Randomized trial of dentists' understanding: treatment benefit in absolute numbers vs relative risk reduction.

This study aimed to assess whether dentists correctly understand the benefit of a dental treatment when it is presented using absolute numbers or relative risk reduction (RRR). This parallel-group randomized controlled trial recruited dentists from 3 postgraduate courses in Rio de Janeiro, Brazil. Participants received, in sequentially numbered sealed opaque envelopes, the description of a hypothetical scenario of the benefit (avoidance of multiple tooth loss) of nonsurgical periodontal treatment without or with antibiotics. Treatment benefit was presented in 2 different formats: absolute numbers or RRR. Dentists were given 10 minutes to read the treatment scenario and answer 5 questions. The final sample for analysis included 101 dentists. When asked to estimate the number of patients out of 100 who would avoid multiple tooth loss without antibiotics, 17 dentists (33%) in the absolute numbers group and 12 (25%) in the RRR group provided the correct response (p = 0.39). Regarding treatment with antibiotics, 26 dentists (50%) in the absolute numbers group and 14 (29%) in the RRR group provided the correct response (p = 0.04). Only 16 dentists (31%) in the absolute numbers group and 12 (25%) in the RRR group gave correct answers for both questions (p = 0.51). Most dentists did not correctly understand the benefit of the treatment, irrespective of the format it was presented. Slightly more dentists correctly understood the benefit of the treatment when it was presented as absolute numbers than as RRR.

How different attributes are weighted in professionals' decision-making in Pediatric Dentistry-a protocol for guiding discrete choice experiment focused on shortening the evidence-based practice implementation for dental care.

BACKGROUND: Important evidence has been constantly produced and needs to be converted into practice. Professional consumption of such evidence may be a barrier to its implementation. Then, effective implementation of evidence-based interventions in clinical practice leans on the understanding of how professionals value attributes when choosing between options for dental care, permitting to guide this implementation process by maximizing strengthens and minimizing barriers related to that. METHODS: This is part of a broader project investigating the potential of incorporating scientific evidence into clinical practice and public policy recommendations and guidelines, identifying strengths and barriers in such an implementation process. The present research protocol comprises a Discrete Choice Experiment (DCE) from the Brazilian oral health professionals' perspective, aiming to assess how different factors are associated with professional decision-making in dental care, including the role of scientific evidence. Different choice sets will be developed, either focusing on understanding the role of scientific evidence in the professional decision-making process or on understanding specific attributes associated with different interventions recently tested in randomized clinical trials and available as newly produced scientific evidence to be used in clinical practice. DISCUSSION: Translating research into practice usually requires time and effort. Shortening this process may be useful for faster incorporation into clinical practice and beneficial to the population. Understanding the context and professionals' decision-making preferences is crucial to designing more effective implementation and/or educational initiatives. Ultimately, we expect to design an efficient implementation strategy that overcomes threats and potential opportunities identified during the DCEs, creating a customized structure for dental professionals. TRIAL REGISTRATION: https://osf.io/bhncv .

Randomized trial of dentists' understanding: treatment benefit in absolute numbers vs relative risk reduction

Abstract This study aimed to assess whether dentists correctly understand the benefit of a dental treatment when it is presented using absolute numbers or relative risk reduction (RRR). This parallel-group randomized controlled trial recruited dentists from 3 postgraduate courses in Rio de Janeiro, Brazil. Participants received, in sequentially numbered sealed opaque envelopes, the description of a hypothetical scenario of the benefit (avoidance of multiple tooth loss) of nonsurgical periodontal treatment without or with antibiotics. Treatment benefit was presented in 2 different formats: absolute numbers or RRR. Dentists were given 10 minutes to read the treatment scenario and answer 5 questions. The final sample for analysis included 101 dentists. When asked to estimate the number of patients out of 100 who would avoid multiple tooth loss without antibiotics, 17 dentists (33%) in the absolute numbers group and 12 (25%) in the RRR group provided the correct response (p = 0.39). Regarding treatment with antibiotics, 26 dentists (50%) in the absolute numbers group and 14 (29%) in the RRR group provided the correct response (p = 0.04). Only 16 dentists (31%) in the absolute numbers group and 12 (25%) in the RRR group gave correct answers for both questions (p = 0.51). Most dentists did not correctly understand the benefit of the treatment, irrespective of the format it was presented. Slightly more dentists correctly understood the benefit of the treatment when it was presented as absolute numbers than as RRR.

Economic evaluation of fluoride varnish application in preschoolers: A systematic review.

BACKGROUND: Fluoride varnish (FV) is a convenient way of professionally applying fluoride in preschoolers. However, its modest anticaries effect highlights the need for economic evaluations. AIM: To assess economic evaluations reporting applications of FV to reduce caries incidence in preschoolers. DESIGN: We included full economic evaluations with preschool participants, in which the intervention was FV and the outcome was related to dentin caries. We searched in CENTRAL; MEDLINE via PubMed; WEB OF SCIENCE; EMBASE; SCOPUS; LILACS; BBO; and BVS Economia em saúde, OpenGrey, and EconoLit. Clinical trial registers, thesis and dissertations, and meeting abstracts were hand searched, as well as 11 dental journals. Risk of bias in the included studies was assessed using the Philips' and Drummond's (full and simplified) tools. RESULTS: Titles and abstracts of 2871 articles were evaluated, and 200 were read in full. Eight cost-effectiveness studies were included: five modeling and three within-trial evaluations. None of the studies gave sufficient information to allow a thorough assessment using the bias tools. We did not combine the results of the studies due to the great heterogeneity among them. Four studies reported that FV in preschool children was a cost-effective measure, but in one of these studies, sealants and fluoride toothpaste were more cost-effective measures than the varnish, and three studies used limited data that compromised the generalizability of their results. The other four studies showed a large increase in costs due to the application of varnish and/or low cost-effectiveness. CONCLUSION: We did not find convincing overall evidence that applying FV in preschoolers is an anticaries cost-effective measure. The protocol of this systematic review is available at Open Science Framework (https://osf.io/xw5va/).

Validation of the brazilian version of the oral health impact profile - Aesthetic questionnaire.

The aim of the study was to develop the Brazilian version of the Oral Health Impact Profile - Aesthetic Questionnaire (OHIP-Aes-Braz) and test its psychometric properties. The questionnaire test versions were developed by a panel of experts and a pre-test was conducted in a focus group. Data used for testing its psychometric properties were obtained from a randomized controlled clinical trial on tooth bleaching. Seventy-nine Brazilian adults were included. The questionnaires were applied before tooth bleaching treatment (baseline), one week (T1), and one month after the intervention (T2). Reliability was assessed in terms of internal consistency and stability, while validity was ascertained by criterion and construct validity. The sensitivity to change was assessed comparing the total scores at baseline and T2, using the Wilcoxon test (α = 0.05). Both stability and internal consistency (intra-class correlation coefficient=0.95, Cronbach's α = 0.92) proved to be adequate. Construct validity was confirmed as the correlation between OHIP-Aes-Braz scores with tooth color satisfaction and self-perceived oral health were in the expected direction. A positive correlation between OHIP-Aes-Braz and OHIP-14 (rs=0.63) and OIDP (rs=0.77) was observed. The instrument was responsive once differences in total scores before and after treatment were statistically significant (p<0.001). The OHIP-Aes-Braz presented good psychometric properties and showed sensitivity to change regarding aesthetics evaluation in Brazilian adults treated with tooth bleaching. A valid and reliable instrument allows a suitable assessment of oral health-related quality of life in Brazilian patients submitted to aesthetics dental interventions.

Validation of the brazilian version of the oral health impact profile - Aesthetic questionnaire

Abstract The aim of the study was to develop the Brazilian version of the Oral Health Impact Profile - Aesthetic Questionnaire (OHIP-Aes-Braz) and test its psychometric properties. The questionnaire test versions were developed by a panel of experts and a pre-test was conducted in a focus group. Data used for testing its psychometric properties were obtained from a randomized controlled clinical trial on tooth bleaching. Seventy-nine Brazilian adults were included. The questionnaires were applied before tooth bleaching treatment (baseline), one week (T1), and one month after the intervention (T2). Reliability was assessed in terms of internal consistency and stability, while validity was ascertained by criterion and construct validity. The sensitivity to change was assessed comparing the total scores at baseline and T2, using the Wilcoxon test (α = 0.05). Both stability and internal consistency (intra-class correlation coefficient=0.95, Cronbach's α = 0.92) proved to be adequate. Construct validity was confirmed as the correlation between OHIP-Aes-Braz scores with tooth color satisfaction and self-perceived oral health were in the expected direction. A positive correlation between OHIP-Aes-Braz and OHIP-14 (rs=0.63) and OIDP (rs=0.77) was observed. The instrument was responsive once differences in total scores before and after treatment were statistically significant (p<0.001). The OHIP-Aes-Braz presented good psychometric properties and showed sensitivity to change regarding aesthetics evaluation in Brazilian adults treated with tooth bleaching. A valid and reliable instrument allows a suitable assessment of oral health-related quality of life in Brazilian patients submitted to aesthetics dental interventions.

Resumo O objetivo do estudo foi desenvolver a versão brasileira do Oral Health Impact Profile - Aesthetic Questionnaire (OHIP-Aes-Braz) e testar suas propriedades psicométricas. As versões de teste do questionário foram desenvolvidas por um painel de especialistas e um pré-teste foi realizado em um grupo focal. Os dados usados para testar suas propriedades psicométricas foram obtidos a partir de um ensaio clínico randomizado controlado de clareamento dental. Setenta e nove brasileiros adultos foram incluídos. Os questionários foram aplicados antes do tratamento clareador (baseline), uma semana (T1) e um mês após a intervenção (T2). A confiabilidade foi avaliada em termos de consistência interna e estabilidade, enquanto a validade foi avaliada pela validade de critério e de construto. A sensibilidade à mudança foi avaliada pela comparação entre os escores totais no baseline e T2, usando o teste de Wilcoxon ((=0,05). Tanto a estabilidade quanto a consistência interna (coeficiente de correlação intraclasse=0,95, alfa de Cronbach=0,92) mostraram-se adequadas. A validade de construto foi confirmada uma vez que a correlação dos escores do OHIP-Aes-Braz com a satisfação com a cor dos dentes e a autopercepção da saúde bucal foram na direção esperada. Uma correlação positiva entre OHIP-Aes-Braz e OHIP-14 (r s =0,63) e OIDP (r s =0,77) foi observada. O instrumento foi responsivo uma vez que as diferenças nos escores totais antes e depois do tratamento foram estatisticamente significantes (p<0,001). O OHIP-Aes-Braz apresentou boas propriedades psicométricas e mostrou sensibilidade a mudanças na avaliação estética em adultos brasileiros submetidos ao clareamento dental. Um instrumento válido e confiável permite uma avaliação adequada da qualidade de vida relacionada à saúde bucal em pacientes brasileiros submetidos a intervenções odontológicas estéticas.

Oral manifestations of congenital Zika virus infection in children with microcephaly: 18-month follow-up case series.

AIMS: To describe oral manifestations in children born with microcephaly attributed to congenital Zika virus syndrome (CZS). METHODS: Data was collected in semiannual intervals from 2017 to 2019, by oral exams of the children and interview with caregivers at a Public Dental Center in Rio de Janeiro, Brazil. A single calibrated examiner performed clinical examinations. RESULTS: Of 38 eligible children, 34 were followed-up from 12 to 30 months of age, 20 boys and 14 girls. The mean age of emergence of their first primary tooth was 12.4 months (SD = 2.9). By 30 months of age only 14.7% (n = 5) had complete primary dentition. Alteration in the sequence of tooth emergence was observed in 41.1% (n = 14). Radiographic examination demonstrated dental agenesis (14.7% n = 5). Dental developmental alterations (38.2%, n = 13), enamel defects (14.7%, n = 5), eruption cysts/hematoma (23.5%, n = 8), gingival bleeding (55.8%, n = 19), narrow palate, and bruxism (64.7%, n = 22) were also observed. No child had dental caries. CONCLUSION: Children with microcephaly attributed to CZS presented oral manifestations early in life.

Efficacy of 30% and 38% Silver Diamine Fluoride in Arresting Caries Lesions After Different Application Times: An in Vitro Study

Abstract Objective: To evaluate the efficacy of silver diamine fluoride (SDF) in arresting dentin caries lesions when applied under different concentrations and times. Material and Methods: Forty-two bovine blocks were selected and fixed in 24-well plates. Each well received a mixed bacterial inoculum added to the culture medium with 5% sucrose. The plates were incubated in microaerophilia (7 days) for caries formation, confirmed by micro-CT (M1). SDF was applied over the carious lesions for different times and concentrations (n=6): SDF 30% - immediate removal, 1 minute and 3 minutes; SDF 38%, - immediate removal, 1 minute and 3 minutes. The group without treatment was the control. Then, the samples were again scanned by micro-CT (M2) and submitted to a second cariogenic challenge for 21 days. Then, a final scan was performed (M3). Results: Mean pH at the culture medium and lesion depth were compared using Kruskal-Wallis and Wilcoxon tests. 38% SDF showed the lowest metabolic activity of the biofilm. All 38% groups and 30% 1 and 3 minutes did not show an increase in mean lesion depth comparing M3 with M1. However, only 30% 3 minutes and 38% 1 and 3 minutes showed a significant reduction of lesion depth. Conclusion: The minimum application time of 30% SDF to arrest dentin caries lesion was 1 minute, while 38% SDF arrested with application and immediate removal.

Dental caries prevalence, prospects, and challenges for Latin America and Caribbean countries: a summary and final recommendations from a Regional Consensus.

Dental caries can be effectively managed and prevented from developing into cavitated lesions while preserving tooth structure at all levels. However, the strong correlation between caries and socioeconomic factors may compromise the efficacy of preventive strategies. The high prevalence of persistent inequalities in dental caries in Latin American and Caribbean countries (LACC) is a matter of concern. The estimates of the burden of disease in some countries in this region are outdated or absent. This paper aims to summarize and present the final recommendations of a regional Consensus for Dental Caries Prevalence, Prospects, and Challenges for LACC. This consensus is based on four articles that were written by a team of Latin American experts, reviewed by dental associations, and presented and discussed in two consensus events. The following domains were explored: epidemiology, risk factors, prevention strategies, and management of dental caries with a focus on restorative procedures. Dental caries can manifest throughout the lifespan of an individual, making it a matter of concern for infants, children, adults, and older people alike. The prevalence rates of untreated caries in deciduous and permanent teeth are high in many parts of the world, including LACCs. Previous evidence suggests that the prevalence of dental caries in 12-year-olds is moderate to high in most Latin American countries. Moreover, the prevalence of treatment needs and dental caries in the adult and elderly population can also be regarded as high in this region. The risk/protective factors (e.g., sugar consumption, exposure to fluoride, and oral hygiene) probably operate similarly in all LACCs, although variations in the interplay of these factors in some countries and within the same country cannot be ruled out. Although salt and water fluoridation programs are implemented in many countries, there is a need for implementation of a surveillance policy. There is also room for improvement with regard to the introduction of minimal intervention techniques in practice and public health programs. Dental caries is a marker of social disadvantage, and oral health promotion programs and interventions aimed at reducing the burden of dental caries in LACCs must consider the complexity of the socioeconomic dynamics in this region. There is an urgent need to promote engagement of stakeholders, policymakers, medical personnel, universities, dental associations, community members, and industries to develop regional plans that enhance the oral health agenda for LACCs. A list of recommendations has been presented to underpin strategies aimed at reducing the prevalence and severity of dental caries and improving the quality of life of the impacted LACC population in the near future.

Fluoreto e inteligência: avaliação crítica de um estudo de coorte prospectivo / Fluoride and intelligence: critical assessment of a prospective cohort study

Introdução: A fluoretação da água é considerada uma estratégia eficaz e segura para a prevenção de cárie dentária. Contudo, com base em um estudo de coorte realizado no Canadá que avaliou a associação entre exposição de gestantes a fluoreto (F) e inteligência (QI) da prole aos 3/4 anos de idade, publicações alarmistas nas redes sociais têm divulgado que o F adicionado à água reduz a inteligência de crianças. Objetivo: Avaliar a qualidade da evidência sobre exposição à F e inteligência proporcionada por esse estudo. Apresentar as principais características do estudo seguida de análise crítica da evidência. Síntese dos dados: A concentração de F na água consumida pelas gestantes expostas à água fluoretada foi 4,5 vezes maior do que na água consumida pelas gestantes que viviam em região sem água fluoretada; o escore médio de QI das crianças dos dois grupos foi o mesmo. Houve associação estatisticamente significante entre excreção urinária materna de F e menor QI de meninos. O aumento de 1 mg F/l na ingestão autorrelatada de F materna foi associado a um decréscimo de 3 pontos no QI da prole. A análise crítica identificou risco de viés de seleção e de informação e confundimento residual, com potencial de comprometer a validade dos resultados. Conclusão: O estudo não proporciona evidência robusta sobre exposição ao fluoreto e diminuição da inteligência. Sua conclusão não deve ser extrapolada como suporte científico para propostas de mudanças na fluoretação da água de abastecimento público.

Introduction: Water fluoridation is considered an effective and safe strategy for preventing dental caries. However, based on a cohort study conducted in Canada that evaluated the association between exposure of pregnant women to fluoride (F) and intelligence (IQ) of offspring at 3/4 years of age, alarmist publications on social networks have reported that F added to water reduces children's intelligence. Objective: To evaluate the quality of the evidence regarding exposure to F and intelligence provided by this study. To describe of the study's main characteristics followed by critical appraisal. Synthesis of data: The concentration of F in water consumed by pregnant women exposed to fluoridated tap water was 4.5 times higher than in water consumed by pregnant women not exposed to fluoridated tap water; mean IQ score of the children in the two groups was the same. There was a statistically significant association between maternal urinary excretion of F and lower IQ in boys. The increase of 1 mg F / l in the self-reported intake of maternal F was associated with a decrease of 3 points in the offspring's IQ. We identified the risk of selection and information bias, as well as potential for residual confounding, which might have affected the validity of the results. Conclusion: the study does not provide robust evidence on exposure to fluoride and impaired intelligence. Its conclusion should not be extrapolated as scientific support for proposals for changes in the fluoridation of public water supply.

Information-seeking behaviors and barriers to the incorporation of scientific evidence into clinical practice: A survey with Brazilian dentists.

The aim of this online cross-sectional study is to identify the sources of scientific information used by Brazilian dentists in clinical decision-making and the barriers that they perceive as important to the incorporation of scientific evidence into clinical practice. A pretested questionnaire created in Google Forms which was made available to participants through links sent by e-mail or shared on Facebook® and Instagram® was used to collect the data between October 2018 and May 2019. Only dentists who were involved in direct or indirect care of patients (i.e. clinicians who performed dental procedures or dental educators who participated in the clinical training of graduate or postgraduate dental students) were asked to complete the questionnaire. The sample was comprised of 528 dentists (the response rate from the alumni database was 6.9%); their mean age was 45.2 years (±12.5) and 30.9% had an academic position. The majority were women (68.0%) and lived in Southern or Southeastern Brazil (96.0%). The sources of scientific information more frequently used by them in clinical decision-making were clinical guidelines (65.1%; 95% CI: 60.9, 69.2), scientific articles (56.8%; 95%CI: 52.5, 61.1) and bibliographic databases (48.3%; 95% CI: 43.9, 52.6). The information resource less frequently used was social media. The most important barriers to the clinical use of scientific evidence were: difficulty in determining whether scientific contents found on the Internet were reliable or not (41.8%; 95% CI: 37.6, 46.2), high cost of access to scientific papers (37.7%; 95% CI: 33.5, 41.9), and lack of time for reading scientific articles (32.4%; 95% CI: 28.4, 36.6). Although Brazilian dentists show a positive attitude towards obtaining scientific evidence from reliable sources, there still remain important barriers to the translation of evidence into practice. This can have significant implications for quality of care and should be further investigated.

Prevalence of dental anxiety in children and adolescents globally: A systematic review with meta-analyses.

BACKGROUND: Dental anxiety (DA) negatively impacts oral health-related quality of life, and patients with DA usually require more dental treatment time. AIM: To describe the global prevalence of DA in children and adolescents and to examine the influence of individual factors (age, sex, and caries experience) and variables related to DA measurement on pooled prevalence. DESIGN: Systematic review with meta-analyses of observational studies published between 1985 and 2020 (PROSPERO CRD42014013879). RESULTS: Searches yielded 1207 unique records; 224 full-text articles were screened, and 50 studies were used in the qualitative and quantitative synthesis. No study was considered as having high methodological quality according to 'The Joanna Briggs Institute assessment tool'. Overall pooled DA prevalence was 23.9% (95% CI 20.4, 27.3). Pooled prevalence in preschoolers, schoolchildren, and adolescents was as follows: 36.5% (95% CI 23.8, 49.2), 25.8% (95% CI 19.5, 32.1), and 13.3% (95% CI 9.5, 17.0), respectively. DA was significantly more prevalent in preschool children (one study) and schoolchildren (two studies) with caries experience and in female adolescents (one study). The scale used for DA assessment was shown to influence pooled prevalence in preschoolers and adolescents. CONCLUSION: DA is a frequent problem in 3- to 18-year-olds worldwide, more prevalent in schoolchildren and preschool children than in adolescents.

Dental caries prevalence, prospects, and challenges for Latin America and Caribbean countries: a summary and final recommendations from a Regional Consensus

Abstract Dental caries can be effectively managed and prevented from developing into cavitated lesions while preserving tooth structure at all levels. However, the strong correlation between caries and socioeconomic factors may compromise the efficacy of preventive strategies. The high prevalence of persistent inequalities in dental caries in Latin American and Caribbean countries (LACC) is a matter of concern. The estimates of the burden of disease in some countries in this region are outdated or absent. This paper aims to summarize and present the final recommendations of a regional Consensus for Dental Caries Prevalence, Prospects, and Challenges for LACC. This consensus is based on four articles that were written by a team of Latin American experts, reviewed by dental associations, and presented and discussed in two consensus events. The following domains were explored: epidemiology, risk factors, prevention strategies, and management of dental caries with a focus on restorative procedures. Dental caries can manifest throughout the lifespan of an individual, making it a matter of concern for infants, children, adults, and older people alike. The prevalence rates of untreated caries in deciduous and permanent teeth are high in many parts of the world, including LACCs. Previous evidence suggests that the prevalence of dental caries in 12-year-olds is moderate to high in most Latin American countries. Moreover, the prevalence of treatment needs and dental caries in the adult and elderly population can also be regarded as high in this region. The risk/protective factors (e.g., sugar consumption, exposure to fluoride, and oral hygiene) probably operate similarly in all LACCs, although variations in the interplay of these factors in some countries and within the same country cannot be ruled out. Although salt and water fluoridation programs are implemented in many countries, there is a need for implementation of a surveillance policy. There is also room for improvement with regard to the introduction of minimal intervention techniques in practice and public health programs. Dental caries is a marker of social disadvantage, and oral health promotion programs and interventions aimed at reducing the burden of dental caries in LACCs must consider the complexity of the socioeconomic dynamics in this region. There is an urgent need to promote engagement of stakeholders, policymakers, medical personnel, universities, dental associations, community members, and industries to develop regional plans that enhance the oral health agenda for LACCs. A list of recommendations has been presented to underpin strategies aimed at reducing the prevalence and severity of dental caries and improving the quality of life of the impacted LACC population in the near future.

Fluoride Varnish and Dental Caries in Preschoolers: A Systematic Review and Meta-Analysis.

The aim of this study was to assess the effectiveness of fluoride varnish (FV) in reducing dentine caries at the patient, tooth, and surface levels as well as caries-related hospitalizations in preschoolers. We performed a systematic review of clinical trials of FV, alone or associated with an oral health program, compared with placebo, usual care, or no intervention. Bibliographical search included electronic searches of seven databases, registers of ongoing trials, and meeting abstracts, as well as hand searching. We performed random-effects meta-analyses and calculated confidence and prediction intervals. The search yielded 2,441 records; 20 trials were included in the review and 17 in at least one meta-analysis. Only one study had low risk of bias in all domains. We found no study reporting on caries-related hospitalizations. At the individual level, the pooled relative risk was 0.88 (95% confidence interval [CI] 0.81, 0.95); this means that in a population of preschool children with 50% caries incidence, we need to apply fluoride varnish in 17 children to avoid new caries in one child. At the tooth level, the pooled weighted mean difference was -0.30 (95% CI -0.69, 0.09) and at the surface level -0.77 (95% CI -1.23, -0.31). Considering the prediction intervals, none of the pooled estimates were statistically significant. We conclude that FV showed a modest and uncertain anticaries effect in preschoolers. Cost-effectiveness analyses are needed to assess whether FV should be adopted or abandoned by dental services.

Is the Neonatal Tongue Screening Test a valid and reliable tool for detecting ankyloglossia in newborns?

BACKGROUND: Although there is a lack of strong evidence for the association between ankyloglossia in newborns and impaired breastfeeding, screening for ankyloglossia using the Neonatal Tongue Screening Test (NTST) is mandated by law in Brazilian maternities. AIM: To assess the reliability and validity of the NTST. DESIGN: cohort study; baseline sample comprised 268 mother-newborn dyads. At follow-up, 169 mothers were contacted by telephone. Interviews with the mothers for data collection were performed up to 48 h and at 1-3 months after childbirth. Trained and calibrated personnel performed the oral examinations of the newborns. Thirty newborns were examined for inter-reproducibility assessment. RESULTS: Of the 268 newborns included, 212 had a lingual frenulum that could be visually inspected and their NTST scores ranged from zero to nine (mean = 2.0, ±2.0). Interexaminer reproducibility was acceptable (Intraclass correlation coefficient = 0.77). Internal consistency of the NTST was poor (Cronbach's alpha = 0.28). Construct validity was investigated through the association between NTST scores and difficulties in breastfeeding at baseline and follow-up, and infants' weight gain at follow-up (mean age 32 ± 6.7 days). No statistically significant associations were found. CONCLUSION: NTST is neither reliable nor valid for detecting ankyloglossia that may interfere with breastfeeding in newborns.

Clinical accuracy data presented as natural frequencies improve dentists' caries diagnostic inference: Evidence from a randomized controlled trial.

BACKGROUND: The authors assessed whether dentists' diagnostic inferences differ when test accuracy information is communicated using natural frequencies versus conditional probabilities. METHODS: A parallel, randomized controlled trial with dentists was carried out in Rio de Janeiro, Brazil. The dentists received a question on the probability of a patient having interproximal caries, given a positive bite-wing radiograph. This question was asked using information that was formulated into either natural frequencies or conditional probabilities. RESULTS: Only 14 (13.9%) of the dentists gave the correct answer; 13 in the natural frequencies group, and 1 in the conditional probabilities group (P < .001). There were 7 nearly correct answers in the natural frequencies group and none in the conditional probabilities group (P = .005). CONCLUSIONS: Representing diagnostic test accuracy in natural frequencies substantially helped dentists make diagnostic inferences. Nearly twice as many dentists overestimated the presence of interproximal caries when given information in conditional probabilities. PRACTICAL IMPLICATIONS: Our study findings show information shared using natural frequencies may be more accurately interpreted by dentists than that based on conditional probabilities. Patients will probably receive different standards of care depending on the format in which dentists receive diagnostic test accuracy information.

A systematic review of the effects of supervised toothbrushing on caries incidence in children and adolescents.

BACKGROUND: The anticaries effect of supervised toothbrushing, irrespective of the effect of fluoride toothpaste, has not been clearly determined yet. AIM: To assess the effects of supervised toothbrushing on caries incidence in children and adolescents. DESIGN: A systematic review of controlled trials was performed (CRD42014013879). Electronic and hand searches retrieved 2046 records, 112 of which were read in full and independently assessed by two reviewers, who collected data regarding characteristics of participants, interventions, outcomes, length of follow-up and risk of bias. RESULTS: Four trials were included and none of them had low risk of bias. They were all carried out in schools, but there was great variation regarding children's age, fluoride content of the toothpaste, baseline caries levels and the way caries incidence was reported. Among the four trials, two found statistically significant differences favouring supervised toothbrushing, but information about the magnitude and/or the precision of the effect estimate was lacking and in one trial clustering effect was not taken into consideration. No meta-analysis was performed due to the clinical heterogeneity among the included studies and differences in the reporting of data. CONCLUSIONS: There is no conclusive evidence regarding the effectiveness of supervised toothbrushing on caries incidence.

Effects on HbA1c in diabetic patients of adjunctive use of systemic antibiotics in nonsurgical periodontal treatment: A systematic review.

OBJECTIVE: To assess the effects of adjunctive use of systemic antibiotics in nonsurgical periodontal treatment compared to nonsurgical periodontal treatment alone, on mean glycated hemoglobin (HbA1c) reductions in patients with diabetes. DATA: Two independent reviewers screened six electronic databases, registers of clinical trials, meeting abstracts and four major dental journals for controlled clinical trials with at least 3-month follow-up. SOURCES: After duplicates removal, electronic and hand searches yielded 2136 records; 32 full-text articles were independently read by two reviewers. To evaluate the additional effect of antibiotic usage, pooled weighted mean differences and 95% confidence intervals were calculated using fixed and random effects models. STUDY SELECTION: Twelve studies met the inclusion criteria, nine of which provided data that allowed their inclusion in meta-analyses. The meta-analyses showed no significant effect favouring scaling and root planing (SRP) plus antibiotic for reductions in mean HbA1c (-0.11% [-0.35, 0.13]; 6 studies), and an estimated prediction interval varying from -0.45 to 0.23. There was also no significant effect favouring the adjunctive usage of sub-antimicrobial doxycycline in HbA1c mean reduction (-0.19% [-1.04, 0.67]; 2 studies). CONCLUSION: Adjunctive use of systemic antibiotic provides no statistically significant benefit in terms of HbA1c improvement in periodontal treatment of patients with diabetes. CLINICAL SIGNIFICANCE: Adjunctive use of systemic antibiotics associated with nonsurgical periodontal treatment provides no additional benefit in terms of HbA1c of diabetic patients. Clinicians should weigh the trade-off between risks and benefits provided by the use of systemic antibiotics before prescribing them for periodontal disease treatment.

Evidence-based pediatric dental practice within the clinician's reach: the case of the esthetic effect of topical silver diamine fluoride for caries control in primary dentition / Prática odontopediátrica baseada em evidência científica ao alcance do clínico: o caso do efeito estético do uso tópico de diaminofluoreto de prata para o controle da cárie na dentição decídua

ABSTRACT Objective: The aim of this paper was to demonstrate how a general dental practitioner tried to answer, based on scientific evidence, to the question: "Does the darkening of caries lesions caused by silver diamine fluoride treatment contribute to reducing parents' acceptance of such treatment?". Methods: The dentist adopted the following approach: formulation of a specific question; bibliographic search using controlled vocabulary and free terms; selection of full-text articles for reading; reading and critical appraisal of selected articles; summary of the available evidence; translation of the evidence into clinical practice. The dentist identified 45 studies and selected 20 to be read in full, but only three could be used; two controlled trials from China and one from Brazil. Results: Results showed that the esthetic effect was neither a major issue nor a decisive factor for the indication of the proposed treatment. However, although there is robust scientific evidence on the effectiveness of silver diamine fluoride in arresting and preventing caries lesions, there is scarce information about its esthetic effect. Thus, the lack of studies assessing the impact of the darkening of caries lesions and the esthetic effect of the treatment on the quality of life of children and their parents must be emphasized. Conclusion: The dentist concluded that there is insufficient evidence about the esthetic effect of silver diamine fluoride applications on primary teeth and opted to inform it to his/her patients' caregivers and to share with them the decision whether to use it or not in each specific case.

RESUMO Objetivo: Mostrar como um cirurgião-dentista clínico geral procurou responder, com base em evidência científica, à pergunta: "O escurecimento das lesões de cárie em dentes decíduos tratados com diaminofluoreto de prata contribui para a redução da aceitação desse tipo de tratamento pelos pais?". Métodos: O dentista seguiu o seguinte roteiro: formulação de uma pergunta específica; realização da busca bibliográfica utilizando descritores e termos livres; seleção dos artigos científicos completos para leitura; leitura e avaliação crítica dos artigos selecionados; resumo da evidência disponível e aplicação da evidência à sua prática clínica. O dentista localizou 45 trabalhos e selecionou 20 para leitura na íntegra, mas apenas três puderam ser utilizados, sendo dois ensaios controlados realizados na China e um no Brasil. Resultados: Os resultados mostraram que a estética não foi uma questão importante nem um fator decisivo para a indicação do tratamento proposto. No entanto, embora haja evidência científica robusta sobre a efetividade do diaminofluoreto de prata em paralisar e prevenir lesões de cárie, há pouca informação sobre seu efeito estético. Assim, a falta de estudos que avaliam o impacto do escurecimento das lesões de cárie e o efeito estético do tratamento sobre a qualidade de vida das crianças e seus familiares deve ser ressaltada. Conclusão: O dentista concluiu que não existe evidência suficiente sobre o efeito estético das aplicações de diaminofluoreto de prata em dentes decíduos e optou por informar os responsáveis por seus pacientes a respeito e compartilhar com eles a decisão sobre a indicação do mesmo para cada caso específico.