Showing papers in "Evidence-based Dentistry in 2015"
TL;DR: The Cochrane OHG has actively responded to the outcomes of this prioritisation process by allocating resources to primarily supporting the maintenance of identified priority evidence for the Cochrane Library.
Abstract: The Cochrane Library is a core resource for clinical decision-making globally, by clinicians, guideline developers, healthcare providers and patients.The publication of Cochrane Library systematic reviews concerning oral health conditions has grown exponentially to over 215 individual titles (as of 20 June 2015) during the past 20 years.Consequently, maintaining updates of the most clinically important reviews to provide up-to-date and accurate sources of evidence for decision-making has become a pressing concern for the editorial group behind their production, Cochrane Oral Health Group.To identify priority research required by oral health decision-makers, the Cochrane OHG embarked on a consultation process across eight defined areas of dentistry (periodontology, operative (including endodontics) and prosthodontics, paediatric dentistry, dental public health, oral and maxillofacial surgery, oral medicine, orthodontics, cleft lip and/or palate) with existing authors (by email), with members of the public (by online survey), and established internationally clinically expert panels for each area of defined area of dentistry to discuss and ratify (by teleconference) a core portfolio of priority evidence to be produced and maintained on the Cochrane Library.The resulting portfolio of priority research encompasses 81 existing titles to be maintained, and an additional 15 new systematic reviews to be developed by the Cochrane OHG in due course.The Cochrane OHG has actively responded to the outcomes of this prioritisation process by allocating resources to primarily supporting the maintenance of identified priority evidence for the Cochrane Library.
65 citations
TL;DR: Clinical prospective and retrospective studies of orthodontic treatment with clear aligners on patients over the age of 15 that included clear descriptions of the materials and applied technique were included and were considered to be of moderate quality.
Abstract: PubMed/Medline, Embase, Cochrane Central Register of Controlled Clinical trials (CENTRAL), Web of Knowledge, SCOPUS, Google Scholar and LILACS databases. Clinical prospective and retrospective studies of orthodontic treatment with clear aligners on patients over the age of 15 that included clear descriptions of the materials and applied technique were included. Selection was undertaken independently by two reviewers. Two reviewers extracted data independently with study quality being assessed using the grading system described by the Swedish Council on Technology Assessment in Health Care (SBU). A narrative summary of the findings was presented. Eleven studies involving a total of 480 patients were included consisting of two randomised controlled trials, five prospective studies and four retrospective studies. Six studies were considered to be of moderate quality, the remainder of limited quality. Most of the studies presented with methodological problems: small sample size, bias and confounding variables, lack of method error analysis, blinding in measurements, and deficient or missing statistical methods. The quality level of the studies was not sufficient to draw any evidence-based conclusions.
36 citations
TL;DR: Clear risk factors for malignant transformation of oral leukoplakia are identified, including location (tongue), appearance (non-homogenous), increased age and female gender, according to a total of 24 studies involving 12,103 patients.
Abstract: Searches were carried out in the Medline, Embase and PubMed databases in July 2014 with a date range, 1960-2013. Observational cohort studies (either prospective or retrospective) were included. Studies following identical cohorts, case control studies, clinical trials, interventional studies, laboratory studies, experimental studies, studies with no follow-up data, studies of pre-leukoplakia or snuff-induced lesions were excluded. The databases were searched by one reviewer who also screened the studies and evaluated them against the inclusion criteria. Final decision on both inclusion and exclusion of the papers was agreed upon by both authors. A total of 24 studies were included in this review, involving 12,103 patients. Of the 24 studies included 14 were retrospective. Studies were analysed by subgroup, allowing the authors to identify the rate of malignant transformation as 14.9% with a range of 0.13% to 34%. Only 11 studies gave information on the site of malignant transformation; the most common site was the buccal mucosa. For buccal mucosa the malignant transformation was 3.53%, compared to 24.22% for the tongue. Homogenous oral leukoplakia (OL) was most common, however non-homogenous types showed a higher rate of transformation of 13.1%. There was an increased risk of malignant transformation with age. Most studies demonstrated that there is a higher risk of transformation in the female population. Malignant transformation rate of OL varies from 0.13 to 34% across the 24 studies reviewed here. The authors identified clear risk factors for malignant transformation of oral leukoplakia, including location (tongue), appearance (non-homogenous), increased age and female gender. There was little evidence that surgical intervention had any benefit in reducing the risk of transformation
23 citations
TL;DR: The annual application of NSF solution was more effective in hardening and arresting dentine caries in primary teeth than the placebo and was found to be similar to silver diamine fluoride when applied once a year, but did not stain the dental tissue black and had no metallic taste.
Abstract: Randomised controlled trial, double blind, in a community setting. School children with active caries in primary teeth and no pulpal exposure, fistula or decay in permanent teeth were chosen. Caries and unsupported enamel were left as found and cotton wool rolls were used for isolation. Two drops of NSF or one drop of water were applied to the tooth with a microbrush for two minutes, once in a 12-month period. At one week, five months and 12 months the presence of active caries, as classified using International Caries Detection and Assessment System (ICDAS II) criteria, was measured. If a blunt probe easily penetrated dentine with light force, active caries was recorded and taken to be a failure. One hundred and thirty primary teeth in 60 children with a mean age of 6.31 (± 0.60) were randomised. Sixty-three teeth were in the NSF group and 67 in the control group. After one week there were no losses, at the five-month follow up eight teeth were lost from the NSF group due to exfoliation or extraction and five from the control group. At twelve months a further five teeth were lost from the NSF group and 13 from the control group. At the one week follow up there was a 19% failure rate in the NSF group compared to 100% in the control group. At the five month recall this was 27.3% NSF compared to 72.6% water and at the final recall there was a 33.3% NSF failure rate and 65.3% control failure rate. The preventative fraction at this point was 50% and the NNT 3.12. All were statistically significant results (p= <0.05). The annual application of NSF solution was more effective in hardening and arresting dentine caries in primary teeth than the placebo. The effectiveness of NSF was found to be similar to silver diamine fluoride when applied once a year, but did not stain the dental tissue black and had no metallic taste. The application is simple, does not require a clinical setting and is inexpensive. NSF was demonstrated to be effective in arresting caries in children in poor communities, but further studies are required to investigate alternative protocols and for use in tooth sensitivity and root caries.
22 citations
TL;DR: The evidence from the review suggests that a prophylactic antibiotic regimen reduces failure of dental implants placed under ordinary conditions, however, there are no apparent differences in the occurrence of post-operative infections in patients receiving or not receiving antibiotics.
Abstract: Electronic searches without time or language restrictions were performed in PubMed, Web of Science and the Cochrane Oral Health Group trials Register. A vast manual search was done in many dental implant-related journals. Reference lists were scanned for possible additional studies. Ongoing clinical trials were also searched. Titles and abstracts of the reports identified were read independently by the three authors. Disagreements were resolved by discussion. Rejected studies were recorded with the reasons for exclusion. The inclusion criteria included clinical human studies, either randomised or not, comparing the implant failure/survival rates in any group of patients receiving antibiotic prophylaxis versus not receiving antibiotics prior to implant placement. Case reports and non-human studies were excluded. Implant failure was considered as complete loss of the implant. Data were extracted by the authors. Study risk of bias was assessed. Implant failure and post-operative infection were the outcomes measured, both dichotomous outcomes. Results were expressed using fixed or a random effect model depending on the heterogeneity calculated using an I2 statistical test. The estimate of relative effect was expressed in risk ratio (RR) with 95% confidence interval. Number needed to treat (NNT) was calculated and sensitivity analysis was performed to detect differences among the studies considered to have high a risk of bias. Fourteen trials were included in the review and evaluated a total of 14,872 implants. Of the fourteen studies included in the review eight were randomised clinical trials, four were controlled clinical trials and two were retrospective studies. Seven studies had both patients and operators/outcome assessors blinded to the tested intervention. Nine studies had short follow-ups; six of them with a follow-up of four months, one of five months and two of six months. The antibiotic regimen was variable: seven studies did not use post-op antibiotics in all patients. Seven studies used amoxicillin as the antibiotic of choice. Ten studies had patients rinse with antimicrobial solutions as well. Among the fourteen studies, 8603 implants were placed in patients receiving antibiotics, 304 failures (3.53%) were recorded; 6269 implants were placed in patients not receiving antibiotics or receiving placebo, with 396 failures recorded (6.32%). From eight articles that provided the information about post-operative infection there were 25 occurrences of infection in 1000 patients receiving antibiotics (2.5%) and 29 episodes in 770 patients not receiving antibiotics (3.8%). Some studies involved grafting procedures and a portion of the patients (in nine studies) were smokers. The test of overall effect for implant failure rate showed that the difference between the procedures with or without antibiotic is statistically significant: RR 0.55, 95% confidence interval (CI) 0.41 to 0.75, p value 0.0002, a relative risk reduction (RRR) of 45% and the number needed to treat (NNT) of 50 (95% CI 33-100). For the post operative infection outcome, the results of the meta-analysis showed no statistically significant results; RR 0.84, 95 % confidence interval 0.49-1.44, and a p value of 0.52. The results did not differ in the sensitivity analysis when removing the high risk of bias studies. For the implant failure, the results were RR 0.37, 95% CI 0.19-0.72, p value 0.003, and for the 'post operative infection' outcome the results were RR 0.78, 95% CI 0.38-1.39. p value 0.33. The funnel plot to calculate publication bias showed asymmetry for the studies reporting implant failure, while the studies reporting post-operative infection the funnel plot did not show asymmetry. The evidence from the review suggests that a prophylactic antibiotic regimen reduces failure of dental implants placed under ordinary conditions. However, there are no apparent differences in the occurrence of post-operative infections in patients receiving or not receiving antibiotics. The results have to be interpreted with caution due to the presence of several cofounding factors in the studies.
19 citations
TL;DR: Why there need a core outcome set for trials of interventions for prevention and management of caries and why this is important for the design of clinical trials.
Abstract: Although the research process, extending from primary evidence creation through to guideline production for delivery at the point of care, should functionally act as a continuum, it consists of different stages. There are many points along this route at which research can fail to deliver its promises of improved patient care. One of these is where the findings of clinical trials cannot be compared to, or combined with, other trials. Failure to combine trials into systematic reviews, with or without meta-analyses, means it is not possible to determine the relative overall benefit of a particular intervention with any certainty. This can hamper the uptake of new evidence into practice or might prevent discontinuing use of an ineffective treatment.
17 citations
TL;DR: It is demonstrated thatperiodontal treatment leads to a reduction of HbA1c in diabetic patients with periodontitis, with improvement of periodontal status for three months after treatment, but the treatment may have no obvious effect on glycaemic control six months aftertreatment.
Abstract: PubMed, Embase, Cochrane Library, the World Health Organization (
http://www.who.int/trialsearch
) and Clinical Trials.gov (
http://www.ClinicalTrials.gov
.) Two reviewers independently selected studies. Randomised controlled trials (RCTs) in adults over the age of 18 with diabetes and periodontal disease undergoing non-surgical periodontal treatment with or without adjunctive antibiotics, with a follow up period of at least three months were considered. Data abstraction was carried out by two reviewers independently with study quality being assessed using the Cochrane risk of bias tool. The absolute difference of HbA1c percentage in each treatment arm was recorded or calculated. Weighted mean difference (WMD) was calculated and meta-analysis conducted. The primary outcome was hemoglobin A1c (HbA1c), and secondary outcomes were periodontal parameters which included probing pocket depth (PPD) and clinical attachment level (CAL). Ten RCTs involving a total of 1135 patients were included. Meta-analysis (ten studies) showed a mean change of HbA1c at three months = −0.36% (95%CI: −0.52% – 0.19%, P< 0.0001) with a change at six months = − 0.30%, (95%CI: −0.69% to 0.09%, P = 0.13). Clinically substantial and statistically significant reduction of PPD and CAL were found between subjects with and without treatment after periodontal therapy (PPD 20.42 mm, 95%CI: 20.60 to 20.23, P,0.00001; CAL 20.34 mm, 95%CI: 20.52 to 20.16, P = 0.0002). This demonstrates that periodontal treatment leads to a reduction of HbA1c in diabetic patients with periodontitis, with improvement of periodontal status for three months after treatment. But the treatment may have no obvious effect on glycaemic control six months after treatment. So physicians and dentists should carefully interpret these results when they apply them in clinical practice.
9 citations
TL;DR: Low quality evidence suggested that fluoride toothpaste containing xylitol may be more effective than fluoride-only toothpaste for preventing caries in the permanent teeth of children and adults.
Abstract: Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, Web of Science Conference Proceedings, Proquest Dissertations and Theses, US National Institutes of Health Trials Register (
http://clinicaltrials.gov
) and the WHO Clinical Trials Registry Platform for ongoing trials. No language or year restrictions were used. Randomised controlled trials assessing the effects of xylitol products on dental caries in children and adults. Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias of the included studies. Authors were contacted where possible for missing data or clarification where feasible. For continuous outcomes, means and standard deviations were used to obtain the mean difference and 95% confidence interval (CI). Continuous data was used to calculate prevented fractions (PF) and 95% CIs to summarise the percentage reduction in caries. For dichotomous outcomes, reported risk ratios (RR) and 95% CIs were used. As there were fewer than four studies included in the meta-analysis, a fixed effect model was used. Ten studies were included with a total of 5903 participants. One study was assessed as being at low risk of bias, two were assessed as unclear risk of bias with seven at high risk of bias. Over 2.5–3 years, low quality evidence demonstrated that with 4216 children analysed, a fluoride toothpaste with 10% xylitol (exact dosage unsure) reduced caries by 13% when compared to a fluoride only toothpaste. (PF −0.13, 95% CI −0.18 to −0.08. Remaining evidence of the use of xylitol in children has risk of bias and uncertainty of effect and was therefore insufficient to determine a benefit from xylitol. Four studies reported that there were no adverse effects from any of the interventions. Two studies reported similar rates of adverse effects between study arms. The remaining studies either mentioned adverse effects but did not report any usable data, or did not mention them at all. Adverse effects include sores in the mouth, cramps, bloating, constipation, flatulence and loose stool or diarrhoea. Low quality evidence suggested that fluoride toothpaste containing xylitol may be more effective than fluoride-only toothpaste for preventing caries in the permanent teeth of children. The effect estimate should be interpreted with caution due to high risk of bias and the fact that it was derived from two studies that were carried out by the same authors in the same population. The remaining evidence was low to very low quality and is insufficient to determine whether any other xylitol-containing products can prevent caries in infants, older children or adults.
9 citations
TL;DR: A cumulative meta-analysis demonstrated vertical transmission of S. mutans from mother to child and showed a tendency of reduction in the percentage of vertical transmission compared with the year the studies were published.
Abstract: DATA SOURCES PubMed, the Cochrane Library databases and the Virtual Health Library were searched from January 1950, with a manual search of the reference lists of the included studies. STUDY SELECTION Duplicate papers, case reports, case series, descriptive studies, review articles, opinion articles and letters were excluded along with studies on children with oral defects, and ongoing preventative/restorative treatment and mothers who used antimicrobial substances. Two authors independently screened the title and abstract of all identified records, with consensus if required by a third author. A PECO (E= exposure) strategy was used to assess the eligibility of identified papers: observational human studies whose subjects were mother and child pairs; P contaminated by S.mutans; E comparison according to the presence and absence of S.mutans; C and whether there is vertical transmission (as defined by molecular analyses); O. DATA EXTRACTION AND SYNTHESIS Included studies were assessed for risk of bias. Two researchers extracted data on the methods, participants and outcomes, and the authors were contacted when it was necessary to clarify details. The percentage of transmission before and after the year 2000 was evaluated using the t-test and the molecular analysis technique was evaluated using ANOVA. A cumulative meta-analysis based on the publication year was performed, combining studies that assessed mother/child bionomy (pairs) and presented the percentage of transmission. RESULTS Thirty-six cross-sectional studies were included, with the age of the children varying among the studies from three weeks to 15 years. All but one of the studies confirmed the vertical transmission of S. mutans from mother to child by genetic methods. The pooled cumulative meta-analysis demonstrated vertical transmission of S. mutans from mother to child (p<0.01) and showed a tendency of reduction in the percentage of vertical transmission compared with the year the studies were published.There was no significant difference in the transmission rate according to the type of technique used (p=0.39; ANOVA test). Quality assessment found that twenty-eight studies had bias such as confounding factors. All of the studies included were cross-sectional studies and therefore none was randomised. There were no reports of blinding in the selected studies although some studies evaluated the testing accuracy and repeatability or calibration; all included microbiological repetition. CONCLUSIONS There is scientific evidence of vertical transmission of S. mutans from mother to child as there was an association between S. mutans strains in mothers and their respective children.
9 citations
TL;DR: There is moderate quality evidence which is insufficient to determine whether sinus lift procedures in bone with residual height between 4 and 9 mm are more or less successful than placing short implants in reducing prosthesis or implant failure up to one year after loading.
Abstract: Insufficient evidence for sinus lifts over short implants for dental implant rehabilitation
9 citations
TL;DR: The collective evidence regarding adjunctive use of the diode laser with SRP indicates that the combined treatment provides an effect comparable to that of SRP alone.
Abstract: Little evidence for the use of diode lasers as an adjunct to non-surgical periodontal therapy
TL;DR: The instruction to use warm saline mouth rinse is beneficial in the prevention of alveolar osteitis after dental extractions and patient compliance may be better than with the six times daily rinse routine.
Abstract: Randomised controlled trial Patients aged ≥16 years requiring non-surgical extraction were randomised into three groups. Group A (n = 40) were instructed to gargle six times daily with warm saline and group B (n = 40) twice daily; group C (n = 40) were not instructed to gargle with warm saline and served as controls. All patients received the same oral antibiotics and analgesics, and similar postoperative instructions, except regarding saline rinses. Mouth rinsing was to start 24 hours after the procedure and patients were reviewed at 72 hours. The patients were evaluated 72 h post-operatively for the presence of alveolar osteitis, acute inflamed socket and acute infected socket by an independent observer who was blinded to the treatment group. One hundred and twenty patients were randomised (40 per group). The overall prevalence of alveolar osteitis was 10.0% and that of acute inflamed socket was 25.0%. No cases of acute infected socket were observed. There was a statistically significant difference between the study groups with respect to the development of alveolar osteitis (x2 = 15.43, df = 2, P = 0.001), but not for acute inflamed socket, with only 2.5% of the saline groups (2 out of 80) developing alveolar osteitis compared with 25% (10 of 40) in the control group. The instruction to use warm saline mouth rinse is beneficial in the prevention of alveolar osteitis after dental extractions. There is no significant difference in the efficacy of the twice-daily warm saline mouth rinse regimen compared to the six times daily regimen. The twice-daily saline mouth rinse regimen is more convenient, and patient compliance may be better than with the six times daily rinse routine.
TL;DR: Financial incentives within remuneration systems may produce changes to clinical activity undertaken by primary care dentists, however, the number of included studies is limited and the quality of the evidence from the two included studies was low/very low for all outcomes.
Abstract: The Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, EconLit the NHS Economic Evaluation Database (EED) and the Health Economic Evaluations Database (HEED). Randomised controlled trials (RCTs), non-randomised controlled clinical trials (NRCTs), controlled before-after (CBA) studies and interrupted time series (ITS) studies were considered. Study selection was undertaken independently by three reviewers. Fee-for-service payments, fixed salary payments, capitation payments of combinations thereof included. Standard Cochrane methodological procedures were followed. Two cluster-RCTs, with data from 503 dental practices, representing 821 dentists and 4771 patients, met the selection criteria. The risk of bias for the two studies was considered to be high and the overall quality of evidence for the outcomes was low/very low for all outcomes, as assessed using the GRADE approach. One study conducted in the four most deprived areas of Scotland used a factorial design to investigate the impact of fee-for-service and an educational intervention on the placement of fissure sealants. The authors reported a statistically significant increase in clinical activity in the arm that was incentivised with a fee-for-service payment. Measures of health service utilisation or patient outcomes were not reported. The second study used a parallel group design undertaken over a three-year period to compare the impact of capitation payments with fee-for-service payments on primary care dentists' clinical activity. The study reported on measures of clinical activity, patient outcomes and healthcare costs. Teeth were restored at a later stage in the disease process in the capitation system and the clinicians tended to see their patients less frequently and tended to carry out fewer fillings and extractions, but also tended to give more preventive advice. There was insufficient information regarding the cost-effectiveness of the different remuneration methods. Financial incentives within remuneration systems may produce changes to clinical activity undertaken by primary care dentists. However, the number of included studies is limited and the quality of the evidence from the two included studies was low/very low for all outcomes. Further experimental research in this area is highly recommended given the potential impact of financial incentives on clinical activity, and particular attention should be paid to the impact this has on patient outcomes.
TL;DR: Based on meta-analysis, dentifrice containing 5,000 ppm F- and professionally applied CHX or SDF varnish may inactivate existing and/or reduce the initiation of RCLs and the high risk of bias within studies, and the limiting grade of evidence.
Abstract: Data sources PubMed, EMBASE and Cochrane Central Register of Controlled Trials. Study selection Randomised and nonrandomised, controlled, and prospective studies comparing preventive regimes for root caries were considered. Only English or German language studies were considered. Data extraction and synthesis Standard data items were extracted. Mean differences (MD) and standard mean differences (SMD) were primary effect measures. Changes were calculated for DMFRS/DFRS (decayed, missing, filled root surfaces), and RCI (root caries index). Random-effects meta-analysis was conducted. Study quality was assessed using the Cochrane risk of bias tool and grading of evidence was performed according to the GRADE. Results Thirty trials reported in 34 studies involving 10,126 patients were included. Twenty-nine were RCTs, the other a controlled trial. Risk of bias was considered low for only five studies. In all 28 chemical agents were tested. Eleven studies assessed dentifrices; ten rinses; eight varnishes; three fluoride solutions; three gels; two ozone applications; one preventive dental regimen. Meta-analyses revealed that dentifrices containing 5,000 ppm F- (RR = 0.49; 95% CI= 0.42, 0.57; high level of evidence) or 1.5% arginine plus 1,450 ppm F- (RR = 0.79; 95% CI = 0.64, 0.98; very low level) are more effective in inactivating RCLs than dentifrices containing 1,100 to 1,450 ppm F-. Self-applied AmF/SnF2-containing dentifrice and rinse decreased the initiation of RCLs when compared with NaF products (SMD = 0.15; 95% CI = -0.22, 0.52; low level evidence). Mouth rinse containing 225 to 900 ppm F- revealed a significantly reduced DMFRS/DFRS (MD = -0.18; 95% CI = -0.35, -0.01; low level) when compared with a placebo rinse. Significantly reduced RCI was found for Chlorhexidine (MD = -0.67; 95% CI = -1.01, -0.32; very low level evidence) as well as SDF (MD = -0.33; 95% CI = -0.39, -0.28; very low level) when compared with placebo varnish. Conclusions Based on meta-analysis, dentifrice containing 5,000 ppm F- and professionally applied CHX or SDF varnish may inactivate existing and/or reduce the initiation of RCLs. However, results should be interpreted with caution due to the low numbers of clinical trials for each agent, the high risk of bias within studies, and the limiting grade of evidence.
TL;DR: The overall quality of the included studies was poor and none of the adjunctive tests can be recommended as a replacement for the currently used standard of a scalpel biopsy and histological assessment.
Abstract: DATA SOURCES Medline, the Cochrane Diagnostic Test Accuracy Studies Register, the Cochrane Oral Health Groups Trials Register, Embase and MEDION. STUDY SELECTION Two of the reviewers independently assessed titles abstracts and extracted data. Cross-sectional diagnostic test accuracy studies (or consecutive series) and randomised studies of diagnostic test accuracy that reported the diagnostic test accuracy of vital staining, oral cytology, light-based detection and oral spectroscopy, blood or saliva analysis used as an adjunct to conventional oral examination in detecting PMD or oral squamous cell carcinoma of the lip or oral cavity were considered. Scalpel, punch or fine needle aspiration biopsy with histological diagnosis was the reference test. DATA EXTRACTION AND SYNTHESIS Study quality was assessed using a modified version of QUADAS-2. Meta-analysis was used to combine the results of studies for each index test using the bivariate approach to estimate the expected values of sensitivity and specificity. Meta-regressionanalysis was undertaken to explore possible sources of heterogeneity. RESULTS Forty-one studies, recruiting 4002 patients were included. No single study could be classified as being at low risk of bias across all domains. Fourteen studies evaluated vital staining, 13 studies oral cytology and 13 studies light-based detection or oral spectroscopy, while six studies assessed two combined index tests. There were no eligible diagnostic accuracy studies evaluating blood or salivary sample analysis. CONCLUSIONS The overall quality of the included studies was poor. None of the adjunctive tests can be recommended as a replacement for the currently used standard of a scalpel biopsy and histological assessment. Given the relatively high values of the summary estimates of sensitivity and specificity for cytology, this would appear to offer the most potential. Combined adjunctive tests involving cytology warrant further investigation.
TL;DR: There is inadequate evidence to draw valid conclusions on the effectiveness of chemiluminescence and autofluorescent imaging devices as screening adjuncts, and these tools are better suited to specialist clinics in which there is a higher prevalence of disease and where experienced clinicians may better discriminate between benign and malignant lesions.
Abstract: Little evidence for the effectiveness of chemiluminescence and autofluorescent imaging devices as oral cancer screening adjuncts
TL;DR: The diagnostic accuracy of CBCT is similar among different types of tooth fractures, which should be interpreted with caution due to unavailability of data for subgroup analysis on horizontal and oblique tooth fractures.
Abstract: PubMed, Embase, Web of Science, ProQuest Dissertations & Theses, CNKI and SIGLE databases. Two reviewers independently selected studies. Studies examining the diagnostic accuracy of CBCT for tooth fractures in vivo were considered. Only studies with a minimum of ten participants using a reference test of surgical exploration or extractions to establish the diagnosis of tooth fractures were included. Data abstraction was carried out independently by two reviewers and study quality assessed using the Quality Assessment of Studies of Diagnostic Accuracy-2 (QUADAS-2) tool. The main study outcomes were sensitivity, specificity, positive likelihood ratio (LR), negative LR and summary receiver operating characteristic (SROC). Twelve studies were included in a meta-analysis. The pooled sensitivity was 0.92 (95% CI=0.89–0.94) and pooled specificity 0.85 (95% CI=0.75–0.92). The pooled positive and negative likelihood ratios were 5.68 (95% CI=3.42–9.45) and 0.13 (95% CI=0.09–0.18) respectively. The summary receiver operating characteristic was 0.94 (95% CI=0.90–0.98). The pooled prevalence of tooth fractures in patients with clinically suspected but periapical-radiography-undetected tooth fractures was 91% (95% CI = 83%-97%). Positive and negative predictive values were 0.98 and 0.43 (subgroup analysis: 0.98 and 0.28 for endodontically treated teeth; 0.99 and 0.77 for non endodontically treated teeth). We suggest that CBCT has a high diagnostic accuracy for tooth fractures and could be used in clinical settings. We can be very confident with positive test results but should be very cautious with negative test results. For patients with negative results, close follow-ups are recommended. The diagnostic accuracy of CBCT is similar among different types of tooth fractures, which should be interpreted with caution due to unavailability of data for subgroup analysis on horizontal and oblique tooth fractures.
TL;DR: Increased rates of haemorrhage are observed in patients on long-term aspirin therapy, and local measures for haemostasis should be enhanced when required, and the authors recommend not stopping long- term aspirin prior to dental extraction.
Abstract: Data sources PubMed, ScienceDirect and EBSCOhost databases. Study selection Prospective randomised controlled trials (RCTs) or controlled trials. Data extraction and synthesis Two independent investigators extracted data. The primary measured outcomes were rates of haemorrhage and bleeding time. Disagreements were clarified with a third investigator. Relevant authors were contacted if any relevant data was missing. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system was used to evaluate the overall quality of evidence. The authors used standardised mean difference or relative risk to evaluate each outcome. Results Ten studies were included, three randomised controlled trials and seven controlled trials. A total of 1752 patients were enrolled in the meta-analysis; the study group comprised 529 patients on long-term aspirin therapy, and the control group comprised 1223 patients. The risk of post-operative haemorrhage was significantly higher in patients on aspirin therapy (relative risk=2.46; 95% confidence interval: 1.45-4.81) but bleeding time was not significantly different between the two groups (standardised mean difference=0.63; 95% CI: - 0.04 to 1.31). Conclusions Increased rates of haemorrhage are observed in patients on long-term aspirin therapy. The authors recommend not stopping long-term aspirin prior to dental extraction, and local measures for haemostasis should be enhanced when required.
TL;DR: Prophylactic L LLT reduced severe mucositis and pain in patients with cancer and HSCT recipients and future research should identify the optimal characteristics of LLLT and determine feasibility in the clinical setting.
Abstract: Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINHAL, Web of Science, Scopus, LILACS, Conference proceedings of the International Society of Paediatric Oncology, American Society of Clinical Oncology, American Society of Hematology, American Society of Pediatric Hematology and Oncology, and Multinational Association of Supportive Care in Cancer and the reference lists of identified studies. Two reviewers independently selected studies for inclusion with randomised controlled trials (RCTs) and quasi-RCTs being considered. Data were extracted using a specifically developed form and study quality was assessed using the Cochrane risk of bias tool. Dichotomous outcomes data were synthesised using the risk ratio (RR) and 95% confidence interval (CI). Continuous outcomes measured using different scales were synthesised using the standardised mean difference (SMD) while those using the same scale were synthesised using the weighted mean difference (WMD). Eighteen RCTs involving 1144 patients were included. Four trials were considered to be at low risk of bias across all domains. Prophylactic LLLT reduced the overall risk of severe mucositis (risk ratio (RR) 0.37, 95% confidence interval (CI) 0.20 to 0.67; P = 0.001). Compared to placebo/no therapy LLLT also reduced the following outcomes; severe mucositis at the time of anticipated maximal mucositis RR = 0.34, (95% CI; 0.20 to 0.59); overall mean grade of mucositis SMD -1.49, (95% CI; -2.02 to -0.95); duration of severe mucositis WMD -5.32, 95% (CI; -9.45 to -1.19) and incidence of severe pain (RR 0.26, 95% CI; 0.18 to 0.37). Prophylactic LLLT reduced severe mucositis and pain in patients with cancer and HSCT recipients. Future research should identify the optimal characteristics of LLLT and determine feasibility in the clinical setting.
TL;DR: It is suggested that the insertion of dental implants in fresh extraction sockets affects the implant failure rates, within the limitations of the existing investigations.
Abstract: PubMed, Web of Science and Cochrane Oral Health Group Trials. Register databases supplemented by hand searching a range of dental implants-related journals. Randomised and non-randomised studies comparing implant failure rates in any group of patients receiving dental implants being inserted in fresh extraction sockets compared to the insertion in healed sites were considered. Study quality was assessed using the Newcastle-Ottawa scale (NOS). Implant failure (complete loss of implant) and postoperative infection were the dichotomous outcomes measures evaluated, with marginal bone loss as a continuous outcome. Seventy-three publications were included, five were randomised controlled trials, 26 clinical controlled trials and 42 retrospective studies. The 73 studies included a total of 8241 dental implants inserted in fresh extraction sockets, with 330 failures (4.00%), and 19,410 implants inserted in healed sites, with 599 failures. A random effects meta-analysis (73 studies) found the relative risk of implant failures in fresh socket sites compared to healed sites was RR= 1.58 (95% CI; 1.27 1.95) for the maxilla only RR= 1.61 (95% CI; 0.97 2.66); mandible only RR= 2.15 (95% CI; 0.62-7.47). For implants supporting single crown restoration RR= 2.05 (95% CI; 1.36-3.11) and RR= 1.42 (95% CI; 0.71- 2.83) for those with a full arch prosthesis. There were 31 controlled studies (CCTs) and randomised controlled studies (RCTs) that included 2021 implants inserted in fresh sockets with 96 failures (4.75%) and 2759 implants were inserted in healed sites with 49 failures (1.59%). The relative risk of implant failures in fresh socket sites compared to healed sites was RR= 2.27 (95% CI; 1.57-3.29). The results of the present review should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies, most of them not randomised trials. Within the limitations of the existing investigations, the present study suggests that the insertion of dental implants in fresh extraction sockets affects the implant failure rates.
TL;DR: There is statistically significant evidence suggesting that a single dose of 2 g or 3 g of amoxicillin given orally is beneficial in reducing dental implant failure in ordinary conditions, and the overall body of the evidence was considered moderate.
Abstract: Cochrane Oral Health Groups Trial Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID and EMBASE via OVID. Databases were searched with no language or date restrictions. Two authors independently reviewed the titles and the abstracts for inclusion. Disagreements were resolved by discussion. If needed, a third author was consulted. Included were randomised clinical trials with a follow-up of at least three months which evaluated the use of prophylactic antibiotic compared to no antibiotic or a placebo and examined different antibiotics of different doses and durations in patients undergoing dental implant placement. The outcomes were implant failure (considered as implant mobility, removal of implant due to bone loss or infection) and prosthesis failure (prosthesis could not be placed). Standard Cochrane methodology procedures were followed. Risk of bias was completed independently and in duplicate by two review authors. Results were expressed as risk ratios (RRs) using a random-effects model for dichotomous outcomes with 95% confidence intervals (CI). The statistical unit was the participant and not the prosthesis or implant. Heterogeneity including both clinical and methodological factors was investigated. Six randomised clinical trials with 1162 participants were identified for the review. Three trials compared 2 g of preoperative amoxicillin versus placebo (927 participants). One trial compared 3 g of preoperative amoxicillin versus placebo (55 participants). Another trial compared 1 g of preoperative amoxicillin plus 500 mg four times a day for two days versus no antibiotic (80 participants). An additional trial compared four groups: (1) 2 g of preoperative amoxicillin; (2) 2 g of preoperative amoxicillin plus 1 g twice a day for seven days; (3) 1 g of postoperative amoxicillin twice a day for seven days and (4) no antibiotics (100 participants). The overall body of the evidence was considered moderate. The meta-analysis of the six trials showed a statistically significant higher number of implant failures in the group not receiving antibiotics, RR= 0.33 (95% CI; 0.16 to 0.67) P = 0.0002. The number needed to treat for one additional benefit outcome (NNTB) to prevent one person having an implant failure is 25 (95% CI; 14 to 100) based on an implant failure of 6% in participants not receiving antibiotics. There was borderline statistical significance for prosthesis failures (RR= 0.44 (95%CI; 0.19 to 1.00) with no statistically significant differences for infections or adverse events. No conclusive information for the different durations of antibiotics could be determined There is statistically significant evidence suggesting that a single dose of 2 g or 3 g of amoxicillin given orally is beneficial in reducing dental implant failure in ordinary conditions. No significant adverse events were reported. It is still unknown whether post-operative antibiotics are beneficial and which antibiotic is more effective.
TL;DR: There are currently no high quality studies in the form of longitudinal or randomised controlled trials to assess the impact of malocclusion and its associated treatment on OHIP-14 scores respectively, and results from existing studies suggest that OHIP -14 scores are significantly lower in individuals without a maloc inclusion, indicating higher levels of OHRQoL.
Abstract: The impact of malocclusion and its treatment on the oral health related quality of life of adults, assessed using the Oral Health Impact Profile (OHIP-14)
TL;DR: Fluoride-releasing sealants (high-viscosity GIC and fluoride RB) were demonstrated to provide protection against caries on the distal surface of second primary molars.
Abstract: Randomised controlled trial. Children with at least two sound permanent first molars and the presence of at least one sound distal surface of adjacent second primary molar were eligible. Children were randomised into three groups. In group one first permanent molars were sealed with a high-viscosity glass ionomer cement (GIC group; n = 926), group two received a resin-based fluoride containing sealant (RBF group; n = 923) and group three a resin-based sealant without fluoride (RB group; n = 927). Two examiners blind to group allocation conducted examinations at 30 months. Sealant retention and caries at D1-D3 levels was assessed. Bitewing radiographs were taken. Caries prevalence and incidence rate ratios were calculated. Two thousand seven hundred and seventy-six children were enrolled; the number of dropouts were similar in each group (GIC group; n = 75), (RBF group; n = 67), (RB group; n = 77). The prevalence of affected surfaces was significantly lower in the GIC (p = .03) and FRB groups (p = .04). Fewer new caries developed on the distal surfaces of the second primary molars in the GIC group than in the other two groups. Incidence rate ratios (IRRs) were: 0.70 (95% CI: 0.50, 0.68; p < .01) for GIC vs. RB; 0.89 (95% CI: 0.89, 1.28; p = .10) for GIC vs. FRB and 0.79 (95% CI: 0.53, 1.04; p = .005) for FRB vs RB. Partial sealant loss was higher in the GIC group (76 molars; 2.95%), compared with FRB (52 molars; 1.41%), RB group (50 molars;1.35%). Fluoride-releasing sealants (high-viscosity GIC and fluoride RB) were demonstrated to provide protection against caries on the distal surface of second primary molars. This preventive strategy might contribute to maintaining the integrity of the mesial surfaces of the first permanent molars.
TL;DR: There is moderate quality evidence of a large caries-inhibiting effect of fluoride gel in the permanent dentition and a apparent lack of small studies with statistically significant large effects.
Abstract: Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline , Embase, CINAHL, LILACS, ProQuest Dissertations and Theses, the Web of Science Conference Proceedings, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. Randomised or quasi-randomised controlled trials comparing topically applied fluoride gel with placebo or no treatment in children up to 16 years were considered. Studies had to be at least one year in duration with a frequency of application of at least once a year with blind outcome assessment. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces in both permanent and primary teeth (D(M)FS and d(e/m)fs). At least two reviewers extracted data and assessed risk of bias. The primary measure of effect was the prevented fraction (PF). Where data could be pooled random-effects meta-analyses were conducted. Potential sources of heterogeneity were examined in random-effects meta-regression analyses. Twenty-eight trials involving 9140 children and adolescents were included. Most of the studies (20) were at high risk of bias, with eight at unclear risk of bias. Twenty-five trials (8479 participants) provided data for meta-analysis on permanent teeth, with a D(M)FS pooled prevented fraction (PF) estimate of 28% (95% CI; 19-36%; P < 0.0001; with substantial heterogeneity (P < 0.0001; I2 = 82%); moderate quality evidence). Subgroup and metaregression analyses suggested no significant association between estimates of D(M)FS prevented fractions and the prespecified trial characteristics. However, the effect of fluoride gel varied according to the type of control group used, with D(M)FS PF on average being 17% (95% CI 3% to 31%; P = 0.018) higher in non-placebo-controlled trials (the reduction in caries was 38% (95% CI 24% to 52%; P < 0.0001, 2808 participants) for the ten trials with no treatment as control group, and 21% (95% CI 15% to 28%; P < 0.0001, 5671 participants) for the 15 placebo-controlled trials. A funnel plot of the 25 trials in the D(M)FS PF meta-analysis indicated a relationship between prevented fraction and study precision, with an apparent lack of small studies with statistically significant large effects. For primary teeth the d(e/m)fs pooled prevented fraction estimate for the three trials (1254 participants) = 20% (95%CI; 1% - 38%; P = 0.04; with no heterogeneity (P = 0.54; I2 = 0%); low quality evidence). There was limited reporting of adverse events. Only two trials reported information on acute toxicity signs and symptoms during the application of the gel (risk difference 0.01, 95% CI -0.01 to 0.02; P = 0.36; with no heterogeneity (P = 36; I2 = 0%); 490 participants; very low quality evidence). None of the trials reported information on tooth staining, mucosal irritation or allergic reaction. The conclusions of this updated review remain the same as those when it was first published. There is moderate quality evidence of a large caries-inhibiting effect of fluoride gel in the permanent dentition. Information concerning the caries-preventive effect of fluoride gel on the primary dentition, which also shows a large effect, is based on low quality evidence from only three placebo-controlled trials. There is little information on adverse effects or on acceptability of treatment. Future trials should include assessment of potential adverse effects.
TL;DR: Chlorhexidine gel can be successfully formulated and will inhibit plaque growth to some degree, but not to the same extent, as a CHX MW, when it is used in a non-brushing model.
Abstract: Medline, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials (RCTs) or controlled clinical trials (CCTs) in adults 18 years of age comparing CHX DF/gel with CHX MW written in English or Dutch were considered. Two reviewers independently selected studies, abstracted data and assessed risk of bias. Where possible, a meta-analysis was performed. Difference in means values between test and control at both baseline and end was calculated using a fixed-effects model. Five RCTs were included, four had a parallel design and one was a cross-over trial. Three studies showed a positive score in favour of the mouthwash. Three studies contributed to a meta-analysis of the effect on 'de novo' plaque formation. There was a difference in means of 0.27 [95% CI: 0.14; 0.39] (P < 0.0001) in favour of CHX MW. One study assessed tooth staining finding more staining with the use of CHX MW compared to the CHX DF/gel. Chlorhexidine gel can be successfully formulated and will inhibit plaque growth to some degree, but not to the same extent, as a CHX MW. When CHX DF/gel is used in a non-brushing model, it is significantly less effective in plaque inhibition compared to CHX MW. Based on one study when CHX gel was applied with a finger after brushing, it is significantly more effective on plaque scores and the gingival index. The only brushing study also with a long follow-up showed that there is no significant difference between CHX DF and CHX MW. However, as a corollary, significantly more tooth discoloration was observed with the CHX MW. Altogether, the data show that when daily oral hygiene cannot be performed, CHX MW is the first product of choice.
TL;DR: Very low quality evidence was found that was insufficient to support or refute whether periodontal therapy can prevent the recurrence of CVD in the long term in patients with chronic periodontitis.
Abstract: Insufficient evidence of effect of periodontal treatment on prevention or management of cardiovascular disease
TL;DR: There is clearly a need for randomised controlled clinical trials to investigate the effectiveness of surgical, medical and psychological interventions for iatrogenic inferior alveolar and lingual nerve injuries.
Abstract: Trials needed to identify best management of iatrogenic inferior alveolar and lingual nerve injuries
TL;DR: Little evidence is found from the eight trials on varnishes and gels included in this review to either support or refute the assertion that chlorhexidine is more effective than placebo or no treatment in the prevention of caries or the reduction of mutans streptococci levels in children and adolescents.
Abstract: Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase and CINAHL. Randomised controlled trials (RCTs) comparing the effects of chlorhexidine-containing oral products with no treatment or placebo on dental caries, and comparing the effects of one chlorhexidine-containing oral product with another were considered. Two reviewers independently extracted trial data and assessed risk of bias. Owing to the clinical diversity of the included studies with respect to age, composition of intervention, and variation in outcome measures and follow-up, meta-analysis was not carried out. A narrative synthesis was presented. Eight trials were included. Six were at high risk of bias and two at unclear risk. Six trials compared chlorhexidine varnish with placebo or no treatment. Data from two trials (690 patients) one using 10% chlorhexidine varnish and the other, 40%, showed that this led to an increase in the DMFS increment in the varnish group of 0.53 (95% CI; -0.47 to 1.53). Only one trial involving 496 patients and using 10% chlorhexidine varnish provided usable data for elevated mutans streptococci levels > 4 with RR 0.93 (95% CI; 0.80 to 1.07). Two trials (487 patients) compared 0.12% chlorhexidine gel with no treatment in the primary dentition. The presence of new caries gave rise to a 95% confidence interval that was compatible with either an increase or a decrease in caries incidence (RR 1.00, 95% CI 0.36 to 2.77). The authors found little evidence from the eight trials on varnishes and gels included in this review to either support or refute the assertion that chlorhexidine is more effective than placebo or no treatment in the prevention of caries or the reduction of mutans streptococci levels in children and adolescents. There were no trials on other products containing chlorhexidine such as sprays, toothpastes, chewing gums or mouthrinses. Further high quality research is required, in particular evaluating the effects on both the primary and permanent dentition and using other chlorhexidine-containing oral products.
TL;DR: There was a minor and most likely clinically insignificant difference between Tcs- and SnF-containing dentifrices; whereas TCS was more effective when assessed by the Q&H PI, it was not when scored with the RMNPI.
Abstract: Little difference between triclosan and stannous fluoride dentifrices on gingival inflammation
TL;DR: Endodontic microsurgery was confirmed as a reliable treatment option with favourable initial healing and a predictable outcome with a statistically significant difference between the weighted pooled success rates for the microsur surgery group and retreatment group.
Abstract: Data sources:
PubMed/Medline, Embase and The Cochrane Library databases.
Study selection:
Clinical studies with a minimum sample size of 20 teeth and six months follow-up period, providing clinical and radiographic assessment of success/failure were considered.
Data extraction and synthesis:
Three reviewers selected the studies and assessed study quality. Weighted pooled success rates and 95% confidence interval (CI) estimates of the outcome were calculated and a random-effects meta-analysis was carried out.
Results:
Eighteen studies involving 2373 patients were included. Eleven studies (1175 patients) considered microsurgery; four of these were RCTs, three prospective studies and four retrospective. Seven studies (1198 patients) addressed endodontic retreatment; six of these were prospective studies and one retrospective. There was a statistically significant difference between the weighted pooled success rates for the microsurgery group and retreatment group. This was apparent in all follow-up periods except those greater than four years.
Conclusions:
The authors concluded that based on this study, endodontic microsurgery was confirmed as a reliable treatment option with favourable initial healing and a predictable outcome. Further long-term clinical studies investigating endodontic microsurgery and retreatment are needed in the future.