Faculty Bibliography

DATA SOURCES: Studies were sourced using Biomed Central, Cochrane Oral Health Reviews, the Cochrane Library, Directory of Open Access Journals, Expanded ASAP Plus, the MetaRegister of Controlled Trials (www.controlled-trials.com/), Medline (PubMed) Science-Direct, Research Findings Electronic Register, and BBO/LILACS. STUDY SELECTION: Clinical trials and systematic reviews relevant to the review objective published in English, German, Portuguese or Spanish were included after independent review by two reviewers; disagreements were resolved by discussion and consensus. DATA EXTRACTION AND SYNTHESIS: Data extraction and quality assessment was undertaken independently in duplicate by two reviewers. The outcome measure for the caries preventive effect was caries-absence on sealed teeth. A meta-analysis was conducted. RESULTS: Out of 25 selected studies, 11 met the inclusion criteria (eight were trials and three were systematic reviews) with six of these being included in a meta-analysis. The pooled odds ratio was 0.96 (95% confidence interval, 0.62-1.49), indicating no difference in the caries-preventive effect of glass ionomer cements (GIC) and resin-based fissure sealant material. CONCLUSIONS: GIC and resin-based sealants exhibited significant caries-preventive effects. This review found no evidence that either material was superior to the other in the prevention of caries. Therefore both materials appear to be equally suitable as fissure sealant materials.

The ultimate goal of evidence-based health care (EBH) and evidence-based dentistry (EBD) is the improvement of health of our patients, our practices, and our families. The mechanics of balancing these in the face of overwhelming and increasing information is a challenge. With this challenge come the benefits of access to knowledge that can improve health, the legal risks for inattention, and arguments to the contrary. This conceptual introduction does not provide the truth--it provides one viewpoint. Clinicians will need to decide for themselves if and when they might (or might not) chose to embrace an evidence-based approach to healthcare improvement.

The antimicrobial use of silver compounds pivots on the 100-year-old application of silver nitrate, silver foil, and silver sutures for the prevention and treatment of ocular, surgical, and dental infections. Ag(+) kills pathogenic organisms at concentrations of <50 ppm, and current/potential anti-infective applications include: acute burn coverings, catheter linings, water purification systems, hospital gowns, and caries prevention. To distill the current best evidence relative to caries, this systematic review asked: Will silver diamine fluoride (SDF) more effectively prevent caries than fluoride varnish? A five-database search, reference review, and hand search identified 99 human clinical trials in three languages published between 1966 and 2006. Dual review for controlled clinical trials with the patient as the unit of observation, and excluding cross-sectional, animal, in vitro studies, and opinions, identified 2 studies meeting the inclusion criteria. The trials indicated that SDF's lowest prevented fractions for caries arrest and caries prevention were 96.1% and 70.3%, respectively. In contrast, fluoride varnish's highest prevented fractions for caries arrest and caries prevention were 21.3% and 55.7%, respectively. Similarly, SDF's highest numbers needed to treat for caries arrest and caries prevention were 0.8 (95% CI=0.5-1.0) and 0.9 (95% CI=0.4-1.1), respectively. For fluoride varnish, the lowest numbers needed to treat for caries arrest and prevention were 3.7 (95% CI=3.4-3.9) and 1.1 (95% CI=0.7-1.4), respectively. Adverse events were monitored, with no significant differences between control and experimental groups. These promising results suggest that SDF is more effective than fluoride varnish, and may be a valuable caries-preventive intervention. As well, the availability of a safe, effective, efficient, and equitable caries-preventive agent appears to meet the criteria of both the WHO Millennium Goals and the US Institute of Medicine's criteria for 21st century medical care.

DATA SOURCES: The Cochrane Central Register of Controlled Trials, PubMed Medline and Latin American and Caribbean Health Science literature databases were searched, and searches made by hand of identified papers, to source relevant data. (BIOSIS Previews) were searched. There were no language restrictions. STUDY SELECTION: Studies were evaluated by two reviewers independently. Only clinical trials were included that were published in the English, Spanish and Portuguese languages and were performed on humans. Articles were excluded when the examiners were not calibrated; when they did not compare manual and electronic probing techniques; when they did not measure the clinical attachment level (CAL); and when the subjects did not present destructive periodontal disease or had already received periodontal treatment. DATA EXTRACTION AND SYNTHESIS: The quality of the identified studies was assessed and standardised data extracted. Only two studies met all the selection criteria so no meta-analysis was performed. RESULTS: Only two of the 37 identified articles were included in the review. The results of these two studies showed that the mean variance and the absolute mean difference between CAL measurements for the two types of probes were not statistically different. CONCLUSIONS: Manual and electronic probes were of similar reliability when used to measure CAL in individuals who had untreated periodontitis and when used by a calibrated examiner, but this finding is not supported by strong evidence.

BACKGROUND: Temporomandibular joint disorders (TMJD) are multifactor, complex clinical problems affecting approximately 60-70% of the general population, with considerable controversy about the most effective treatment. For example, reports claim success rates of 70% and 83% for non-surgical and surgical treatment, whereas other reports claim success rates of 40% to 70% for self-improvement without treatment. Therefore, the purpose of this study was to (1) identify systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment, (2) evaluate their methodological quality, and (3) evaluate the evidence grade within the systematic reviews. METHODS: A search strategy was developed and implemented for MEDLINE, Cochrane Library, LILACS, and Brazilian Dentistry Bibliography databases. Inclusion criteria were: systematic reviews (+/- meta-analysis) comparing surgical and non-surgical TMJD treatment, published in English, Spanish, Portuguese, Italian, or German between the years 1966 and 2007(up to July). Exclusion criteria were: in vitro or animal studies; narrative reviews or editorials or editorial letters; and articles published in other languages. Two investigators independently selected and evaluated systematic reviews. Three different instruments (AMSTAR, OQAQ and CASP) were used to evaluate methodological quality, and the results averaged. The GRADE instrument was used to evaluate the evidence grade within the reviews. RESULTS: The search strategy identified 211 reports; of which 2 were systematic reviews meeting inclusion criteria. The first review met 23.5 +/- 6.0% and the second met 77.5 +/- 12.8% of the methodological quality criteria (mean +/- sd). In these systematic reviews between 9 and 15% of the trials were graded as high quality, and 2 and 8% of the total number of patients were involved in these studies. CONCLUSION: The results indicate that in spite of the widespread impact of TMJD, and the multitude of potential interventions, clinicians have expended sparse attention to systematically implementing clinical trial methodology that would improve validity and reliability of outcome measures. With some 20 years of knowledge of evidence-based healthcare, the meager attention to these issues begins to raise ethical issues about TMJD trial conduct and clinical care.