Faculty Bibliography

Data sourcesThe Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Medline and Embase databases were searched together with the reference lists of primary studies, commentaries and reviews. Grey literature resources including the System for Information on Grey Literature in Europe, the Scopus Web and Patent searches, Proquest Dissertations and Theses Fulltext, the Index to Scientific and Technical Proceedings and the clinical trials registry (http://clinicaltrials.gov) were also searched.Study selectionRandomised controlled trials (RCTs) involving nucleoside antiviral agents for the prevention of recurrent oral herpes in healthy immunocompetent subjects >/=12 years old were included. No language restrictions were applied. Study quality was assessed following Cochrane guidelines.Data extraction and synthesisData were abstracted using a standardised data extraction form and analysed with meta-analysis carried out only with studies that reported the same outcome measure.ResultsTen studies were included, only one study was considered to have a low risk of bias, five an unclear risk and four a high risk of bias. Oral acyclovir (800-1,600 mg daily) and valacyclovir (500 mg daily for four months) were shown to be effective in the prevention of RHL when taken prior to the appearance of any symptoms or exposure to triggers.ConclusionsThis review found support for the use of systemic acyclovir and valacyclovir for the prevention of RHL. However, the findings from this review should be interpreted with caution, because the methodologic assessment of the quality of the included studies showed an unclear risk of bias in five out of the ten included papers, and a high risk of bias in four studies.

BACKGROUND: Members of the practice-based research network Practitioners Engaged in Applied Research and Learning (PEARL) Network investigated the dentin caries activity in early occlusal lesions and its relationship to patient age, preoperative tooth sensitivity and radiographic appearance, as well as its influence on preparation depth and volume. METHODS: PEARL Network practitioner-investigators (P-Is) (n = 45), general dentists who were trained but whose methods were not calibrated, conducted a study regarding postoperative hypersensitivity in resin-based composite restorations. The P-Is enrolled as study participants 613 patients with occlusal carious lesions that, in the P-Is' clinical judgment, required restoration. The P-Is used baseline radiographs to assess the depth and extent of the lesions. Data for 671 restorations included baseline sensitivity; ranking of dentin caries activity on the opening of the enamel; radiographic visibility (n = 652); and measurements of preparation depth, width and length. RESULTS: P-Is found rapidly progressing dentin caries in 38.5 percent (258 of 671) of lesions and slowly progressing (and potentially inactive dentin) caries in the remainder of the lesions. Rapidly progressing caries was not related to the participant's age or participant-reported preoperative hypersensitivity but was related to the lesion depth as seen radiographically (P < .001) and depth (P < .001) and volume (P < .001) of the preparation. Molars had slightly higher but not statistically significant levels of caries activity. CONCLUSION: Rapidly progressing dentin caries, while present in only 38.5 percent of lesions, was related to the lesion's radiographic appearance but not to the participant's age or the study tooth's pre-operative sensitivity. CLINICAL IMPLICATIONS: On the basis of the low level of rapidly progressing dentin caries in this study population and the fact that slowly progressing caries can be inactive or remineralizing, the authors advise sealing versus operative treatment of early or shallow occlusal lesions.

DATA SOURCES: The Cochrane Oral Health Group's Trials Register, CENTRAL, Medline, Embase, and LILACS databases were searched with no restrictions. STUDY SELECTION: Randomised controlled trials (RCTs) involving single or multi-rooted permanent teeth requiring root canal treatment (RoCT) which compared irrigants against each other or against inactive irrigant or placebo were included. Combinations of irrigants were allowed and if used in conjunction with EDTA (ethylenediaminetetra-acetic acid) or similar chelating agents. DATA EXTRACTION AND SYNTHESIS: Two review authors independently assessed risk of bias of included trials and extracted data. RESULTS: Eleven trials (851 participants, 879 teeth) were included. Six trials were assessed at high risk of bias, three unclear and two low. Four compared sodium hypochlorite versus chlorhexidine, the other trials compared different interventions and only two of these trials included useable data on the primary outcomes of swelling and pain. Meta-analysis of sodium hypochlorite versus chlorhexidine indicated no strong evidence of a difference in the existence of bacterial growth between the interventions (risk ratio 0.73; 95% confidence interval 0.34 to 1.56; P = 0.41). None of the included trials reported any data on adverse effects nor radiological changes in periapical radiolucency. CONCLUSIONS: Although root canal irrigants such as sodium hypochlorite and chlorhexidine appear to be effective at reducing bacterial cultures when compared to saline, most of the studies included in this review failed to adequately report these clinically important and potentially patient-relevant outcomes. There is currently insufficient reliable evidence showing the superiority of any one individual irrigant. The strength and reliability of the supporting evidence was variable, and clinicians should be aware that changes in bacterial counts or pain in the early postoperative period may not be accurate indicators of long-term success. Future trials should report both clinician-relevant and patient-preferred outcomes at clearly defined perioperative, as well as long-term, time points.

DESIGN: Randomised controlled trial. INTERVENTION: Patients were randomised to receive either a 5 g tube of dexamethasone ointment (containing 5 mg dexamethasone) [n=120] or placebo ointment [n=120]. Participants were instructed to apply the given agents to the ulcer three times a day (after meals) for five days. The initial application of the medication was performed under observation for >30 minutes for any signs of adverse effects. Patients kept a daily log and were reviewed clinically on day 6 +/- 2. OUTCOME MEASURE: The size, pain level, healing ratio, average duration of ulcers and the safety of the agents were evaluated. The serum concentration of dexamethasone was monitored. RESULTS: After 6 +/- 2 days of treatment, there was significant difference in the ulcer size between the treatment group (7.167+/- 6.3415 mm(2)) and the control group (4.346 +/- 7.0666 mm(2); P=.000), and in the variation of pain level between the treatment group (5.623+/- 1.9570) and the control group (4.940+/- 2.2449; P=.001). The healing ratio was 83.33% in the treatment group and 54.70% in the control group (P=.000). No severe adverse reactions were observed. No serum dexamethasone was detected before or after the use of the agents (<0.502 ng/mL). CONCLUSIONS: The current study revealed that dexamethasone ointment was safe and efficient in reducing ulcer size, alleviating ulcer pain and hastening ulcer healing in patients with recurrent aphthous ulceration. In addition, the patients had a good overall assessment of the agents. We could not detect dexamethasone in the serum of patients, which illustrated further the safety of dexamethasone ointment.

DESIGN: Randomised controlled trial. INTERVENTION: Participants were randomly assigned to receive either a Hawley retainer (HR) or a clear overlay retainer (COR). The HR was composed of a 2 mm-thick acrylic resin base plate, one-arm clasps with 0.9 mm-diameter stainless steel wire on the first molars, and a Hawley bow with 0.7 mm stainless steel wire. The COR was made from a 0.75 mm-thick thermoplastic material with the buccal edge paralleling the gingival margin, the lingual portion extending 4 to 5 mm beyond the lingual gingival margin. Distally the second molars were covered. Both groups of patients were required to wear the retainers full-time, except during meals and were followed for one year. OUTCOME MEASURE: Retainer survival was the primary outcome. Small surface cracks were not considered as a breakage unless the retainers could not be worn because of crack expansion. RESULTS: One hundred and twenty patients were randomised, 61 in the HR group, 59 in the COR group, nine patients (five in the HR group and four in the COR group) were lost to follow up. Fracture was the most often cited reason for breakage, followed by retainer loss. No significant differences were seen in survival times between the two groups. Both retainers tended to fracture, but the fracture locations were different. CONCLUSIONS: This analysis suggests that the survival times of the HRs and CORs were not statistically significantly different. Therefore, clinicians could advise their patients to wear either of the two retainers without taking breakage into consideration.

Practice-based research networks (PBRNs) provide a novel venue in which providers can increase their knowledge base and improve delivery of care through participation in clinical studies. This article describes some aspects of our experience with a National Institute of Dental and Craniofacial Research-supported PBRN and discusses the role it can play in dental education. PBRNs create a structured pathway for providers to advance their professional development by participating in the process of collecting data through clinical research. This process allows practitioners to contribute to the goals of evidence-based dentistry by helping to provide a foundation of evidence on which to base clinical decisions as opposed to relying on anecdotal evidence. PBRNs strengthen the professional knowledge base by applying the principles of good clinical practice, creating a resource for future dental faculty, training practitioners on best practices, and increasing the responsibility, accountability, and scope of care. PBRNs can be the future pivotal instruments of change in dental education, the use of electronic health record systems, diagnostic codes, and the role of comparative effectiveness research, which can create an unprecedented opportunity for the dental profession to advance and be integrated into the health care system