Evidence-based dentistry
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Evidence-based dentistry · Jan 2010
CommentUsing a fluoridated supplement with a high fluoride concentration in children aged under 6 years may increase the risk of fluorosis.
The Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase, BIOSIS, Dissertation Abstracts and LILACS/BBO databases were searched. Also, reference lists from relevant articles and five journals (Community Dentistry and Oral Epidemiology, Caries Research, Journal of Dental Research, British Dental Journal, Journal of Public Health Dentistry) were searched by hand, and experts in the field of preventive dentistry and oral epidemiology contacted. ⋯ There should be a balanced consideration of the benefits of topical fluorides in caries prevention and the risk of the development of fluorosis. Most of the available evidence focuses on mild fluorosis. There is weak unreliable evidence that starting the use of fluoride toothpaste in children aged <12 months may be associated with an increased risk of fluorosis. The evidence if use begins between the age of 12 and 24 months is equivocal. If the risk of fluorosis is of concern, the fluoride level of toothpaste for young children (under 6 years of age) is recommended to be lower than 1000 parts per million (ppm). More evidence from studies with low risk of bias is needed. Future trials assessing the effectiveness of different types of topical fluorides (including toothpastes, gels, varnishes and mouthrinses) or different concentrations or both should ensure that they include an adequate followup period in order to collect data on potential fluorosis. As it is unethical to propose RCT to assess fluorosis itself, further observational studies will necessarily be undertaken in this area. Attention does, however, need to be given to the choice of study design, bearing in mind that prospective, controlled studies will be less susceptible to bias than retrospective and/ or uncontrolled studies.
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Evidence-based dentistry · Jan 2010
CommentFluoride toothpaste prevents caries in children and adolescents at fluoride concentrations of 1000 ppm and above.
The Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE databases were searched. Previously published systematic reviews of fluoride toothpastes were also screened to identify any reports that met the inclusion criteria. In addition, the trials database at www.controlled-trials.com/ and the meta Register of Controlled Trials (www.controlledtrials.com) were searched to identify any ongoing studies of relevance. ⋯ This review confirms the benefits of using fluoride toothpaste in preventing caries in children and adolescents compared with placebo, but only statistically significantly at fluoride concentrations of 1000 ppm and above. The relative caries preventive effects of fluoride toothpastes of different concentrations increase with higher fluoride concentration. The decision of what fluoride levels to use for children aged under 6 years should be balanced with the risk of fluorosis.
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Critical appraisal is one of the key skills of evidence-based practice and is now increasingly being taught in dental schools. Here we outline the key principles of appraising systematic reviews.
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Evidence-based dentistry · Jan 2010
CommentTreating periodontal disease may improve metabolic control in diabetics.
The Cochrane Oral Health Group's Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), Medline, EMBASE, CINAHL, ZETOC, ISIWeb of Knowledge and LILACS databases were searched together with hand searches of the journals Annals of Periodontology (1996 to 2003) and Periodontology 2000 (1993 to 2003).There were no language restrictions. ⋯ There is some evidence of improvement in metabolic control in people with diabetes, after treating periodontal disease. There are few studies available and individually these lacked the power to detect a significant effect. Most of the participants in the study had poorly controlled type 2 DM and there was little data from randomised trials on the effects on people with type 1 DM. Improving periodontal health is an important objective in itself. However, in order to understand the potential of this treatment to improve glycaemic control among people with diabetes, larger, carefully conducted and reported studies are needed.