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, and posts and cores.

Questions and Answers and Guidelines in EBD Volume 5

Abstract: In the previous years, we have outlined the questions and answers addressed by summaries in EBD1, 2. Here we list the two guidelines, 39 questions, answers and evidence levels of areas addressed in EBD volume five. Evidence levels3 are only given for those papers achieving level 3A and above.

Smokeless tobacco use is associated with a substantial risk of oral cancers in India.

Abstract: Data sources Medline, Embase, CINAHL and Dissertation Abstracts were searched, supplemented by screening reference lists, smoking-related websites, and contacting experts. Study selection Analytical observational studies of use of smokeless tobacco (ST; cohorts, case–control, cross-sectional studies) with a sample size of ≥500 were included if they reported on one or more of the following outcomes: mortality from any cause, oral and pharyngeal cancers, other cancers, cardiovascular diseases, dental diseases, pregnancy outcomes or surgical outcomes. Data extraction and synthesis Data extraction covered control of confounding, selection of cases and controls, sample size, clear definitions and measurements of the health outcome, and ST use. Selection, extraction and quality assessments were carried out by one or two independent reviewers. Results Many of the studies lacked sufficient power to estimate precise risks, mainly because of the small number of ST users. Studies were often not designed to investigate ST use, and many also had major methodological limitations including poor control for cigarette smoking and imprecise measurements of exposure. Studies in India showed a substantial risk of oral or oropharyngeal cancers associated with chewing betel quid and tobacco. Studies from other regions and of other cancer types were not consistent. Few studies have adequately considered the non-cancer health effects of ST use. Conclusions Chewing betel quid and tobacco is associated with a substantial risk of oral cancers in India. Most recent studies from the US and Scandinavia are not statistically significant, but moderate positive associations cannot be ruled out due to lack of power. Further rigorous studies with adequate sample sizes are required, especially for cardiovascular disease.