Evidence-based dentistry
-
Evidence-based dentistry · Sep 2013
CommentOral hygiene regimes for mechanically ventilated patients that use chlorhexidine reduce ventilator-associated pneumonia.
The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, LILACS, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan Fang Database, OpenGrey and ClinicalTrials.gov databases were searched. Reference lists of identified articles were also scanned for relevant papers. There were no language restrictions. ⋯ Effective OHC is important for ventilated patients in intensive care. OHC that includes either chlorhexidine mouthwash or gel is associated with a 40% reduction in the odds of developing ventilator-associated pneumonia in critically ill adults. However, there is no evidence of a difference in the outcomes of mortality, duration of mechanical ventilation or duration of ICU stay. There is no evidence that OHC including both CHX and toothbrushing is different from OHC with CHX alone, and some weak evidence to suggest that povidone iodine mouthrinse is more effective than saline in reducing VAP. There is insufficient evidence to determine whether powered toothbrushing or other oral care solutions are effective in reducing VAP.
-
Evidence-based dentistry · Sep 2013
CommentPartial caries removal may have advantages but limited evidence on restoration survival.
Cochrane Oral Health Group's Trials Register, CENTRAL, Medline via OVID, EMBASE via OVID; no restrictions on language or date of publication. ⋯ For management of dentinal caries, both stepwise and partial excavation showed clinical advantage over complete caries removal by reducing the incidence of pulp exposure in symptomless, vital, carious primary as well as permanent teeth. The review found no difference in signs or symptoms of pulpal disease between stepwise excavation and complete caries removal.There was insufficient evidence to determine whether there was a difference in signs and symptoms of pulp disease or a difference in the risk of restoration failure with partial caries removal.For the two no dentinal caries removal studies, the one investigating permanent teeth found no difference in restoration failure and the one investigating primary teeth found a statistically significant difference in restoration failure favouring the intervention.Due to the short term follow-up, low reporting of patient centred outcomes and high risk of bias, further high quality, long-term clinical trials are still required to assess the most effective intervention.
-
Evidence-based dentistry · Sep 2013
CommentToothbrushing may reduce ventilator-associated pneumonia.
The databases Embase, Medline, CINAHL, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, clinical trials.gov and controlled-trials.com were searched. Reference lists of reviewed articles and eligible trials were also searched, and toothpaste and toothbrush manufactures were contacted. ⋯ In summary, randomised trials to date show that toothbrushing is associated with a trend toward lower rates of VAP in intubated, mechanically ventilated critically ill patients. There is no clear difference between electric and manual toothbrushing. Toothbrushing has no effect on ICU mortality, hospital mortality, or ICU length of stay.
-
Evidence-based dentistry · Sep 2013
CommentStrong evidence for the effectiveness of resin based sealants.
Cochrane Oral Health Group's Trials Register, CENTRAL, Medline via OVID, EMBASE via OVID; SCISEARCH, CAplus, INSPEC, NTIS and PASCAL via STN Easy and DARE, NHS EED, HTA (all to September/ November 2012) and ClinicalTrials.gov (to July 2012). There were no restrictions on language or date of publication. ⋯ Sealants compared with no sealants, on the occlusal surfaces of permanent molars in children and adolescents, are effective at reducing caries up to 48 months. There is less evidence for longer term follow-up and little for the relative effectiveness of sealing in less high caries risk children. No conclusions could be drawn on the relative effectiveness of different types of sealants.