Evidence-informed guidelines in oral health: insights from a systematic survey.

BACKGROUND: Oral diseases are a major global public health problem, impacting the quality of life of those affected. While consensus exists on the importance of high-quality, evidence-informed guidelines to inform practice and public health decisions in medicine, appropriate methodologies and standards are not commonly adhered to among producers of oral health guidelines. This study aimed to systematically identify organizations that develop evidence-informed guidelines in oral health globally and survey the methodological process followed to formulate recommendations. METHODS: We searched numerous electronic databases, guideline repositories, and websites of guideline developers, scientific societies, and international organizations (January 2012-October 2023) to identify organizations that develop guidelines addressing any oral health topic and that explicitly declare the inclusion of research evidence in their development. Pairs of reviewers independently evaluated potentially eligible organizations according to predefined selection criteria and extracted data about the organization's characteristics, key features of their guidelines, and the process followed when formulating formal recommendations. Descriptive statistics were used to analyze and summarize data. RESULTS: We included 46 organizations that developed evidence-informed guidelines in oral health. The organizations were mainly professional associations and scientific societies (67%), followed by governmental organizations (28%). In total, organizations produced 55 different guideline document types, most of them containing recommendations for clinical practice (77%). Panels were primarily composed of healthcare professionals (87%), followed by research methodologists (40%), policymakers (24%), and patient partners (18%). Most (60%) of the guidelines reported their funding source, but only one out of three (33%) included a conflict of interest (COI) policy management. The methodology used in the 55 guideline document types varied across the organizations, but only 19 (35%) contained formal recommendations. Half (51%) of the guideline documents referred to a methodology handbook, 46% suggested a structured approach or system for rating the certainty of the evidence and the strength of recommendations, and 37% mentioned using a framework to move from evidence to decisions, with the GRADE-EtD being the most widely used (27%). CONCLUSION: Our findings underscore the need for alignment and standardization of both terminology and methodologies used in oral health guidelines with current international standards to formulate trustworthy recommendations.

Infiltración de resina y barniz de flúor para el tratamiento de caries interproximales no cavitadas en dentición temporal / Resin infiltration plus fluoride varnish for non-cavitated proximal caries in primary dentition

RESUMEN: Introducción: Con el fin de prevenir la progresión de la caries interproximal no cavitada en dientes temporales, se ha generalizado el uso de estrategias mínimamente invasivas como la aplicación de sellantes, barniz de flúor o la resina infiltrante, ya sea combinadas o como monoterapia. Pese a lo anterior, hay incertidumbre con relación al efecto de la infiltración de resina en combinación con el barniz de flúor en dientes temporales. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Se identificaron nueve revisiones sistemáticas que en conjunto incluyeron tres estudios primarios que corresponden a ensayos clínicos aleatorizados. Se concluye que la infiltración de resina probablemente reduce el riesgo de la progresión de la caries interproximal no cavitada en dientes temporales. No se encontraron estudios que evaluaran los eventos adversos. Palabras claves: caries, infiltración de resina, caries interproximal, barniz de flúor, tratamiento mínimamente invasivo, Epistemonikos, GRADE.

ABSTRACT: Introduction: Minimally invasive techniques are widely used in non-cavitated interproximal caries treatment in primary dentition. Sealants, fluoride varnish, or resin infiltration can be applied in conjunction or as monotherapy. There is uncertainty regarding the effect of resin infiltration in conjunction with fluoride varnish in primary dentition. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified 9 systematic reviews including three studies overall, of which all were randomized trials. We conclude that resin infiltration plus fluoride varnish probably decreases the risk of progression of non-cavitated interproximal caries in primary dentition. No studies were found that looked at adverse effects.

Distonía de la embocadura: revisión narrativa de la literatura / Embouchure dystonia: narrative literature review

RESUMEN La ejecución excesiva de instrumentos de viento puede ser un factor causal para el desarrollo de distonía de la embocadura, caracterizada clínicamente por la aparición de contracciones musculares involuntarias, asociadas con la pérdida del control motor. Es importante que los profesionales y especialistas tengan el conocimiento necesario al momento de diagnosticar y tratar a la población que puede presentar este trastorno. El objetivo de esta revisión es examinar la literatura científica disponible en cuanto a la historia, epidemiología, fisiopatología, diagnóstico y tratamiento de la distonía de la embocadura en intérpretes de instrumentos de viento, con el fin de brindar herramientas para la prevención, el diagnóstico y el tratamiento de los músicos potencialmente susceptibles de desarrollar este trastorno.

SUMMARY Excessive practice of musical wind instruments may be a causal factor for the development of embouchure dystonia, clinically characterized by the appearance of involuntary muscle contractions associated with loss of motor control while interpreting a wind instrument. It is important for health professionals to have the necessary knowledge when diagnosing and treating musicians that are at risk or already have this disorder. The purpose of this review is to examine the scientific literature on the history, epidemiology, pathophysiology, diagnosis and treatment of embouchure dystonia in wind instrument interpreters, in order to provide the clinician tools for prevention, diagnosis and treatment in musicians who are susceptible for the development of this disorder.