INTRA-ARTICULAR PHARMACOLOGICAL INJECTIONS FOR TEMPOROMANDIBULAR JOINT OSTEOARTHRITIS ARE COMPARABLE TO PLACEBO.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Effectiveness of intra-articular injections of sodium hyaluronate, corticosteroids, platelet-rich plasma on temporomandibular joint osteoarthritis: a systematic review and network meta-analysis of randomized controlled trials. Xie Y, Zhao K, Ye G, Yao X, Yu M, Ouyang H. J Evid Based Dent Pract. 2022 Sep;22(3):101720. doi:10.1016/j.jebdp.2022.101720. SOURCE OF FUNDING: National Natural Science Foundation of China (nos. T2121004, 81630065). TYPE OF STUDY/DESIGN: Systematic review with network meta-analysis of data.

PROBIOTICS MAY LOWER THE RISK OF ORAL MUCOSITIS IN CANCER PATIENTS.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Shu Z, Li P, Yu B, Huang S, Chen Y. The effectiveness of probiotics in prevention and treatment of cancer therapy-induced oral mucositis: A systematic review and meta-analysis [published online ahead of print, 2020 Jan 7]. Oral Oncol. 2020;102:104,559. doi:10.1016/j.oraloncology.2019.104559. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Zinc Supplementation May Reduce the Effects of Oral Mucositis for Patients With Cancer Receiving Either Chemotherapy or Radiotherapy.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Effects of oral supplementation in the management of oral mucositis in cancer patients: A meta-analysis of randomized clinical trials. de Menêses AG, Normando AGC, Porto de Toledo I, Reis PED, Guerra ENS. J Oral Pathol Med. 2020;49(2):117-125. SOURCE OF FUNDING: Information not available from the study. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

WITHDRAWN: Interventions for replacing missing teeth: partially absent dentition.

BACKGROUND: Management of individuals presenting with partial loss of teeth is a common task for dentists. Outcomes important to the management of missing teeth in the partially absent dentition should be systematically summarized. This review recognizes both the challenges associated with such a summarization and the critical nature of the information for patients. OBJECTIVES: To assess the effects of different prostheses for the treatment of partially absent dentition in terms of the following outcomes: long-term success, function, morbidity and patient satisfaction. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 21 March 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to March 2011) and EMBASE via OVID (1980 to March 2011). There were no restrictions regarding language or date of publication. We contacted several authors to identify non-published trials. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing different methods (including the design and materials used) of treating partial edentulism, with clinically relevant outcomes, were included in this review. Trials reporting only surrogate outcomes, such as plaque accumulation or gingival volume, were excluded from this review. DATA COLLECTION AND ANALYSIS: Two review authors independently carried out the screening of eligible studies, assessment of dimensions of quality of trials, and data extraction. Results were expressed as mean differences for continuous data, risk ratios for dichotomous outcomes, and hazard ratios with 95% confidence intervals for time-to-event data. MAIN RESULTS: Twenty-one trials met the inclusion criteria for this review. Twenty-four per cent of these were assessed as being at high risk of bias and the remainder were at unclear risk of bias. The clinical heterogeneity among the included studies precluded any attempt at meta-analysis. There was insufficient evidence to determine whether one type of removable dental prosthesis (RDP) was better or worse than another. With fixed dental prostheses (FDPs), there was no evidence that high gold alloys are better or worse than other alloys, nor that gold alloys or frameworks are better or worse than titanium. There is insufficient evidence to determine whether zirconia is better or worse that other FDP materials, that ceramic abutments are better or worse than titanium, or that one cement was better or worse than another in retaining FDPs. There is insufficient evidence to determine the relative effectiveness of FDPs and RDPs in patients with shortened dental arch or to determine the relative advantages of implant supported FDPs versus tooth/implant supported FDPs. AUTHORS' CONCLUSIONS: Based on trials meeting the inclusion criteria for this review, there is insufficient evidence to recommend a particular method of tooth replacement for partially edentulous patients.

The Risk of Medication-Related Osteonecrosis of the Jaw After Dental Extraction is Higher for Patients on Intravenous as Compared With Oral Antiresorptive Drugs.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Occurrence and risk indicators of medication-related osteonecrosis of the jaw after dental extraction: a systematic review and meta-analysis. Gaudin E, Seidel L, Bacevic M, Rompen E, Lambert F. J Clin Periodontol 2015;42(10):922-32. SOURCE OF FUNDING: Internal institutional support TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

DNA-image cytometry has promise for oral cancer detection.

DATA SOURCES: The Medline, Embase, PubMed, Elsevier and Web of Science databases and the reference lists of known primary and review papers were scanned for relevant citations. STUDY SELECTION: Prospective and retrospective studies evaluating brush cytology were considered. Only computer-assisted methods that included histologically confirmed disease positive status were included. DATA EXTRACTION AND SYNTHESIS: Data were extracted using a standardised form. Study quality was assessed by one reviewer using the quality assessment of diagnostic accuracy studies (QUADAS) checklist. Pooled sensitivity and specificity were calculated with 95% CIs (confidence intervals) separately for each study. Likelihood and diagnostic odds ratios were also calculated along with a summary receiver-operating characteristic (SROC) curve analysis. RESULTS: Thirteen studies (eight of OralCDx brush biopsy and five of DNA-image cytometry) reporting on 1981 oral mucosa lesions were included. OralCDx brush biopsy had a pooled sensitivity of 86% (95% CI; 81-90) and pooled specificity of 81% (95% CI; 78-85). The pooled sensitivity and specificity of DNA-image cytometry were 89% (95% CI; 83-94) and 99% (95% CI; 97-100). Diagnostic odds ratio estimates for OralCDx brush biopsy and DNA-image cytometry were 20.36 (95% CI; 2.72-152.67) and 446.08 (95% CI; 73.36-2712.43), respectively. Study size was found to be closely related to heterogeneity among studies and analysis suggested publication bias in relation to OralCDx brush biopsy. CONCLUSIONS: The results of this meta-analysis suggest that DNA-image cytometry has a highly significant potential over OralCDx brush biopsy as an accurate and simple diagnostic tool for clinically suspected oral precancer and oral cancer.

Defective composite restorations--repair or replace?

DATA SOURCES: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, BIOSIS via Web of Knowledge, Web of Science and Opengrey databases were searched. In addition researchers and experts in the field were contacted to trace unpublished or ongoing studies. No restrictions were placed on the language or date of publication. STUDY SELECTION: Randomised controlled trials (including split-mouth studies), involving replacement and repair of resin composite restorations in adults with a defective molar restoration in a permanent molar or premolar teeth were to be considered. DATA EXTRACTION AND SYNTHESIS: Two review authors independently assessed titles and abstracts for each article identified by the searches in order to decide whether the article was likely to be relevant. Full papers were obtained for relevant articles and both review authors studied these. The Cochrane Collaboration statistical guidelines were followed for data synthesis. RESULTS: The search strategy retrieved 298 potentially eligible studies, after de-duplication. After examination of the titles and abstracts, full texts of potentially relevant studies were retrieved, but none of the retrieved studies met the inclusion criteria of the review. CONCLUSIONS: There are no published randomised controlled trials relevant to this review question. Therefore there is a need for methodologically sound randomised controlled trials that are reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement (www.consort-statement.org/). Further research also needs to explore qualitatively the views of patients on repairing versus replacement, and investigate themes around pain, anxiety and distress, time and costs.

Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures.

The Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures evidence-based clinical practice guideline was codeveloped by the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association. This guideline replaces the previous AAOS Information Statement, "Antibiotic Prophylaxis in Bacteremia in Patients With Joint Replacement," published in 2009. Based on the best current evidence and a systematic review of published studies, three recommendations have been created to guide clinical practice in the prevention of orthopaedic implant infections in patients undergoing dental procedures. The first recommendation is graded as Limited; this recommendation proposes that the practitioner consider changing the long-standing practice of routinely prescribing prophylactic antibiotic for patients with orthopaedic implants who undergo dental procedures. The second, graded as Inconclusive, addresses the use of oral topical antimicrobials in the prevention of periprosthetic joint infections. The third recommendation, a Consensus statement, addresses the maintenance of good oral hygiene.

The limitations of the clinical oral examination in detecting dysplastic oral lesions and oral squamous cell carcinoma.

BACKGROUND: The clinical oral examination (COE) is the criterion standard for the initial detection of oral lesions that harbor dysplasia or oral squamous cell carcinoma (OSCC) at an early stage when they are most treatable. The authors conducted a systematic review to assess the effectiveness of the COE in predicting histologic diagnosis of dysplasia or OSCC. METHODS: The authors conducted automated searches of PubMed, Web of Knowledge, and the Cochrane Library from 1966 through 2010 for randomized controlled trials and observational studies that included the terms "oral mucosal lesion screening" and "oral lesions." They determined the quality (sensitivity, specificity, positive predictive value, negative predictive value and diagnostic odds ratio) of selected studies by using the Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS: The overall diagnostic odds ratio was 6.1 (95% confidence interval, 2.1-17.6); therefore, the COE was considered to have poor overall performance as a diagnostic method for predicting dysplasia and OSCC. CLINICAL IMPLICATIONS: On the basis of the available literature, the authors determined that a COE of mucosal lesions generally is not predictive of histologic diagnosis. The fact that OSCCs often are diagnosed at an advanced stage of disease indicates the need for improving the COE and for developing adjuncts to help detect and diagnose oral mucosal lesions.

The potential harm of not following clinical practice guideline recommendations.

BACKGROUND: Clinical practice guidelines (CPGs) provide recommendations for clinicians on the basis of best evidence. CPGs are often not followed because of numerous barriers, including lack of awareness, inability to understand recommendations, and problems with implementation. CASE DESCRIPTION: A case report is presented in which treatment of a patient's incipient caries lesions may not have followed a CPG available to practitioners, recommending conservative nonrestorative medical interventions. The resulting treatment led to pain and the need for endodontic therapy and full-coverage restoration. PRACTICAL IMPLICATIONS: This case represents possible mismanagement leading to undue pain and additional costs that could have been avoided by being aware of, and following, the recommendations from CPGs.

Temporomandibular disorders: current status of research, education, policies, and its impact on clinicians in the United States of America.

Temporomandibular disorders (TMDs) encompass a number of different musculoskeletal disorders often accompanied by pain and dysfunction. Most TMDs are acute, but can become chronic leading to disability and quality of life issues. There is wide variation in treatment of TMDs, including both conservative/reversible therapies as well as invasive/irreversible treatments, which present difficulties for clinicians, patients, and third-party payers as to what constitutes appropriate care. Data sources: A recent report by the National Academies of Sciences, Engineering, and Medicine highlighted a number of deficiencies, most notably in the education of TMDs within United States of America dental schools at both the predoctoral and postdoctoral (dental) levels as well as addressing the historic inconsistencies in both diagnosis and treatment. New areas for research and interprofessional collaboration should assist in the understanding of TMDs, and updated clinical practice guidelines should help reduce variation in the delivery of evidence-based care. Recently, the American Dental Association recognized orofacial pain as a specialty, which should increase the level and availability of expertise in treating these issues. Summary: Based on the current best evidence, this report is an attempt to alert the profession to discontinue irreversible and invasive therapies for the vast majority of TMDs and recognize that the majority of these disorders are amenable to conservative, reversible interventions.

Interventions for replacing missing teeth: partially absent dentition.

BACKGROUND: Management of individuals presenting with partial loss of teeth is a common task for dentists. Outcomes important to the management of missing teeth in the partially absent dentition should be systematically summarized. This review recognizes both the challenges associated with such a summarization and the critical nature of the information for patients. OBJECTIVES: To assess the effects of different prostheses for the treatment of partially absent dentition in terms of the following outcomes: long-term success, function, morbidity and patient satisfaction. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 21 March 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1), MEDLINE via OVID (1950 to March 2011) and EMBASE via OVID (1980 to March 2011). There were no restrictions regarding language or date of publication. We contacted several authors to identify non-published trials. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing different methods (including the design and materials used) of treating partial edentulism, with clinically relevant outcomes, were included in this review. Trials reporting only surrogate outcomes, such as plaque accumulation or gingival volume, were excluded from this review. DATA COLLECTION AND ANALYSIS: Two review authors independently carried out the screening of eligible studies, assessment of dimensions of quality of trials, and data extraction. Results were expressed as mean differences for continuous data, risk ratios for dichotomous outcomes, and hazard ratios with 95% confidence intervals for time-to-event data. MAIN RESULTS: Twenty-one trials met the inclusion criteria for this review. Twenty-four per cent of these were assessed as being at high risk of bias and the remainder were at unclear risk of bias. The clinical heterogeneity among the included studies precluded any attempt at meta-analysis. There was insufficient evidence to determine whether one type of removable dental prosthesis (RDP) was better or worse than another. With fixed dental prostheses (FDPs), there was no evidence that high gold alloys are better or worse than other alloys, nor that gold alloys or frameworks are better or worse than titanium. There is insufficient evidence to determine whether zirconia is better or worse that other FDP materials, that ceramic abutments are better or worse than titanium, or that one cement was better or worse than another in retaining FDPs. There is insufficient evidence to determine the relative effectiveness of FDPs and RDPs in patients with shortened dental arch or to determine the relative advantages of implant supported FDPs versus tooth/implant supported FDPs. AUTHORS' CONCLUSIONS: Based on trials meeting the inclusion criteria for this review, there is insufficient evidence to recommend a particular method of tooth replacement for partially edentulous patients.

Can dental x-rays increase the risk of meningioma?

UNLABELLED: CASE/CONTROL SELECTION: Cases consisted of individuals who had histologically confirmed intracranial meningioma form the states of Connecticut, Massachusetts, North Carolina and 6 counties in the state of California. The control group were selected using random-digit-dialing and matched to cases by 5-year age interval, sex, and state of residence. Information was collected from consenting participants by telephone interview. The sample that was used in this analysis included 1433 cases and 1350 controls. DATA ANALYSIS: Descriptive statistics were used to examine associations between the risk of meningioma and independent covariates. Conditional logistic regression was used to assess the odds of meningioma associated with risk factors. RESULTS: The authors reported an odds ratio of 2.0 (95%CI 1.4-2.9), meaning patients with meningioma (cases) had double the odds of reporting ever having a bitewing x-ray as compared with non-disease controls. Individuals who reported receiving bitewing x-rays on a yearly or more frequent basis had an elevated odds as age increased. An increased risk of meningioma also was associated with panorex films taken at a young age. CONCLUSIONS: Exposure to some dental x-rays in the past, especially when radiation exposure was greater than it is currently, is associated with increased risk of meningioma. As with other sources of ionizing radiation, limiting its use may be a benefit to patients.

Strategies for developing evidence-based clinical practice guidelines to foster implementation into dental practice.

BACKGROUND: Professional and other organizations, including oral health care organizations, have been developing evidence-based clinical practice guidelines (CPGs) to help providers incorporate the best available evidence into their clinical decision making. Although the rigor of guideline development has increased over time, ongoing challenges prevent the full adoption of CPGs into clinical practices that experience variability in provider expertise and opinion, patient flow pace, and use of electronic dental records. These challenges include lack of relevant evidence, failure to keep guidelines up to date, and failure to adopt strategies aimed at overcoming the barriers preventing implementation into clinical practice. RESULTS: This article provides a brief overview of strategies that can be used to overcome common challenges to guideline adoption. Such strategies include creating evidence-based CPGs that use additional sources of evidence and methods to inform guideline development and accelerate the guideline updating and dissemination process (that is, evidence directly from clinical practice, big data, patients' values and preferences, and living guidelines) and applying implementation strategies that have been documented as improving translation of CPGs into routine clinical practice (that is, guideline implementability, implementation science, and computable guidelines). PRACTICAL IMPLICATIONS: Adopting newer strategies for developing and translating evidence into practice could lead to improvements in patient care and population health.

Computer-aided design/ computer-aided manufacturing crown survival rates.

DESIGN: A randomised controlled trial (RCT) was conducted in a dental school. INTERVENTION: A total of 224 patients were randomised into two treatment groups, with 123 patients having teeth restored with KaVo Everest high-performance ceramic (HPC) crowns, fabricated by a computer-aided manufacturing procedure (KaVo Dental GmbH, Biberach an der Riss, Germany) and 101 patients receiving gold crowns. All crowns were conventionally cemented with glass-ionomer cement. OUTCOME MEASURE: Crowns were assessed for loss of vitality, surface roughness, fractures, marginal integrity, secondary caries at the crown margin, margin discolouration, marginal gap and crown loss at set time intervals of 6 and 12 months. The cumulative incidence of clinical complications was used as the criterion for failure. Time-to-event (failure) analysis was used for survival data. The incidence-free survival probabilities were then assessed using Kaplan-Meier analysis. A proportional hazard model (Cox) was used to test the treatment effect. RESULTS: After an observation period of 6, 12 and 24 months, the prospective survival rates (Kaplan-Meier) for the KaVo Everest HPC crowns were 97.9%, 95.1% and 89.8%, and for the gold crowns were 100%, 94.8% and 92.7%, respectively. There were no significant differences between the two groups (P 0.2). The 1-year failure rates were 4.9% for the KaVo Everest HPC crowns and 5.2% for the gold crowns. The 1-year cumulative risks for loss of vitality, secondary caries, fractures, loss of crown and extraction of abutment of the analysed abutments (88) were 8.9%, 0%, 0%, 1.1% and 1.1%, respectively, for the gold crowns and 2.8%, 0%, 4.7%, 0% and 0.9%, respectively, for the ceramic crowns (107 analysed abutments). No perfect marginal fit was shown by 49.5% of the evaluated ceramic crowns and 26.1% of the gold crowns. CONCLUSIONS: The 12-month results indicate that Everest HPC crowns are suitable for posterior restorations, provided that an adequate tooth reduction is possible. The marginal fit shows potential for improvement.

Understanding statistics 2.

The first article in this series addressed both qualitative and quantitative research. This article will discuss the different types and nature of data used in quantitative research.

Understanding statistics 1.

Understanding the basics of statistics can be quite challenging. One of the problems with statistical analysis is the manner in which it is presented, which is often rather disjointed. This series of articles will attempt to approach statistics by keeping issues in specific categories, to try to facilitate understanding of key concepts. This first article will examine the need for statistical analysis, explore the development of the null hypothesis, and describe what general domains of statistics are used in scientific studies.

Smoking increases dental implant failures and complications.

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

Effect of dental treatment before cardiac valve surgery: Systematic review and meta-analysis.

BACKGROUND: The purpose of this systematic review was to determine the potential effect of dental treatment before cardiac valve surgery (CVS) or left ventricular assist device (LVAD) implantation on morbidity and mortality. TYPES OF STUDIES REVIEWED: The authors included relevant studies from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, including randomized controlled trials and cohort studies, published from 1998 through 2019 and involving adults who received dental treatment before CVS or LVAD implantation. The authors assessed bias by using the Newcastle-Ottawa Quality Assessment Scale and evidence certainty by using the Grading of Recommendations Assessment, Development and Evaluation approach. The authors used a meta-analysis with a random-effects model to estimate dichotomous and continuous outcomes, expressed as relative risk (RR) and weighted mean difference. RESULTS: Six studies met the inclusion criteria for CVS but none for LVAD implantation. Very low certainty in the evidence suggested uncertainty as to whether health outcomes for patients undergoing dental treatment before CVS differed from those who did not. Postsurgical outcomes included all-cause mortality (RR, 1.00; 95% confidence interval [CI], 0.53 to 1.91), infective endocarditis (RR, 1.30; 95% CI, 0.51 to 3.35), postsurgical infection (RR, 1.01; 95% CI, 0.76 to 1.33), and length of stay in the hospital (weighted mean difference, 2.9; 95% CI, -2.3 to 8.1). CONCLUSIONS AND PRACTICAL IMPLICATIONS: From the available evidence, it is unclear whether postoperative outcomes differ in patients receiving dental treatment before CVS compared with outcomes in those who do not. Dentists and medical care professionals should collaborate on an appropriate course of action for each patient, weighing any potentially relevant care considerations.

Antibiotics for the urgent management of symptomatic irreversible pulpitis, symptomatic apical periodontitis, and localized acute apical abscess: Systematic review and meta-analysis-a report of the American Dental Association.

BACKGROUND: Patients with pulpal and periapical conditions often seek treatment for pain, intraoral swelling, or both. Even when definitive, conservative dental treatment (DCDT) is an option, antibiotics are often prescribed. The purpose of this review was to summarize available evidence regarding the effect of antibiotics, either alone or as adjuncts to DCDT, to treat immunocompetent adults with pulpal and periapical conditions, as well as additional population-level harms associated with antibiotic use. TYPE OF STUDIES REVIEWED: The authors updated 2 preexisting systematic reviews to identify newly published randomized controlled trials. They also searched for systematic reviews to inform additional harm outcomes. They conducted searches in MEDLINE, Embase, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. Pairs of reviewers independently conducted study selection, data extraction, and assessment of risk of bias and certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: The authors found no new trials via the update of the preexisting reviews. Ultimately, 3 trials and 8 additional reports proved eligible for this review. Trial estimates for all outcomes suggested both a benefit and harm over 7 days (very low to low certainty evidence). The magnitude of additional harms related to antibiotic use for any condition were potentially large (very low to moderate certainty evidence). CONCLUSIONS AND PRACTICAL IMPLICATIONS: Evidence for antibiotics, either alone or as adjuncts to DCDT, showed both a benefit and a harm for outcomes of pain and intraoral swelling and a large potential magnitude of effect in regard to additional harm outcomes. The impact of dental antibiotic prescribing requires further research.