Preformed metal crowns for decayed primary molar teeth

BackgroundPreformed metal crowns (PMCs) are recommended by the British Society of Paediatric Dentistry (BSPD) for restoring badly broken down primary molar teeth. However, few dental practitioners adopt this technique in clinical practice, citing cost and clinical difficulty as reasons for this. Whilst there is a subjective impression by clinical academics that PMCs provide a more durable restoration than filling materials, there appears to be little evidence within the literature to support this.ObjectivesThe primary aim of this systematic review was to compare clinical outcomes for primary molar teeth restored using PMCs compared to those restored with filling materials.Search methodsThe literature was searched using: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2005, Issue 3); MEDLINE (1966 to August 2005); EMBASE (1980 to August 2005); System for Information on Grey Literature in Europe (SIGLE) (1976 to August 2005). Relevant publications' reference lists were reviewed for relevant articles. The most recent search was carried out on 24 August 2005.Selection criteriaRandomised controlled trials (RCTs) that assessed the effectiveness of PMCs compared with filling materials or where there had been no treatment in children with untreated tooth decay in one or more primary molar teeth.Data collection and analysisTwo review authors independently assessed the title and abstracts for each article from the search results to decide whether it was likely to be relevant. Full papers were obtained for relevant articles and all three review authors studied these.Main resultsForty‐seven records were retrieved by the search strategies of which some were duplicates. Of these, 14 studies were scrutinised. No studies met the inclusion criteria and six studies were excluded from the review as they were either retrospective in design or reported as prospective outcomes but not randomised. No data were available for extraction and analysis and therefore, no conclusion could be made as to whether PMCs were more successful than filling materials for restoring primary molar teeth.Authors' conclusionsNo RCTs were available for appraisal. Whilst this technique is recommended by the BSPD for use in clinical practice, the evidence to support this is not strong, consisting mainly of case reports and uncontrolled studies. It is important that the absence of evidence for PMCs is not misinterpreted as evidence for their lack of efficacy.There is a strong need for prospective RCTs comparing PMCs and fillings for managing decayed primary molar teeth. The lower levels of evidence that have been produced, however, have strength in that the clinical outcomes are consistently in favour of PMCs, despite many of the studies placing PMCs on the most damaged of the pair of teeth being analysed

Is personal oral hygiene advice effective in preventing coronal dental caries?

Data sources PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials databases. Study selection PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials databases were searched for studies published in English between January 1950 and February 2017. Data extraction and synthesis Data were extracted independently by two reviewers and risk of bias assessed using a modified Jadad scale. Heterogeneity was evaluated using the chi-squared statistic and meta-analysis performed. Results Three randomised trials were included, involving 681 participants; all children 10-13 years old. Two trials were conducted in the USA and one in the UK. Two studies tested school-based, daily supervised oral hygiene (including plaque staining and removal and supervised flossing) against control groups; one study tested the same intervention every two weeks against controls. Two studies measured decayed, missing or filled surfaces (DMFS) scores at three years and one trial at 29 months. Personal oral hygiene interventions failed to influence the incidence of dental caries, (DMFS = -0.11; 95% CI -0.91, 0.69: P value <0.79). Four non-randomised trials were retained to conduct sensitivity analyses. Conclusions Personal oral hygiene interventions delivered to school children failed to show a reduction in coronal dental carious lesion incidence over three years when compared to control groups

protocol

Background Clinical trials on caries lesion management use an abundance of outcomes, hampering comparison or combination of different study results and their efficient translation into clinical practice. Core outcome sets are an agreed standardized collection of outcomes which should be measured and reported in all trials for a specific clinical area. We aim to develop a core outcome set for trials investigating management of caries lesions in primary or permanent teeth conducted in primary or secondary care encompassing all stages of disease. Methods To identify existing outcomes, trials on prevention and trials on management of caries lesions will be screened systematically in four databases. Screening, extraction and deduplication will be performed by two researchers until consensus is reached. The definition of the core outcome set will by based on an e-Delhi consensus process involving key stakeholders namely patients, dentists, clinical researchers, health economists, statisticians, policy-makers and industry representatives. For the first stage of the Delphi process, a patient panel and a separate panel consisting of researchers, clinicians, teachers, industry affiliated researchers, policy- makers, and other interested parties will be held. An inclusive approach will be taken to involve panelists from a wide variety of socio-economic and geographic backgrounds. Results from the first round will be summarized and fed back to individuals for the second round, where panels will be combined and allowed to modify their scoring in light of the full panel’s opinion. Necessity for a third round will be dependent on the outcome of the first two. Agreement will be measured via defined consensus rules; up to a maximum of seven outcomes. If resources allow, we will investigate features that influence decision making for different groups. Discussion By using an explicit, transparent and inclusive multi-step consensus process, the planned core outcome set should be justifiable, relevant and comprehensive. The dissemination and application of this core outcome set should improve clinical trials on managing caries lesions and allow comparison, synthesis and implementation of scientific data

A road map for designing and reporting clinical trials in paediatric dentistry

Background Unless clinical trials are well‐designed, there is a risk that they will not be usable to improve patient care. Aim This paper discusses some factors important in designing clinical trials in paediatric dentistry. It uses the prevention and management of dental caries in children as the lens through which to look at these. Findings Amongst the factors to consider are clear research questions and objectives; appropriate outcomes and outcome measures; sample size calculation and the level of randomisation; methods for random allocation; and operator/assessor training. Experts in trial design including statisticians and a trialist should be consulted early in the design process. The aspects of trial design unique to cariology trials such as ‘clustering’ of data items, mixed dentition issues and those related to trials involving children (communication, consent etc) should be considered. Comprehensive reporting of trial results is essential. Conclusion There are many readily available resources and tools to help the researcher design a trial of good quality that will yield results useful to the research community and beyond, to those who will implement the findings and ultimately those who will benefit from them

Comparator choice in cariology trials limits conclusions on the comparative effectiveness of caries interventions

Comparator choice has been found one major factor impacting on the overall evidence supporting clinical interventions. We performed social network analysis on trials on the prevention/management of caries/carious lesions, hypothesizing that certain comparators are proportionally over-investigated, and others under-investigated, and that comparisons within comparator classes are preferred over comparisons between classes. A systematic review of randomized controlled trials on the prevention/management of caries/existing carious lesions was carried out. All comparators were classified at each of three levels of granularity, becoming more detailed with each level; (a) degree of invasiveness (non-, micro- or invasive), (b) the specific non-invasive, micro-invasive or invasive approach, (c) the actual material or technique used. Social network analysis was used to evaluate trial networks. Searching electronic databases found 4,774 articles of which 765 were relevant and 605 were included. The networks for all levels were polygonal. There was a high degree of separation of comparisons in prevention versus management trials. Invasive comparators were tested most frequently (number of comparators: 611), mainly in management trials. Non-invasive comparators were tested next often (474), mainly in caries prevention. Micro-invasive strategies were tested next often (233), in both prevention and management trials. On more granular levels, few interventions dominated the networks. Regardless of the level, the majority of trials compared within, not between classes. Prevention trials were mainly conducted in children (number of trials in adults/children/both: 37/241/11), while those on managing lesions were conducted in both children and adults (117/179/21). Comparator choice in cariology trials is driven by indication, and limits conclusions on the true comparative effectiveness of all strategies. There are a variety of comparators that have not been, but should be, compared to one another, which should be addressed by future trials. Factors underlying trialists’ comparator choice need to be identified

A Longitudinal Study of Changes in New Dental Graduates’ Engagement with Evidence-Based Practice During Their Transition to Professional Practice

Introduction Clinicians' use, interpretation and application of evidence in everyday practice is fundamental to their delivery of appropriate, contemporary, high-quality dentistry. Little is known about whether new dental graduates' (NDGs') perspectives and use of evidence-based practice (EBP) change when they enter professional practice. Aim To explore changes in NDGs' perception of EBP for: self-efficacy; knowledge of EBP principles; attitudes; confidence in appraisal skills; and frequency of accessing evidence. Methods Two pre-validated instruments: knowledge, attitude, confidence and accessing EBP resources, EBP confidence scale, and clinical scenarios. NDGs from one dental school completed the questionnaire upon graduation (R1) and six to nine months into vocational dental training (R2). Results Response rates of R1 were 34 (52%) and R2, 21 (62% of R1, 32% overall). Between R1 and R2, knowledge (median [25th-75th percentiles]: R1 = 4 [2.5-4]; R2 = 3 [2.8-3], p = 0.07), self-efficacy (R1 = 645 [587-782]; R2 = 630 [550-690], p = 0.8) and scores related to knowledge of gold standards were comparable. However, attitude (R1 = 38 [34-39], R2 = 27 [25-30]), confidence in appraisal skills (R1 = 16 [14-20], R2 = 11[8-16]) and frequency of accessing evidence (R1 = 26 [22-28]; R2 = 18 [16-19]) all showed statistically significant reductions. Conclusion After six months in professional practice, NDGs showed statistically significant reductions in the value they place on EBP, their EBP-related skills and their use of reliable evidence sources. There were no differences in their 'self-efficacy' knowledge of EBP principles

Silver diamine fluoride for managing carious lesions:an umbrella review

Background: This umbrella review comprehensively appraised evidence for silver diamine fluoride (SDF) to arrest and prevent root and coronal caries by summarizing systematic reviews. Adverse events were explored. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, PubMed, Embase, Cochrane Library, PROSPERO register and Joanna Briggs Institute Database of Systematic Reviews were searched for systematic reviews investigating SDF for caries prevention or arrest (1970–2018) without language restrictions. Systematic reviews were selected, data extracted, and risk of bias assessed using ROBIS by two independent reviewers, in duplicate. Corrected covered area was calculated to quantify studies’ overlap across reviews. Results: Eleven systematic reviews were included; four focussing on SDF for root caries in adults and seven on coronal caries in children. These cited 30 studies (4 root caries; 26 coronal caries) appearing 63 times. Five systematic reviews were of “low”, one“unclear” and five “high” risk of bias. Overlap of studies was very high (50% root caries; 17% coronal caries). High overlap and heterogeneity, mainly comparators and outcome measures, precluded meta-analysis. Results were grouped by aim and outcomes to present an overview of direction and magnitude of effect. SDF had a positive effect on prevention and arrest of coronal and root caries, consistently outperforming comparators (fluoride varnish, Atraumatic Restorative Treatment, placebo). For root caries prevention, the prevented fraction (PF) was 25–71% higher for SDF compared to placebo (two systematic reviews with three studies) and PF=100–725% for root caries arrest (one systematic review with two studies). For coronal caries prevention, PF=70–78% (two systematic reviews with two studies) and PF=55–96% for coronal caries arrest (one systematic review with two studies) with arrest rates of 65–91% (four systematic reviews with six studies). Eight systematic reviews reported adverse events, seven of which reported arrested lesions black staining. Conclusion: Systematic reviews consistently supported SDF’s effectiveness for arresting coronal caries in the primary dentition and arresting and preventing root caries in older adults for all comparators. There is insufficient evidence to draw conclusions on SDF for prevention in primary teeth and prevention and arrest in permanent teeth in children. No serious adverse events were reported

Managing dental caries against the backdrop of COVID-19:approaches to reduce aerosol generation

Contains fulltext : 225331.pdf (Publisher’s version ) (Closed access)The COVID-19 pandemic resulted in severe limitation and closure of dental practices in many countries. Outside of the acute (peak) phases of the disease, dentistry has begun to be practised again. However, there is emerging evidence that SARS-CoV-2 can be transmitted via airborne routes, carrying implications for dental procedures that produce aerosol. At the time of writing, additional precautions are required when a procedure considered to generate aerosol is undertaken.This paper aims to present evidence-based treatments that remove or reduce the generation of aerosols during the management of carious lesions. It maps aerosol generating procedures (AGPs), where possible, to alternative non-AGPs or low AGPs. This risk reduction approach overcomes the less favourable outcomes associated with temporary solutions or extraction-only approaches. Even if this risk reduction approach for aerosol generation becomes unnecessary in the future, these procedures are not only suitable but desirable for use as part of general dental care post-COVID-19

Outcomes in Trials for Management of Caries Lesions (OuTMaC):protocol

Background Clinical trials on caries lesion management use an abundance of outcomes, hampering comparison or combination of different study results and their efficient translation into clinical practice. Core outcome sets are an agreed standardized collection of outcomes which should be measured and reported in all trials for a specific clinical area. We aim to develop a core outcome set for trials investigating management of caries lesions in primary or permanent teeth conducted in primary or secondary care encompassing all stages of disease. Methods To identify existing outcomes, trials on prevention and trials on management of caries lesions will be screened systematically in four databases. Screening, extraction and deduplication will be performed by two researchers until consensus is reached. The definition of the core outcome set will by based on an e-Delhi consensus process involving key stakeholders namely patients, dentists, clinical researchers, health economists, statisticians, policy-makers and industry representatives. For the first stage of the Delphi process, a patient panel and a separate panel consisting of researchers, clinicians, teachers, industry affiliated researchers, policy-makers, and other interested parties will be held. An inclusive approach will be taken to involve panelists from a wide variety of socio-economic and geographic backgrounds. Results from the first round will be summarized and fed back to individuals for the second round, where panels will be combined and allowed to modify their scoring in light of the full panel’s opinion. Necessity for a third round will be dependent on the outcome of the first two. Agreement will be measured via defined consensus rules; up to a maximum of seven outcomes. If resources allow, we will investigate features that influence decision making for different groups. Discussion By using an explicit, transparent and inclusive multi-step consensus process, the planned core outcome set should be justifiable, relevant and comprehensive. The dissemination and application of this core outcome set should improve clinical trials on managing caries lesions and allow comparison, synthesis and implementation of scientific data. Trial registration Registered 12 April 2015 at COMET (http://www.comet-initiative.org