RESUMO
BACKGROUND: Patients with multi-bracketed fixed orthodontic appliances are at a higher risk of developing enamel demineralisation. AIM: To compare the efficacy of the quarterly application of two varnishes in preventing white spot lesions (WSLs) during multi-bracketed fixed orthodontic treatment. DESIGN: Ninety-nine patients were randomly allocated into three intervention groups: Group A-standard oral hygiene instructions (OHI); Group B-5% sodium fluoride (NaF) varnish with standard OHI; and Group C-NaF plus tricalcium phosphate varnish with standard OHI. The outcome was assessed at 6-monthly intervals using a quantitative laser fluorescence device, clinical evaluation and photographic evaluation on six maxillary anterior teeth. A logistic regression model using generalised estimating equations with the intervention group, time and their interaction was used to compare the occurrence of WSLs, whereas the independent-samples Kruskal-Wallis test was used to compare the means of fluorescent values among different groups at p = .05. RESULTS: Generalised estimating equations (with intervention and time as predictors) showed that only the effect of time was found to be significant (p < .001), whereas there was no significant difference among the three intervention groups (p = .305) using clinical assessment or photographic assessment (p = .599). At the 18-month follow-up, sodium fluoride (NaF) varnish with standard OHI was shown to reduce the odds of WSLs by 55% (p = .200), and NaF plus tricalcium phosphate varnish with standard OHI by 42% (p = .327). CONCLUSION: The study failed to demonstrate that the quarterly application of both the study varnishes with OHI provided additional benefits compared with standard OHI alone in preventing WSLs, taking the effect of time of follow-up into consideration. There were higher odds of developing WSLs with an increased duration of orthodontic treatment.
Assuntos
Cárie Dentária , Fluoretos Tópicos , Humanos , Fluoretos Tópicos/uso terapêutico , Fluoreto de Sódio/uso terapêutico , Aparelhos Ortodônticos Fixos , Cárie Dentária/prevenção & controleRESUMO
BACKGROUND: The review aims to determine the risk predictability of mutans streptococci in the development of carious lesions in children with primary dentition. METHODS: Longitudinal observational studies with at least 6 months follow-up and evaluating mutans streptococci presence in caries-free children under 6 years of age for the development of any cavitated or non-cavitated carious lesion. Six databases and grey literature were searched without any restrictions. Risk of bias was evaluated using the New Castle Ottawa scale for longitudinal studies, and the certainty of the evidence was evaluated by Grading of Recommendations Assessment, Development and Evaluation using GRADEpro software. Meta-analysis was performed using a random effect (DerSimonian and Laird, DL) model, and heterogeneity was evaluated using tau-squared, I2 statistics and prediction interval. Sensitivity analysis was performed to assess the relationship between the mutans streptococci presence at baseline and the caries development, according to the sample and methods used for the microbiological assessment and the length of follow-up of the studies. Publication bias was checked by funnel plot using a random effect (DerSimonian and Laird, DL) model. RESULTS: Twelve studies met the inclusion criteria and were included in the review. Four studies received a maximum of 9 stars, and among the remaining eight studies, six received 8 stars and the rest two studies were assigned 7 stars in the risk of bias scale. After pooling the results quantitatively, odds ratio (OR) was found to be 4.13 (95% CI: 3.33, 5.12), suggesting that children with mutans streptococci had 4 times higher odds of developing caries later (p < 0.001). Four studies were pooled to compare future caries experience among children with and without mutans streptococci at baseline, obtaining standardized mean difference (SMD) of 0.85 (95% CI: 0.33, 1.37), indicating a large effect (p < 0.001). Certainty of evidence was found to be moderate, and no publication bias was reported by the funnel plot criteria of symmetry. CONCLUSIONS: Presence of mutans streptococci in a preschool child is a risk predictor for future caries experience. Early identification of children with increased caries-risk may facilitate in implementation of appropriate preventive strategies.
Assuntos
Cárie Dentária , Humanos , Pré-Escolar , Bases de Dados Factuais , Razão de Chances , Viés de Publicação , Software , Streptococcus mutansRESUMO
BACKGROUND: The aim of the present paper is to summarize the effectiveness of Phentolamine mesylate on the reversal of local anesthesia (LA). METHODOLOGY: Seven electronic databases were searched for randomized clinical trials in patients who received LA (population) and either received a Phentolamine injection (intervention) after LA compared to placebo or sham (control) to cause a return of normal sensation (outcome). Risk of bias assessment was performed using Cochrane risk of bias assessment tool 2.0. The hazard ratio (HR) was calculated as the event (time to return to the normal sensation) was a time-dependent event, as well as the weighted mean difference (WMD), was computed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the certainty of the evidence. RESULTS: Ten studies met our inclusion criteria and were included in this review. After pooling the results quantitatively, the value of the HR in the tongue was 0.56 (95% CI: 0.41-0.75, P<.001); in lower lip, the value was 0.56 (95% CI: 0.38-0.83, Pâ¯=â¯.004) and for upper lip, the value was 0.50 (95% CI: 0.31-0.80, Pâ¯=â¯.004). The WMD for the time to return for normal sensation was -47.71 min for the tongue (95% CI: -73.63 to -21.80 min, P<.001), -73.29 min for lower lip (95% CI: -88.41 to -58.16 min, P<.001) and -86.86 min for upper lip (95% CI: -101.16 to -72.57 min, P<.001). There is a high certainty of evidence that patients who have been administered local anesthesia may achieve faster recovery of normal sensation in tongue, and moderate certainty of evidence for return of normal sensation in lower lip and upper lip, if Phentolamine was administered after the local anesthesia. The adverse effects were reported in a few studies and were minor, not necessitating any medical intervention. CONCLUSIONS: Phentolamine might be a useful adjunct in patients who desire an earlier return of normal sensation and function after local anesthesia. Future research should be directed to study the cost-effectiveness or dental patient-reported outcomes of Phentolamine after local anesthetic injections.
Assuntos
Anestesia Local , Anestésicos Locais , Humanos , Fentolamina/farmacologia , Anestésicos Locais/farmacologia , Medidas de Resultados Relatados pelo PacienteRESUMO
BACKGROUND: Demineralization during multi-bracketed fixed orthodontic treatment is a well-known problem. AIM: To systematically evaluate the evidence for the prevention of enamel demineralization during multi-bracketed fixed orthodontic treatment. DESIGN: Systematic reviews (with or without meta-analysis) that have appraised the primary studies on the prevention of demineralization during multi-bracketed fixed orthodontic treatment were searched systematically and included as per pre-defined eligibility criteria. The risk of bias of the included reviews was assessed by two authors using the ROBIS tool and AMSTAR-2 tool. RESULTS: Twenty-nine reviews conducted on 128 exclusive primary studies were included for the present overview; 23 of these reviews were assessed to be of a high risk of overall bias, 5 were of low risk, and 1 review was of unclear risk of bias. CONCLUSIONS: Predominantly, the published reviews have focused on fluorides, whereas some reviews have also studied the role of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), reminder therapy, lasers, and sealants. Professional fluorides, sealants, reminder therapy, and lasers might be valuable interventions to prevent demineralization during orthodontic treatment based on the conclusions of reviews with high quality; however, further studies are required to elucidate the role of CPP-ACP, chlorhexidine varnish, and powered toothbrushes.
Assuntos
Fluoretos , Desmineralização do Dente , Cariostáticos , Assistência Odontológica , Esmalte Dentário , Materiais Dentários , Humanos , Revisões Sistemáticas como Assunto , Desmineralização do Dente/prevenção & controleRESUMO
Fissure sealant is a recommended preventive measure on permanent molars, but its efficacy on primary molars in preschool children is still in doubt. Sodium fluoride varnish (NaFV) enhances remineralization and is effective in preventing caries in smooth surfaces, but limited information is available regarding its use on occlusal surfaces of primary molars. The present study aimed to compare the efficacy of glass ionomer sealant (GIS) versus topical application of 5% NaFV in preventing and arresting occlusal caries in primary second molars among preschool children. One calibrated examiner examined children aged 3-4 years for visible plaque index (VPI), decayed-missing-filled primary surface (dmfs) index, and extent of carious lesions by the International Caries Detection and Assessment System (ICDAS). Subjects with 1 or more primary second molars that were sound or with incipient lesions (ICDAS 0-1), with distinct visual enamel changes (ICDAS 2), or with localized enamel breakdown (ICDAS 3) were recruited. The children were randomly assigned to either NaFV group - application of 5% NaFV at 3-monthly intervals or GIS group - 1 single placement of GIS. A parental questionnaire was used to collect information on the children's sociodemographic background and oral health-related habits. Two blinded examiners conducted clinical examinations after 6 and 12 months to evaluate the development of occlusal caries and the retention of GIS. Negative binomial regression using generalized estimating equations was employed to adjust for the clustering effect and evaluate the influence of selected variables on the development of occlusal caries into dentin at 12 months. A total of 323 children with 1,159 primary second molars received the respective preventive measures at baseline. At 12 months, 280 children with 989 molars were evaluated. Caries had developed or progressed into dentin in 7.8% and 8.0% of the molars in the NaFV and GIS groups, respectively, with no significant difference between the groups (p = 0.913). The overall retention rates of GIS were 24.6% and 13.5% at 6 and 12 months, respectively. Regression analyses showed only baseline caries experience, and an ICDAS code had a significant association with occlusal caries progression. Quarterly NaFV application and single GIS placement showed similar effectiveness in the prevention of occlusal caries development among preschool children.
Assuntos
Cárie Dentária , Fluoretos Tópicos , Resinas Acrílicas , Pré-Escolar , Cárie Dentária/prevenção & controle , Suscetibilidade à Cárie Dentária , Fluoretos , Fluoretos Tópicos/uso terapêutico , Humanos , Dente Molar , Selantes de Fossas e Fissuras/uso terapêutico , Dióxido de SilícioRESUMO
BACKGROUND/AIMS: Evidence mapping of systematic reviews (SRs) systematically and comprehensively identifies, organizes, and summarizes the distribution of scientific evidence in a field. The aims of this study were to delineate domains in dental traumatology (DT), evaluate the existing SRs within the domains, and identify the paucity of evidence for future research. METHODS: Domains and sub-domains of DT were established according to the methods of qualitative research. The protocol for evidence mapping was prepared as per the guidelines of GEM and PRISMA. The search strategy was formulated using words and MeSH terms in eight databases without restriction of languages and year of publication. Gray literature, protocol registries, and references of selected articles were also searched. Duplicates were removed, and the final selection of SRs was completed. Data extraction and quality analysis using the ROBIS tool and the PRISMA checklist were performed. RESULTS: The overall search resulted in 64 SRs from 1999 to 2020 with 44 published in last six years. The highest number of SRs had been performed in the Prognostic domain (n = 19) followed by the domains of Epidemiology (n = 15), Therapeutics (n = 10), Oral Biology (n = 7), Diagnostics (n = 6), Preventive (n = 5), and Research Methods (n = 2). Within each domain, there were variabilities in the number of reviewers, a priori protocols, search limitations, risk of bias methods, and meta-analysis. Of the SRs, including 4 Cochrane reviews, 28.4% were inconclusive. A low risk of bias was found in 48.4% of the SRs. Among the registered and ongoing SRs, six were from the domain of epidemiology, two in the domain of therapeutics, five from prognostics, and one each in the domains of prevention and research methods. CONCLUSION: The SRs in DT could be mapped in seven domains with variabilities in the methods. The majority had an a priori registered protocol and a low risk of reporting errors. Within the Epidemiology and Preventive domains, SRs were present in all the sub-domains with the majority demonstrating low-risk of bias (ROB). The domain of prognosis had SRs in most sub-domains but with a high ROB. Insufficient numbers of SRs were present in most sub-domains of the Diagnostics, Therapeutics, Research Methods and Oral Biology domains.
Assuntos
Traumatologia , Viés , Projetos de PesquisaRESUMO
BACKGROUND: Conventional methods of oral health education (OHE) are not suitable for children with visual impairment, as these methods usually involve visual demonstration with models or plaque-disclosing dyes. AIM: To systematically review the literature to support the best approach for providing OHE to children and adolescents with visual impairment. DESIGN: A systematic search of five electronic databases and grey literature was conducted. Randomized controlled trials that compared different OHE methods in children and adolescents with visual impairment were included. The Cochrane risk-of-bias tool (RoB 2) was used for the risk-of-bias assessment. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used to determine the certainty of evidence. RESULTS: Nine randomized controlled trials with a total of 804 participants were included in this review. Seven OHE methods were compared. Seven studies were assessed to be at high risk of bias, one study was assessed to have some concerns, and one study was assessed to be at low risk of bias. The overall certainty of evidence was very low according to GRADE. CONCLUSION: There was insufficient evidence to recommend a particular method of OHE as more effective in improving the oral hygiene of children with visual impairment, but combination methods may show similar or better results.
Assuntos
Placa Dentária , Higiene Bucal , Adolescente , Criança , Educação em Saúde Bucal , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Transtornos da Visão/prevenção & controleRESUMO
OBJECTIVE: This meta-evaluation aimed to summarize all available evidence regarding different fissure sealants on occlusal caries prevention, arrest, retention rate, adverse effect, and cost-effectiveness; when compared with no intervention, other preventive or minimally-invasive procedures. MATERIALS AND METHODS: The systematic reviews and meta-analyses were identified via four electronic databases and manual searching. Two independent reviewers performed study selection, data extraction, quality assessment with AMSTAR-2. RESULTS: Among the 366 records yielded, 38 systematic reviews were identified as eligible 24 of them included meta-analyses. Moderate evidence has supported the efficacies of resin-based sealants (RBS) in occlusal caries prevention, arrest and cost-effectiveness compared to no interventions. Low to very low certainty of evidence suggested similar effectiveness of glass-ionomer cements in caries prevention with RBS and more superior performance of resin infiltration in arresting non-cavitated occlusal lesions. CONCLUSION: This meta-evaluation supports the use of RBS on permanent molars to reduce occlusal caries occurrence, arrest lesion progression and alleviate oral health inequalities between individuals of different socioeconomic status. This meta-evaluation also advocates further research on glass-ionomer cements and resin infiltration with respect to their efficacies in caries prevention and arrest.
Assuntos
Cárie Dentária , Selantes de Fossas e Fissuras , Cárie Dentária/prevenção & controle , Suscetibilidade à Cárie Dentária , Cimentos de Ionômeros de Vidro , Humanos , Dente MolarRESUMO
OBJECTIVE: The use of pit and fissure sealants have been well supported in permanent teeth, but no concrete evidence is available to support this procedure in primary molars. This review aims to systematically assess randomized controlled trials and summarize the evidence on the effectiveness of different sealants in prevention and arrest of the pit and fissure occlusal caries in primary molars of children. MATERIALS AND METHODS: Four electronic databases were searched from inception to March 2018. Seven studies were included in the qualitative and quantitative syntheses. Two reviewers independently selected studies, extracted data, assessed risk of bias using the revised Cochrane risk of bias tool, and evaluated the certainty in the evidence adopting the Grading of Recommendations Assessment Development and Evaluation approach. Odds ratio and retention rate of different sealants were recalculated and analyzed. RESULTS: This review identified no significant difference in the overall caries incidence and progression when evaluated over 24 months between (1) resin-based sealant (RBS) and glass ionomer sealants (GIS) or resin-modified GIS; (2) conventional and newly developed RBS; (3) autopolymerized and light-polymerized RBS; (4) RBS with topical fluoride application and topical fluoride alone; and (5) RBS with topical fluoride application and resin infiltration with topical fluoride application. The pooled estimates of the mean retention rates of RBS and GIS on primary molars over an 18-months period were 85.94% and 23.18%, respectively. The certainty in the evidence of each outcome was determined as low or very low mainly because of high risk of overall bias and imprecision. CONCLUSION: There are currently insufficient well-controlled randomized controlled clinical trials to determine whether sealants are beneficial in preventing or arresting noncavitated occlusal caries in the primary molars.
Assuntos
Cárie Dentária , Selantes de Fossas e Fissuras , Criança , Dentição Permanente , Fluoretos Tópicos , Humanos , Dente MolarRESUMO
BACKGROUND: The regular use of fluoride dentifrices is quite practical, widespread and linked to global decline of dental caries. However, the role of self-applied topical fluorides in prevention and reversal of Enamel White Spot Lesions (EWSLs) during multi-bracketed fixed orthodontic treatment is not yet explored. OBJECTIVE: To systematically appraise the current literature on the effectiveness of self-applied topical fluorides in the prevention and reversal of EWSLs occurring during multi-bracketed fixed orthodontic treatment. SEARCH METHODS: Four electronic databases (Cochrane Library, Embase via Ovid, Medline via Ovid, and Scopus) and gray literature were searched using the broad MeSH terms and keywords. SELECTION CRITERIA: Only randomized/quasi-randomized controlled clinical trials evaluating the effectiveness of self-applied fluorides in the prevention of EWSLs during multi-bracketed fixed orthodontic treatment or reversal of post-orthodontic EWSLs were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened for studies, extracted data and assessed the risk of bias using the Cochrane risk of bias tool 2.0. Due to substantial variations in the interventions, control groups, and the measurement of outcome among studies, quantitative synthesis could not be performed as planned. RESULTS: Only three studies could be included in the present review; two of them assessing prevention of EWSLs and one addressing reversal of post-orthodontic EWSLs. One of the studies was judged to be of low risk of overall bias, whereas 2 studies were adjudged to be of high risk of overall bias because of deviations from intended interventions. The certainty of evidence about the role of self-applied fluorides in prevention and reversal of EWSLs was found to be of low quality; hence, our confidence in the effect estimate is limited, and future well-conducted trials might alter the effect estimates. LIMITATIONS: The inclusion of only English literature and inability to perform quantitative synthesis due to a limited number of studies. CONCLUSIONS AND IMPLICATIONS: Although the review did not confirm the effectiveness of self-applied fluorides in the reversal of EWSLs, it did partially substantiate the positive role of self-applied fluorides in the prevention of EWSLs occurring during multi-bracketed fixed orthodontic treatment. The review recommends the need for well-designed randomized controlled trials evaluating the effectiveness of self-applied fluorides on the prevention and reversal of EWSLs during multi-bracketed fixed orthodontic treatment. REGISTRATION: PROSPERO database (Registration number: CRD42018108590) and is freely available at: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018108590. FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Assuntos
Cárie Dentária/prevenção & controle , Fluoretos Tópicos , Assistência Odontológica , Esmalte Dentário , Fluoretos , HumanosRESUMO
Antibiotics are prescribed by dentists in dental practice, during dental treatment as well as for prevention of infection. Indications for the use of systemic antibiotics in dentistry are limited because most dental and periodontal diseases are best managed by operative intervention and oral hygiene measures. The use of antibiotics in dental practice is characterised by empirical prescription based on clinical and bacteriological epidemiological factors, resulting in the use of a very narrow range of broad-spectrum antibiotics for short periods of time. This has led to the development of antimicrobial resistance (AMR) in a wide range of microbes and to the consequent inefficacy of commonly used antibiotics. Dentists can make a difference by the judicious use of antimicrobials--prescribing the correct drug, at the standard dosage and appropriate regimen--only when systemic spread of infection is evident. The increasing resistance problems of recent years are probably related to the over- or misuse of broad-spectrum agents. There is a clear need for the development of prescribing guidelines and educational initiatives to encourage the rational and appropriate use of drugs in dentistry. This paper highlights the need for dentists to improve antibiotic prescribing practices in an attempt to curb the increasing incidence of antibiotic resistance and other side effects of antibiotic abuse. The literature provides evidence of inadequate prescribing practices by dentists for a number of factors, ranging from inadequate knowledge to social factors.
Assuntos
Antibacterianos/uso terapêutico , Assistência Odontológica , Antibioticoprofilaxia , Contraindicações , Farmacorresistência Bacteriana , Humanos , Prescrição Inadequada , Guias de Prática Clínica como AssuntoRESUMO
OBJECTIVES: To compare the effectiveness of two 5% sodium fluoride (NaF) varnishes containing casein phosphopeptide amorphous calcium phosphate (CPP-ACP) (MI VarnishTM) or tricalcium phosphate (TCP) (ClinproTM White) to the conventional 5% NaF varnish (Duraphat®) in preventing early childhood caries (ECC) in high-risk preschool children. METHODS: A double-blinded, randomized controlled trial recruited healthy 3-4-year-old children (N = 582) having at least one carious lesion (pre-cavitated or cavitated) after obtaining written informed consent from parents. Using a computer-generated random-number table, children were assigned to one of the 3 groups: Control group (n = 196): 5% NaF varnish (Duraphat®) or two test groups: 5% NaF with TCP (Clinpro™ White) (n = 193) and 5% NaF varnish with CPP-ACP (MI Varnish™) (n = 193) to receive quarterly (every 3 months) application over 24 months. RESULTS: Incidence of new caries over 2 years was 59.2% in MI Varnish™ group (n = 125), 65.1% in the Clinpro™ White group (n = 129) and 66.1% in the Duraphat® group (n = 127) (p = 0.466). The mean cavitated lesions increment was not significant among the 3 groups (p = 0.714), as was the mean increment in non-cavitated carious lesions (p = 0.223). There was no significant difference (p = 0.630) in the distribution of total fluoride varnish applications among the three groups. Also, no significant difference was found in comparison of outcomes among the different number of fluoride varnish applications received by children in each group. CONCLUSIONS: Both calcium- and phosphate-containing NaF varnishes showed similar efficacy against cavitated and non-cavitated carious lesions as compared to conventional NaF varnish in high-risk preschool children. CLINICAL SIGNIFICANCE: Randomized trial provided a crucial opportunity to advance the understanding of the clinical effectiveness of different fluoride varnishes in preventing early childhood caries. Varnishes containing tricalcium phosphate or casein phosphopeptide amorphous calcium phosphate when compared to sodium fluoride varnish, demonstrated a similar efficacy against early childhood caries in high caries-risk preschool children.
Assuntos
Fosfatos de Cálcio , Cariostáticos , Caseínas , Cárie Dentária , Fluoretos Tópicos , Fluoreto de Sódio , Humanos , Cárie Dentária/prevenção & controle , Caseínas/uso terapêutico , Pré-Escolar , Fluoreto de Sódio/uso terapêutico , Fluoretos Tópicos/uso terapêutico , Feminino , Cariostáticos/uso terapêutico , Masculino , Método Duplo-Cego , Fosfatos de Cálcio/uso terapêutico , Resultado do TratamentoRESUMO
OBJECTIVE: To establish consensus recommendations for clinicians to manage white spot lesions (WSLs) during orthodontic treatment. MATERIALS AND METHODS: Three task force members reviewed the literature to identify best practices for minimizing WSLs during orthodontic treatment. Each draft statement was read to the task force members by a facilitator, followed by voting, accepting, or editing if necessary. The statements were then sent electronically by an independent third party (Magellan Medical Technology Consultants Inc, Minneapolis, Minn) to a previously formed content validation panel consisting of 20 independent private practitioners and clinical academicians for validation. RESULTS: Twenty-one statements were developed and sent for content validation. While 19 statements achieved a content validation index (CVI) of 0.78, two items did not. These items were edited by the task force members based on qualitative feedback from content validation participants. Each of these revised statements did achieve a CVI of 0.78 on second evaluation from the content validation panelists and therefore were included in this document. CONCLUSION: To reduce the risk of WSLs, it is essential to implement individualized caries management measures based on a comprehensive assessment of the patient's oral and systemic health. Effective at-home and professional mechanical and chemical plaque control should be implemented for high-risk orthodontic patients. Fluoride to support prevention and materials such as orthodontic sealants should also be used to provide a physical barrier around the brackets in high-risk patients. By following these guidelines, orthodontic professionals can help promote oral health and minimize the need for restorative treatment.
Assuntos
Cárie Dentária , Braquetes Ortodônticos , Ortodontia , Humanos , Cárie Dentária/prevenção & controle , Fluoretos , Saúde Bucal , Braquetes Ortodônticos/efeitos adversosRESUMO
AIM: To exemplify, summarize and critically appraise the systematic reviews (SRs) that evaluated different oral health education (OHE) interventions in individuals with visual impairment (VI). METHODOLOGY: Six electronic databases were searched for SRs evaluating OHE programs in individuals with VI. The internal validity of the included SRs was evaluated using the Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2) tool. The degree of overlap of the primary studies in the included SRs was calculated using the "corrected covered area (CCA)" approach. RESULTS: Seven SRs were included in this umbrella review that included 30 primary studies with a CCA of 26% (very high overlap). Six of the included SRs were assessed to have critically low confidence in the results, whereas only one had moderate confidence. CONCLUSIONS: A combination of various OHE methods for individuals with VI might be better than using one method alone to improve oral hygiene. There is no conclusive evidence that one OHE method is superior to others. However, the evidence of OHE in improving the outcomes related to dental trauma or caries is inconclusive. Furthermore, it appears that most of the evaluations of oral health programs come from limited parts of the world, and data from many other regions is lacking.
Assuntos
Cárie Dentária , Saúde Bucal , Humanos , Revisões Sistemáticas como Assunto , Educação em Saúde Bucal , Transtornos da VisãoRESUMO
We compare the effect of calcium and phosphate-containing sodium fluoride (NaF) varnishes to conventional NaF varnish on S. mutans and L. fermentum counts. 3-4 years old children were grouped according to their caries status (n = 45 each): caries-free, with non-cavitated and with cavitated lesions. Each group was randomly subdivided (n = 15 each) into: Group 1- 5% NaF, Group 2- 5% NaF with tricalcium phosphate, Group 3- 5% NaF with casein phosphopeptide- amorphous calcium phosphate. Biofilm and saliva were collected to quantify microorganisms at baseline (T1) and 24-months (T2). Differences between groups were compared using Kruskal-Wallis test, followed by Dunn-Bonferroni post-test, at 0.0167 α-level. Significant difference was found for percentage of children with detectable biofilm L. fermentum (p = 0.013) at T1 and salivary S. mutans (p = 0.011) at T2. Percentage of children increased from T1 to T2 in Group 2 with salivary S. mutans (p = 0.007), salivary L. fermentum (p = 0.035), and biofilm L. fermentum (p = 0.019) and in Group 3 with salivary L. fermentum (p = 0.035). Bacterial change was not significant in both samples of intervention groups, except increase in salivary S. mutans (p = 0.038) in Group 3. Both calcium- and phosphate-containing NaF varnishes demonstrated similar antibacterial effect on S. mutans and L. fermentum compared to conventional NaF varnish.
Assuntos
Cárie Dentária , Fluoretos Tópicos , Pré-Escolar , Humanos , Fluoretos Tópicos/farmacologia , Cálcio , Fluoretos/farmacologia , Fluoreto de Sódio/farmacologia , Bactérias , Cálcio da DietaRESUMO
AIM: To compare the validity of DIAGNOdent pen™ 2190 and clinical photographs in the diagnosis (presence or absence) and assessment of white spot lesions (WSLs) during multi-bracketed fixed orthodontic treatment. METHODS: A total of 1607 readings from 99 patients were obtained using DIAGNOdent pen™ 2190, clinical photographs, and visual assessment criteria to assess WSLs at 6 -, 12- and 18 months after bonding of brackets. Receiver operating characteristic curves were constructed, and areas under the curve (AUC) were calculated to assess the presence or absence of WSLs and distinguish the severity of WSLs as slight or severe. Sensitivities, specificities, and AUC were calculated for outcomes at an alpha of 0.05 and 95% confidence intervals (CIs). RESULTS: The values of sensitivity and specificity of DIAGNOdent pen™ 2190 were found to be 0.78 and 0.83, respectively, to distinguish presence/absence of WSLs with good accuracy (AUC= 0.855; 95% CI: 0.820-0.889) and for digital photographs, accuracy was excellent (AUC= 0.973, 95% CI: 0.956-0.991) with sensitivity and specificity of 0.96 and 0.99, respectively. However, the accuracy of DIAGNOdent pen™ 2190 was poor (AUC= 0.543, 95% CI: 0.418-0.668) in delineating slight and severe WSLs with a sensitivity of 0.31 and specificity of 0.83; while the values of sensitivity and specificity for distinguishing slight or severe lesions for clinical photographs were 0.96 and 0.99, respectively with excellent accuracy (AUC=0.978, 95% CI: 0.936-1.000). CONCLUSIONS: Clinical photographs had better validity than DIAGNOdent pen™ 2190 in diagnosis and assessment of severity of demineralized lesions during multi-bracketed fixed orthodontic treatment.
Assuntos
Cárie Dentária , Braquetes Ortodônticos , Fotoquimioterapia , Fluorescência , Humanos , Lasers , Fotoquimioterapia/métodos , Fotografação , Curva ROC , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: To summarize the evidence on prevention of early childhood caries (ECC) by professionally or self-applied topical fluorides using network meta-analysis. DATA: Randomized-controlled trials with minimum 1-year follow-up assessing caries-preventive effect among children younger than six years. SOURCES: Eight electronic databases and grey literature. STUDY SELECTION: After screening and data extraction, risk of bias assessment using Cochrane risk of bias tool 2.0 was done. Twenty-four trials were included, among which 17 were assessed as "high risk" and remaining as "low risk". Fifteen studies evaluated professionally-applied, and the other nine used self-applied topical fluorides. Ten studies on professionally-applied fluorides reporting the net caries increment (dmfs increment) at 2-years follow-up were included in Network meta-analysis (NMA). NMA and ranking the interventions were conducted using a frequentist random-effects approach and surface under the cumulative ranking command, followed by assessing the certainty of evidence using an extension of GRADE approach with CINeMA framework. Among the eight included interventions of professionally-applied fluorides, only two, i.e., 3-monthly 0.9% difluorosilane (DFS) and 6-monthly 5% sodium fluoride varnish were effective in preventing ECC compared to control with 3-monthly DFS application ranking higher than 6-monthly sodium fluoride varnish application. CONCLUSION: Among all the professionally-applied topical fluoride interventions reviewed, very low to moderate evidence was found with 0.9% DFS application at 3-monthly intervals, which was ranked highest in prevention of ECC. Among the included studies on self-applied topical fluorides, the evidence was inconclusive due to heterogeneity among studies. CLINICAL SIGNIFICANCE: The 0.9% DFS varnish applied every 3 months is most effective for preventing early childhood caries. The review recommends that good quality studies be conducted in future, comparing two or more interventions for both self- as well as professionally-applied topical fluoride agents with adequate follow-up.
Assuntos
Cárie Dentária , Fluoretos Tópicos , Cariostáticos/uso terapêutico , Criança , Pré-Escolar , Cárie Dentária/tratamento farmacológico , Cárie Dentária/prevenção & controle , Suscetibilidade à Cárie Dentária , Fluoretos/uso terapêutico , Fluoretos Tópicos/uso terapêutico , Humanos , Metanálise em RedeRESUMO
The current global COVID-19 pandemic has almost marked its one year of existence and influenced everyone either at an individual or community level. There are plenty of clinical recommendations and guidelines for the practitioners, and beyond doubt, the treating clinicians and other healthcare providers who have been in the frontline of this battle might have been significantly affected as a direct consequence of this pandemic. However, most of the clinical recommendations and guidelines are pivoted on intense research, and thus it is entirely reasonable to foretell that if dental research is impacted, the care-providers and consequently the patients will inevitably be affected. The present paper attempts to narratively summarize the potential disruptions on dental research due to the pandemic and endeavours to forewarn the dental researchers and scientific communities about the impact of COVID-19 on ongoing and ensuing dental research in the coming years. The ongoing COVID-19 pandemic has significantly affected laboratory and clinical research globally and will probably change the course of individuals and organizations engaged in dental research for some time. Tailor-made contingency plans by the individuals and organizations and sustaining the momentum of dental research by maintaining the flexibility in administration and utilization of research grants, extensions of grants and funding deadlines, adaption of study designs and procedures, pause or delay enrolment of participants, innovation in research collaborations and scholarly communications across different fields are some of the suggested measures that can be utilized to minimize the disruption during this pandemic.
Assuntos
COVID-19 , Pandemias , Pesquisa em Odontologia , Pessoal de Saúde , Humanos , SARS-CoV-2RESUMO
Purpose: To systematically evaluate the horizontal transmission of Streptococcus mutans in children and analyze its relationship with dental caries. Methods: Seven databases were searched for observational studies that have determined the transmission of S. mutans among children younger than seven years. Selection of included studies, data extraction, and quality assessment using Downs and Black's (1998) scoring system were performed. The inverse variance random-effect approach was used to pool the results, and statistical heterogeneity was evaluated using I-squared statistics. Results: Fifteen studies were included for qualitative synthesis, five of which were pooled for quantitative analysis. The risk ratio (RR) of sharing only one genotype in caries-free children versus children with caries was found to be 0.60 (95 percent confidence interval [95% CI] equals 0.45 to 0.80; P ≤ 0.001). The RR of sharing more than one genotype was 1.46 (95% CI equals 1.13 to 1.89; P=0.004) in children with caries versus caries-free children. These findings imply that children sharing only one genotype have a 40 percent lesser risk, and children sharing more than one genotype have a 46 percent higher risk of having dental caries. Conclusions: The systematic review provides evidence of the horizontal transmission of S. mutans and its association with dental caries.