Faculty Bibliography

By arresting and preventing caries, silver diamine fluoride (SDF) offers an alternate care path for patients for whom traditional restorative treatment is not immediately available. Current data from controlled clinical trials encompassing more than 3,900 children indicate that biannual application of SDF reduces progression of current caries and risk of subsequent caries. The purpose of this paper was to highlight the best evidence from systematic reviews and clinical trials for clinicians to consider the benefits, risks, and limitations as they implement silver diamine fluoride therapy on young children.

BACKGROUND: The treatment of periodontitis begins with a non-surgical phase that includes scaling and root planing(SRP) and on occasion the use of systemic antibiotics. The goal was to systematically evaluate in systemic healthy adults the effect of the concomitant administration of amoxicillin (amx) and metronidazole (met) adjunctive to SRP compared to SRP alone. METHODS: The PubMed-MEDLINE, Cochrane-CENTRAL and EMBASE databases were searched up to November 2014 to identify appropriate studies. Probing Pocket Depth (PD), Clinical Attachment Level (CAL), Bleeding on Pocket Probing(BOP) and Plaque Indices(PI) were selected as outcome variables. Based on the extracted data a meta-analysis was conducted. RESULTS: A total of 526 unique articles were found, 20 studies met the eligibility criteria. A meta-analysis showed that SRP + amx + met provided significantly better effects overall and more pronounced PD reduction in periodontal pockets initially measuring >/=6 mm (DiffM:-0.86 mm, p < 0.00001) and gain in CAL(DiffM:+0.75 mm, p = 0.0001). The meta-analysis for the secondary inflammatory parameter BOP showed that SRP + amx + met provided full mouth significantly greater reduction in BOP than SRP alone (DiffM:-6.98 %, p = 0.0001). CONCLUSION: Adjunctive systemic amoxicillin and metronidazole medication to SRP significantly improved the clinical outcomes with respect to mean PD, CAL and BOP compared to SRP alone. There is moderate to strong evidence in support of the recommendation that adjunctive amx + met therapy to SRP significantly improves the clinical outcomes, with respect to mean PD and CAL compared to SRP alone especially in initially deep (>/=6 mm) pockets. No major side effects associated with the intake of amx + met were reported. This treatment regimen is an efficacious, minimally invasive, practical and inexpensive approach for periodontitis therapy. The key components are mechanical tooth and pocket debridement, supportive treatment of the disease with systemic antibiotics and attention to proper self-care.

Most of us assume that what we do, and teach, is evidence-based. The challenge is to insure that this is indeed the case. More to the point, how can we readily find the credible evidence we need to guide practice and teaching? And, can we differentiate high-quality evidence from less trustworthy reports? This paper presents a basic, three-step process for querying the literature, identifying levels of evidence, evaluating the evidence, and summarizes the early experiences of three dental schools in developing a curriculum that incorporates EBD and critical thinking.

Current systematic reviews are important for health care providers in supporting their evidence-based practice decisions. Equally important is the ability to determine when a new systematic review is needed in view of the rapid publication output. The current best evidence from a 2013 systematic review suggests that certain treatments may accelerate orthodontic tooth movement. Our aim was to determine if an updated systematic review is needed on this topic by applying the modified Ottawa method. A systematic search of Pubmed, Embase, CENTRAL, and Web of Science databases, identical to the previous systematic review, was executed. Two authors performed screening for inclusion/exclusion of studies and selected full-text articles were reviewed. Qualitative and quantitative criteria were applied to assess studies describing the following types of interventions to accelerate tooth movement: electrical, photobiomodulation, micro-osteoperforations, vibration, corticotomy, and low-level laser therapy. The Ottawa method showed that studies produced since 2011 have (1) potentially invalidating evidence and description of new methods and (2) combined new data that would enhance the precision of the existing evidence on low-level laser therapy. These collectively indicate the need for a new systematic review on adjunct procedures to accelerate orthodontic tooth movement, which may offer new evidence and techniques not previously mentioned. (C) 2015 Elsevier Inc. All rights reserved.

In their remarkable article, "Redefining Global Health Care Delivery," Kim et al. posit that health care delivery is the effective provision of services to people with diseases for which proven therapies exist. Polio vaccination and deworming are exemplars of place-based and population-based success stories. How might this approach be applied to other prevalent conditions worldwide? Consider dental caries, a preventable, mixed microaerophilic, Gram-positive infection. According to a new report by Marcenes et al., untreated caries in permanent teeth is the most prevalent condition worldwide, and untreated caries in primary teeth is the 10th-most prevalent condition. Sadly, however, from 1990 to 2010, the prevalence and incidence for untreated caries remained virtually unchanged. Looking ahead, with expected increases in population and longevity, the burden of untreated caries is expected to increase. (Am J Public Health. Published online ahead of print July 16, 2015: e1. doi:10.2105/AJPH.2015.302746).

The World Bank will publish the nine volumes of Disease Control Priorities, 3rd edition, in 2015-16. Volume 1--Essential Surgery--identifies 44 surgical procedures as essential on the basis that they address substantial needs, are cost effective, and are feasible to implement. This report summarises and critically assesses the volume's five key findings. First, provision of essential surgical procedures would avert about 1.5 million deaths a year, or 6-7% of all avertable deaths in low-income and middle-income countries. Second, essential surgical procedures rank among the most cost effective of all health interventions. The surgical platform of the first-level hospital delivers 28 of the 44 essential procedures, making investment in this platform also highly cost effective. Third, measures to expand access to surgery, such as task sharing, have been shown to be safe and effective while countries make long-term investments in building surgical and anaesthesia workforces. Because emergency procedures constitute 23 of the 28 procedures provided at first-level hospitals, expansion of access requires that such facilities be widely geographically diffused. Fourth, substantial disparities remain in the safety of surgical care, driven by high perioperative mortality rates including anaesthesia-related deaths in low-income and middle-income countries. Feasible measures, such as WHO's Surgical Safety Checklist, have led to improvements in safety and quality. Fifth, the large burden of surgical disorders, cost-effectiveness of essential surgery, and strong public demand for surgical services suggest that universal coverage of essential surgery should be financed early on the path to universal health coverage. We point to estimates that full coverage of the component of universal coverage of essential surgery applicable to first-level hospitals would require just over US$3 billion annually of additional spending and yield a benefit-cost ratio of more than 10:1. It would efficiently and equitably provide health benefits, financial protection, and contributions to stronger health systems.

Data sourcesThe Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, National Institutes of Health Trials Register and the WHO Clinical Trials Registry Platform for ongoing trials. Reference lists of identified articles were also scanned for relevant papers. Identified manufacturers were contacted for additional information.Study selectionOnly randomised controlled trials comparing manual and powered toothbrushes were considered. Crossover trials were eligible for inclusion if the wash-out period length was more than two weeks.Data extraction and synthesisStudy assessment and data extraction were carried out independently by at least two reviewers. The primary outcome measures were quantified levels of plaque or gingivitis. Risk of bias assessment was undertaken. Standard Cochrane methodological approaches were taken. Random-effects models were used provided there were four or more studies included in the meta-analysis, otherwise fixed-effect models were used. Data were classed as short term (one to three months) and long term (greater than three months).ResultsFifty-six trials were included with 51 (4624 patients) providing data for meta-analysis. The majority (46) were at unclear risk of bias, five at high risk of bias and five at low risk. There was moderate quality evidence that powered toothbrushes provide a statistically significant benefit compared with manual toothbrushes with regard to the reduction of plaque in both the short and long-term. This corresponds to an 11% reduction in plaque for the Quigley Hein index (Turesky) in the short term and a 21% reduction in the long term. There was a high degree of heterogeneity that was not explained by the different powered toothbrush type subgroups.There was also moderate quality evidence that powered toothbrushes again provide a statistically significant reduction in gingivitis when compared with manual toothbrushes both in the short and long term. This corresponds to a 6% and 11% reduction in gingivitis for the Loe and Silness indices respectively. Again there was a high degree of heterogeneity that was not explained by the different powered toothbrush type subgroups. The greatest body of evidence was for rotation oscillation brushes which demonstrated a statistically significant reduction in plaque and gingivitis at both time points.ConclusionsPowered toothbrushes reduce plaque and gingivitis more than manual toothbrushing in the short and long term. The clinical importance of these findings remains unclear. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses. Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and only temporary.