The journal of evidence-based dental practice
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J Evid Based Dent Pract · Sep 2012
CommentEssential oil mouthwash (EOMW) may be equivalent to chlorhexidine (CHX) for long-term control of gingival inflammation but CHX appears to perform better than EOMW in plaque control.
For inclusion in this systematic review, studies had to be randomized clinical trials (RCTs) or controlled trials in healthy human subjects comparing the effects of essential-oil mouthwash (EOMW) with chlorhexidine (CHX) on plaque and calculus accumulation, tooth staining, and gingival inflammation. Included studies could be either short-term (< 4 weeks' duration) or long-term (> 4 weeks' duration). Studies were required to include a specific formulation of EOMW (Listerine, Johnson and Johnson). They reportedly selected this standard formula of EOMW because it was representative of essential oil-based mouthwashes and because it has the American Dental Association seal of approval. Conversely, there were no restrictions on the concentration of CHX used in studies. The CHX concentration in studies varied from 0.1% to 0.2%. Studies could include no brushing (de novo model) or brushing in conjunction with EOMW or CHX. The authors identified 390 unique articles from electronic database searches. Twenty-five of these articles were selected for full review. Seven articles were excluded because they did not meet the inclusion criteria. Hand searching the reference list of selected manuscripts resulted in the addition of one article. The final systematic review included 19 articles, with a total of 826 subjects who completed all trials. The systematic review included short-term studies lasting less than 4 weeks and long-term studies of 4 or more weeks' duration. Six of these trials were included in the 7 separate meta-analyses performed, yielding a total of 315 participants. The age of subjects in the trials ranged from 16 to 62 years. The study by Axelsson and Lindhe was included twice in the metaanalysis of plaque index, gingival index, and stain index because CHX was used in 0.1% and 0.2% concentrations. The studies by Haffajee et al and Charles et al were each used in meta-analyses for both plaque index and gingival index. Three separate meta-analyses included assessments for plaque index, whereas 2 involved gingival index and 2 assessed tooth staining index. ⋯ The authors concluded that CHX was significantly better at reducing plaque accumulation than EOMW in short-and long-term studies. Staining and calculus accumulation were greater among CHX users compared to EOMW. CHX and EOMW were not different with respect to long-term control of gingival inflammation. They suggested that EOMW might be a reliable alternative to CHX for controlling gingival inflammation in cases where a dental professional deems that anti-inflammatory oral care is beneficial. However, they concluded that CHX remains the first choice when plaque control is the focus of therapy.
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J Evid Based Dent Pract · Jun 2010
Patient-reported outcomes (PROs) in dental clinical trials and product development: introduction to scientific and regulatory considerations.
Although typically measured with objective assessments, treatment efficacy and disease progression may also be examined using reports directly from the patient (patient-reported outcomes or PROs). PROs can enhance clinician and researcher understanding of an illness and its treatment in multiple ways, ranging from an assessment of core signs and symptoms to assessment of impairments and impacts across a variety of domains (eg, physical, social, occupational, emotional). Regulated drug and medical device development programs are increasingly using PROs as endpoints to support label claims. ⋯ The goals of this article were to introduce the concept of PROs and to provide an introduction to PRO scientific and regulatory principles. These principles can be used as a blueprint for using PROs in clinical research and for evaluating trials that have implemented PROs. When used appropriately, PROs may be useful in understanding the patient's perspective on illness and interventions and this perspective may be critical in fully evaluating the efficacy of dental treatments.
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J Evid Based Dent Pract · Jun 2010
Randomized trials published in the journal of dental research are cited more often compared with those in other top-tier non-specialty-specific dental journals.
Randomized controlled trials (RCTs) are viewed as the gold standard for clinical research. Oftentimes the citation counts serve as an important measure for assessing the significance of an RCT to promote the dissemination of science. This study attempts to identify the factors associated with the number of times RCTs are cited within the first 24 months since publication. ⋯ Based on our initial analysis of 4 journals, publishing randomized trials in high-impact journals will likely provide better dissemination of research findings.
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J Evid Based Dent Pract · Sep 2007
Practice GuidelineThe evidence-based clinical decision support guide: mucogingival/esthetics making clinical decisions in the absence of strong evidence.
Although evidence-based decision-making in dentistry is quickly evolving, large gaps remain in our clinical knowledge base regarding every day decisions and procedures. Especially in the absence of strong evidence, as is the case with mucogingival conditions, risk assessment and identification are important components of the clinical decision-making process. Utilization of clinical decision support (CDS) guides, frameworks and systems enhances chairside decision-making and improves delivery of patient care. ⋯ This CDS guide delineates treatment strategies based upon evidence-based risk assessment and when possible, risk management. It provides the clinician with a framework that will support decision-making at the point of care. Recommendations for consultation, treatment and referral are reviewed.
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J Evid Based Dent Pract · Mar 2007
Clinical decision support complements evidence-based decision making in dental practice.
Dental professionals as well as consumers of dental health care are driving the demand for access to reliable information so they can make more informed decisions. Clinical decision support (CDS) includes a variety of printed and electronic tools, systems, products, and services that make knowledge and information available to the user. CDS is the main way people will be able to access important facts, ideas, concepts, and the latest thinking about personal and population-based health subjects. CDS has its greatest potential at the point of care where it can facilitate good-quality evidence-based decision-making.