Knowledge Translation Among General Dental Practitioners in the Field of Periodontics.

INTRODUCTION: Evidence-based practice (EBP) is an expectation of medical professionals and is positively received in the dental community. Investigations of evidence-based dentistry (EBD) have discussed its use in broad terms and daily clinical practice, but there is only limited information about its use and barriers with respect to particular dental specialities. METHODS: A cross-sectional questionnaire was developed to survey implementation and obstacles to EBP; EBD specific to periodontics; and preferences for types of dissemination of evidence. The target population was active general dentists in Nova Scotia (n = 446). An email link to the questionnaire was distributed to dentists, and reminders were sent 4 and 10 days later. RESULTS: The response rate was limited (16.6%). Most respondents were comfortable evaluating the growing body of research, although many reported use of low-level evidence, including that from other health professionals or expert opinion. A common barrier to use was insufficient time. Respondents who found strong evidence for certain periodontal procedures were more likely to refer these procedures, which included tissue regeneration and periodontics related to endodontics. On-site lecture-based dissemination was preferred by most respondents. CONCLUSION: General evidence-based concepts and use were similar to EBD results reported elsewhere, although external validity is limited by our low response rate and narrow target population. Specific data related to periodontics may be useful in directing a modified questionnaire to a broader target population. Respondents who are truly interested in EBD and responded to our questionnaire may ultimately benefit the most from our results, where further educational opportunities can be tailored to overcome the identified barriers and aid in more effective translation of evidence-based periodontal decisions in a general dental practice.

Attitudes of dental students in a Canadian university towards communication skills learning.

INTRODUCTION: Strong dentist communication skills (CS) are necessary for patient-centred care and oral health promotion. CS are imparted through the dental education experience, which can be optimised in part by incorporating student perceptions and needs into curricular development. The current study assessed student attitudes towards communication skills learning (CSL) in a Canadian university. METHODS: A 20-item questionnaire adapted from the Dental Communication Skills Attitude Scale and qualitative survey questions were completed by students (n = 124). RESULTS: Questionnaire findings indicate that attitudes towards CSL are generally favourable, with significant variation based on year of study, gender and ethnicity. Students understood the importance of CS for dental practice and patient-centred care. Whilst they appreciated the value of CSL, students described that challenges such as demanding programme schedules would preclude the utility of more formalised CSL activities. CONCLUSION: These findings may be useful for institutions seeking to implement or refine a CSL curriculum.

Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

BACKGROUND: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations. METHODS: Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants. RESULTS: Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues. CONCLUSION: An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.

PRACTICE PROFILE OF PERIODONTISTS IN CANADA: A NATIONAL SURVEY.

OBJECTIVE: To document the profile of periodontists in private practice in Canada in terms of services provided and referral patterns. METHODS: An online survey consisted on 45 questions in 3 categories: demographics, referral patterns and periodontal procedures performed. The sampling frame consisted of all active members of the Canadian Academy of Periodontology (n= 280). Letters and email containing links to the online survey were used to invite participants and to send reminders to non-respondents on days 7, 21 and 49. RESULTS: The response rate was 164/280 (58.6%); 135 respondents completed the entire survey. Of the respondents who noticed changes in referral dynamics in the last 10 years (68.1%), most (61.9%) perceived an overall decrease in the number of referrals, and 74.0% reported that general dentists were referring patients later in the disease progression. The most common referrals (71.6%) were for limited treatment. Most respondents placed dental implants (93.7%) and performed maxillary sinus lifts (81.6%). All performed surgical debridement, esthetic and prerestorative crown lengthening and connective tissue grafts. Only 13.7% provided photodynamic therapy. Fewer years in practice (<20 years), more recent graduation (after 1990) and younger age (<45 years) were correlated with greater use of single-implant placement, sinus lifts and procedures requiring intravenous sedation. Men were more likely than women to use lasers (p=0.020). CONCLUSION: Periodontal specialists perceived a change in referral dynamics over the last 10 years with most reporting both a decrease in number and delayed timing of referrals. Practice patterns have changed, with younger periodontists performing more advanced surgical procedures. These findings may guide periodontal residency programs and create awareness among general dentists of the role of the periodontist and their repertoire of treatment options.

The Canadian systemic sclerosis oral health study II: the relationship between oral and global health-related quality of life in systemic sclerosis.

OBJECTIVE: Both oral and global health-related quality of life (HRQoL) are markedly impaired in SSc. In this study we aimed to determine the degree of association between oral HRQoL and global HRQoL in SSc. METHODS: Subjects were recruited from the Canadian Scleroderma Research Group registry. Global HRQoL was measured using the Medical Outcomes Trust 36-item Short Form Health Survey (SF-36) and oral HRQoL with the Oral Health Impact Profile (OHIP). The Medsger Disease Severity Score was used to determine organ involvement. Multivariate regression models determined the independent association of the OHIP with the SF-36 after adjusting for confounders. RESULTS: This study included 156 SSc subjects. The majority (90%) were women, with a mean age of 56 years, mean disease duration 13.8 years (s.d. 8.5) and 29% of the subjects had dcSSc. Mean total OHIP score was 40.8 (s.d. 32.4). Mean SF-36 mental component summary (MCS) score was 49.7 (s.d. 11.1) and physical component summary (PCS) score was 37.0 (s.d. 10.7). In adjusted analyses, the total OHIP score was significantly associated with the SF-36 MCS and PCS, accounting for 9.7% and 5.6% of their respective variances. Measures of disease severity were not related to OHIP score. CONCLUSION: Oral HRQoL in SSc is independently associated with global HRQoL. Oral HRQoL, however, is not related to physician-assessed disease severity. This suggests that physicians may be disregarding issues related to oral health. HRQoL is an additional dimension of HRQoL not captured by generic instruments such as the SF-36.

The Canadian systemic sclerosis oral health study: orofacial manifestations and oral health-related quality of life in systemic sclerosis compared with the general population.

OBJECTIVE: The aim of this study was to compare oral abnormalities and oral health-related quality of life (HRQoL) of patients with SSc with the general population. METHODS: SSc patients and healthy controls were enrolled in a multisite cross-sectional study. A standardized oral examination was performed. Oral HRQoL was measured with the Oral Health Impact Profile (OHIP). Multivariate regression analyses were performed to identify associations between SSc, oral abnormalities and oral HRQoL. RESULTS: We assessed 163 SSc patients and 231 controls. SSc patients had more decayed teeth (SSc 0.88, controls 0.59, P = 0.0465) and periodontal disease [number of teeth with pocket depth (PD) >3 mm or clinical attachment level (CAL) ≥5.5 mm; SSc 5.23, controls 2.94, P < 0.0001]. SSc patients produced less saliva (SSc 147.52 mg/min, controls 163.19 mg/min, P = 0.0259) and their interincisal distance was smaller (SSc 37.68 mm, controls 44.30 mm, P < 0.0001). SSc patients had significantly reduced oral HRQoL compared with controls (mean OHIP score: SSc 41.58, controls 26.67, P < 0.0001). Multivariate regression analyses confirmed that SSc was a significant independent predictor of missing teeth, periodontal disease, interincisal distance, saliva production and OHIP scores. CONCLUSION: Subjects with SSc have impaired oral health and oral HRQoL compared with the general population. These data can be used to develop targeted interventions to improve oral health and HRQoL in SSc.

Adoption issues associated with a new periodontal screening tool: an online survey of Canadian dentists.

OBJECTIVE: To determine barriers and facilitators associated with the acceptance of a new diagnostic screening tool for periodontitis. METHODS: As part of a larger study to examine factors that affect the adoption of new technology by dentists, we piloted an online survey of Canadian dentists through an electronic newsletter produced by the Journal of the Canadian Dental Association. A new oral rinse that screens for the presence of periodontitis by estimating neutrophil abundance in saliva was used for illustrative purposes. The survey included questions about the types of patients for which the test would be beneficial, how the test might be incorporated into practice and how much the dentist would be willing to pay for the test. RESULTS: As the survey was delivered through a new communication tool, the response rate was low. Nonetheless there appeared to be interest in new periodontal screening tools to complement existing diagnostic tests for periodontitis. The test was seen as a valuable educational tool for patients; however, the cost to administer the test was determined to be an issue. CONCLUSIONS: Despite the low response rate, dentists were interested in new screening tests for periodontitis. A larger study with a more representative sample could provide valuable information for scientists who are interested in taking their research from the bench to chairside.

The oral health of ageing baby boomers: a comparison of adults aged 45-64 and those 65 years and older.

OBJECTIVES: To compare the oral health status of adults aged 45-64 (baby boomers) and those aged 65 and older. METHODS: An observational, cross-sectional survey of adults living independently in rural and urban settings in Nova Scotia, Canada was conducted. Using random digit dialing, calibrated interviewers completed a telephone survey, and clinicians calibrated to WHO standards conducted clinical examinations. Weighting was used to correct for sampling bias. RESULTS: 747 community dwelling adults completed both the clinical exam and the questionnaire (n=411, age 45-64; n=336, age 65 or older). Rates of edentulism were low (2.6% aged 45-64; 15.7% aged 65+; p<0.001). Untreated root caries was greater in the older dentate group (19.7 vs. 10.1%; p<0.001). Being 65 years of age or older was identified as a predictor of increased decayed, missing, filled teeth, presence of decayed and/or filled roots and presence of attachment loss≥4 mm, but was not a significant predictor of presence of untreated coronal caries. CONCLUSIONS: A falling rate of edentulism and a higher risk for root caries with increasing age may predict the need for more complex dental care as our population ages.

Prevention and treatment of periodontal diseases in primary care.

SCOPE AND PURPOSE: The aim of this guidance is to support the dental team to; manage patients with periodontal diseases in primary care appropriately; improve the quality of decision making for referral to secondary care; improve the overall oral health of the population. It focuses on the prevention and non-surgical treatment of periodontal diseases and implant diseases in primary care. The surgical treatment of periodontal and implant diseases and the management of patients by periodontal specialists or in a secondary care setting are outwith the scope of this guidance and are not discussed in detail. The guidance is based on existing guidelines, including those from the British Society of Periodontology, relevant systematic reviews, research evidence and the opinion of experts and experienced practitioners. METHODOLOGY: The methodological approach is based on the international standards set out by the Appraisal of Guidelines Research and Evaluation (AGREE) Collaboration (www.agreetrust.org). The guiding principle for developing guidance within SDCEP is to first source existing guidelines, policy documents, legislation or other recommendations. Similarly, relevant systematic reviews are also initially identified. These documents are appraised for their quality of development, evidence base and applicability to the remit of the guidance under development. In the absence of these documents or when supplementary information is required, other published literature and unpublished work may be sought.Review and updating. The guidance will be reviewed in three years and updated accordingly. RECOMMENDATIONS: Recommendations are provided for assessment and diagnosis; changing patient behaviour; treatment of gingival conditions; periodontal conditions; long term maintenance; management of patients with dental implants; referral and record keeping. The key recommendations highlighted are: Assess and explain risk factors for periodontal diseases to patients. Screen all patients for periodontal diseases at every routine examination. Carry out a full periodontal examination for patients with BPE scores 3, 4 and (*)Use the Oral Hygiene TIPPS (talk, instruct, practise, plan, support) behaviour change strategy to address inadequate plaque removal. Raise the issue of smoking cessation where appropriate. Encourage patients to modify other lifestyle factors that may impact on their oral health. Ensure the patient is able to perform optimal plaque removal. Remove supra-gingival plaque, calculus and stain and sub-gingival deposits. Ensure that local plaque retentive factors are corrected. Remove supra-gingival plaque, calculus and stain and correct any local plaque retentive factors. Carry out root surface instrumentation at sites ≥ 4 mm probing depth where sub-gingival deposits are present or which bleed on probing. Do not use antimicrobial medication to treat chronic periodontitis. Remove supra-gingival plaque, calculus and stain and sub-gingival deposits and ensure that local plaque retentive factors are corrected. Assign an individual's risk level based on the patient's medical history and oral health status and schedule recall appointments accordingly. Ensure the patient is able to perform optimal plaque removal around the dental implant(s)Examine the peri-implant tissues for signs of inflammation and bleeding on probing and/or suppuration and remove supra- and sub- mucosal plaque and calculus deposits and excess residual cement. Perform radiographic examination only where clinically indicated. Consult any locally produced referral guidelines and the BSP 'Referral Policy and Parameters of Care' to determine if the patient is a suitable candidate for referral. Carry out initial therapy to address inadequate plaque removal, smoking status (if applicable) and to remove supra- and sub-gingival deposits. Provide supportive periodontal therapy and monitoring for patients who have been discharged from secondary care. Record the results of the periodontal examinations (basic and/or full) carried out and the current standard of oral hygiene. Record the diagnosis, suggested treatment plan and details of costs. Document any discussions you have with the patient, for example, treatment options, risks and benefits of treatment, oral hygiene advice, smoking cessation, alcohol consumption and/or other lifestyle factors. RESEARCH RECOMMENDATIONS: There is a need for high-quality research carried out within an appropriate governance framework to improve the evidence base in the following areas: barriers and facilitators to the delivery of oral hygiene interventions in primary care;behaviour change interventions to improve inadequate oral hygiene;optimal timescales for provision of routine supra-gingival debridement (dental prophylaxis) and supportive periodontal therapy;effectiveness of supportive periodontal therapy regimens;effectiveness of supportive therapy regimens to maintain peri-implant tissues;effectiveness of interventions to treat peri-implant mucositis and peri-implantitis.Consensus is urgently required on the importance and validity of surrogate periodontal outcomes (eg bleeding on probing, changes in clinical probing depth and clinical attachment level and bone levels) and their relationship to true outcomes (eg tooth loss and patient-centred outcomes) so that consistency can be achieved across studies. There is also a need for independent research into the effectiveness of oral hygiene tools such as toothbrushes, interdental aids, toothpastes and mouthwashes and gels containing antibacterial agents.

Local antimicrobials in addition to scaling and root planing provide statistically significant but not clinically important benefit.

DATA SOURCES: The databases Medline, Embase and the Cochrane Oral Health Group Trials Register were searched. Handsearching of the Journal of Periodontology, Journal of Clinical Periodontology and Journal of Periodontal Research was also carried out. STUDY SELECTION: Randomised controlled trials published in English were included. DATA EXTRACTION AND SYNTHESIS: Risk of bias and quality assessment were conducted following Cochrane recommendations with data being extracted independently in duplicate. Because of the nature of the available data, qualitative summary is presented with meta-analysis conducted where appropriate. RESULTS: The overall effect of the subgingival application of antimicrobials was statistically significant (p = 0.000) for both changes in probing pocket depth (PPD) and clinical attachment level (CAL), with a weighted mean difference (WMD) of -0.407 and -0.310 mm respectively. No significant differences occurred for changes in bleeding on probing (BOP) and plaque index (PlI). Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction (WMD between 0.5 and 0.7 mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo (WMD between 0.1 and 0.4 mm). CONCLUSIONS: In conclusion, the scientific evidence supports the adjunctive use of local antimicrobials to SRP in deep or recurrent periodontal sites, mostly when the vehicle has shown pharmacodynamic properties assuring the sustained release of the antimicrobial. This evidence must be interpreted with caution, as the reported data were highly heterogeneous and most of the selected studies were categorised with a high degree of bias.

Oral health-related quality of life in an aging Canadian population.

BACKGROUND: The purpose of the study is to describe the impact of oral health-related quality of life (OHRQoL) on the lives of pre-seniors and seniors living in Nova Scotia, Canada. METHODS: This cross-sectional study involved 1461 participants, grouped by age (pre-seniors [45-64] and seniors [65+]) and residential status (long-term care facility [LTC] or community). OHRQoL was measured using the 14-item Oral Health Impact Profile questionnaire (OHIP-14) in a random digit dialing telephone survey (for community residents) or a face-to-face interview (for LTC residents). Intra-oral examinations were performed by one of six dentists calibrated to W.H.O. standards. RESULTS: Approximately one in four pre-seniors and seniors reported at least one OHRQoL impact 'fairly/very often'. The most commonly reported impacts were within the dimensions 'physical pain' and 'psychological discomfort'. It was found that 12.2% of LTC residents found it uncomfortable to eat any foods 'fairly/very' often compared to 7.7% in the community, and 11.6% of LTC residents reported being self-conscious 'fairly/very often' compared to 8.2% in the community. Of those residing in the community, pre-seniors (28.8%) reported significantly more impacts than seniors (22.0%); but there were no significant differences in OHRQoL between pre-seniors (21.2%) and seniors (25.3%) in LTC. Pre-seniors living in the community scored significantly higher than community dwelling seniors on prevalence, extent and severity of OHIP-14 scores. Logistic regression revealed that for the community dwelling sample, individuals living in rural areas in addition to those being born outside of Canada were approximately 2.0 times more likely to report an impact 'fairly/very often', whereas among the LTC sample, those having a high school education or less were 2.3 times more likely to report an impact. CONCLUSIONS: Findings indicate that the oral health and OHRQoL of both pre-seniors and seniors in LTC residents is poor. Community dwelling pre-seniors have the highest prevalence rate of oral impacts.

Periodontal practice and referral profile of general dentists in Nova Scotia, Canada.

BACKGROUND: In contrast to an expected increase in demand for periodontal services with aging of the population, it appears that referrals to periodontists are declining. OBJECTIVE: To determine the extent to which general dentists in Nova Scotia, Canada, provide periodontal and surgical implant therapies and to determine the factors influencing a dentist's decision to provide treatment or refer patients to a specialist. METHODS: A cross-sectional survey study was performed. The survey questionnaire was mailed to all 443 general dentists practising in Nova Scotia in summer 2009. The questionnaire presented several clinical scenarios and asked respondents whether they would treat the patient in the office or refer to a specialist. The data were analyzed by logistic regression. RESULTS: Of the 279 (63.0%) dentists responding to the survey, 272 (61.4% of the total) were eligible for inclusion in the analysis. The majority of dentists reported rendering nonsurgical periodontal therapy, including scaling (98.5%; 262/266), periodontal maintenance (95.9%; 255/266), and treatment for bruxism (95.1%; 252/265). The most common surgical procedures performed by dentists were frenectomy (29.4%; 78/265), gingivectomy (29.3%; 77/263) and crown-lengthening procedures (17.0%; 46/271). Eleven factors significantly influenced dentists' decisions to treat or refer patients. The most common criteria used in selecting a periodontist were satisfaction of previous patients, previous success with the treatment, and the personality of and good communications with the periodontist. CONCLUSIONS: In this study, dentists reported rendering nonsurgical periodontal therapy on a wide scale, whereas their involvement in oral or periodontal and implant surgical therapies was limited.

Oral health status of long-term care residents-a vulnerable population.

OBJECTIVE: To conduct an observational, cross-sectional survey of the oral health status of adults ≥ 45 years of age in rural and urban long-term care (LTC) facilities in Nova Scotia, Canada. METHODS: Residents capable of informed consent were recruited by LTC staff in a stratified random sample of LTC facilities. Calibrated personnel administered standard clinical and quality-of-life instruments. RESULTS: Of the 335 adults (74% female) surveyed (mean age 80.8 ± 11.6 years), only 25% reported having regular dental care. Although 76% described their oral health as good or excellent, 41% were edentulous, 41% had some mucosal abnormality, 36% reported xerostomia and 25% had perceived or self-reported untreated dental conditions. Most mandibular dentures were nonretentive (59%) and almost half were unstable (49%). Among the dentate, 51% had untreated coronal caries, 44% had untreated root caries and 67% had attachment loss of ≥ 4 mm at ≥ 1 site. Predictors of coronal decay were a debris score ≥ 2 (adjusted odds ratio [adj OR] = 2.12; p = 0.045) or a history of smoking (adj OR = 1.02 per year of smoking; p = 0.024). Predictors of root caries were participants' perceiving a need for dental treatment (adj OR = 2.56; p = 0.015) or a history of smoking (adj OR = 1.02 per year of smoking; p = 0.026). CONCLUSIONS: This epidemiologic study of the oral health of LTC residents revealed a high prevalence of untreated oral disease and low use of oral care services, highlighting the need for better access to oral care for this population.

Assessing the oral health of an ageing population: methods, challenges and predictors of survey participation.

OBJECTIVES: To examine predictors of participation and to describe the methodological considerations of conducting a two-stage population-based oral health survey. METHODS: An observational, cross-sectional survey (telephone interview and clinical oral examination) of community-dwelling adults aged 45-64 and ≥65 living in Nova Scotia, Canada was conducted. RESULTS: The survey response rate was 21% for the interview and 13.5% for the examination. A total of 1141 participants completed one or both components of the survey. Both age groups had higher levels of education than the target population; the age 45-64 sample also had a higher proportion of females and lower levels of employment than the target population. Completers (participants who completed interview and examination) were compared with partial completers (who completed only the interview), and stepwise logistic regression was performed to examine predictors of completion. Identified predictors were as follows: not working, post-secondary education and frequent dental visits. CONCLUSION: Recruitment, communications and logistics present challenges in conducting a province-wide survey. Identification of employment, education and dental visit frequency as predictors of survey participation provide insight into possible non-response bias and suggest potential for underestimation of oral disease prevalence in this and similar surveys. This potential must be considered in analysis and in future recruitment strategies.

Impact of everyday oral activities on the risk of bacteraemia is unclear.

DATA SOURCES: The Cochrane Library, Medline and Embase databases were searched as well as the references of identified articles and reviews. STUDY SELECTION: Studies were selected independently by two authors with disagreements being resolved by discussion. Only English language papers were included. DATA EXTRACTION AND SYNTHESIS: Data abstraction was conducted independently and meta-analysis conducted where appropriate. RESULTS: Twelve studies were included; seven on toothbrushing, one on dental flossing and four on chewing were included. Plaque and gingival indices were found to have a significant effect on the prevalence of bacteraemia following toothbrushing, with pooled odds ratios of 2.61 [95% confidence interval (CI) = 1.45-4.69] and 2.77 (95% CI = 1.50-5.11) respectively. None of five studies on bacteraemia following dental flossing and chewing revealed a statistically significant association between oral hygiene, gingival or periodontal status and the development of bacteraemia. CONCLUSIONS: Meta-analysis showed that plaque accumulation and gingival inflammation scores significantly increased the prevalence of bacteraemia following toothbrushing. However, systematic review showed no relationship between oral hygiene, gingival and periodontal status and the development of B-chewing, and there is no evidence that gingival and periodontal health status affects B-flossing.

Evidence is weak that the use of tissue regenerative membranes may improve class II molar furcation defects over open-flap debridement alone.

PURPOSE/QUESTION: To determine the efficacy of various treatment modalities for class II furcation involvement in molars, as measured during reentry surgery. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data. LEVEL OF EVIDENCE: Level 2: Limited-quality, patient-oriented evidence. STRENGTH OF RECOMMENDATION GRADE: Grade B: Inconsistent or limited-quality patient-oriented evidence.

No difference between 0.12% and 0.2% chlorhexidine mouthrinse on reduction of gingivitis.

DATA SOURCES: Medline, Cochrane Central Register of Controlled Trials (CENTRAL) and the reference lists of potentially relevant studies and reviews. STUDY SELECTION: Randomised controlled or controlled clinical trials conducted in adults (>18yr) comparing 0.12% and 0.2% CHX were included. Plaque scores, parameters of periodontal inflammation and periodontal attachment loss were selected as primary outcome parameters. Only studies written in English were accepted. DATA EXTRACTION AND SYNTHESIS: Study quality (risk of bias) and heterogeneity was assessed. Where appropriate, meta-analysis was conducted using a random effect model. A narrative summary was also presented. RESULTS: Ten separate experiments were included in the review, and a meta-analysis of seven studies using the same plaque index found a significant difference between 0.2% and 0.12% CHX (p50.008). The Weighted Mean Difference for plaque based on the Quigley & Hein Plaque Index was 0.10 (95%CI [0.03-0.17]) (heterogeneity I2 50%, p=0.87). Three studies that compared 0.12% and 0.2% CHX mouthrinse products provided data on gingival inflammation but no difference between the two concentrations was found. No studies were found that compared the two CHX concentrations and evaluated the probing pocket depth and/or the periodontal attachment level. CONCLUSIONS: In comparing 0.12% and 0.2% CHX, information concerning the effect on gingival inflammation was sparse and no studies could be found that compared the two CHX concentrations and evaluated the probing pocket depth and/or the periodontal attachment level. With respect to plaque inhibition, the results showed a small but significant difference in favour of the 0.2% CHX concentration. However the clinical relevance of this difference is probably negligible.

Journal clubs most effective if tailored to learner needs.

DATA SOURCES: The search strategy was developed using Medline and adapted for the requirements of other databases. The strategy included all study types, enabling the retrieval of qualitative research. Databases searched were; Australian Education Index, ACP Journal Club, British Education Index, Cochrane Library, CINAHL, Embase, Eric, LISA Medline, metaRegister of Controlled Trials, National Research Register, Psychinfo, REFER, Sociological Abstracts, Web of Knowledge. Bibliographies of relevant publications and review articles were scanned and relevant references were retrieved. No language restrictions were applied. Information on databases searched provided by original authors as not included in published article. STUDY SELECTION: All study designs which evaluated whether clubs promote changes in learner reaction, attitudes, knowledge, skills, behaviour or patient outcomes in undergraduate, postgraduate and practice settings. Studies evaluating video/internet meetings or single meetings were excluded. DATA EXTRACTION AND SYNTHESIS: Each article was reviewed by two authors independently with pilot-tested data collection forms. No quality assessment was pre-specified. RESULTS: Eighteen studies were included. Studies reported improvements in reading behaviour (N=5/11), confidence in critical appraisal (N=7/7), critical appraisal test scores (N=5/7) and ability to use findings (N=5/7). No studies reported on patient outcomes. Sixteen studies used self-reported measures, but only four studies used validated tests. Interventions were too heterogeneous to allow pooling. Realist synthesis identified potentially 'active educational ingredients', including mentoring, brief training in clinical epidemiology, structured critical appraisal tools, adult-learning principles, multifaceted teaching approaches and integration of the JC with other clinical and academic activities. CONCLUSIONS: The effectiveness of JCs in supporting evidence-based decision making is not clear. Better reporting of the intervention and a mixed methods approach to evaluating active ingredients are needed in order to understand how JCs may support evidence-based practice.

Assessing the quality of randomized controlled trials examining psychological interventions for pediatric procedural pain: recommendations for quality improvement.

OBJECTIVE: Systematic reviews of randomized controlled trials (RCTs) support the efficacy of psychological interventions for procedural pain management. However, methodological limitations (e.g., inadequate randomization) have affected the quality of this research, thereby weakening RCT findings. METHODS: Detailed quality coding was conducted on 28 RCTs included in a systematic review of psychological interventions for pediatric procedural pain. RESULTS: The majority of RCTs were of poor to low quality (criteria reported in <50% of RCTs). Commonly reported criteria addressed study background, conditions, statistical analyses, and interpretation of results. Commonly nonreported criteria included treatment administration, evaluation of treatment efficacy (effect sizes, summary statistics, intention-to-treat analyses), caregiver demographics, follow-up, and participant flow. Quality was greater in more recent trials, and did not vary by journal type (psychology vs. medical). CONCLUSION: Despite poor quality ratings, quality reporting in psychological RCTs for pediatric procedural pain has improved over time. Recommendations for quality enhancement are provided.

Seeing the Light--the truth about soft tissue lasers and nonsurgical periodontal therapy.

Although laser treatment has generated considerable interest among dentists and the public, there is no evidence that any laser system adds clinical value over and above scaling and root planing and conventional surgical treatment for periodontitis. Following a brief explanation of the mechanism behind soft tissue lasers, the evidence on the use of laser therapy in addition to traditional nonsurgical periodontal treatment in the management of periodontal diseases is reviewed.