Pub Date : 2024-06-01DOI: 10.1038/s41432-024-01022-6
Deborah Moore, Anne-Marie Glenny
Human, animal, and in vitro studies. Extensive literature search of multiple bibliographic databases, trial registries, major grey literature sources and bibliographies of identified studies. The authors aimed to identify studies which could be used to determine the maximum safe level for fluoride in drinking water. To identify new studies published since a 2016 Australian review, the search period was 2016 to July 2021. Studies which evaluated the association between either naturally or artificially fluoridated water (any concentration) and any health outcomes were included. No restrictions on study design or publication status. Articles published in a ‘non-Latin language’ were excluded. Screening of abstracts and full texts was in duplicate. For IQ and dental fluorosis, a top-up search was conducted between 2021 and Feb 2023. Extensive data extraction. Risk of bias assessment using the OHAT tool. A narrative synthesis of the results was carried out. The review included 89 studies in humans, 199 in animals and 10 reviews of in vitro studies. Where there was consistent evidence of a positive association, in relation to a water fluoride concentration of <20 ppm (mg F/L), and where studies were judged to be acceptable or high quality, health effects were taken forwards for further examination of causality using Bradford Hill’s 9 criteria. Of the 39 health outcomes reviewed, 4 were further assessed for causality. The authors reported ‘strong’ evidence of causality for dental fluorosis and reductions in children’s IQ scores, ‘moderate’ strength evidence for thyroid dysfunction, ‘weak’ for kidney dysfunction, and ‘limited’ evidence for sex hormone disruption. The authors conclude that moderate dental fluorosis and reductions in children’s IQ scores are the most appropriate health outcomes to use when setting an upper safe level of fluoride in drinking water. For reductions in children’s IQ, the authors acknowledge a biological mechanism of action has not been elucidated, and the dose response curve is not clear at lower concentrations, limiting the ability to set an upper safe threshold.
{"title":"Fluoride and children’s IQ: evidence of causation lacking","authors":"Deborah Moore, Anne-Marie Glenny","doi":"10.1038/s41432-024-01022-6","DOIUrl":"10.1038/s41432-024-01022-6","url":null,"abstract":"Human, animal, and in vitro studies. Extensive literature search of multiple bibliographic databases, trial registries, major grey literature sources and bibliographies of identified studies. The authors aimed to identify studies which could be used to determine the maximum safe level for fluoride in drinking water. To identify new studies published since a 2016 Australian review, the search period was 2016 to July 2021. Studies which evaluated the association between either naturally or artificially fluoridated water (any concentration) and any health outcomes were included. No restrictions on study design or publication status. Articles published in a ‘non-Latin language’ were excluded. Screening of abstracts and full texts was in duplicate. For IQ and dental fluorosis, a top-up search was conducted between 2021 and Feb 2023. Extensive data extraction. Risk of bias assessment using the OHAT tool. A narrative synthesis of the results was carried out. The review included 89 studies in humans, 199 in animals and 10 reviews of in vitro studies. Where there was consistent evidence of a positive association, in relation to a water fluoride concentration of <20 ppm (mg F/L), and where studies were judged to be acceptable or high quality, health effects were taken forwards for further examination of causality using Bradford Hill’s 9 criteria. Of the 39 health outcomes reviewed, 4 were further assessed for causality. The authors reported ‘strong’ evidence of causality for dental fluorosis and reductions in children’s IQ scores, ‘moderate’ strength evidence for thyroid dysfunction, ‘weak’ for kidney dysfunction, and ‘limited’ evidence for sex hormone disruption. The authors conclude that moderate dental fluorosis and reductions in children’s IQ scores are the most appropriate health outcomes to use when setting an upper safe level of fluoride in drinking water. For reductions in children’s IQ, the authors acknowledge a biological mechanism of action has not been elucidated, and the dose response curve is not clear at lower concentrations, limiting the ability to set an upper safe threshold.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 2","pages":"95-97"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11213703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141186247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-31DOI: 10.1038/s41432-024-01023-5
Patrick Quinn, Brett Duane
An in vitro study to determine the immediate and sustained effect of fluoride varnish and its combination with fluoride toothpastes in preventing the development of root caries. Human root dentine samples (150) were randomly divided into five experimental protocols of 30 specimens each: 1) fluoride varnish (22,600 ppm fluoride and 1–5% CPP-ACP); 2) fluoride varnish followed by Paste One (1100 ppm sodium fluoride and CPP-ACP); 3) fluoride varnish followed by Paste Plus (900 ppm sodium fluoride and CPP-ACP); 4) fluoride varnish followed by Paste One and Paste Plus; and 5) no treatment (control). A layer of varnish was applied to specimens except the control group and was left in situ for 18 h. The varnish layer was removed, and the various toothpaste treatments were initiated. Half of the specimens in each group were assigned to a short-term incubation model in which they were immediately subjected to a 7-day cariogenic challenge consisting of a combination of human saliva and artificial saliva containing 2% sucrose. The other half of the specimens in each group were assigned to the long-term incubation model in which the experimental protocol was continued for 8 weeks before initiating the seven-day cariogenic challenge. The protocols were evaluated by assessing dentine porosity (rhodamine intensity), mineral density, biofilm biomass, and viability assays. Confocal laser scanning microscopy was used to determine dentine porosity and Levene’s test was used to verify the assumption of equality of variances and normal distribution of errors before two-way ANOVA and the Games-Howell test were carried out at a significance level of 0.05 for both incubation models. Microcomputed tomography was used to determine mineral density with statistical analysis involving Levene’s test, two-way ANOVA and Tukey’s test at a significance level of 0.05 for both incubation models. Biomass was evaluated using a biofilm biomass assay with analysis of optical density data using Levene’s test, ANOVA and Scheffe’s test at a significance level of 0.05. For both the short- and long-term incubation models, all the experimental regimes resulted in a statistically significant decrease in dentine porosity and an increase in mineral density when compared to the control group. Fluoride varnish followed by both pastes and fluoride varnish followed by Paste One resulted in a statistically significant decrease in dentine porosity for some depths in both models when compared to fluoride varnish alone. Changes in dentine porosity and mineral density were observed within groups over time. All the experimental regimes demonstrated anti-biofilm effects. Immediate and sustained anti-caries effects were observed for all preventive protocols, with the combination of fluoride varnish and Paste One resulting in superior additional anti-caries effects. The authors concluded that all protocols demonstrated immediate and sustained anti-caries effects against the development of root caries despite
{"title":"Immediate and sustained root caries prevention of fluoride varnish combined with toothpastes: findings of clinical relevance?","authors":"Patrick Quinn, Brett Duane","doi":"10.1038/s41432-024-01023-5","DOIUrl":"10.1038/s41432-024-01023-5","url":null,"abstract":"An in vitro study to determine the immediate and sustained effect of fluoride varnish and its combination with fluoride toothpastes in preventing the development of root caries. Human root dentine samples (150) were randomly divided into five experimental protocols of 30 specimens each: 1) fluoride varnish (22,600 ppm fluoride and 1–5% CPP-ACP); 2) fluoride varnish followed by Paste One (1100 ppm sodium fluoride and CPP-ACP); 3) fluoride varnish followed by Paste Plus (900 ppm sodium fluoride and CPP-ACP); 4) fluoride varnish followed by Paste One and Paste Plus; and 5) no treatment (control). A layer of varnish was applied to specimens except the control group and was left in situ for 18 h. The varnish layer was removed, and the various toothpaste treatments were initiated. Half of the specimens in each group were assigned to a short-term incubation model in which they were immediately subjected to a 7-day cariogenic challenge consisting of a combination of human saliva and artificial saliva containing 2% sucrose. The other half of the specimens in each group were assigned to the long-term incubation model in which the experimental protocol was continued for 8 weeks before initiating the seven-day cariogenic challenge. The protocols were evaluated by assessing dentine porosity (rhodamine intensity), mineral density, biofilm biomass, and viability assays. Confocal laser scanning microscopy was used to determine dentine porosity and Levene’s test was used to verify the assumption of equality of variances and normal distribution of errors before two-way ANOVA and the Games-Howell test were carried out at a significance level of 0.05 for both incubation models. Microcomputed tomography was used to determine mineral density with statistical analysis involving Levene’s test, two-way ANOVA and Tukey’s test at a significance level of 0.05 for both incubation models. Biomass was evaluated using a biofilm biomass assay with analysis of optical density data using Levene’s test, ANOVA and Scheffe’s test at a significance level of 0.05. For both the short- and long-term incubation models, all the experimental regimes resulted in a statistically significant decrease in dentine porosity and an increase in mineral density when compared to the control group. Fluoride varnish followed by both pastes and fluoride varnish followed by Paste One resulted in a statistically significant decrease in dentine porosity for some depths in both models when compared to fluoride varnish alone. Changes in dentine porosity and mineral density were observed within groups over time. All the experimental regimes demonstrated anti-biofilm effects. Immediate and sustained anti-caries effects were observed for all preventive protocols, with the combination of fluoride varnish and Paste One resulting in superior additional anti-caries effects. The authors concluded that all protocols demonstrated immediate and sustained anti-caries effects against the development of root caries despite","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 2","pages":"106-107"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11213700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141183992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-29DOI: 10.1038/s41432-024-01020-8
Majidi Bakar, Brett Duane
A randomised parallel controlled clinical trial was conducted between 2013 and 2015 at the University of Sao Paulo, Brazil, to assess the impact of pulpectomy or extraction on the oral health-related quality of life (OHRQoL) of children with pulp necrosis in primary molars. Children between the ages of 3 and 5 who were in good health but had extensive caries in at least one primary molar with signs of pulpal necrosis (also as seen radiographically, caries reaching the pulp with no signs of internal or external resorption) were considered for inclusion. Additionally, teeth with sufficient structure for rubber dam placement were also included. Children with any systemic, neurological, or other conditions that negatively impacted their growth were excluded. After computer-generated randomisation, 100 children were assigned randomly into two groups: 50 in the pulpectomy group and 50 in the dental extraction group. A paediatric dentist performed all procedures under local anaesthesia without sedation or general anaesthesia, and a rubber dam was used for pulpectomy with composite restoration in a single session. The OHRQoL scores were evaluated at baseline, 4, 8, and 12 months using the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) via face-to-face interviews with parents conducted by a researcher trained in a single-blinded fashion. Additionally, the child’s self-reported dental anxiety was measured using the Facial Image Scale (FIS), and dental pain was assessed using the Wong-Baker Faces Pain Scale (WBFPS) immediately after the treatment as secondary outcomes. The mean difference (SD) in the total B-ECOHIS score between baseline and after 12 months was 12.66 (6.79) for the pulpectomy group and 10.94 (9.28) for the extraction group, with effect sizes of 3.2 (95% CI: 2.42–4.20) and 1.4 (95% CI: 0.84–2.11), respectively. While both treatments significantly improved the children’s OHRQoL after 12 months, the pulpectomy group showed greater long-term improvement compared to the extraction group, with mean differences (SD) of 4.86 (6.13) and effect sizes of 0.8 (0.46–1.13; p < 0.001). Moreover, children in the extraction group showed higher levels of anxiety compared with those in the pulpectomy group at 12-month follow-up (OR = 2.52; 95% CI = 1.30–4.89), and they reported 93% more odds of ‘dental pain with high level’ immediately after treatment than those in the pulpectomy group (OR = 1.93; 95% CI = 0.83–4.49). Children treated with pulpectomy in their necrotic primary molars were found to have better OHRQoL than those who had their primary molars extracted.
{"title":"Has children’s oral health-related quality of life improved more following necrotic primary molars pulpectomy or extraction?","authors":"Majidi Bakar, Brett Duane","doi":"10.1038/s41432-024-01020-8","DOIUrl":"10.1038/s41432-024-01020-8","url":null,"abstract":"A randomised parallel controlled clinical trial was conducted between 2013 and 2015 at the University of Sao Paulo, Brazil, to assess the impact of pulpectomy or extraction on the oral health-related quality of life (OHRQoL) of children with pulp necrosis in primary molars. Children between the ages of 3 and 5 who were in good health but had extensive caries in at least one primary molar with signs of pulpal necrosis (also as seen radiographically, caries reaching the pulp with no signs of internal or external resorption) were considered for inclusion. Additionally, teeth with sufficient structure for rubber dam placement were also included. Children with any systemic, neurological, or other conditions that negatively impacted their growth were excluded. After computer-generated randomisation, 100 children were assigned randomly into two groups: 50 in the pulpectomy group and 50 in the dental extraction group. A paediatric dentist performed all procedures under local anaesthesia without sedation or general anaesthesia, and a rubber dam was used for pulpectomy with composite restoration in a single session. The OHRQoL scores were evaluated at baseline, 4, 8, and 12 months using the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) via face-to-face interviews with parents conducted by a researcher trained in a single-blinded fashion. Additionally, the child’s self-reported dental anxiety was measured using the Facial Image Scale (FIS), and dental pain was assessed using the Wong-Baker Faces Pain Scale (WBFPS) immediately after the treatment as secondary outcomes. The mean difference (SD) in the total B-ECOHIS score between baseline and after 12 months was 12.66 (6.79) for the pulpectomy group and 10.94 (9.28) for the extraction group, with effect sizes of 3.2 (95% CI: 2.42–4.20) and 1.4 (95% CI: 0.84–2.11), respectively. While both treatments significantly improved the children’s OHRQoL after 12 months, the pulpectomy group showed greater long-term improvement compared to the extraction group, with mean differences (SD) of 4.86 (6.13) and effect sizes of 0.8 (0.46–1.13; p < 0.001). Moreover, children in the extraction group showed higher levels of anxiety compared with those in the pulpectomy group at 12-month follow-up (OR = 2.52; 95% CI = 1.30–4.89), and they reported 93% more odds of ‘dental pain with high level’ immediately after treatment than those in the pulpectomy group (OR = 1.93; 95% CI = 0.83–4.49). Children treated with pulpectomy in their necrotic primary molars were found to have better OHRQoL than those who had their primary molars extracted.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 2","pages":"85-86"},"PeriodicalIF":0.0,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11213704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-25DOI: 10.1038/s41432-024-01018-2
Darshini Ramasubbu, Brett Duane
Three electronic databases (Pubmed, Embase and the Cochrane Library) were searched in December 2022, and again for additional literature on 3–5th January 2023. Reference lists of relevant systematic reviews were hand searched for other eligible studies for inclusion. Randomised controlled clinical trials and controlled clinical trials conducted on children (aged ≤ 18 years), conducted between 1974–2022 and available in English, were eligible for inclusion. Studies were excluded if caries was not an outcome, the control group was not sufficient, they were lab-based studies or studies where xylitol delivery was not a sweet or chewing gum and where the xylitol product contained a component such as fluoride which may influence the outcomes. Four calibrated reviewers independently screened titles and abstracts, and disagreements were resolved via group discussion. Preventative effect was determined by comparing the mean caries increment in the control and intervention groups, producing a preventative fraction. A total of 617 titles were initially screened for relevance. After duplicate removal, 268 abstracts were screened and 16 full text articles reviewed, with one more study then excluded. 10 studies investigated xylitol-containing chewing gum, and six looked at xylitol candy (one did both). Eight included studies were randomised controlled trials. Data extraction was undertaken by two reviewers. 3466 participants were included in the 10 studies that investigated xylitol chewing gum, and all 10 studies reported a statistically significant preventive effect compared to a no chewing gum or placebo control. In 9 studies, the preventive fraction was clinically significant. The six studies investigating xylitol candies contained a total of 1023 participants, and only one study demonstrated a significant preventative effect. There is some evidence that incorporating xylitol chewing gum daily has a caries-reducing effect in those with a moderate-to-high baseline caries level. This effect was not present for xylitol sweets.
{"title":"Do chewing gums and sweets containing xylitol prevent caries in children?","authors":"Darshini Ramasubbu, Brett Duane","doi":"10.1038/s41432-024-01018-2","DOIUrl":"10.1038/s41432-024-01018-2","url":null,"abstract":"Three electronic databases (Pubmed, Embase and the Cochrane Library) were searched in December 2022, and again for additional literature on 3–5th January 2023. Reference lists of relevant systematic reviews were hand searched for other eligible studies for inclusion. Randomised controlled clinical trials and controlled clinical trials conducted on children (aged ≤ 18 years), conducted between 1974–2022 and available in English, were eligible for inclusion. Studies were excluded if caries was not an outcome, the control group was not sufficient, they were lab-based studies or studies where xylitol delivery was not a sweet or chewing gum and where the xylitol product contained a component such as fluoride which may influence the outcomes. Four calibrated reviewers independently screened titles and abstracts, and disagreements were resolved via group discussion. Preventative effect was determined by comparing the mean caries increment in the control and intervention groups, producing a preventative fraction. A total of 617 titles were initially screened for relevance. After duplicate removal, 268 abstracts were screened and 16 full text articles reviewed, with one more study then excluded. 10 studies investigated xylitol-containing chewing gum, and six looked at xylitol candy (one did both). Eight included studies were randomised controlled trials. Data extraction was undertaken by two reviewers. 3466 participants were included in the 10 studies that investigated xylitol chewing gum, and all 10 studies reported a statistically significant preventive effect compared to a no chewing gum or placebo control. In 9 studies, the preventive fraction was clinically significant. The six studies investigating xylitol candies contained a total of 1023 participants, and only one study demonstrated a significant preventative effect. There is some evidence that incorporating xylitol chewing gum daily has a caries-reducing effect in those with a moderate-to-high baseline caries level. This effect was not present for xylitol sweets.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 2","pages":"89-90"},"PeriodicalIF":0.0,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01018-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141152802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-25DOI: 10.1038/s41432-024-01019-1
Alexander Hall, Emilie Baerts, David Edwards
A systematic review and meta-analysis of the literature was carried out assessing the success rate of root canal retreatment using gutta percha. Four of the largest databases were used to identify existing literature with no date or language restrictions. PubMed, Cochrane, ScienceDirect, Scopus and other additional sources were searched. Grey literature was also reviewed. Two authors, with Master’s degrees in endodontics and with extensive university teaching experience, were selected to screen the databases to identify suitable studies. In case the authors were not able to agree during the study selection process, a third investigator was consulted. Specific inclusion and exclusion criteria were outlined and adhered to in the study selection. Two randomised controlled trials, seven single arm prospective studies and one single arm ambispective study published before the 10th of December 2022 were included. These studies evaluated the success of root canal re-treatment, obturated with gutta percha with at least a 1-year follow-up. Nine of the studies were published between 1998 and 2022. Seven studies were conducted in Europe, one in North America and one in Asia. Standard Cochrane methods to assess interval validity were used. Risk of bias in individual studies was assessed using The Newcastle-Ottawa quality assessment scale (NOS) for single-arm studies, and the Cochrane risk of bias tool (RoB2) was used for randomised controlled trials. Outcome measures were standardised as either success or failure of root canal retreatment. Success was classified into 2 different criteria: Strict criteria = absence of clinical signs and symptoms and radiographically normal periodontal ligament space; and Loose criteria = absence of clinical signs and symptoms and absence or reduction of apical radiolucency in the control radiograph. Statistical analysis was undertaken using R software and the Freeman-Turkey transformation was performed. Results were visualised using forest plots. Heterogeneity between studies was measured using the Cochrane Q test and I2 values. Whilst following strict criteria, the success rate of non-surgical root canal retreatment obturated with gutta percha was 71% for 1–3 years follow-up (95% CI, 0.66–0.77) and 77% for 4–5 years follow-up (95% CI, 0.67–0.86). Heterogeneity was moderate (I2 = 61.4) and low (I2 = 0.0), respectively. Factors reducing the success rate of root canal re-retreatment under the strict criteria were older patients, mandibular teeth, molar teeth, the presence of a peri-apical radiolucency, teeth with a previous radiolucency, large peri-apical radiolucency’s, higher initial periapical index scores and multiple visit-retreatments. Following the loose criteria, the success rate of non-surgical root canal re-treatment obturated with gutta percha was 87% for 1–3 years follow-up (95% CI, 0.79–0.93) with significant heterogeneity across the studies (I2 = 88.5%). Factors influencing the success rate under the loo
{"title":"Root canal re-treatment with gutta percha - which techniques influence success?","authors":"Alexander Hall, Emilie Baerts, David Edwards","doi":"10.1038/s41432-024-01019-1","DOIUrl":"10.1038/s41432-024-01019-1","url":null,"abstract":"A systematic review and meta-analysis of the literature was carried out assessing the success rate of root canal retreatment using gutta percha. Four of the largest databases were used to identify existing literature with no date or language restrictions. PubMed, Cochrane, ScienceDirect, Scopus and other additional sources were searched. Grey literature was also reviewed. Two authors, with Master’s degrees in endodontics and with extensive university teaching experience, were selected to screen the databases to identify suitable studies. In case the authors were not able to agree during the study selection process, a third investigator was consulted. Specific inclusion and exclusion criteria were outlined and adhered to in the study selection. Two randomised controlled trials, seven single arm prospective studies and one single arm ambispective study published before the 10th of December 2022 were included. These studies evaluated the success of root canal re-treatment, obturated with gutta percha with at least a 1-year follow-up. Nine of the studies were published between 1998 and 2022. Seven studies were conducted in Europe, one in North America and one in Asia. Standard Cochrane methods to assess interval validity were used. Risk of bias in individual studies was assessed using The Newcastle-Ottawa quality assessment scale (NOS) for single-arm studies, and the Cochrane risk of bias tool (RoB2) was used for randomised controlled trials. Outcome measures were standardised as either success or failure of root canal retreatment. Success was classified into 2 different criteria: Strict criteria = absence of clinical signs and symptoms and radiographically normal periodontal ligament space; and Loose criteria = absence of clinical signs and symptoms and absence or reduction of apical radiolucency in the control radiograph. Statistical analysis was undertaken using R software and the Freeman-Turkey transformation was performed. Results were visualised using forest plots. Heterogeneity between studies was measured using the Cochrane Q test and I2 values. Whilst following strict criteria, the success rate of non-surgical root canal retreatment obturated with gutta percha was 71% for 1–3 years follow-up (95% CI, 0.66–0.77) and 77% for 4–5 years follow-up (95% CI, 0.67–0.86). Heterogeneity was moderate (I2 = 61.4) and low (I2 = 0.0), respectively. Factors reducing the success rate of root canal re-retreatment under the strict criteria were older patients, mandibular teeth, molar teeth, the presence of a peri-apical radiolucency, teeth with a previous radiolucency, large peri-apical radiolucency’s, higher initial periapical index scores and multiple visit-retreatments. Following the loose criteria, the success rate of non-surgical root canal re-treatment obturated with gutta percha was 87% for 1–3 years follow-up (95% CI, 0.79–0.93) with significant heterogeneity across the studies (I2 = 88.5%). Factors influencing the success rate under the loo","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 2","pages":"104-105"},"PeriodicalIF":0.0,"publicationDate":"2024-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01019-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141152776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate the systematic reviews assessing the effectiveness of any type of school-based oral health programs in children and adolescents. A two-staged search strategy comprising electronic databases and registries based on systematic reviews was employed to evaluate the effectiveness of school-based interventions. The quality assessment of the systematic reviews was carried out using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) tool. The Corrected Covered Area was used to evaluate the degree of overlap. Nine reviews were included in this umbrella review. The Critical Covered Area reported moderate overlap (5.70%) among the primary studies. The assessment of risk of bias revealed one study with a high level confidence; one with moderate whereas all other studies with critically low confidence. Inconclusive evidence related to improvements in dental caries and gingival status was reported whereas, plaque status improved in a major proportion of the reviews. Knowledge, attitude, and behavior significantly increased in students receiving educational interventions when compared to those receiving usual care. The evidence points to the positive impact of these interventions in behavioral changes and clinical outcomes only on a short term basis. There is a need for long-term follow-up studies to substantiate the outcomes of these interventions.
{"title":"Effectiveness of school oral health programs in children and adolescents: an umbrella review","authors":"Upendra Singh Bhadauria, Harsh Priya, Bharathi Purohit, Ankur Singh","doi":"10.1038/s41432-024-01013-7","DOIUrl":"10.1038/s41432-024-01013-7","url":null,"abstract":"To evaluate the systematic reviews assessing the effectiveness of any type of school-based oral health programs in children and adolescents. A two-staged search strategy comprising electronic databases and registries based on systematic reviews was employed to evaluate the effectiveness of school-based interventions. The quality assessment of the systematic reviews was carried out using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) tool. The Corrected Covered Area was used to evaluate the degree of overlap. Nine reviews were included in this umbrella review. The Critical Covered Area reported moderate overlap (5.70%) among the primary studies. The assessment of risk of bias revealed one study with a high level confidence; one with moderate whereas all other studies with critically low confidence. Inconclusive evidence related to improvements in dental caries and gingival status was reported whereas, plaque status improved in a major proportion of the reviews. Knowledge, attitude, and behavior significantly increased in students receiving educational interventions when compared to those receiving usual care. The evidence points to the positive impact of these interventions in behavioral changes and clinical outcomes only on a short term basis. There is a need for long-term follow-up studies to substantiate the outcomes of these interventions.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 4","pages":"211-211"},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141087605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-18DOI: 10.1038/s41432-024-01016-4
Lucy Hutton, John Linden
To establish the worldwide prevalence of paediatric dental fear and anxiety (DFA) and its associated components. A systematic review and meta-analysis of 25 observational studies found on three well known English language publication databases dating from 2000. 2895 studies were identified relating to paediatric dental fear, anxiety, or phobia. 25 met the inclusion criteria and were subject to the Joanna Briggs Institute quality assessment tool and subsequently analysed using PRISMA framework. Studies exploring levels of DFA in children 2–6 years old were included. Studies were excluded if they were not published in English, included children with ‘special needs’ including intellectual disabilities, and studies which explored DFA intervention. Of the included studies, the following was recorded: Country of Origin, DFA prevalence, age of participants, study design, sample size, assessment method and who reported on the level of DFA of the child. The pooled level of DFA of children aged 2–6 was estimated to be 30% (95% CI = 25, 36). Children with no dental experience and children with caries experience were found to have higher odds of experiencing DFA (OR = 1.37, 95% CI = 1.18, 1.59) and (OR = 1.18, 95% CI = 1.09, 1.27), respectively. This review shows that approximately 30% of 2–6-year-old children will experience a level of dental and anxiety. Levels are expected to be higher in children who have not visited the dentist and children with dental caries.
{"title":"Tiny teeth in terrified tots - what is the global prevalence of paediatric dental fear and anxiety?","authors":"Lucy Hutton, John Linden","doi":"10.1038/s41432-024-01016-4","DOIUrl":"10.1038/s41432-024-01016-4","url":null,"abstract":"To establish the worldwide prevalence of paediatric dental fear and anxiety (DFA) and its associated components. A systematic review and meta-analysis of 25 observational studies found on three well known English language publication databases dating from 2000. 2895 studies were identified relating to paediatric dental fear, anxiety, or phobia. 25 met the inclusion criteria and were subject to the Joanna Briggs Institute quality assessment tool and subsequently analysed using PRISMA framework. Studies exploring levels of DFA in children 2–6 years old were included. Studies were excluded if they were not published in English, included children with ‘special needs’ including intellectual disabilities, and studies which explored DFA intervention. Of the included studies, the following was recorded: Country of Origin, DFA prevalence, age of participants, study design, sample size, assessment method and who reported on the level of DFA of the child. The pooled level of DFA of children aged 2–6 was estimated to be 30% (95% CI = 25, 36). Children with no dental experience and children with caries experience were found to have higher odds of experiencing DFA (OR = 1.37, 95% CI = 1.18, 1.59) and (OR = 1.18, 95% CI = 1.09, 1.27), respectively. This review shows that approximately 30% of 2–6-year-old children will experience a level of dental and anxiety. Levels are expected to be higher in children who have not visited the dentist and children with dental caries.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 2","pages":"93-94"},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140956991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SARS-CoV-2 virus and its variants continue to be on a rampage worldwide. Several vaccines are being marketed to control their spread and reduce severity of symptoms in the affected. Various adverse events are being reported following the vaccine administration and therefore this systematic review investigated the oral adverse events post-COVID-19 vaccination. A systematic search of five databases was conducted. Case reports, case series and observational studies describing oral lesions/oral adverse effects (outcome) following anti-SARS-CoV-2 vaccination (exposure) in humans were included. Quality assessment of the studies was done using Joanna Briggs Institute Critical Appraisal tools. A working classification was developed from reported final diagnosis. The systematic review included 18 individual cases. Majority of oral lesions occurred following BNT162b2 vaccination with average age of occurrence at 59.94 years. 67% of the affected individuals were female, with hypertension being the most common comorbidity. Immune-mediated oral events have a propensity of occurrence following COVID-19 vaccination. mRNA-based vaccinations may have an affinity for causing oral adverse effects. It might be due to the immune dysregulation caused by these vaccinations. The female, geriatric population and older individuals with co-morbidities might have an increased affinity to develop oral lesions post-COVID-19 vaccination.
{"title":"Effects of post-COVID-19 vaccination in oral cavity: a systematic review","authors":"Anubhuti Sood, Sreevatsan Raghavan, Deepika Mishra, Harsh Priya","doi":"10.1038/s41432-024-01014-6","DOIUrl":"10.1038/s41432-024-01014-6","url":null,"abstract":"SARS-CoV-2 virus and its variants continue to be on a rampage worldwide. Several vaccines are being marketed to control their spread and reduce severity of symptoms in the affected. Various adverse events are being reported following the vaccine administration and therefore this systematic review investigated the oral adverse events post-COVID-19 vaccination. A systematic search of five databases was conducted. Case reports, case series and observational studies describing oral lesions/oral adverse effects (outcome) following anti-SARS-CoV-2 vaccination (exposure) in humans were included. Quality assessment of the studies was done using Joanna Briggs Institute Critical Appraisal tools. A working classification was developed from reported final diagnosis. The systematic review included 18 individual cases. Majority of oral lesions occurred following BNT162b2 vaccination with average age of occurrence at 59.94 years. 67% of the affected individuals were female, with hypertension being the most common comorbidity. Immune-mediated oral events have a propensity of occurrence following COVID-19 vaccination. mRNA-based vaccinations may have an affinity for causing oral adverse effects. It might be due to the immune dysregulation caused by these vaccinations. The female, geriatric population and older individuals with co-morbidities might have an increased affinity to develop oral lesions post-COVID-19 vaccination.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 3","pages":"168-168"},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140956990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-14DOI: 10.1038/s41432-024-01017-3
Omer Waleed Majid
A systematic review and meta-analysis. To evaluate and compare stability and functionality between narrow and standard implant-retained mandibular overdentures in edentulous patients from multiple perspectives. Assessments included clinical parameters [survival rate (SR) and marginal bone loss (MBL)], along with patient-reported outcome measures (PROMs) including patient satisfaction and oral health-related quality of life (OHRQoL). The study protocol followed PRISMA criteria for reporting reviews and meta-analyses. Using appropriate keywords, electronic search was conducted in each of the following databases: Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus, up to July 22, 2022. There were no restrictions based on language, publication type, or publication date. Additionally, ongoing studies were explored in ClinicalTrials.gov and WHO ICTRP, while cross-references in each selected study were manually examined. The eligible studies were randomized controlled trials (RCTs) or controlled clinical trials (CCTs) comparing narrow implants (diameter ≤ 3.5 mm) to standard implants (diameter > 3.5–4.5 mm) retaining mandibular overdentures in edentulous patients. Excluded were studies with unclear implant diameter information, fewer than 5 patients per group, observational studies, reviews, and laboratory studies. Two authors independently conducted study selection, data collection, and analysis, resolving any discrepancies through discussion with a third author. Methodological quality was assessed using RoB-2 and ROBINS-I tools. Implant SR and MBL measurements at final follow-up were recorded, while patient satisfaction and OHRQoL were evaluated using visual analogue scale (VAS-100) and oral health impact profile (OHIP) questionnaire, respectively. After duplicate removal, 782 publications and 83 registered clinical trials were identified, of which 26 were eligible for full-text assessment. Ultimately, the quantitative evaluation included 12 publications from 8 independent studies: 4 parallel design RCTs and 4 CCTs. Risk of bias assessment revealed variations among the studies, with only one study being rated as having low risk. The follow-up periods ranged from 1 to 3 years. Meta-analysis showed no significant difference in SR and MBL between narrow and standard implant groups (p = 0.29 and p = 0.93, respectively), with considerable heterogeneity (I2 = 100% and I2 = 78%, respectively). Regarding PROMs, the narrow implant group showed significantly higher levels of patient satisfaction (mean difference (MD): 8.18; 95% CI: 5.83 to 10.53; p < 0.00001; I2 = 36%) and exhibited a significant improvement in OHRQoL (MD: −4.36; 95% CI: −6.83 to −1.89; p < 0.001; I2 = 55%) compared to the standard implant group. For implant-retained mandibular overdentures, the use of narrow implants is associated with comparable SR and MBL, along with higher patient satisfaction and better OHRQoL improvement as compared to stan
{"title":"Can narrow-diameter implants enhance patient-reported outcomes for mandibular implant-retained overdentures?","authors":"Omer Waleed Majid","doi":"10.1038/s41432-024-01017-3","DOIUrl":"10.1038/s41432-024-01017-3","url":null,"abstract":"A systematic review and meta-analysis. To evaluate and compare stability and functionality between narrow and standard implant-retained mandibular overdentures in edentulous patients from multiple perspectives. Assessments included clinical parameters [survival rate (SR) and marginal bone loss (MBL)], along with patient-reported outcome measures (PROMs) including patient satisfaction and oral health-related quality of life (OHRQoL). The study protocol followed PRISMA criteria for reporting reviews and meta-analyses. Using appropriate keywords, electronic search was conducted in each of the following databases: Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus, up to July 22, 2022. There were no restrictions based on language, publication type, or publication date. Additionally, ongoing studies were explored in ClinicalTrials.gov and WHO ICTRP, while cross-references in each selected study were manually examined. The eligible studies were randomized controlled trials (RCTs) or controlled clinical trials (CCTs) comparing narrow implants (diameter ≤ 3.5 mm) to standard implants (diameter > 3.5–4.5 mm) retaining mandibular overdentures in edentulous patients. Excluded were studies with unclear implant diameter information, fewer than 5 patients per group, observational studies, reviews, and laboratory studies. Two authors independently conducted study selection, data collection, and analysis, resolving any discrepancies through discussion with a third author. Methodological quality was assessed using RoB-2 and ROBINS-I tools. Implant SR and MBL measurements at final follow-up were recorded, while patient satisfaction and OHRQoL were evaluated using visual analogue scale (VAS-100) and oral health impact profile (OHIP) questionnaire, respectively. After duplicate removal, 782 publications and 83 registered clinical trials were identified, of which 26 were eligible for full-text assessment. Ultimately, the quantitative evaluation included 12 publications from 8 independent studies: 4 parallel design RCTs and 4 CCTs. Risk of bias assessment revealed variations among the studies, with only one study being rated as having low risk. The follow-up periods ranged from 1 to 3 years. Meta-analysis showed no significant difference in SR and MBL between narrow and standard implant groups (p = 0.29 and p = 0.93, respectively), with considerable heterogeneity (I2 = 100% and I2 = 78%, respectively). Regarding PROMs, the narrow implant group showed significantly higher levels of patient satisfaction (mean difference (MD): 8.18; 95% CI: 5.83 to 10.53; p < 0.00001; I2 = 36%) and exhibited a significant improvement in OHRQoL (MD: −4.36; 95% CI: −6.83 to −1.89; p < 0.001; I2 = 55%) compared to the standard implant group. For implant-retained mandibular overdentures, the use of narrow implants is associated with comparable SR and MBL, along with higher patient satisfaction and better OHRQoL improvement as compared to stan","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 3","pages":"131-133"},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140921820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-13DOI: 10.1038/s41432-024-01009-3
Amy Carroll
The updated systematic review by Khan et al. reviews the evidence surrounding the possible factors that could contribute to the development of early childhood caries (ECC) in children of a particular age group. This follows a previously published systematic review across 1997-2017. These factors can then be used for the development of a Caries Risk Assessment (CRA) tool. This review aimed to identify established and updated evidence-based factors that could contribute to a child’s development of Early Childhood Caries (ECC). Four online databases were used to source evidence including the Cochrane Library, EMBASE, MEDLINE, and Scopus. The data search selected studies published between 2017 and 2021. Three specific terms were used to search: Dental Caries, Children, and Risk Assessment. There were three teams involved in data collection, two teams then reviewed selected articles. Exclusion criteria included any duplicate studies, commentaries, and editorials. Inclusion criteria included only randomised control trials and cohort studies. Selected studies must include children younger than 72 months, define the demographics, their clinical characteristics, and have clear follow-up of the patients involved. Commonly identified factors that were mentioned in multiple studies were then collected and assigned strength depending on the evidence measured using ratios. These could then be utilised to form a draft Caries Risk Assessment tool. 512 abstracts and 52 articles were screened, having matched the criteria set. Extraction of the data was completed under four headings: the child’s age at the time of study (in years/months), risk predictors, the outcome, and the quality of the evidence presented. The GRADE system was then employed to separate the studies into high, moderate, low, and very low categorisation. Eventually, 22 new studies were included that would build on the original 25 articles that were identified in the previous systematic review. The most defining factors across the most recent systematic reviews in 2021 highlighted behavioural factors such as toothbrushing quality – parental supervision, frequency, and fluoride exposure. Specifically, the presence of plaque was used as a marker for oral hygiene evaluation. Dietary history included snacking frequency and, controversially, baby-toddler breastfeeding patterns. However, this does not take into consideration the dental impact – mainly the frequency or timing of breastfeeding (e.g. overnight). The review emphasises the importance of consideration of socio-economic factors though this may be a difficult topic of discussion if families are struggling i.e. household income and education level of parents or guardians. There is also mention of factors that do not have a significant evidence base such as the child’s gender, ethnicity, and parental smoking status. In conclusion, the factors found to be relevant in the development of ECC were the child’s age, toothbrushing quality/
{"title":"More than clean teeth! Identifying factors that contribute to the development of early childhood caries","authors":"Amy Carroll","doi":"10.1038/s41432-024-01009-3","DOIUrl":"10.1038/s41432-024-01009-3","url":null,"abstract":"The updated systematic review by Khan et al. reviews the evidence surrounding the possible factors that could contribute to the development of early childhood caries (ECC) in children of a particular age group. This follows a previously published systematic review across 1997-2017. These factors can then be used for the development of a Caries Risk Assessment (CRA) tool. This review aimed to identify established and updated evidence-based factors that could contribute to a child’s development of Early Childhood Caries (ECC). Four online databases were used to source evidence including the Cochrane Library, EMBASE, MEDLINE, and Scopus. The data search selected studies published between 2017 and 2021. Three specific terms were used to search: Dental Caries, Children, and Risk Assessment. There were three teams involved in data collection, two teams then reviewed selected articles. Exclusion criteria included any duplicate studies, commentaries, and editorials. Inclusion criteria included only randomised control trials and cohort studies. Selected studies must include children younger than 72 months, define the demographics, their clinical characteristics, and have clear follow-up of the patients involved. Commonly identified factors that were mentioned in multiple studies were then collected and assigned strength depending on the evidence measured using ratios. These could then be utilised to form a draft Caries Risk Assessment tool. 512 abstracts and 52 articles were screened, having matched the criteria set. Extraction of the data was completed under four headings: the child’s age at the time of study (in years/months), risk predictors, the outcome, and the quality of the evidence presented. The GRADE system was then employed to separate the studies into high, moderate, low, and very low categorisation. Eventually, 22 new studies were included that would build on the original 25 articles that were identified in the previous systematic review. The most defining factors across the most recent systematic reviews in 2021 highlighted behavioural factors such as toothbrushing quality – parental supervision, frequency, and fluoride exposure. Specifically, the presence of plaque was used as a marker for oral hygiene evaluation. Dietary history included snacking frequency and, controversially, baby-toddler breastfeeding patterns. However, this does not take into consideration the dental impact – mainly the frequency or timing of breastfeeding (e.g. overnight). The review emphasises the importance of consideration of socio-economic factors though this may be a difficult topic of discussion if families are struggling i.e. household income and education level of parents or guardians. There is also mention of factors that do not have a significant evidence base such as the child’s gender, ethnicity, and parental smoking status. In conclusion, the factors found to be relevant in the development of ECC were the child’s age, toothbrushing quality/","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 2","pages":"87-88"},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140916151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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