Faculty Bibliography

Data sourcesThe Cochrane Oral Health Groups Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, OpenGrey, ZETOC Conference Proceedings World Health Organization (WHO) International Trials Registry Platform and the US National Institutes of Health Trials Registry databases were searched with no restrictions on the language or date of publication.Study selectionRandomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage or endodontic treatment) and with or without analgesics.Data extraction and synthesisStudy selection, data abstraction and risk of bias assessment were carried out independently by two reviewers.ResultsTwo trials involving 62 patients were included. They compared the effects of oral penicillin V potassium versus a matched placebo given in conjunction with a surgical intervention and analgesics to adults with an acute apical abscess or symptomatic necrotic tooth. One study was considered to have a high risk of bias and the other an unclear risk of bias. The primary outcomes were patient-reported pain and swelling. There were no statistically significant differences in participant-reported measures of pain or swelling at any of the time points assessed within the review. The body of evidence was assessed as at very low quality.ConclusionsThere is very low quality evidence that is insufficient to determine the effects of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess.

Data sourcesThe Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase and the metaRegister of Controlled Trials were searched with no language restrictions.Study selectionRandomised controlled double-blinded clinical trials using the third molar model were included.Data extraction and synthesisTwo review authors independently and in duplicate extracted data. The proportion of patients with at least 50% pain relief (based on total pain relief (TOTPAR) and summed pain intensity difference (SPID) data) was calculated for all three drugs at both two and six hours post-dosing and meta-analysed for comparison.ResultsSeven studies involving 2241 patients were included. Two studies were considered to be at low risk of bias, three at high risk and two unclear risk of bias. Ibuprofen was found to be a superior analgesic to paracetamol at several doses, with high quality evidence suggesting that ibuprofen 400 mg is superior to 1000 mg paracetamol based on pain relief (estimated from TOTPAR data) and the use of rescue medication meta-analyses. Risk ratio (RR) for at least 50% pain relief (based on TOTPAR) at six hours was 1.47 (95% confidence interval (CI) 1.28 to 1.69; five trials) favouring 400 mg ibuprofen over 1000 mg paracetamol, RR for not using rescue medication (also favouring ibuprofen) was 1.50 (95% CI 1.25 to 1.79; four trials). For combined drug RR for at least 50% of the maximum pain relief over six hours of 1.77 (95% CI 1.32 to 2.39) (paracetamol 1000 mg and ibuprofen 400 mg) (one trial; moderate quality evidence). RR not using rescue medication 1.60 (95% CI 1.36 to 1.88) (two trials; moderate quality evidence). Adverse events were comparable between the treatment groups, but no formal analysis could be undertaken.ConclusionsThere is high quality evidence that ibuprofen is superior to paracetamol at doses of 200 mg to 512 mg and 600 mg to 1000 mg respectively based on pain relief and use of rescue medication data collected at six hours postoperatively. The majority of this evidence (five out of six trials) compared ibuprofen 400 mg with paracetamol 1000 mg, these are the most frequently prescribed doses in clinical practice. The novel combination drug is showing encouraging results based on the outcomes from two trials when compared to the single drugs.

Data sourcesThe Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, and CINAHL databases were searched. Abstracts of the Conference Proceedings of the International Association for Dental Research and reference lists of identified articles were also scanned for relevant papers.Study selectionRandomised trials where children and adolescents with AI who required restoration of teeth were allocated to different restoration techniques would have been selected.Data extraction and synthesisStandard Cochrane review protocols would have been followed.ResultsNo studies met the inclusion criteria.ConclusionsWe found no randomised controlled trials of restorative treatments for children and adolescents with AI, and therefore there is no evidence as to which is the best restoration. Well defined randomised controlled trials which recruit children and adolescents and focus on the type and severity of the disorder should be undertaken to determine the best intervention for restoring teeth affected by AI.

DesignMulticentre randomised controlled clinical trial in a rural underserved African setting.InterventionThe technical and electrical infrastructure still remains unstable in Gambia. Therefore, block randomisation was chosen. Patients included in 2010 were treated according to the original BRT method with tactile working length determination, whereas patients included in 2011 were treated with radiographic working length control. During the latter study period and the 24-month evaluation, a generator was provided to ensure sufficient power supply to run a radiographic unit.Outcome measureThe primary end point was the apical extension score of the radiographic quality parameter of root canal fillings. The secondary radiographic end point was the periapical index, and the secondary clinical end point was tooth tender to percussion. The safety end point was tooth loss as a consequence of endodontic failure.ResultsBRT with tactile working length determination compared with standard radiographic working length control did not significantly differ in terms of radiographic and clinical outcomes after 24 months. The apical extension of the root canal fillings and the periapical anatomic structures showed no significant differences according to radiographic analyses (P = 0.5). Corresponding results were found in clinical aspects of tooth tender to percussion (P = 0.6) and tooth loss (P = 0.7).ConclusionsWithin the limits of this randomised controlled trial it was shown that tactile working length determination in BRT resulted in comparable treatment outcomes in radiographic and clinical aspects compared with standard endodontic treatment with radiographic working length determination. Tactile working length determination turned out to be an accurate method in BRT.

Data sourcesMedline, Embase and the reference lists of identified articles were also scanned for relevant papers.Study selectionOnly randomised controlled trials in English were considered.Data extraction and synthesisTwo reviewers extracted data independently and study quality was assessed using the Jadad score. Meta-analysis was conducted.ResultsFour RCTs with a total of 183 patients were included. Intraoperative blood loss in the tranexamic acid group was statistically reduced (weighted mean difference [WMD] = -93.56, 95% CI = -132.59-54.52, P < .00001). No statistical difference was seen in the postoperative levels of haemoglobin and haematocrit (WMD = 0.50, 95% CIs = -0.43-1.43, P = .29 and WMD = 0.18, 95% CIs = -1.64-1.99, P = .85, respectively).ConclusionsThis meta-analysis confirms that tranexamic acid can effectively reduce intraoperative blood loss in orthognathic surgery, especially by intravenous administration. But tranexamic acid cannot affect postoperative levels of haemoglobin and haematocrit.

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of all CAD/CAM designed restorations (including inlays, onlays and crowns) for indirect restoration of teeth in need of a final permanent dental restoration in adults and adolescents with erupted second molars. To compare the effects of CAD/CAM designed restorations (inlays, onlays, crowns) with restorations (inlays, onlays, crowns) designed and produced by other available indirect systems.

BACKGROUND: Amalgam has been the traditional material for filling cavities in posterior teeth for the last 150 years and, due to its effectiveness and cost, amalgam is still the restorative material of choice in certain parts of the world. In recent times, however, there have been concerns over the use of amalgam restorations (fillings), relating to the mercury release in the body and the environmental impact following its disposal. Resin composites have become an esthetic alternative to amalgam restorations and there has been a remarkable improvement of its mechanical properties to restore posterior teeth.There is need to review new evidence comparing the effectiveness of both restorations. OBJECTIVES: To examine the effects of direct composite resin fillings versus amalgam fillings for permanent posterior teeth, primarily on restoration failure. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 22 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 22 October 2013), EMBASE via OVID (1980 to 22 October 2013), and LILACs via BIREME Virtual Health Library (1980 to 22 October 2013). We applied no restrictions on language or date of publication when searching the electronic databases. We contacted manufacturers of dental materials to obtain any unpublished studies. SELECTION CRITERIA: Randomized controlled trials comparing dental resin composites with dental amalgams in permanent posterior teeth. We excluded studies having a follow-up period of less than three years. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS: Of the 2205 retrieved references, we included seven trials (10 articles) in the systematic review. Two trials were parallel group studies involving 1645 composite restorations and 1365 amalgam restorations (921 children) in the analysis. The other five trials were split-mouth studies involving 1620 composite restorations and 570 amalgam restorations in an unclear number of children. Due to major problems with the reporting of the data for the five split-mouth trials, the primary analysis is based on the two parallel group trials. We judged all seven trials to be at high risk of bias and we analyzed 3265 composite restorations and 1935 amalgam restorations.The parallel group trials indicated that resin restorations had a significantly higher risk of failure than amalgam restorations (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.52 to 2.35, P value < 0.001 (fixed-effect model) (low-quality evidence)) and increased risk of secondary caries (RR 2.14, 95% CI 1.67 to 2.74, P value < 0.001 (low-quality evidence)) but no evidence of an increased risk of restoration fracture (RR 0.87, 95% CI 0.46 to 1.64, P value = 0.66 (moderate-quality evidence)). The results from the split-mouth trials were consistent with those of the parallel group trials.Adverse effects of dental restorations were reported in two trials. The outcomes considered were neurobehavioral function, renal function, psychosocial function, and physical development. The investigators found no difference in adverse effects between composite and amalgam restorations. However, the results should be interpreted with caution as none of the outcomes were reported in more than one trial. AUTHORS' CONCLUSIONS: There is low-quality evidence to suggest that resin composites lead to higher failure rates and risk of secondary caries than amalgam restorations. This review reinforces the benefit of amalgam restorations and the results are particularly useful in parts of the world where amalgam is still the material of choice to restore posterior teeth with proximal caries. Though the review found insufficient evidence to support or refute any adverse effects amalgam may have on patients, new research is unlikely to change opinion on its safety and due to the decision for a global phase-down of amalgam (Minamata Convention on Mercury) general opinion on its safety is unlikely to change.

Data sourcesThe Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, AMED, CINAHL and CANCERLIT databases were searched. The metaRegister of Controlled Clinical Trials and ClinicalTrials.gov were also searched to identify ongoing and completed trials. Reference lists of included studies and relevant reviews were also searched. There were no restrictions on the language of publication or publication status.Study selectionRandomised controlled trials of non-pharmacological treatments for patients with dry mouth at baseline.Data extraction and synthesisStudy assessment and data extraction were carried out independently by at least two reviewers. Mean difference (MD) and standardised mean differences (SMD) together with 95% CIs were calculated where appropriate.ResultsNine studies (366 participants) were included in this review, eight were assessed at high risk of bias and one at unclear risk of bias. Five small studies (153 participants), with dry mouth following radiotherapy treatment compared acupuncture with placebo. Four were at high risk and one at unclear risk of bias. Two trials reported outcome data for dry mouth in a form suitable for meta- analysis. The pooled estimate of these two trials (70 participants, low quality evidence) showed no difference between acupuncture and control in dry mouth symptoms (SMD -0.34, 95% CI -0.81 to 0.14, P value 0.17, I2 = 39%) with the confidence intervals including both a possible reduction or a possible increase in dry mouth symptoms.Acupuncture was associated with more adverse effects (tiny bruises and tiredness which were mild and temporary). There was a very small increase in unstimulated whole saliva (UWS) at the end of four to six weeks of treatment (three trials, 71 participants, low quality evidence) (MD 0.02 ml/minute, 95% CI 0 to 0.04, P value 0.04, I2 = 57%), and this benefit persisted at the 12-month follow-up evaluation (two trials, 54 participants, low quality evidence) (UWS, MD 0.06 ml/minute, 95% CI 0.01 to 0.11, P value 0.03, I2 = 10%). For the outcome of stimulated whole saliva (SWS, three trials, 71 participants, low quality evidence) there was a benefit favouring acupuncture (MD 0.19 ml/minute, 95% CI 0.07 to 0.31, P value 0.002, I2 = 1%) an effect which also persisted at the 12-month follow-up evaluation (SWS MD 0.28 ml/minute, 95% CI 0.09 to 0.47, P value 0.004, I2 = 0%) (two trials, 54 participants, low quality evidence).Two small studies, both at high risk of bias, compared the use of an electrostimulation device with a placebo device in participants with Sjogren's Syndrome (total 101 participants). A further study, also at high risk of bias, compared acupuncture-like electrostimulation. None of these studies reported the outcome of dry mouth.A single study at high risk of bias compared the stimulatory effect of powered versus manual toothbrushing and found no difference for the outcomes of UWS or SWS.ConclusionsThere is low quality evidence that acupuncture is no different from placebo acupuncture with regard to dry mouth symptoms, which is the most important outcome. This may be because there were insufficient participants included in the two trials to show a possible effect or it may be that there was some benefit due to 'placebo' acupuncture, which could have biased the effect to the null. There is insufficient evidence to determine the effects of electrostimulation devices on dry mouth symptoms. It is well known that dry mouth symptoms may be problematic even when saliva production is increased, yet only two of the trials that evaluated acupuncture reported dry mouth symptoms, a worrying reporting bias. There is some low quality evidence that acupuncture results in a small increase in saliva production in patients with dry mouth following radiotherapy.There is insufficient evidence to determine the effects of electrostimulation devices on dry mouth symptoms or saliva production in patients with Sjogren's Syndrome. Reported adverse effects of acupuncture are mild and of short duration, and there were no reported adverse effects from electrostimulation.

Data sourcesThe Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the US National Institutes of Health Trials Register and the metaRegister of Controlled Trials.Study selectionRandomised controlled trials (RCTs) and controlled clinical trials (CCTs) would be included where available. Due to the low incidence of bacterial endocarditis it was anticipated that few such trials would be found. Cohort and case-control studies were included where suitably matched control or comparison groups had been studied.Data extraction and synthesisTwo review authors independently selected studies for inclusion then assessed risk of bias and extracted data from the included study.ResultsOnly one case controlled study met the inclusion criteria. It collected all the cases of endocarditis in the Netherlands over two years, finding a total of 24 people who developed endocarditis within 180 days of an invasive dental procedure, definitely requiring prophylaxis according to current guidelines, and who were at increased risk of endocarditis due to a pre-existing cardiac problem. This study included participants who died because of the endocarditis (using proxies). Controls attended local cardiology outpatient clinics for similar cardiac problems, had undergone an invasive dental procedure within the past 180 days, and were matched by age with the cases. No significant effect of penicillin prophylaxis on the incidence of endocarditis could be seen. No data were found on other outcomes.ConclusionsThere remains no evidence that antibiotic prophylaxis is either effective or ineffective against bacterial endocarditis in people considered at risk who are about to undergo an invasive dental procedure. It is not clear whether the potential harms and costs of penicillin administration outweigh any beneficial effect. Ethically, practitioners need to discuss the potential benefits and harms of antibiotic prophylaxis with their patients before a decision is made about administration.