Evidence-based dentistry
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Evidence-based dentistry · Jan 2007
CommentParacetamol is an effective drug to use for pain following oral surgery.
Studies were identified using the Cochrane trials registers of the Oral Health Group and of the Pain, Palliative and Supportive Care Group, along with the Cochrane Central Register of Controlled Trials, Medline, Embase and the Current Controlled Trials Register. Handsearching included several dental journals as well as the bibliographies of relevant clinical trials and review articles for studies outside the journals searched by hand. Authors of the randomised controlled trials (RCT) identified and manufacturers of analgesic pharmaceuticals were contacted in an attempt to identify unpublished or ongoing RCT. No language restriction was applied. ⋯ Paracetamol is an effective drug to use for postoperative pain following oral surgery, and the reporting of adverse events shows it to be a safe drug: the number-needed-to-treat (NNT) to benefit is three for 1000 mg of paracetamol at 6 h and the NNT to harm is 33. It is most effective at a 1000 mg dose, and can be taken at 6-hourly intervals without compromising safety. It could be considered more readily by dentist and patients both as a first-choice analgesic, or to be taken alternately with other analgesics such as nonsteroidal anti-inflammatory drugs.
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Evidence-based dentistry · Jan 2007
CommentNo definitive conclusion as to the most effective method of pulp treatment of asymptomatic carious teeth.
The Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase, National Research Register and the Science Citation Index SCISEARCH were searched. Key journals were searched by hand, together with reference lists of review articles and endodontic textbooks. There was no language restriction. ⋯ The findings of this review suggest that there should not be any significant change from accepted conventional practice procedures when the pulp of the carious tooth is considered. Further well-designed RCT are needed to investigate the potential of contemporary materials which may be suitable when used in the management of carious teeth.
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This guidance is intended to promote good clinical practice for the provision in dentistry of conscious sedation that is both safe and effective. It is not a recipe book for sedation and therefore does not include details of drug dosages. The recommendations are applicable to all patients receiving conscious sedation, to facilitate the provision of any type of dental treatment whether it is delivered in a dental practice, a community dental service clinic or a hospital setting. It also covers the provision of conscious sedation for dental treatment provided on a domiciliary basis. Specifically excluded from this guidance, however, are patients who require assisted ventilation, intensive care sedation, premedication for general anaesthesia, postoperative analgesia, sedation in palliative care, night sedation and sedation in the home setting other than for the provision of dental treatment on a domiciliary basis. ⋯ A number of recommendations were made regarding the future conduct and reporting of clinical trials. The following areas were highlighted as requiring further high-quality research: Fasting before conscious sedation. Conscious sedation of paediatric dental patients. Dental conscious sedation using combinations of drugs. Dental conscious sedation using continuous infusion. The choice of sedation method for dental patients. Cognitive and behavioural effects of conscious sedation. The interaction of pharmacological and nonpharmacological anxiety management techniques. The complete guidance is available for download at www.scottishdental.org/cep/guidance/dentalsedation.htm.
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Evidence-based dentistry · Jan 2006
CommentRobust randomised control trials needed for drug treatments for trigeminal neuralgia.
Searches for appropriate studies were made using the following: Cochrane Neuromuscular Disease Group Register, Medline, Embase and LILACS (Latin American and Caribbean Literature on the Health Sciences) together the Chinese Biomedical Retrieval System, the database of the Chinese Cochrane Centre, conference paper databases and checked bibliographies. 10 Chinese journals were searched by hand. ⋯ Trials of non-antiepileptic drugs for treating trigeminal neuralgia have all been limited by poor methodological quality or poor reporting. There is insufficient evidence from randomised clinical trials to show significant benefit from non-antiepileptic drugs for trigeminal neuralgia.