Faculty Bibliography

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.

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.

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.

Data sourcesCochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CANCERLIT, CINAHL, the US National Institutes of Health Trials Registry and the WHO Clinical Trials Registry Platform.Study selectionRandomised controlled trials (RCTs) assessing the effects of oral cryotherapy in patients with cancer receiving treatment compared to usual care, no treatment or other interventions to prevent mucositis. The primary outcome was incidence of mucositis and its severity.Data extraction and synthesisTwo reviewers carried out study assessment and data extraction independently. Treatment effect for continuous data was calculated using mean values and standard deviations and expressed as mean difference (MD) and 95% confidence interval. Risk ratio (RR) was calculated for dichotomous data. Meta-analysis was performed.ResultsFourteen studies with 1280 participants were included. Subgroup analysis was undertaken according to the main cancer treatment type. Cryotherapy reduced the risk of developing mucositis by 39% (RR = 0.61; 95%CI, 0.52 to 0.72) on patients treated with fluorouracil (5FU). For melphalan-based treatment the risk of developing mucositis was reduced by 41% (RR =0.59; 95%CI, 0.35 to 1.01). Oral cryotherapy was shown to be safe, with very low rates of minor adverse effects, such as headaches, chills, numbness/taste disturbance and tooth pain. This appears to contribute to the high rates of compliance seen in the included studies.ConclusionsThere is confidence that oral cryotherapy leads to a large reduction in oral mucositis in adults treated with 5FU. Although there is less certainty on the size of the reduction on patients treated with melphalan, it is certain there is reduction of severe mucositis.

Data sourcesCochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase and CINAHL databases. Reference lists of identified articles were checked and experts in the field and relevant pharmaceutical companies were contacted.Study selectionRandomised controlled trials, including parallel and crossover, carried out in any setting on any patient population with radiation-induced salivary dysfunction using parasympathomimetics drugs.Data extraction and synthesisThe two authors independently assessed for inclusion, established the risk of bias and abstracted data. The primary outcome was level of xerostomia. The authors intended to report risk ratio, odds ratio, risk difference and NNT for dichotomous data and mean difference and standard mean difference for continuous data.ResultsOf the three included studies, one (n=20) reported mean improvement on the VAS (22.5 mm on a 100 mm scale). The other two studies considered a change in 25 mm on the VAS a positive response. Of those one (n=207) reported positive response in 51% of subjects on 5mg of pilocapine TID and 47% for 10mg TID. The second (n= 162) reported a 42% positive response with a titrated dose regimen. The side effects rate was high,and the main reason for discontinuation.ConclusionsThere is limited evidence to support the use of pilocarpine hydrochloride in the treatment of radiation-induced xerostomia. Currently, there is little evidence to support the use of other parasympathomimetic drugs in the treatment of radiation-induced xerostomia. Available studies suggest that approximately half of patients will respond, but side effects can be problematic. The conclusions of the update are the same as the conclusions of the original review, since no new relevant studies have been published in the interim.

Data sourcesThe Cochrane library was searched for Cochrane systematic reviews.Study selectionCochrane reviews on single pain medications for the treatment of acute pain were included. Non-Cochrane reviews were included for tramadol.Data extraction and synthesisTwo reviewers independently searched, selected reviews for inclusion, assessed quality and performed data extraction. A protocol in case of disagreement was in place. Data were collected on number of included studies and participants, drug, dose and formulation and pain model. The authors concentrated on the amount of information and the potential for publication bias.Pain relief was calculated using at least 50% maximum pain relief, as a percentage, and as NNTs. Duration of analgesia was measured as mean or median and time to remedication was calculated as percentage of patients.ResultsThirty-nine reviews including 41 interventions were analysed and NNTs for at least 50% maximum pain relief were summarised in a graphic. NNTs range from almost one all the way to five. Only one intervention, codeine 60, had an NNT >/=10. Results judged to be reliable were listed in detail. Mean or median time to remedication was also presented in a graphic.The authors conclude that there is a great amount of quality information on single dose analgesics, and highlighted the potential benefit of fast acting formulations and fixed formulations to achieve good long-lasting analgesia.ConclusionsThere is a wealth of reliable evidence on the analgesic efficacy of single dose oral analgesics. Fast acting formulations and fixed dose combinations of analgesics can produce good and often long-lasting analgesia at relatively low doses. There is also important information on drugs for which there are no data, inadequate data, or where results are unreliable due to susceptibility to publication bias. This should inform choices by professionals and consumers.

Data sourcesAn electronic search was conducted on PubMed Central. References of retrieved papers and previously published systematic reviews were hand searched.Study selectionRandomised controlled trials (RCTs) with at least six months follow-up evaluating the use of test products used in mouthrinses, toothpastes or gels as adjuncts to mechanical oral hygiene (including toothbrushing) were considered.Data extraction and synthesisTwo trained and calibrated reviewers independently assessed the studies for eligibility, with any disagreement being resolved by discussion. Two reviewers under the supervision of a third reviewer extracted data. Risk of bias was evaluated using the Cochrane risk of bias tool and the CONSORT statement. Outcomes were summarised as means and standard deviation (SD) or standard error (SE), the results were pooled and analysed using weighted mean differences (WMD), and heterogeneity among the studies was calculated.ResultsEighty-seven articles with 133 comparisons were included in the review. A majority of the studies (75) were considered to be at high risk of bias, eight at unclear risk and four at low risk. Fifteen different categories of active agent were used in toothpastes and ten in mouthwashes. The additional effects of the tested products were statistically significant for the Loe & Silness gingival index (46 studies), WMD -0.217, the modified gingival index (23 studies) - 0.415, gingivitis severity index (26 studies) - 14.939% or bleeding index (23 studies) - 7.626% with significant heterogeneity. For plaque, additional effects were found for Turesky (66 studies) W

Data sourcesPubmed, the Cochrane library, Scopus, Science Direct and two publishing company journals between 1998 and 2012.Study selectionRandomised controlled trials (RCTs) where the population included patients having OLP and the interventions were the use of clobetasol or tacrolimus compared to another intervention, while the outcome was improvement in clinical status.Data extraction and synthesisTwo authors working independently assessed for inclusion and performed data extraction. Quality was evaluated using Critical Appraisal Skills Programme (CASP) worksheets (http://www.casp-uk.net/). The treatment effect was calculated using OR and then pooled using a fixed model since heterogeneity was calculated as very low.ResultsTen studies were included; five studies involved clobetasol and five involved tacrolimus. Two meta-analyses were presented. The odds ratio for improvement for clobetasol was 1.21 (95%CI; 0.48 - 3.05) and 8.09 (95%CI; 3.77 - 17.38) for tacrolimus.ConclusionsThe authors concluded that using clobetasol or tacrolimus increases the odds of improvement of OLP lesions and therefore they are effective treatment for the condition, and go on to recommend tacrolimus as first-line therapy.