Treatment of dental and orthodontic complications in thalassaemia.

BACKGROUND: Thalassaemia is a quantitative abnormality of haemoglobin caused by mutations in genes controlling production of alpha or beta globins. Abnormally unpaired globin chains cause membrane damage and cell death within organ systems and destruction of erythroid precursors in the bone marrow, leading to haemolytic anaemia. The life-long management of the general health effects of thalassaemia is highly challenging, and failure to deal with dental and orthodontic complications exacerbates the public health, financial and personal burden of the condition. There is a lack of evidence-based guidelines to help care seekers and providers manage such dental and orthodontic complications. This review aimed to evaluate the available evidence on methods for treating dental and orthodontic complications in people with thalassaemia to inform future recommendations. This is an update of a Cochrane Review first published in 2019. OBJECTIVES: To assess different methods for treating dental and orthodontic complications in people with thalassaemia. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register in September 2022, and we searched nine online databases and trials registries in January 2022. We searched the reference lists of relevant articles and reviews and contacted haematologists, experts in fields of dentistry, organisations, pharmaceutical companies and researchers working in this field. SELECTION CRITERIA: We searched for published or unpublished randomised controlled trials (RCTs) that evaluated treatment of dental and orthodontic complications in individuals diagnosed with thalassaemia, irrespective of phenotype, severity, age, sex and ethnic origin. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the 37,242 titles retrieved by the search. After deduplication, we identified two potentially relevant RCTs. On assessing their eligibility against our inclusion and exclusion criteria, we excluded one and included the other. MAIN RESULTS: We included one parallel-design RCT conducted in Saudi Arabia and involving 29 participants (19 males, 10 females) with thalassaemia. It aimed to assess the effectiveness of photodynamic therapy as an adjuvant to conventional full-mouth ultrasonic scaling for the treatment of gingivitis. The average age of participants was around 23 years. There is very low-certainty evidence from this trial that full-mouth ultrasonic scaling plus photodynamic therapy compared to full-mouth ultrasonic scaling alone may improve gingival index score and bleeding on probing after 12 weeks in people with thalassaemia. We found no studies that assessed other interventions for the various dental or orthodontic complications of thalassaemia. AUTHORS' CONCLUSIONS: Although the included study showed greater reduction in gingivitis in the group treated with full-mouth ultrasonic scaling plus photodynamic therapy, the evidence is of very low certainty. The study had unclear risk of bias, a short follow-up period and no data on safety or adverse effects. We cannot make definitive recommendations for clinical practice based on the limited evidence of a single trial. Future studies will very likely affect the conclusions of this review. This review highlights the need for high-quality RCTs that investigate the effectiveness of various treatment modalities for dental and orthodontic complications in people with thalassaemia. It is crucial that future trials assess adverse effects of interventions.

Treatment of dental complications in sickle cell disease.

BACKGROUND: Sickle cell disease is the most common single gene disorder and the commonest haemoglobinopathy found with high prevalence in many populations across the world. Management of dental complications in people with sickle cell disease requires special consideration for three main reasons. Firstly, dental and oral tissues are affected by the blood disorder resulting in several oro-facial abnormalities. Secondly, living with a haemoglobinopathy and coping with its associated serious consequences may result in individuals neglecting their oral health care. Finally, the treatment of these oral complications must be adapted to the systemic condition and special needs of these individuals, in order not to exacerbate or deteriorate their general health. Guidelines for the treatment of dental complications in this population who require special care are unclear and even unavailable in many aspects. Hence this review was undertaken to provide a basis for clinical care by investigating and analysing the existing evidence in the literature for the treatment of dental complications in people with sickle cell disease. This is an update of a previously published review. OBJECTIVES: To assess methods of treating dental complications in people with sickle cell disease. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Review Group's Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. Date of last search: 01 August 2019. Additionally, we searched nine online databases (PubMed, Google Scholar, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Literature in the Health Sciences in Latin America and the Caribbean database, African Index Medicus, Index Medicus for South East Asia Region, Index Medicus for the Eastern Mediterranean Region, Indexing of Indian Medical Journals). We also searched the reference lists of relevant articles and reviews and contacted haematologists, experts in fields of dentistry, organizations, pharmaceutical companies and researchers working in this field. Date of last search: 07 November 2019. SELECTION CRITERIA: We searched for published or unpublished randomised controlled studies of treatments for dental complications in people with sickle cell disease. DATA COLLECTION AND ANALYSIS: Two review authors intended to independently extract data and assess the risk of bias of the included studies using standard Cochrane methodologies; however, no studies were identified for inclusion in the review. MAIN RESULTS: No randomised controlled studies were identified. AUTHORS' CONCLUSIONS: This Cochrane Review did not identify any randomised controlled studies assessing interventions for the treatment of dental complications in people with sickle cell disease. There is an important need for randomised controlled studies in this area, so as to identify the most effective and safe method for treating dental complications in people with sickle cell disease.

Treatment of dental and orthodontic complications in thalassaemia.

BACKGROUND: Thalassaemia is a quantitative abnormality of haemoglobin caused by mutations in genes controlling production of alpha or beta globins. Abnormally unpaired globin chains cause haemolytic anaemia by causing membrane damage and cell death within organ systems and destruction of erythroid precursors in the bone marrow. The life-long management of the general health effects of thalassaemia in affected individuals is a highly challenging issue in and of itself; and failure to deal with dental and orthodontic complications in people with thalassaemia exacerbates the public health, financial and personal burden posed by the condition. There exists a lack of evidence-based guidelines for care-seekers and providers to best deal with such dental and orthodontic complications in thalassaemia, which this review seeks to address. OBJECTIVES: The main objective of this review was to assess different methods to treat dental and orthodontic complications in people with thalassaemia. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We searched the reference lists of relevant articles and reviews.Date of last search: 01 August 2019.We also searched nine online databases (PubMed, Google Scholar, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Literature in the Health Sciences in Latin America and the Caribbean database, African Index Medicus, Index Medicus for South East Asia Region, Index Medicus for the Eastern Mediterranean Region, Indexing of Indian Medical Journals). We searched the reference lists of relevant articles and reviews and contacted haematologists, experts in fields of dentistry, organizations, pharmaceutical companies and researchers working in this field.Date of last search: 22 July 2019. SELECTION CRITERIA: We searched for published or unpublished randomised controlled trials for treatment of dental and orthodontic complications in individuals diagnosed with thalassaemia, irrespective of phenotype, severity, age, gender and ethnic origin. DATA COLLECTION AND ANALYSIS: Two review authors independently screened 35,202 titles from search results. We identified four unique randomised controlled trials, of which one seemed potentially relevant. Based on closer inspection, the trial was found not to be eligible for inclusion. MAIN RESULTS: We did not find any relevant trials for inclusion in the review. AUTHORS' CONCLUSIONS: We were unable to draw any conclusions due to the lack of available data and trials. This review highlights the need for conducting and appropriate reporting, of high-quality randomised controlled trials investigating the effectiveness of various treatment modalities for dental and orthodontic complications in people with thalassaemia.

Ergonomic interventions for preventing musculoskeletal disorders in dental care practitioners.

BACKGROUND: Dentistry is a profession with a high prevalence of work-related musculoskeletal disorders (WMSD) among practitioners, with symptoms often starting as early in the career as the student phase. Ergonomic interventions in physical, cognitive, and organisational domains have been suggested to prevent their occurrence, but evidence of their effects remains unclear. OBJECTIVES: To assess the effect of ergonomic interventions for the prevention of work-related musculoskeletal disorders among dental care practitioners. SEARCH METHODS: We searched CENTRAL, MEDLINE PubMed, Embase, PsycINFO ProQuest, NIOSHTIC, NIOSHTIC-2, HSELINE, CISDOC (OSH-UPDATE), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP) Search Portal to August 2018, without language or date restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs, and cluster RCTs, in which participants were adults, aged 18 and older, who were engaged in the practice of dentistry. At least 75% of them had to be free from musculoskeletal pain at baseline. We only included studies that measured at least one of our primary outcomes; i.e. physician diagnosed WMSD, self-reported pain, or work functioning. DATA COLLECTION AND ANALYSIS: Three authors independently screened and selected 20 potentially eligible references from 946 relevant references identified from the search results. Based on the full-text screening, we included two studies, excluded 16 studies, and two are awaiting classification. Four review authors independently extracted data, and two authors assessed the risk of bias. We calculated the mean difference (MD) with 95% confidence intervals (CI) for continuous outcomes and risk ratios (RR) with 95% confidence intervals for dichotomous outcomes. We assessed the quality of the evidence for each outcome using the GRADE approach. MAIN RESULTS: We included two RCTs (212 participants), one of which was a cluster-randomised trial. Adjusting for the design effect from clustering, reduced the total sample size to 210. Both studies were carried out in dental clinics and assessed ergonomic interventions in the physical domain, one by evaluating a multi-faceted ergonomic intervention, which consisted of imparting knowledge and training about ergonomics, work station modification, training and surveying ergonomics at the work station, and a regular exercise program; the other by studying the effectiveness of two different types of instrument used for scaling in preventing WMSDs. We were unable to combine the results from the two studies because of the diversity of interventions and outcomes.Physical ergonomic interventions. Based on one study, there is very low-quality evidence that a multi-faceted intervention has no clear effect on dentists' risk of WMSD in the thighs (RR 0.57, 95% CI 0.23 to 1.42; 102 participants), or feet (RR 0.64, 95% CI 0.29 to 1.41; 102 participants) when compared to no intervention over a six-month period. Based on one study, there is low-quality evidence of no clear difference in elbow pain (MD -0.14, 95% CI -0.39 to 0.11; 110 participants), or shoulder pain (MD -0.32, 95% CI -0.75 to 0.11; 110 participants) in participants who used light weight curettes with wider handles or heavier curettes with narrow handles for scaling over a 16-week period.Cognitive ergonomic interventions. We found no studies evaluating the effectiveness of cognitive ergonomic interventions.Organisational ergonomic interventions. We found no studies evaluating the effectiveness of organisational ergonomic interventions. AUTHORS' CONCLUSIONS: There is very low-quality evidence from one study showing that a multi-faceted intervention has no clear effect on dentists' risk of WMSD in the thighs or feet when compared to no intervention over a six-month period. This was a poorly conducted study with several shortcomings and errors in statistical analysis of data. There is low-quality evidence from one study showing no clear difference in elbow pain or shoulder pain in participants using light weight, wider handled curettes or heavier and narrow handled curettes for scaling over a 16-week period.We did not find any studies evaluating the effectiveness of cognitive ergonomic interventions or organisational ergonomic interventions.Our ability to draw definitive conclusions is restricted by the paucity of suitable studies available to us, and the high risk of bias of the studies that are available. This review highlights the need for well-designed, conducted, and reported RCTs, with long-term follow-up that assess prevention strategies for WMSDs among dental care practitioners.

Evidence-based practice and the evidence pyramid: A 21st century orthodontic odyssey.

Organized evidence-based practice is said to have started in the medical field in the late 20th century. Its principles and usage eventually spread to other health sciences, including orthodontics. Although the conceptual foundations and basic tenets of evidence-based orthodontics are based on the classical approach of testing medical interventions, differences unravel as we encounter the ground realities in orthodontics, which are unique due to the length, complexity, and diversity involved in orthodontic treatment and research. How has this led to the evolution of evidence-based orthodontics and changes in its applications? Is it being translated to better clinical answers, treatment strategies, patient satisfaction, and information for orthodontists? What more needs to be done, considering the rapidly changing orthodontic scenario? This article aims to explore these questions to evaluate how evidence-based orthodontics has played itself out so far, so that it can continue to grow strong and stand up to the challenges of 21st century orthodontics.

Treatment of dental complications in sickle cell disease.

BACKGROUND: Sickle cell disease is the most common single gene disorder and the commonest haemoglobinopathy found with high prevalence in many populations across the world. Management of dental complications in people with sickle cell disease requires special consideration for three main reasons. Firstly, dental and oral tissues are affected by the blood disorder resulting in several oro-facial abnormalities. Secondly, living with a haemoglobinopathy and coping with its associated serious consequences may result in individuals neglecting their oral health care. Finally, the treatment of these oral complications must be adapted to the systemic condition and special needs of these individuals, in order not to exacerbate or deteriorate their general health.Guidelines for the treatment of dental complications in this population who require special care are unclear and even unavailable in many aspects. Hence this review was undertaken to provide a basis for clinical care by investigating and analysing the existing evidence in the literature for the treatment of dental complications in people with sickle cell disease. OBJECTIVES: To assess methods of treating dental complications in people with sickle cell disease. SEARCH METHODS: We searched the Cochrane Haemoglobinopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books.Date of last search: 11 April 2016.Additionally, we searched nine online databases (PubMed, Google Scholar, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Literature in the Health Sciences in Latin America and the Caribbean database, African Index Medicus, Index Medicus for South East Asia Region, Index Medicus for the Eastern Mediterranean Region, Indexing of Indian Medical Journals). We also searched the reference lists of relevant articles and reviews and contacted haematologists, experts in fields of dentistry, organizations, pharmaceutical companies and researchers working in this field.Date of last search: 03 March 2016. SELECTION CRITERIA: We searched for published or unpublished randomised controlled studies of treatments for dental complications in people with sickle cell disease. DATA COLLECTION AND ANALYSIS: Two review authors intended to independently extract data and assess the risk of bias of the included studies using standard Cochrane methodologies; however, no studies were identified for inclusion in the review. MAIN RESULTS: No randomised controlled studies were identified. AUTHORS' CONCLUSIONS: This Cochrane review did not identify any randomised controlled studies assessing interventions for the treatment of dental complications in people with sickle cell disease. There is an important need for randomised controlled studies in this area, so as to identify the most effective and safe method for treating dental complications in people with sickle cell disease.