An Epistemic Look at Parental Conceptual Knowledge and Oral Health Outcomes in Children.

Objective. This study explores the impact of parental oral health knowledge on children's oral health, investigating if limited knowledge contributes to poor outcomes. The CAMBRA caries risk assessment and the World Health Organization dmft/DMFT index measure oral health. Methods. Over 23 months, the Knowledge Related to Oral Health Literacy (KROHL) questionnaire assesses parental knowledge in 4 domains and 5 oral health conditions. Pearson Correlation Coefficient analyzes the association between KROHL scores and CAMBRA outcomes. Results. Positive correlation emerges between parental oral health knowledge levels and children's dental caries risk, indicating the KROHL questionnaire's utility in identifying knowledge gaps. No standardized method for measuring oral health knowledge exists, although various tools claim to address aspects of the issue. This study pioneers the correlation between oral health knowledge and CAMBRA outcomes. Conclusion. The KROHL questionnaire proves a practical, disease-specific tool for research, emphasizing parental oral health knowledge's pivotal role in children's oral health. It serves as a valuable means to identify knowledge gaps and potential areas for intervention and education in oral health.

Toward the development of an antibiotic stewardship competency in dental education.

Antimicrobial resistance was recently described by the World Health Organization (WHO) as "a clear and present danger to global health." It is well documented that this resistance is significantly driven by the overuse and inappropriate use of antibiotics. Impactful change can only come from the adoption of antibiotic stewardship practices in all aspects of health care. With dentistry responsible for approximately 10% of all prescribed antibiotics in the United States, there is a potential to be acutely impactful with adequate interventions. After extensively reviewing the most current national and international literature on the topic, we identified that predoctoral dental education provides a potentially impactful opportunity to introduce and support the development of responsible antibiotic practices. To that extent, we developed a detailed framework of antibiotic stewardship competencies to promote responsible best practices among dental students.

Development of KROHL, a tool for evaluating oral health knowledge.

Objectives: The authors aim to evaluate a scale assessing oral health knowledge, the KROHL (Knowledge Related to Oral Health Literacy) including the inter-rater reliability for scoring open-ended questions, internal consistency of the hypothesized scales, the discriminant validity of the resulting scale and its relationship to existing measures of oral health literacy. Methods: The questionnaire was administered via face-to-face interviews to 144 volunteers recruited in the waiting areas of clinics throughout the NYU College of Dentistry.The KROHL questionnaire evaluates oral health knowledge by asking open-ended questions about the appearance, cause, treatment and prevention of caries, gum disease, oral cancer, tooth loss and malocclusion. Those 20 questions were scored to produce scale scores. Demographic information, a self-reported measure of HL and the CMOHK (Comprehensive Measure of Oral Health Knowledge) were also collected.Data were analyzed using Pearson correlation coefficients and principal components analysis, by computing Cronbach's alpha and Cohen's kappa, and by comparing group means with ANOVA. Results: Kappa indicated good to excellent agreement among raters for the full and the individual subscales of the KROHL. Cronbach's alpha indicated good consistency of the full scale score, but not the individual scales. The mean (SD) KROHL score was lower in the patient group than in the dental students (13.3 (5.9) vs. 26.1 (4.7), p < .001), and varied directly with education level within the patients. KROHL scores were unrelated to existing measures of health literacy. Conclusions: The KROHL scale is an innovative, reliable and valid tool to assess overall oral health knowledge and provide information to customize educational interventions. Further research is needed to determine the validity and reliability of the scale in multiple settings. Innovation: The innovation of the KROHL tool of assessment of oral health knowledge lies in its ability to scale depth of knowledge within the domains of identification, causes, prevention, and treatment for the most common oral conditions.

Which crucial measures do patients need to follow to prevent transmission of COVID-19 in the dental setting?

Data sources Medline via PubMed, Scopus, Science Direct, Scielo and Google Scholar were searched without language restriction until 28 May 2020.Study selection Publications on the topic of biosafety measures before, during and after dental practice from observational studies, systematic reviews and literature reviews were included, while letters to the editor, individual opinions and books were excluded.Data extraction and synthesis The authors used a narrative review to describe the findings and grouped them into two categories: those considerations before dental care and those during dental consultation.Results The review was based on 43 publications. Of those, 23 were recent reviews, guidelines, protocols and recommendations from national and international organisations; three were COVID-related original studies and the remainder were pre-COVID publications on handpieces, surface contamination, ventilation, aerosols and airborne spread, ultrasonics, hand washing and dental pain management.Conclusions Patients should conform to COVID-19 screening protocols in order to receive dental care and follow all the procedures in place to prevent transmission while in the dental office.

Development of the Knowledge Related to Oral Health Literacy for Spanish Speakers Scale.

The Hispanic population has one of the highest levels of untreated oral disease of any linguistic or ethnic population in the United States. Research examining the factors leading to such outcomes is limited. Since health literacy has been identified as a mediator of health disparities, it is important to identify the most appropriate tool to assess it. The Knowledge Related to Oral Health Literacy model for Spanish speakers (KROHL-S) is an inclusive framework to evaluate oral health knowledge and other modifiable factors at the individual level among the Hispanic population as related to oral health literacy. KROHL-S intends to provide concrete, practical information to help customize interpersonal interactions and educational experiences to individuals' needs and capabilities. The questionnaire that will allow the creation of the KROHL-S scale consists of orally administered open-ended questions to measure knowledge that is condition specific (caries, periodontal disease, oral cancer, tooth loss, and malocclusion) and domain that is knowledge specific (identification of condition, causes, prevention, treatment, general knowledge). Implementation of the KROHL-S framework will provide in depth information that could be shared among health care providers and the creation of patient-centred initiatives.

Injectable local anaesthetic agents for dental anaesthesia.

Data sources The following traditional databases were searched until January 2018; Cochrane Central Register of Controlled Trials (CENTRAL); the Cochrane Library; Issue 1, MEDLINE Ovid, Embase Ovid, CINHAL Plus and the Institute of Scientific Information (ISI) Web of Science. In addition, five more databases (IndMED, KoreaMED, Panteleimon, ANZCTR and Ingenta Connect) and bibliographies. References lists were also searched until January 2018 as well as handsearching of multiple relevant journals and potential sources of unpublished studies.Study selection All included studies were randomised controlled trials comparing different agents, different dosage or different concentration of local anaesthetics in clinical procedures or simulated scenarios using parallel or cross-over design with no language or year of publication restrictions. Data extraction and synthesis Two reviewers independently selected, reviewed and extracted data using a standardised form. Risk of bias was also assessed by two authors. Quality of the evidence was evaluated by the GRADE approach. Treatment effect was presented as odds ratios (OR) and risk ratios (RR) with 95% confidence intervals (CI) for binary data, while mean differences (MD) with 95% CI was used for continuous data. Statistical heterogeneity was calculated by the 'Q' statistic and I2. 'Summary findings' tables were created for eight comparisons. Subgroup analysis was performed based on the tissue anaesthetised.Results From the 123 studies (19,223 participants) on dental anaesthesia using commercially available formulations that met the inclusion criteria, 68 studies with 6615 participants were included for quantitative analysis. The comparison of 4% articaine, 1:100.000 adrenaline with 2% lidocaine, 1:100.000 adrenaline was reported as the main comparison and included the results of four studies with 203 participants with irreversible pulpitis during endodontic access and instrumentation. For the primary outcome of success, as measured by the absence of pain, the calculated RR of 1.60 (95% CI 1.10 to 2.32) favoured articaine with low heterogeneity. No evidence of difference was observed on pain during injection (MD 4.74 mm, 95% CI -1.98 to 11.46 mm) or following injection (MD 6.41 mm CI 95% 1.01 to 11.80 mm) based on three cross-over studies comparing the same formulations used for the evaluation of success.Conclusions The authors concluded there is no sufficient high quality evidence to determine which formulation is more effective. Four percent, 1:100,000 adrenaline was superior to lidocaine 2%, 1:100,000 epinephrine when measuring success on posterior teeth with irreversible pulpitis. Two percent lidocaine, 1:100,000 epinephrine was superior to 3% prilocaine 0.03 IU felypressin during surgical procedures and 4% prilocaine plain during surgical and periodontal treatment.

Buffered local anaesthetic and injection pain and onset time.

Data sourcesMedline, Embase, Scopus and Scielo were searched until April 2017 supplemented by manual searching.Study selectionClinical trials with parallel-groups, crossover and split mouth in patients older than 18 years were included with no language restrictions. The primary outcome considered was changes in pain intensity, while the secondary outcome was changes on onset time.Data extraction and synthesisTwo authors extracted data using a standard data form. Inter-rater reliability was calculated as high. For the primary outcome all scales were converted to a 0-100 scale. For the secondary outcome all measures were normalised in minutes. Risk of bias was assessed using the Cochrane Collaboration tool. The treatment effect was calculated using mean differences and 95% confidence interval. Heterogeneity and sensitivity analysis were performed. Data were combined using a random effect model.ResultsFourteen studies were included in the review. Of those nine were included in a meta-analysis for the primary outcome pain showing no significant reduction: -7.38 (-15.67-0.91) for normal tissue (five studies) and -4.41 (-15.25-6.43) for inflamed tissue on four studies. No statistically significant results were found in the block (three studies) or the infiltration groups (seven studies). Four studies were included in a meta-analysis for onset time. Significant reduction was achieved for inferior alveolar nerve blocks: -1.26 (-1.41 to -1.10) on three studies and when used on inflamed tissue: -1.37 (-2.03 to -0.70) from one study. High degree of heterogeneity was observed in all groups.ConclusionsThe authors concluded that buffered lidocaine does not reduce pain from injection and the onset time reduction in inferior alveolar nerve blocks and in inflamed tissues while the magnitude of the reduction is not clinically relevant.

Photodynamic therapy for symptomatic oral lichen planus.

Data sourcesMEDLINE/PubMed, Scopus and ISI Web of knowledge, from date of inception up to July 2017. Hand searching of the reference lists of the included studies was performed.Study selectionRandomised (RCT) and non-randomised (n-RCT) controlled trials and controlled and comparative studies were included in patients more than 18 years old diagnosed with symptomatic oral lichen planus, histopathologically confirmed, on the use of photodynamic therapy (PDT) compared with corticosteroids, published in English.Data extraction and synthesisTwo authors independently assessed for inclusion and performed quality assessment of the included studies following the CONSORT statement followed by the overall estimation of the risk of bias. Data extraction was also done independently by two authors. The primary outcome was the effect of PDT on pain and clinical improvement.ResultsFive studies were included: three RCTs and two n-RCTs having between eight and 30 participants. Two studies used diode laser and three used light emitting diode (LED) and the duration of the radiation ranged between 30 seconds to ten minutes. Each study used a unique corticosteroid agent. Three studies used methylene blue, one toluidine blue and one 5-aminolevulinic acid as photosensitiser agent. Follow-up was between one and three months. The authors presented the results as a narrative review.ConclusionsThe limited present evidence suggests that PDT is an effective treatment option for the management of OLP by reduction in pain, burning and decrease in the size of the lesions.

Surgical treatments for nonsyndromic odontogenic keratocysts.

Data sourcesPubMed/MEDLINE, Science Direct, Web of Science, Scopus and the Cochrane Library were searched until October 2017.Study selectionClinical trials, controlled trials, retrospective studies and case series containing at least ten cases with a minimum follow-up of ten years of patients treated with marsupialisation or decompression with or without enucleation, and enucleation alone evaluating the recurrence rates.Data extraction and synthesisTwo reviewers independently assessed for eligibility and extracted data. The level of agreement between reviewers was calculated. The quality of the included studies was assessed using the Methodological Index of Nonrandomised Studies (MINORS) scoring system and the Newcastle Ottawa Quality Assessment Scale (NOS).Data were combined in meta-analysis using a fixed effect model of the calculated odds ratio with 95% CI for each comparison.ResultsTwenty-nine studies were included in the review. Of those 25 were characterised as retrospective studies, one cohort and three case series. Of the 1321 cases 99 were marsupialisation; 45 received marsupialisation followed by enucleation; 27 were treated by decompression; 101 received decompression followed by enucleation and 1049 cases were treated by enucleation alone.The recurrence rate for decompression followed by enucleation was 11.9% (95% CI 5.6 to 18.2%), marsupialisation followed by enucleation 17% (95% CI 6.6 to 28.9%), enucleation 20.8% (95% CI 18.3 to 23.2% ), decompression alone 18.5% (95% CI 8.2 to 28.9%) and marsupialisation 18.2% (95% CI 10.6 to 25.8%).ConclusionsThe authors concluded that there is a significant superiority for OKC treatment when decompression is used before enucleation OR 0.48 (95% CI 0.22 to 1.08).

Botulinum toxin for facial neuralgia.

Data sourcesMedline via PubMed, the Web of Science and the Cochrane Library were searched until April 2014.Study selectionRandomised controlled trials (RCTs) comparing the efficacy of botulinum toxin type A (BoTN-A) with placebo in patients with painful trigeminal (TN) and postherpetic neuralgia (PHN) reporting changes in pain intensity in patients aged 19 years and older available in English were included.Data extraction and synthesisThree authors independently assessed for inclusion, extracted standard data and assessed for risk of bias. The primary outcomes were baseline and post treatment intensity of pain and patients reporting pain relief of 50% or greater.For continuous outcomes the treatment effect was measured as mean differences with 95% confidence intervals (CIs). For dichotomous outcome of reduction of pain of 50% or more, relative risk (risk ratio) with 95% CIs was reported. Statistical heterogeneity was tested with Cochran's test for heterogeneity and quantified by the I2 statistic. Results were combined using random-effects model in the presence of statistical heterogeneity otherwise fixed effect model was used.ResultsSix studies were included. The effects of the interventions were presented in three meta-analyses. Mean difference in post treatment pain (six studies) pooled results showed a reduction of -3.009 in the VAS (95% CI -4.566 to -1.453 p<0.001) with the use of BoTN-A. Standardised difference in mean post treatment pain (six studies) was -0.918 (95% CI -1.197 to -0.639 p<0.001) in favor of BoTN-A. For the percentage of patients experiencing 50% pain reduction (three studies) absolute risk difference and relative risk were calculated (RR 2.892, 95% CI 1.726 to 4.848 p<0.001) in favour of the use of BoTN-A.ConclusionsThe authors concluded that there is moderate evidence regarding the efficacy of BoTN-A in treating patients with trigeminal neuralgia and postherpetic neuralgia.

Bruxism- is botulinum toxin an effective treatment?

Data sourcesPubMed, Scopus, Web of Science, Embase, Cochrane, Scielo and Lilacs databases were searched from 1980 to March 2016. Literature reviews were explored in order to retrieve any other relevant papers.Study selectionRandomised controlled studies (RCTs), prospective and before and after studies that applied botulinum toxin (BoNT-A) to the masseter and/or temporalis muscles assessing objective and subjective parameters of bruxism published in English were included.Data extraction and synthesisThree reviewers independently assessed for eligibility. Disagreement was solved by discussion and when reaching consensus between at least two. Standard data items were extracted. Quality assessment was assessed using the Cochrane Collaboration's risk of bias tool and the Critical Appraisal Skills Program (CASP) tool. Before-After Study Checklist was used for the nonrandomised studies. Results were presented as a narrative review.ResultsFive studies were included in the review, of those three were RCTs and two before and after. A total of 188 subjects were included. Regimen was unique in each study and the follow-up ranged from two to 24 weeks. The risk of bias of the RCTs was assessed as low to unclear, while the before and after studies were assessed as of moderate risk of bias.ConclusionsThe authors concluded that botulinum toxin represents a possible option for the management of sleep bruxism (SB), minimising symptoms and reducing the intensity of contractions rather than for SB itself.

Cone-beam computed tomography or conventional radiography for localising of maxillary impacted canines?

Data sourcesPubMed, Web of Science, CINHAL and the Cochrane Library were searched until May 2016. Unpublished data were searched in Pro-Quest Dissertation, Abstracts and Thesis and Google Scholar, supplemented with manual search of the included studies references. No language restriction was used.Study selectionAll types of study designs were included, except case reports, comparing CBCT data with conventional radiographs. The primary outcome was: diagnostic accuracy between modalities, agreement in position, treatment planning and outcome efficacy. The secondary outcome was intermodality agreement in lateral root resorption detection and intra and inter-observer agreement values.Data extraction and synthesisTwo reviewers independently selected the studies for inclusion, performed data extraction and evaluated risk of bias. Discrepancies were resolved by discussions and reaching consensus. The Newcastle-Ottawa Scale was used to assess the risk of bias for case-controlled and cohort studies and a modified version for cross-sectional studies. The Quality Assessment of Diagnostic Accuracy (QUADAS-2) tool was used to rate diagnostic accuracy studies.ResultsEight studies met the inclusion criteria, two on diagnostic accuracy. The remaining six included 292 impacted canines in 224 patients. Outcomes were presented as calculated level of agreement and statistical significance for each primary outcome reported. Based on the diagnostic accuracy of two in vitro studies, the CBCT accuracy ranged from 50% to 95% while for conventional radiographs it ranged from 39% to 85%.The other six studies reported inter-modalities agreement in localisation (six studies) and treatment planning agreement (three studies). The inter-modalities agreement varied from 0.20 to 0.82, with observed agreement of 64% to 84% in localisation of canine. The treatment planning agreement varied from 0.36 to 0.72.ConclusionsThe authors concluded that CBCT is more accurate than conventional radiographs in localising maxillary impacted canines and there is a broad range of inter-observer and modalities agreement for location and treatment planning. There is no robust evidence to support using CBCT as first line imaging method.

Periodontal treatment for the prevention of adverse birth outcomes.

Data sourcesCochrane Oral Health and Pregnancy and Childbirth's Trial Registries, Cochrane Register of Controlled Trials, Cochrane Library, Medline Ovid, Embase Ovid and LILACS BIREME, clinicaltrials.com and the WHO Clinical Trials Registry Platform were searched for published and ongoing trials until October of 2016.Study selectionRandomised controlled trials (RCTs) investigating the effects of periodontal treatment in reducing or preventing perinatal and maternal morbidity and mortality with no exclusions of language or date of publication. Primary perinatal outcomes included: gestational age at birth, birth weight, small for gestational age and perinatal mortality, while the primary maternal outcomes included mortality, pre-eclampsia and treatment adverse effects.Data extraction and synthesisTwo authors independently screened for inclusion and extracted data. Risk of bias was assessed using the Cochrane 'risk of bias' tool.Dichotomous results were expressed as risk ratios (RR) with a 95% confidence interval (CI), and continuous data were expressed as mean differences (MD) with 95% confidence interval. Random-effects model was used for combining results.The quality of the evidence was assessed using GRADE.ResultsFifteen studies with a total of 7,161 participants met the inclusion criteria.Eleven studies (n = 5671) compared periodontal treatment with no treatment. For the outcome preterm birth before <37 weeks a calculated RR of 0.87, 95% CI 0.70-1.10 shows no clear difference. From seven studies (n = 3470) there is evidence that periodontal treatment may reduce birth weight <2500g (RR 0.77, 95% CI 0.48-0.95).There is unclear evidence on the effect of periodontal treatment on preterm birth <35 weeks, <32 weeks, perinatal mortality and pre-eclampsia.Three studies with 3,610 participants showed no evidence of difference in the outcome small for gestational age: RR 0.97, 95% CI 0.81-1.16.ConclusionsThere is no clear evidence that periodontal treatment during pregnancy has an effect on preterm birth. There is some evidence that it may reduce incidence of low birth weight.There is insufficient evidence to define what type of periodontal treatment is superior in preventing any adverse pregnancy outcome.

Are pharmacological treatments for oro-facial pain effective?

Data sourcesElectronic searches of PubMed, the Cochrane Library, Embase, the National Health Service Economic Evaluation Database and HTA until March 2017. Also handsearched referenced in the original articles. Grey literature was not included.Study selectionRandomised controlled trials with more than ten participants with oro-facial pain duration of more than three months were sub grouped into: TMD-muscle pain (TMD-m), TMD-joint pain (TMD-j), burning mouth syndrome (BMS) and other oro-facial pain. Studies include any pharmacological treatment against another pharmacological, non-pharmacological treatment, placebo or no treatment. The primary outcome was change in pain intensity and the secondary outcome was the effect on quality of life.Data extraction and synthesisThree authors formed three review pairs that independently checked for inclusion. Four pairs of reviewers independently evaluated the risk of bias using the Swedish Agency for Health Technology Assessment and Assessment of Social Services tool. Two authors independently extracted data that were later assessed according to a modified GRADE system.ResultsForty-one studies, rated medium to low risk of bias, were included in qualitative analysis on patients with TMD-j pain (15 studies, n = 790), TMD-m pain (nine studies, n = 375), BMS (17 studies n = 868). For the TMD-j group five studies support NSAIDs and nine corticosteroid and hyaluronate injections. Eight of the nine TMD-m studies were included in a network meta-analysis (NMA), they support cyclobenzaprine, botulinum toxin injections and topical treatment with Ping-On ointment. Five of the 17 BMS studies included in a NMA support topical capsaicin and clonazepam. Of the remaining 12, five showed no effect while the remaining support alpha lipoic acid, gabapentin, clonazepam, amisulpride and SSRIs.ConclusionsBased on the results of the NMA the authors concluded that clonazepam and capsaicin are effective for BMS while cyclobenzaprine, a muscle relaxant, has a positive treatment effect on TMJ-m. Evidence from the narrative synthesis suggests NSAIDs, corticosteroid and hyaluronate injections are effective for TMD-j pain.

Low quality evidence for treatment approaches for oro-antral communications.

Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline via Ovid, Embase via Ovid, US National Institutes of Health Trials Registry and the World Health Organisation (WHO) International Clinical Trials Registry Platform were searched until July 2015 followed by hand searching of relevant references.Study selectionUsing no language restrictions, two authors independently assessed for inclusion of randomised controlled trials (RCTs) evaluating any intervention for treating oro-antral communications (OAC) and oro-antral fistulae (OAF) due to dental procedures. Quasi-RCTs and crossover trials were excluded.Data extraction and synthesisTwo authors independently assessed for inclusion, resolved disagreement by discussion and a third reviewer was consulted if necessary.Qualitywas determined independently by using GRADE 2004.For the dichotomous outcome complete closure, they expressed the estimate effect as risk ratio (RR) with 95% confidence interval (CI).ResultsA single study that started with 22 participants was included in the review where the overall risk of bias was judged as unclear. The main outcome was complete closure. The study compared pedicled buccal fat pad flap (PBFPF) with buccal flap (BF) and showed no difference in the closure of OAC, with a calculated RR of 1.00, 95% CI 0.83 to 1.20.ConclusionsVery low quality evidence from a small single study provided insufficient proof to judge if there is a difference in the effectiveness of the interventions.

Limited evidence for interventions to treat oral leukoplakia.

Data sourcesCochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline Ovid, Embase, Ovid, CancerLit via PubMed. MetaRegister of Controlled Trials, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched for ongoing trials.The reference lists of included studies and existing reviews were manually searched.Study selectionRandomised control trials (RCTs) including patients diagnosed with oral leukoplakia comparing any treatment to placebo or no treatment were included with no restrictions on language or date of publication.Data extraction and synthesisTwo reviewers independently checked for inclusion, performed data extraction using a specially designed form, and assessed the risk of bias for each study and by domain over all studies. The primary outcome considered was onset of oral cancer reported as dichotomous data. Secondary outcomes were clinical resolution, histological changes and adverse events that were mostly reported as ordinal data.ResultsFourteen studies with 909 participants were included in the review. Of the included studies, four compared topical interventions to placebo, nine compared systemic interventions to placebo, and one compared a combination of topical and systemic treatments versus placebo. The risk of bias was considered to be low in one study, unclear in seven, and high for the remaining six. Only three studies provided usable data on the primary outcome: cancer incidence. Clinical improvement was achieved in three studies using: systemic vitamin A or retinoids (two studies) and systemic beta-carotene or carotenoids (one study). Only two studies using beta-carotene or carotenoids were meta-analysed, showing no benefit on the outcome cancer development.ConclusionsThere is no evidence that any of the active treatments included work better than placebo in reducing the risk of developing oral cancer.

Little evidence to support or refute interventions for the management of burning mouth syndrome.

Data sourcesCochrane Oral Health's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline Ovid, Embase Ovid, US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform. Handsearch of the proceedings from the British Society for Oral Medicine (BSOM), British Society for Dental Research (BSDR) and the International Association for Dental Research (IADR).Study selectionAll included studies were randomised placebo controlled trials comparing a treatment to placebo with no language or year of publication restrictions. Symptom relief and changes in quality of life were considered primary outcomes.Data extraction and synthesisTeams of two authors independently screened for inclusion, extracted data using an ad-hoc tool and assessed the risk of bias using the Cochrane's tool. Outcomes were analysed for <3 months (short term) and ≥3 to ≤6 months (long term). For single studies with multiple interventions, the number of participants in the control group was adjusted to half before combining the results. For crossover studies without washout periods, the first period was analysed. RRs (risk ratios) and 85% confidence intervals were calculated for dichotomous outcomes and MDs (mean differences) and 95% confidence intervals for continuous data.ResultsA total of 23 studies encompassing 1121 patients were included. One study was considered as having overall low risk of bias, four unclear and the rest as high risk of bias. The interventions were grouped into: antidepressants and antipsychotics, anticonvulsants, benzodiazepines, cholinergics, dietary supplements, electromagnetic radiation, physical barriers, psychological therapies and topical treatments. Short-term symptom relief was demonstrated by: energy waves (one study, 58 participants) MD -30.36, 95% CI -44.22 to -16.50, physical barriers (one study, 50 participants) MD -1.1 95% CI -2.14 to 0.06, the anticonvulsant gabapentin (one study, 100 participants) RR 4.00, 95% CI 2.09 to 7.67 and topical benzodiazepine (two studies, 111 participants) MD -1.89 95% CI -2.19 to -1.59. Long term symptom relief was achieved with topical benzodiazepine (one study, 66 participants) MD -1.39 95% CI -1.96 to 0.83ConclusionsFrom studies mostly classified as high risk of bias, there is insufficient evidence to support or refute the use of any particular intervention for the management of BMS.

Treatment for bisphosphonate-related osteonecrosis of the jaw.

Data sourcesCochrane Oral Health Group Trials Register, CENTRAL, Medline, Embase, CancerLit, CINAHL, AMED, clinicaltrials.gov and the WHO International Trial Registry Platform. The reviewers searched six grey literature sites and contacted authors, researchers and pharmaceutical companies.Study selectionRandomised controlled trials for the treatment of BRONJ comparing interventions with other treatment or placebo were included in any setting with no age restriction.Data extraction and synthesisIndependently, two reviewers selected studies for inclusion, risk of bias and data extraction. The main outcome was healing. Secondary outcomes were pain improvement and quality of life.ResultsOne RCT with 49 patients met the inclusion criteria comparing the addition of hyperbaric oxygen therapy to standard of care alone. Changes in the lesion size and number were assessed at 3, 6, 12 and 18 months. Pain was assessed weekly while quality of life was assessed at baseline and six months. Improvement, as measured by the decrease in the size or number of lesions, achieved a RR 1.94, CI 95% (1.01 to 3.74) at three months. No other measure of this outcome was statistically significant. Pain changes and quality of life could not be numerically analysed.ConclusionsThe authors concluded that there is insufficient evidence to support a particular regimen for the treatment of BRONJ.

Reliability of CBCT diagnosing root fractures remains uncertain.

Data sourcesPubMed, Web of Science, Science Direct, Cochrane library, Embase, SCOPUS, CNKI and Wanfang databases were searched until April 2014 followed by hand searching of relevant references.Study selectionUsing no language restrictions two authors independently assessed for inclusion of in vivo and in vitro studies involving at least ten teeth on the use of CBCT for diagnosing complete root fractures on non-endodontically treated teeth.Data extraction and synthesisTwo authors independently assessed for inclusion and performed quality assessment using QUADAS-2 (quality assessment of studies of diagnostic accuracy-2). A random effects model was used to calculate pooled sensitivity, specificity and likelihood ratio (positive and negative). In addition, the correlation between voxel size and diagnostic accuracy was calculated.ResultsTwelve studies were included in the review. Seven used i-CAT with 372 teeth and four used 3D Accuitomo with 237 teeth (one study used both). For i-CAT pooled sensitivity was 0.83 (0.78 to 0.86), while specificity was 0.91(0.87 to 0.93). For 3D Accuitomo sensitivity was 0.95 (0.90 to 0.96) and the specificity 0.96 (0.92 to 0.99) Correlation between voxel size and diagnostic accuracy was analysed among five subgroups for i-CAT and two subgroups on the 3D Accuitomo group. No statistically significant difference was observed based on voxel size.ConclusionsAccording to the authors CBCT provides clinically relevant accuracy and reliability to detect root fractures in untreated teeth independently of the voxel size.

Antibiotics in aggressive periodontitis, is there a clinical benefit?

Data sourcesMedline, Embase and CENTRAL databases were searched up to December 2014. Unpublished data were sought by searching a database listing unpublished studies OpenGray [http://www.opengrey.eu/], formerly OpenSIGLE.Study selectionRandomised clinical trials assessing treatment of patients with AgP comparing scaling and root planing (SRP) alone with SRP plus a single antibiotic or a combination of drugs with a minimum of three months follow-up were considered. Studies specifically designed to evaluate smokers or subjects with diabetes mellitus and HIV/AIDS were not included.Data extraction and synthesisTwo researchers independently screened titles, abstracts and full texts of the search results. The studies, which fulfilled inclusion criteria, underwent validity assessment and data extraction using a specifically designed form. The quality of included studies was assessed using the Cochranes collaboration tool for risk of bias. Only two of the 11 included trials were considered at a low risk of bias. The data extracted from ten studies was analysed by pair-wise meta-analyses and the data extracted from five studies was included in Bayesian network meta-analyses pooled estimates. The six studies evaluated in the pairwise meta-analyses were excluded in the pooled estimates because four studies included patients with advanced disease only and one study did not present average data for pocket depth (PD) and clinical attachment level (CAL) and another one for using a different mechanical treatment.ResultsFourteen studies reporting 11 randomised clinical trials with a total of 388 patients were included in the review. Nine of 11 studies reported a statistically significant greater gain in full mouth mean clinical attachment (CA) and reduction in probing depth (PD) when a systemic antibiotic was used. From those studies the calculated mean difference for CA gained was 1.08 mm (p < 0.0001) and for PD reduction was 1.05 mm (p< 0.00001) for SRP + Metronidazole (Mtz). For SRP + Mtz+ amoxicillin (Amx) group the mean difference was 0.45 mm for CA gained and 0.53 mm for PD reduction (p<0.00001) than SRP alone/placebo. Bayesian network meta-analysis showed some additional benefits in CA gain and PD reduction when SRP was associated with systemic antibiotics.ConclusionsThe results support a statistically significant benefit of adjunctive systemic antibiotics in the treatment of AgP. The most consistent advantages - reduction in PD and CAL gain - were attained with the use of Mtz and Mtz + Amx. Future RCTs should be designed in order to directly compare these two antibiotic protocols in the treatment of AgP.