Showing papers in "Evidence-based Dentistry in 2009"

Significant oral cancer risk associated with low socioeconomic status.

Abstract: Data sources Searches were made for studies in Medline, Medline In-Process and other Non-indexed Citations Embase, CINAHL, PsychINFO, CAB Abstracts 1973-date, EBM Reviews, ACP Journal Club, Cochrane Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Management Information Consortium database and Pubmed. Un-published data were also received from the International Head and Neck Cancer Epidemiology Consortium. Study selection Studies were identified independently by two reviewers and were included if their subject was oral and/ or oropharyngeal cancer; they used case-control methodology; gave data regarding socioeconomic status (SES; eg, educational attainment, occupational social classification or income) for both cases and controls; and the odds ratio (OR) for any SES measure was presented or could be calculated. Corresponding authors were contacted where there was an indication that data on oral and/ or oropharyngeal cancers could potentially be obtained from the wider cancer definition or grouping presented in the article, or if SES data were collected but had not been presented in the article. Methodological assessment of selected studies was undertaken. Data extraction and synthesis Countries where the study was undertaken were classified according to level of development and income as defined by the World Bank. Where available the adjusted OR (or crude OR) with corresponding 95% confidence intervals (CI) were extracted, or were calculated for low compared with high SES categories. Meta-analyses were performed on the following subgroups: SES measure, age, sex, global region, development level, time-period and lifestyle factor adjustments. Sensitivity analyses were conducted based on study methodological issues. Publication bias was assessed using a funnel plot. Results Forty-one studies met the inclusion criteria and yielded 15,344 cases and 33,852 controls. Compared with individuals who were in high SES strata, the pooled OR for the risk of developing oral cancer were 1.85 (95% CI, 1.60-2.15; N=37 studies) for individuals with low educational attainment versus 1.84 (95% CI, 1.47-2.31; N=14) for those with low occupational social class versus and 2.41 (95% CI, 1.59-3.65; N=5) for people with low incomes. Subgroup analyses showed that low SES was significantly associated with increased oral cancer risk in high- and lower-income countries, across the world, and remained when adjusting for potential behavioural confounders. Conclusions Oral cancer risk associated with low SES is significant and related to lifestyle risk factors. These results provide evidence to steer

Consistent evidence to support the use of xylitol- and sorbitol-containing chewing gum to prevent dental caries

Abstract: Studies were identified using searches with Medline, the Cochrane Library and Google Scholar. Studies were screened independently and were included if they evaluated the effect of one or more chewing gums containing at least one polyol (xylitol, sorbitol, mannitol or maltitol) on caries development, provided they supplied original data generated by means of a comparative design (experimental or observational) and were published in English. Studies were excluded if only an abstract was available or they described only the pharmacodynamic or pharmacokinetic properties of polyols or did not include a no-treatment arm in the study. Randomised trial quality was assessed using the Jadad scale, and the US Preventive Services Task Force criteria to grade the internal validity of individual nonrandomised studies. Data were extracted independently with only the final outcomes of a study being recorded. It was decided that surface rather than tooth level data would be recorded. Incremental caries was converted to prevented fraction (PF; the proportional reduction in dental caries in experimental groups relative to control groups) for meta-analysis. The studies were grouped according to type of polyol and a separate meta-analysis performed. Data were pooled using both a random and a fixed-effects model and heterogeneity assessed using I2. Of 231 articles identified 25 studies were initially selected with 19 being included in the review [six randomised controlled trials (RCT) of which four were cluster RCT, nine controlled clinical trials (CCT) and four cohort studies]. Two RCT had a Jadad score of three or higher. The mean preventive fraction for the four main gum types are shown in the table 1, results of all except the sorbitol -mannitol blend were statistically significant. Sensitivity analyses confirmed the robustness of the findings. Although research gaps exist, particularly on optimal dosing and relative polyol efficacy, there is consistent evidence to support the use of xylitol- and sorbitol-containing chewing gum as part of normal oral hygiene to prevent dental caries.

Ridge Preservation Techniques for Implant Therapy

Abstract: PURPOSE: The aim of this review was to evaluate the techniques and outcomes of postextraction ridge preservation and the efficacy of these procedures in relation to subsequent implant placement. MATERIALS AND METHODS: A MEDLINE/PubMed search was conducted and the bibliographies of reviews from 1999 to March 2008 were assessed for appropriate studies. Randomized clinical trials, controlled clinical trials, and prospective/retrospective studies with a minimum of five patients were included. RESULTS: A total of 135 abstracts were identified, from which 53 full-text articles were further examined, leading to 37 human studies that fulfilled the search criteria. Many different techniques, methodologies, durations, and materials were presented in the publications reviewed, making direct comparison difficult. CONCLUSIONS: Despite the heterogeneity of the studies, it was concluded that ridge preservation procedures are effective in limiting horizontal and vertical ridge alterations in postextraction sites. There is no evidence to support the superiority of one technique over another. There is also no conclusive evidence that ridge preservation procedures improve the ability to place implants.

Periodontal disease is a risk marker for coronary heart disease

Abstract: Data sources Relevant studies were identified using Medline and bibliographies of reviews, editorials, book chapters and letters discussing the relationship between periodontal disease and coronary heart disease (CHD). Study selection Studies were assessed for inclusion by two reviewers. Prospective studies with cohort or nested case-control design with CHD or cardiovascular disease (CVD) as an outcome were included. Study quality was rated. Data extraction and synthesis Data were abstracted by one reviewer and reviewed for accuracy by another author: any discrepancies were adjudicated by a third author. Meta-analysis was conducted to evaluate heterogeneity and publication bias. Results Seven studies were included, some of which found that periodontal disease was independently associated with increased risk of CHD. Summary relative risk estimates for different categories of periodontal disease (including periodontitis, tooth loss, gingivitis and bone loss) ranged from 1.24 [95% confidence interval (CI), 1.01-1.51] to 1.34 (95% CI, 1.10-1.63). Risk estimates were similar in subgroup analyses by gender, outcome, study quality and method of periodontal disease assessment. Conclusions Periodontal disease is a risk factor or marker for CHD that is independent of traditional CHD risk factors, including socioeconomic status. Further research is warranted in this important area of public health.

GRADING--levels of evidence.

Abstract: As this journal changes, it is worth highlighting one the key elements of the Summaries we publish in Evidence-based Dentistry, namely the assignment of levels of evidence.

Periodontal treatment could improve glycaemic control in diabetic patients

Abstract: Medline, Pascal, Embase, LILACS, the Cochrane Library, International Association of Dental Research Abstracts and Current Contents databases were searched and, in addition, a manual search was made of the bibliography of all pertinent articles. Unpublished articles were researched by contacting authors. No restrictions on language or type of article were applied in the literature search. Two investigators reviewed the full texts independently. To be included in the meta-analysis, studies had to be original interventional studies, conducted on a human population in which subjects had both diabetes and periodontitis, and provided a numerical value for HbA1c (glycosylated haemoglobin level). Review articles and meta-analyses were excluded and only the most recent reference of a multiple publication was included. The two reviewers independently extracted data using a standardised data-extraction grid. Data from the controlled studies were combined to estimate the pooled differential variation of HbA1c between control and treatment groups, using the inverse-variance method. Both fixed and random-effects models were used to calculate the overall standardised mean difference (SMD). Statistical homogeneity across the studies was tested by Cochran's Q test. Potential publication bias was tested using the rank-correlation test for funnel-plot asymmetry. Twenty-five studies, involving 976 subjects in total, were included in the present systematic review. Of these, nine studies, comprising 485 patients, were controlled trials and were included in the meta-analysis. The SMD in HbA1c with the treatment of periodontal disease was 0.46 [95% confidence interval (CI), 0.11–0.82]. These findings suggest that periodontal treatment could lead to a significant 0.79% (95% CI, 0.19–1.40) reduction in HbA1c level. The present meta-analysis represents the best information available to date that addresses this issue, and suggests that periodontal treatment could improve glycaemic control. Nevertheless, these results should be viewed with caution because of a lack of robustness and deficiencies in the design of some of the studies included. A randomised controlled trial (RCT) with sufficient statistical power would help to confirm the results of this meta-analysis.

Smoking increases dental implant failures and complications.

Abstract: Top of pageAbstract Data Sources Medline, Pubmed, Embase and the references of retrieved articles were used to identify relevant data. Study selection Clinical studies were included for meta-analysis if they compared implant or patient-related data on failures of implant treatment in relation to the numbers of smokers and nonsmokers. Published clinical studies providing statistically examined data [odds ratios (OR), risk ratios or hazard ratios] of implant failures or biological complications among smokers compared with nonsmokers were included for systemic analysis. Data extraction and synthesis Screening of eligible studies was carried out by two independent reviewers. Patient-related studies and implant-related studies were analysed separately. Heterogeneity was investigated and publication bias assessed using funnel plots. Additional data extracted, when available, included the sex of the patient, mandibular or maxillary placement, and any augmentation measures. These dichotomous outcomes were expressed as risk ratios with 95% confidence intervals (CI). Post implant observation periods were categorised for analysis. Results In all, 29 studies were included for meta-analysis and 35 for systematic review. Meta-analysis revealed a significantly enhanced risk for implant failure, with or without augmentation, in smokers. The systemic review showed significantly enhanced risks of peri-implant complications and bone loss in smokers. In five studies, in which implants had particle-blasted, acid-etched or anodic oxidised surfaces, smoking had no significant impact on the prognosis of such implants. Conclusions The risk of implant failures and biological complications with and without accompanying augmentation procedures was found to be significantly increased in smokers compared with nonsmokers.

NHS Clinical Knowledge Summaries

Abstract: The UK National Health Service (NHS) Clinical Knowledge Summaries, formerly known as PRODIGY, are part of the National Library for Health and provide a source of evidence-based information and practical know-how relating to the common conditions managed in primary care.

Oral health, mouthwashes and cancer – what is the story?

Abstract: Two hospital-based case–control studies were conducted in central and eastern Europe and Latin America. Cases and controls were recruited in Moscow (Russia), Bucharest (Romania) and Lodz and Warsaw (Poland) from 1998 to 2002, and from 1998 to 2003 in Buenos Aires (Argentina), La Habana (Cuba) and the Brazilian towns Rio de Janeiro, Sao Paulo, Pelotas, Porto Alegre and Goiânia. Incident cases of squamous cell carcinoma of the head and neck (oral cavity, pharynx, larynx) and oesophagus, as well as age- (in quinquennia) and sex frequency-matched controls, were enrolled from 1998 to 2003. Control subjects included residents of the study areas for at least 1 year who were admitted to the same hospitals as the cases or in a comparable catchment area (controls in Sao Paulo were not recruited from oncology hospitals, and population-based controls were enrolled in Warsaw). Controls were hospitalised for prespecified conditions thought to be unrelated to tobacco use or alcohol consumption. Both studies were coordinated by the International Agency for Research on Cancer according to an identical protocol for both case and control recruitment. Data from the central European and Latin American studies were analysed separately. Multivariable logistic regression models, including terms for oral health indicators, age, sex, education, country (central Europe) or centre (Latin America), tobacco pack–years and cumulative alcohol consumption, were used to obtain odds ratios (OR) and 95% confidence intervals (CI). All oral hygiene indicators and covariates were analysed as categorical variables, except for age, cumulative alcohol consumption, tobacco pack–years, and age when full-time education was completed, which were analysed as continuous variables. Case–control comparisons were made using t tests for continuous variables and chi-square tests for categorical variables; two-sided P values were obtained. Effect modification was assessed by stratifying on smoking (never/ former/ current) and drinking (never/ ever) habit. Heterogeneity between centres was tested. Risk factors for head and neck cancer, independent of tobacco use and alcohol consumption, were as follows: poor condition of the mouth [central Europe OR, 2.89 (95% CI, 1.74–4.81); Latin America OR, 1.89 (95% CI, 1.47–2.42)]; lack of toothbrush use [Latin America OR, 2.36 (95% CI, 1.28–4.36)], and daily mouthwash use [Latin America OR, 3.40 (95% CI,1.96–5.89]. Missing six to 15 teeth was an independent risk factor for oesophageal cancer [central Europe OR, 2.84 (95% CI, 1.26–6.41); Latin America OR, 2.18 (95% CI, 1.04–4.59)]. These results indicate that periodontal disease (as indicated by poor condition of the mouth and missing teeth) and daily mouthwash use may be independent causes of cancers of the head, neck and oesophagus.

The use of interdental brushes along with toothbrushing removes most plaque.

Abstract: Data sources The National Library of Medicine (Washington DC; to access Medline-PubMed) and the Cochrane Central Register of Controlled Trials were searched for articles dated from 1965 up to November 2007. Study selection Two independent reviewers assessed studies for inclusion, aiming to identify appropriate randomised controlled clinical trials and controlled clinical trials. Studies were selected if they were conducted in humans, and included subjects of over 18 years of age in good general health with sufficient interdental space to use an interdental brushes. The articles were limited to English-language publications. Case reports, letters and narrative or historical reviews were excluded. Data extraction and synthesis As there was considerable heterogeneity in the design of the studies, a meta-analysis was only conducted for the comparison of the interdental brush with floss, with weighted mean differences (WMD) calculated using a random effects model. Descriptive comparisons were presented for brushing alone, brushing and flossing or brushing and woodsticks where appropriate. Results After searching the literature, 234 titles and abstracts required screening, resulting in 18 full-text articles. Based on the full texts, another five articles were excluded and finally nine studies were identified as eligible. Two were of crossover design, three of a split-mouth design and four were parallel design. The longest study duration was 12 weeks. Conclusions The evidence showed that interdental brush use as an adjunct to toothbrushing removes more dental plaque than brushing alone, being even more effective than dental floss or woodsticks in removing dental plaque. The evidence available for the effect on gingival inflammation is less conclusive. The reduction of pocket depth after the use of the interdental brush is more pronounced than with floss.

Oral health promotion initiated during pregnancy successful in reducing early childhood caries.

Abstract: Oral health promotion initiated during pregnancy successful in reducing early childhood caries

Vitamin B12 for the treatment of recurrent aphthous stomatitis.

Abstract: This was a randomised, double-blind, placebo-controlled trial. One tablet was taken each day before sleep for 6 months. The test group received sublingual vitamin B12 tablets (1000 mcg of vitamin B12) whereas the control group took a placebo of the same shape, size, colour and flavour. Participants met with staff monthly. Duration (days) of an aphthous stomatitis episode, monthly number of aphthous ulcers, and severity of pain according to the Numerous Rating Scale (NRS), were recorded in a diary. Fifty-eight people suffering from recurrent aphthous stomatitis (RAS) participated: 31 were allocated to the intervention group and 27 to the control group. The duration of outbreaks, the number of ulcers, and the level of pain were reduced significantly (P <0.05) at 5 and 6 months of treatment with vitamin B12, regardless of initial vitamin B12 levels in the blood. During the last month of treatment a significant number of participants in the intervention group reached “no aphthous ulcers status” (74.1% vs 32.0%; P <0.01). Vitamin B12 treatment, which is simple, inexpensive and low-risk, seems to be effective for patients suffering from RAS, regardless of the serum vitamin B12 level.

Single- or multiple-visit endodontics: which technique results in fewest postoperative problems?

Abstract: Single- or multiple-visit endodontics: which technique results in fewest postoperative problems?

Lack of reliable evidence for oral submucous fibrosis treatments

Abstract: Searches were made for relevant studies using the Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase and IndMED (bibliographic database of Indian biomedical journals). There were no language restrictions. Randomised controlled trials were to be selected if they compared surgery, systemic or topical medicines, or other interventions, to manage the symptoms of oral submucous fibrosis (OSF). Two authors independently assessed trial quality and extracted trial data. Disagreements were resolved by consultation with a third author. Attempts were made to contact study authors where necessary for clarification and for additional information. Because of limited poor quality data, only a descriptive summary of the results of the included trials was carried out. Two trials, involving 87 participants, evaluated either lycopene in conjunction with intralesional injections of a steroid, and pentoxifylline in combination with mouth-stretching exercises and heat. There were no reports of toxicity to the interventions but some side-effects, which were mostly gastric irritation to pentoxifylline, were noted. The lack of reliable evidence for the effectiveness of any specific interventions for the management of OSF is illustrated by the paucity, and poor methodological quality, of trials retrieved for this review.

Lack of evidence about the effectiveness of the different denture cleaning methods.

Abstract: Relevant studies were sourced by searching the Cochrane Oral Health Group Trials Register, Cochrane CENTRAL (Cochrane Library), Medline, Embase, LILACS and CINAHL. There were no language restrictions. Randomised controlled trials (RCT) were considered if they compared any mechanical method (eg, brushing or ultrasound) or chemical (eg, enzymes, sodium hypochlorite, oral rinses or peroxide solutions) in adults over the age of 18 years who wore removable partial dentures or complete dentures. Two independent review authors screened and extracted information from, and independently assessed the risk of bias in, the included trials. Although six RCT were included in this review, the wide range of different interventions and outcome variables did not permit pooling of data in a meta-analysis. Isolated reports indicated that chemicals and brushing appear to be more effective than placebo in reducing plaque coverage and reducing microbial counts of anaerobes and aerobes on complete denture bases. There is a lack of evidence about the comparative effectiveness of the different denture cleaning methods considered in this review. Few well-designed RCT were found. Future research should focus on comparisons between mechanical and chemical methods, should assess the association between methods, and consider primary variables and costs.

The NTI-tss device may be used successfully in the management of bruxism and TMD.

Abstract: The Cochrane Library, Medline, TRIP database, MEDPILOT.DE, BIREME, several German-language journals, Google Scholar, the Web of Science, NTI-tss-associated websites , references of relevant articles and the MAUDE database of adverse events. Randomised controlled trials (RCT) were included and their quality was assessed using the Jadad score. A qualitative synthesis was carried out. Nine out of 68 relevant publications reported the results of five different RCT. Two RCT concentrated on electromyographic (EMG) investigations in patients with temporomandibular disorders (TMD) and concomitant bruxism or with bruxism alone. In both studies, the NTI-tss device showed significant reduction of EMG activity compared with use of an occlusal stabilisation splint. Two RCT focused exclusively on TMD patients: in one, a stabilisation appliance led to greater improvement than use of an NTI-tss device, whereas in the other no difference was found. In a further RCT, participants who suffered from tension-type headaches or migraines responded more favourably to the NTI-tss splint than to a bleaching tray. NTI-tss-induced complications related predominantly to single teeth or to the occlusion. Evidence from RCT suggests that the NTI-tss device may be successfully used for the management of bruxism and TMD. To avoid potential unwanted effects, it should be chosen only if the practitioner is certain a patient will be compliant with follow-up appointments. The NTI-tss bite splint may be justified when a reduction of jaw closer muscle activity (eg, jaw clenching or tooth grinding) is desired, or as an emergency device when people have acute temporomandibular pain and, possibly, restricted jaw opening.

Mini-implants for direct or indirect orthodontic anchorage.

Abstract: DATA SOURCES: Studies were sourced using Medline, the Cochrane Library and hand searches of key orthodontic journals. STUDY SELECTION: The review was restricted to peer-review articles (randomised controlled studies, prospective clinical studies and retrospective clinical studies) dealing with mini-implants (implant diameter smaller than 2.5 mm) and conducted in humans. Articles were excluded if: they dealt with standard dental implants, onplants (palatal implants), miniplates used as orthodontic anchorage, or miniscrews or microscrews for dental surgery, and implant materials research; if they were animal studies, in-vitro studies, case reports and case series, or technique presentations of mini-implants and micro-implants, review articles and letters; or if they were articles that did not meet the objective of this review or were reported in a language other than English. DATA EXTRACTION AND SYNTHESIS: Data were extracted independently by two authors, with disagreements resolved by discussion. Study quality was assessed. A qualitative synthesis was conducted. RESULTS: Sixteen articles met the inclusion criteria and, because of quality limitations, the literature was summarised in two broad areas, placement-related and loading-related factors. CONCLUSIONS: Mini-implants are effective as anchorage, and their success depends on proper initial mechanical stability and loading quality and quantity.

Cetylpyridinium chloride-containing mouth rinses and plaque control.

Abstract: DATA SOURCES Medline and the Cochrane Central register of controlled trials were used to identify relevant reports. STUDY SELECTION Randomised controlled trials and controlled clinical trials were included if they were of >/= 4 weeks' duration, were conducted in people of >/= 18 years of age and in good general health, and used plaque/ bleeding/ gingivitis or pocket depth as outcome measures. Case reports, letters and narrative or historical reviews were excluded and only English language papers were considered. DATA EXTRACTION AND SYNTHESIS Descriptive comparisons are presented for brushing only or for brushing and rinsing and, where appropriate, a meta-analysis was performed using a random effects model. RESULTS Eight studies met the inclusion criteria and they showed a small but significant additional benefit of cetylpyridinium chloride (CPC) use. CONCLUSIONS The existing evidence supports the use of CPC-containing mouthrinses as adjuncts to either supervised or unsupervised oral hygiene as they provide a small but significant additional benefit in reducing plaque accumulation and gingival inflammation.

Continuing warfarin therapy does not increased risk of bleeding for patients undergoing minor dental procedures.

Abstract: Continuing warfarin therapy does not increased risk of bleeding for patients undergoing minor dental procedures

Early childhood caries--risk factors.

Abstract: Design This was an Australian case-control study. CASE-CONTROL SELECTION: Cases were recruited from children referred for dental treatment under general anaesthesia at free public hospitals in eight health service districts in the state of Queensland, Australia [early childhood caries (ECC) public cases], and three private specialist paediatric dental clinics (ECC private cases). Controls were selected from a full list of all childcare facilities in the area using a selection ratio of one in seven children. As dental health status of the children was unknown prior to recruitment, a subgroup of 62 children with ECC was recruited in the control cohort (ECC childcare) and formed the third source of ECC cases. ASCERTAINMENT: The teeth of children in dental clinics or childcare facilities were examined using lighting from an examiner's head-lamp, with the child placed on the laps of the mother and examiner. A child was considered to have ECC if at least one cavity was present. Caries was charted using the World Health Organization oral health survey basic methods criteria(1) and enamel hypoplasia using the modified Developmental Defects of Enamel index. Presence of Streptococcus mutans was also assessed. Mothers were interviewed and screened to determine their social, medical and dental histories; dental caries experience; absence or presence of plaque and gingival inflammation; and presence of S. mutans. Validated questionnaires were used to obtain social, medical, dental, dietary and toothbrushing histories of the mothers. Data analysis Group comparisons of continuous variables (such as age and birthweight) were compared for statistical significance using analysis of variance. Categorical variables were compared for statistical difference across groups using contingency chi2 tests together with multinomial logistic regression modelling. Results A large proportion of children tested positive for S. mutans if their mothers also tested positive. A common risk indicator found in ECC children from childcare facilities and public hospitals was visible plaque [odds ratio (OR), 4.1; 95% confidence interval (CI), 1.0-15.9; and OR, 8.7; 95% CI, 2.3-32.9, respectively). Compared with ECC-free controls, the risk indicators specific to childcare cases were enamel hypoplasia (OR, 4.2; 95% CI, 1.0-18.3), difficulty in cleaning the child's teeth (OR 6.6; 95% CI, 2.2-19.8), presence of S. mutans (OR, 4.8; 95% CI, 0.7-32.6), sweetened drinks (OR, 4.0; 95% CI, 1.2-13.6) and maternal anxiety (OR, 5.1; 95% CI, 1.1-25.0). Risk indicators specific to public hospital cases were presence of S. mutans in the child (OR, 7.7; 95% CI, 1.3-44.6) or mother (OR, 8.1; 95% CI, 0.9-72.4), ethnicity (OR, 5.6; 95% CI, 1.4-22.1), and access of mother to pension or healthcare card (OR, 20.5; 95% CI, 3.5-119.9). By contrast, a history of chronic ear infections was found to be protective for ECC in childcare children (OR, 0.28; 95% CI, 0.09-0.82). Conclusions This case-control study showed that children of different socioeconomic backgrounds who have ECC share the common risk indicators of visible plaque, consumption of sugary snacks and presence of S. mutans. Additional risk indicators in children from childcare facilities were enamel hypoplasia, difficulty in cleaning the child's teeth, sweetened drinks and maternal anxiety, whereas ethnicity and mothers' access to pension or healthcare cards were specific to the public hospital cases.

Oral hygiene in elderly people in hospitals and nursing homes.

Abstract: Data sources Searches were made using Medline, the Cochrane Library, the National Health Service Economic Evaluation database and, by hand, of relevant articles' reference lists. Study selection The search was limited to studies conducted in humans only. The predetermined inclusion criteria were: clinical studies and randomised controlled trials (RCT) that linked oral hygiene with healthcare-associated pneumonia or respiratory tract infection in elderly people. Publications in Dutch, English, German and any of the Nordic languages (Danish, Finnish, Icelandic, Norwegian, Swedish) were included. Articles about authority opinions and reports of expert committees were excluded, as were studies on subjects who required mechanical ventilation or tube feeding. Data extraction and synthesis Data extraction from RCT was focused on the outcomes. Assessments were made of the quality and validity of the studies, using statistical methods to test these. To ensure the consistency of the assessments throughout the study, two authors (EN, PS) performed the data extraction independently, and any disagreements were resolved in consensus meetings. Pooling data from individual studies (meta-analysis) was not deemed appropriate because of heterogeneous study designs, quality of reporting methodological aspects and trial conduct. To provide an overview of additional clinical studies in this research area, the non-RCT studies that were identified were scrutinised for the authors' main conclusion(s). Results Fifteen publications, of which five were RCT, fulfilled the inclusion criteria and were considered throughout all the assessments. All of the RCT revealed positive preventive effects of oral care on pneumonia or respiratory tract infection in nursing home residents, with numbers needed to treat ranging from 8.6-15.3. Conclusions Available results from RCT provide evidence that mechanical oral hygiene decreases mortality risk from pneumonia and seems to have a clinically relevant preventive effect on nonfatal pneumonia in independent elderly individuals. The data show that providing mechanical oral hygiene may prevent approximately 1 in 10 cases of death from pneumonia in dependent elderly people and indicate a largely similar effect for prevention of pneumonia.

Caries prevention for older people in residential care homes

Abstract: When attempting to prevent dental caries in older people who live in residential care homes, what is the effectiveness and relative cost benefit of high concentration fluoride toothpaste compared with fluoride varnish application?

Vacuum-formed retainers more effective than Hawley retainers.

Abstract: Design A randomised controlled trial (RCT) was performed in a single orthodontic practice. Intervention The aim was to compare the clinical effectiveness of Hawley and vacuum-formed retainers (VFR) over a 6-month period of retention. Three hundred and ninety-seven patients were treated by a specialist orthodontist and randomly allocated to wear either Hawley retainers (n=196) or VFR (n=201). Outcome measure A blinded examiner analysed the records of maxillary and mandibular dental casts at debond and at 6 months into retention, assessing tooth rotation mesial to the first permanent molar, intercanine and intermolar widths, and Little's Index of Irregularity. Results Three hundred and fifty-five individuals participated through to the conclusion of the trial, giving a completion rate of 89%. The results showed significantly greater changes in irregularity of the incisors in the Hawley group than in the VFR group at 6 months. Conclusions VRF are more effective than Hawley retainers at holding the correction of the maxillary and mandibular labial segments.

The therapeutic use of botulinum toxin in cervical and maxillofacial conditions

Abstract: DATA SOURCES Medline, Cochrane Library and bibliographies of identified articles. STUDY SELECTION Studies of high methodological quality (systematic reviews or randomised controlled trials; RCT) were selected if considered use of botulinum toxin (BTX) either prophylactically or therapeutically, as an adjunct to dental implant therapy for temporomandibular disorders or for other maxillofacial conditions such as bruxism, masseteric hypertrophy, oromandibular dystonia or cervical dystonia. DATA EXTRACTION AND SYNTHESIS Only studies with high levels of evidence were evaluated. Four RCT met the search criteria in the area of cervical dystonia and chronic facial pain. RESULTS No RCT were identified that evaluated dental implant therapy along with use of BTX. Four RCT did meet the search criteria in the area of cervical dystonia and chronic facial pain. People who had cervical dystonia exhibited significant improvements in baseline functional, pain and global assessments compared with placebo, whereas individuals with chronic facial pain improved significantly compared with placebo in terms of pain. CONCLUSIONS During the period of study, no references were found evaluating use of BTX in dental implantology. Nevertheless, it appears relatively safe and effective in treating cervical dystonia and chronic facial pain associated with masticatory hyperactivity.

Temporomandibular joint arthrocentesis and lavage

Abstract: DATA SOURCES: The Cochrane Oral Health Group's Trials Register, Cochrane CENTRAL (Cochrane Library), Medline and Embase were used to identify likely studies. OpenSIGLE,(*) CBMdisc (the Chinese Biomedical Literature Database) and the Chinese Medical Library were also searched. All the Chinese professional journals in the oral health field were searched by hand and conference proceedings were consulted. There was no language restriction. STUDY SELECTION: Randomised controlled trials (RCT) and quasi-RCT that aimed to test the therapeutic effects of arthrocentesis and lavage on temporomandibular joint (TMJ) disorders were included.ATA EXTRACTION AND SYNTHESIS: Two review authors independently extracted data, and three review authors independently assessed the risk of bias of included trials. The first authors of the selected articles were contacted for additional information. RESULTS: Two trials were included in the review, one of which was judged to have a high risk of bias and one to be unclear in its risk of bias. The two trials, which included 81 individuals who had TMJ disorders, compared arthrocentesis with arthroscopy. No statistically significant difference was found between the interventions in terms of pain. A statistically significant difference was found in favour of arthroscopy in maximum incisal opening (weighted mean difference of -5.28; 95% confidence interval, -7.10 to -3.46). Mild and transient adverse reactions, such as discomfort or pain at the injection site, were reported in both groups. No data about quality of life were reported. CONCLUSIONS: There is insufficient, consistent evidence to either support or refute the use of arthrocentesis and lavage for treating patients with TMJ disorders. Further high-quality RCT of arthrocentesis need to be conducted before firm conclusions can be drawn with regard to its effectiveness.

Traumatic intrusion of primary teeth and developmental defects in successor teeth.

Abstract: This was a clinical observational study of primary incisor trauma, in children of under 4 years of age at the time of injury, with a 7-year follow up period. Children treated for intrusive injuries (as defined by World Health Organization guidelines) of primary incisors in a paediatric clinic. Patient's age, sex, cause of trauma, site and number of primary teeth involved, and nature of immediate treatment were recorded. Photographs and radiographs were taken. At 6–12-month intervals clinical and radiographical examinations recorded the process of re-eruption, and any post-traumatic changes to the intruded primary teeth: namely, pulpal necrosis, root resorption, ankylosis, or obliteration of the pulp canal. Developmental defects were recorded on the fully erupted successor teeth, namely enamel hypoplasia, malformation of tooth and/ or root, and site of eruption. Chi-squared tests were used to determine significant differences between the patient's age at diagnosis; subsequent changes to the intruded primary teeth; and any developmental defects in the successor teeth. Complete data were obtained over a 7-year followup period, for 78 children (138 teeth) who were aged between 12 and 48 months at initial examination. Thirty-six of these teeth, in 23 children, were extracted at the first visit because of extensive lateral luxation as well as intrusion. Of the remaining (unextracted at initial visit) 102 intruded primary incisors, 78% fully re-erupted, 15% partially re-erupted, and only 7% remained impacted. Post-traumatic consequences were recorded in 54% of the teeth. Over half of the permanent successors (74 out of the initial sample of 138 traumatised primary incisors) were found to have one or more developmental disturbances: enamel hypoplasia (28.3% of all incisors); dilacerations (16.7% of all incisors); or ectopic eruption (16.7% of all incisors). The study did not find any correlation between the child's age at the time of the intrusion injury and the frequency of subsequent developmental disturbances.

Music may reduce anxiety during invasive procedures in adolescents and adults.

Abstract: Design A block randomised controlled trial was conducted. Intervention Patients in the music (test) group listened to selected sedative music using headphones throughout the root canal treatment procedure. The control group subjects wore headphones but without the music. Outcome measure Anxiety was measured before the study and at the end of the treatment procedure. Patients' heart rate, blood pressure and finger temperature were measured before the study and every 10 min until the end of the root canal treatment procedure. Results The results revealed that there were no significant differences between the two groups for baseline data and procedure-related characteristics, except for gender. The subjects in the music group, however, showed a significant increase in finger temperature and a decrease in anxiety score over time compared with the control group. The effect size for state anxiety and finger temperature was 0.34 and 0.14, respectively. Conclusions Relaxing music administered through headphones to subjects during root canal treatment decreased the procedure-related anxiety of the patients and significantly increased finger temperature, but does not significantly affect blood pressure and heart rate over the procedure.

Silver lining for caries cloud

Abstract: DATA SOURCES Data, from reports written in English, Spanish, or Portuguese, were identified using searches in Medline, LILACS (Latin American and Caribbean Health Sciences Literature), Embase, the Cochrane Library, and the Brazilian Dental Library databases. STUDY SELECTION Human randomised controlled trials (RCT), or cohort or case-control studies, where patients not teeth were the unit of assessment, were included. Studies were excluded if they were early reports of longer studies, in vitro or animal studies, narrative reviews or editorials, or were published in languages other than English, Spanish or Portuguese. Studies were assessed independently by two investigators with disputes being resolved by a third. Quality was assessed using the Jadad scale. Data extraction and synthesis Data were extracted independently by two investigators. The prevented fraction (PF) and number-needed-to-treat (NNT) were calculated. RESULTS Two studies met the inclusion criteria. They indicated that the silver diamine fluoride (SDF) lowest PF for caries arrest and caries prevention were 96.1% and 70.3%, respectively; NNT were 0.8 (95% confidence interval, 0.5-1.0) and 0.9 (95% confidence interval, 0.4-1.1), respectively. Adverse events were monitored, with no significant differences being found between control and experimental groups. CONCLUSIONS These promising results suggest that SDF is more effective than fluoride varnish, and may be a valuable caries-preventive intervention.

Are the outcomes of immediate and early single tooth implants comparable to conventionally placed implants

Abstract: Medline, Embase, the Cochrane Central Register of Controlled Trials (Central) and references of relevant studies were searched. Longitudinal studies [randomised controlled trials (RCT), clinical trials, cohort-studies and case series] were considered for evaluation. Retrospective studies were excluded. Only case series that investigated at least five patients were considered for inclusion. Outcome measures considered were implant survival, radiographical assessment of marginal peri-implant bone levels, dental-professional-assessed aesthetics, peri-implant biological structures (level of marginal gingiva, papilla index, probing depth, presence of plaque, bleeding on probing), patient satisfaction, and biological and technical complications. Articles were screened independently by two examiners and the following parameters recorded: number of patients, implants placed, dropouts, followup time, type of intervention and details of outcomes. To assess the agreement between the two reviewers on the quality of studies, Cohen's kappa statistic was calculated. A meta-analysis was performed using a statistical software package [Comprehensive Meta-analysis Version 2.2, Biostat, Englewood NJ]. To calculate the overall effects for the included studies, weighted rates together with random effects models were used. Stratification procedures were applied for followup time and type of intervention. No formal heterogeneity testing was conducted. Nineteen studies were included, of which five were RCT, two were clinical trials and 12 were case series. A meta-analysis showed an overall survival rate of 95.5% 95% confidence interval, 93.0–97.1) after 1 year. A stratified meta-analysis revealed no differences in survival between immediate, early and conventional implant strategies. Little marginal peri-implant bone resorption was found together with low incidence of biological and technical complications. No significant differences in outcome measures were reported in clinical trials comparing immediate, early or conventional implant strategies. The selected studies provide promising short-term results for immediate, early and conventional single-implants in the aesthetic zone. Important parameters, such as aesthetic outcome, peri-implant structures and patient satisfaction, however, still need further evaluation. The outcome measures could not be fully evaluated when comparing immediate, early and conventional implants because of the lack of RCT.

Do lip bumpers work

Abstract: Top of pageAbstract Data sources Searches were made using PubMed, Embase, the Cochrane Central Register of Controlled Trials and the Cochrane database of systematic reviews, along with searches by hand of the following journals: Angle Orthodontist, American Journal of Orthodontics and Dentofacial Orthopedics, Journal of Orthodontics and European Journal of Orthodontics. Study selection The first step was to identify eligible reports based on their titles and abstracts: 52 articles were found. Inclusion and exclusion criteria were then applied. Studies were included if subjects were human; they were randomised controlled trials and prospective or retrospective studies; they discussed the effect of the lip bumper on the arch and teeth; and they were reported in the English language. Articles excluded were mainly animal studies, case reports, case series, review articles, abstracts, in-vitro studies, discussions and interviews; were published in a language other than English; or did not follow the objective of this review. The selection was made by two researchers. Their results were compared to identify discrepancies and reach mutual agreement. Data extraction and synthesis If two or more studies had evaluated the same technique, a meta-analysis was planned. Results A total of 16 RCT were identified of which 13 underwent detailed evaluation; of these, only one study was considered to have usable outcome information. The others were excluded because of control group, sex, age, study casts and cephalometric analysis, and measurement error. This single small study showed that lip bumper can increase arch dimensions and contribute to crowding relief in mixed dentition. Conclusions The results showed increases in arch dimensions, including a greater arch length. This was attributed to incisor proclination, distalisation, and distal tipping of the molars. There were also increases in arch width and intercanine and deciduous intermolar or premolar distances. The long-term stability of the effects of the lip bumper need to be elucidated.