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Clinical Oral Investigations Aug 2021This systematic review and meta-analysis aimed to assess the diagnostic performance of commonly used methods for occlusal caries diagnostics, such as visual examination... (Meta-Analysis)
Meta-Analysis Review
AIM
This systematic review and meta-analysis aimed to assess the diagnostic performance of commonly used methods for occlusal caries diagnostics, such as visual examination (VE), bitewing radiography (BW) and laser fluorescence (LF), in relation to their ability to detect (dentin) caries under clinical and laboratory conditions.
MATERIALS AND METHODS
A systematic search of the literature was performed to identify studies meeting the inclusion criteria using the PIRDS concept (N = 1090). A risk of bias (RoB) assessment tool was used for quality evaluation. Reports with low/moderate RoB, well-matching thresholds for index and reference tests and appropriate reporting were included in the meta-analysis (N = 37; 29 in vivo/8 in vitro). The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR) and areas under ROC curves (AUCs) were computed.
RESULTS
SP ranged from 0.50 (fibre-optic transillumination/caries detection level) to 0.97 (conventional BW/dentine detection level) in vitro. AUCs were typically higher for BW or LF than for VE. The highest AUC of 0.89 was observed for VE at the 1/3 dentin caries detection level; SE (0.70) was registered to be higher than SP (0.47) for VE at the caries detection level in vivo.
CONCLUSION
The number of included studies was found to be low. This underlines the need for high-quality caries diagnostic studies that further provide data in relation to multiple caries thresholds.
CLINICAL RELEVANCE
VE, BW and LF provide acceptable measures for their diagnostic performance on occlusal surfaces, but the results should be interpreted with caution due to the limited data in many categories.
Topics: Dental Caries; Dental Caries Susceptibility; Fluorescence; Humans; Radiography, Bitewing; Reproducibility of Results; Sensitivity and Specificity; Transillumination
PubMed: 34128130
DOI: 10.1007/s00784-021-04024-1 -
The Journal of Evidence-based Dental... Dec 2020This systematic review and meta-analysis aimed to investigate the effectiveness and safety of ozone therapy for treating dental caries. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review and meta-analysis aimed to investigate the effectiveness and safety of ozone therapy for treating dental caries.
METHODS
We searched for randomized controlled trials (RCTs) in 8 databases, from inception to April 4, 2020 (MEDLINE, EMBASE, CENTRAL, LILACS, Bibliografia Brasileira de Odontologia, ClinicalTrials.gov, WHO, and OpenGrey). Primary outcome measures were antimicrobial effect and adverse events. We used the Cochrane risk of bias tool to evaluate methodological quality of included RCTs and GRADE approach to evaluate the certainty of the evidence. We used the Review Manager software to conduct meta-analyses.
RESULTS
We included 12 RCTs comparing ozone therapy with no ozone, chlorhexidine digluconate, fissure sealants (alone and added to ozone), and fluoride. Considering primary outcomes, ozone therapy showed (a) lower reduction in the bacterial number than chlorhexidine digluconate in children (mean difference [MD]: -5.65 [-9.79 to -1.51]), but no difference was observed in adults (MD: -0.10 [-1.07 to 0.88]); (b) higher reduction in the bacterial number than sealant (MD: 12.60 [3.86-21.34]), but no difference was observed after final excavation (MD: -0.00 [-0.01 to 0.01]). Regarding safety of ozone therapy, results from individual studies presented no adverse events during or after treatment. Most of these results are imprecise and should be interpreted with caution because of clinical and methodological concerns, small sample size, and wide confidence interval, precluding to determine the real effect direction.
CONCLUSION
Based on a very low certainty of evidence, there is not enough support from published RCTs to recommend the use of ozone for the treatment of dental caries. Well-conducted studies should be encouraged, measuring mainly the antimicrobial effects of ozone therapy at long term and following the recommendations of the CONSORT statement for the reporting of RCTs.
Topics: Adult; Child; Dental Caries; Fluorides; Humans; Ozone; Pit and Fissure Sealants
PubMed: 33303100
DOI: 10.1016/j.jebdp.2020.101472 -
Journal of the American Dental... Jun 2016The authors of this systematic review and meta-analysis had 2 aims: to evaluate fissure sealant retention with and without the use of an adhesive system and to compare... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The authors of this systematic review and meta-analysis had 2 aims: to evaluate fissure sealant retention with and without the use of an adhesive system and to compare fissure sealant retention using etch-and-rinse adhesive systems versus self-etching adhesive systems.
TYPES OF STUDIES REVIEWED
The authors conducted a literature search (all articles published through November 1, 2015) to identify studies for inclusion in this systematic review. They assessed the quality of the evidence provided using the modified Jadad scale and performed meta-analyses using a random-effects model.
RESULTS
The authors considered 12 studies that met the inclusion criteria for the systematic review. In addition, they used 5 of 9 studies related to the first part of the study and 3 of 4 studies related to the second part of the study that met the inclusion criteria for meta-analysis. In the analysis of the first part of the systematic review, the authors found that adhesive systems had a significant positive effect on fissure sealant (odds ratio, 3.294; 95% confidence interval, 1.292-8.401; P = .013). In the analysis of the second part of the systematic review, the authors found that etch-and-rinse adhesives were superior to self-etching adhesives in the fissure sealant procedure (odds ratio, 14.569; 95% confidence interval, 2.616-81.131; P = .002).
CONCLUSIONS AND PRACTICAL IMPLICATIONS
The use of adhesive systems beneath fissure sealants can increase the retention of fissure sealants. Also, when adhesive systems are used with fissure sealants, etch-and-rinse systems are preferable.
Topics: Dental Bonding; Dental Cements; Humans; Pit and Fissure Sealants
PubMed: 26993212
DOI: 10.1016/j.adaj.2016.01.014 -
International Journal of Dentistry 2021The aim of this study was to explore the literature in order to assess systematically the association between amelogenesis imperfecta (AI) and caries development and to... (Review)
Review
OBJECTIVES
The aim of this study was to explore the literature in order to assess systematically the association between amelogenesis imperfecta (AI) and caries development and to evaluate the DMF index among AI patients. . PubMed was used to explore the database Medline. The key words used were "Amelogenesis Imperfecta" [Mesh], "Dental Caries" [Mesh], "Tooth Loss" [Mesh], "DMF Index" [Mesh], and "Dental Restoration, Permanent" [Mesh]. Moreover, an ad hoc search was performed in order to make the study as exhaustive as possible.
RESULTS
Fifty-five articles were retained. The total number of patients gathered was 499. A percentage of 68.8% of the articles dealt with cases with a relatively low dental caries process, 20.8% dealt with cases in which the dental caries process was relatively moderate, and 10.4% dealt with cases in which the dental caries process was severe. Teeth extraction due to dental caries was mentioned in 10 articles. Eleven articles, concerning 53 patients, mentioned dental fillings. Four patients did not have dental filling due to dental caries. DMF index was very low in 2 articles and low-to-high in 3 articles.
CONCLUSION
Low dental caries susceptibility with AI patients was noticed in this study. A possible factor could be the lack of proximal contacts and elimination of fissures through enamel loss. The lack of dental caries susceptibility was also explained by the microbacterial specificity of hypoplastic AI patients. Moreover, it was also noted that the prevalence of dental caries among AI patients depends on sociodemographic change.
PubMed: 34447436
DOI: 10.1155/2021/5577615 -
Journal of Dentistry Nov 2017Aim of this systematic review was to assess the clinical performance of sealants on various teeth in an evidence-based manner. (Review)
Review
OBJECTIVE
Aim of this systematic review was to assess the clinical performance of sealants on various teeth in an evidence-based manner.
SOURCES
Five databases were searched from inception to February 2017.
DATA
Randomized clinical studies on humans.
METHODS
After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, Paule-Mandel random-effects meta-analyses of Relative Risks (RRs) and their 95% confidence intervals (CIs) were calculated.
RESULTS
A total of 16 randomized clinical trials with 2778 patients (male/female 49.1%/50.9%) and an average age of 8.4 years were included. No significant difference in either caries incidence of sealed teeth or sealant retention could be found according to (i) mouth side (right versus left), (ii) jaw (upper versus lower), (iii) and tooth type (1st permanent molar versus 2nd permanent molar/1st permanent molar versus 2nd deciduous molar/1st deciduous molar versus 2nd deciduous molar), based on evidence of very low to low quality. On the other side, compared to 1st permanent molars, sealed premolars were significantly less likely to develop caries (3 trials; RR=0.12; 95% CI=0.03 to 0.44; P=0.001) and less likely to experience loss of the sealant (5 trials; RR=0.33; 95% CI=0.20 to 0.54; P=0.001), both based on low to moderate quality evidence.
CONCLUSIONS
The performance of pit and fissure sealants does not seem to be negatively affected by mouth side, jaw, and tooth type, apart from the exception of a favorable retention on premolars.
CLINICAL SIGNIFICANCE
Based on existing evidence, pit and fissure sealants can be effectively applied on any deciduous or permanent posterior teeth without adverse effects on their clinical performance.
Topics: Child; Databases, Factual; Dental Caries; Dentition, Permanent; Female; Humans; Male; Meta-Analysis as Topic; Molar; Mouth; Pit and Fissure Sealants; Randomized Controlled Trials as Topic; Tooth, Deciduous
PubMed: 28797916
DOI: 10.1016/j.jdent.2017.08.004 -
Journal of the American Dental... Aug 2016National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly one-fourth of children and over one-half of adolescents... (Review)
Review
Sealants for preventing and arresting pit-and-fissure occlusal caries in primary and permanent molars: A systematic review of randomized controlled trials-a report of the American Dental Association and the American Academy of Pediatric Dentistry.
BACKGROUND
National Health and Nutrition Examination Survey 2011-2012 data indicated that, in the United States, nearly one-fourth of children and over one-half of adolescents experienced dental caries in their permanent teeth. The purpose of this review was to summarize the available clinical evidence regarding the effect of dental sealants for the prevention and management of pit-and-fissure occlusal carious lesions in primary and permanent molars, compared with a control without sealants, with fluoride varnishes, or with other head-to head comparisons.
TYPE OF STUDIES REVIEWED
The authors included parallel and split-mouth randomized controlled trials that included at least 2 years of follow-up, which they identified using MEDLINE (via PubMed), Embase, LILACS, the Cochrane Central Register of Controlled Trials, and registers of ongoing trials. Pairs of reviewers independently conducted the selection of studies, data extraction, risk of bias assessments, and quality of the evidence assessments by using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
Of 2,869 records screened, the authors determined that 24 articles (representing 23 studies) proved eligible. Moderate-quality evidence suggested that participants who received sealants had a reduced risk of developing carious lesions in occlusal surfaces of permanent molars compared with those who did not receive sealants (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.08-0.27) after 7 or more years of follow-up. When the authors compared studies whose investigators had compared sealants with fluoride varnishes, they found that sealants reduced the incidence of carious lesions after 7 or more years of follow-up (OR, 0.19; 95% CI, 0.07-0.51); however, this finding was supported by low-quality evidence. On the basis of the evidence, the authors could not provide a hierarchy of effectiveness among the studies whose investigators had conducted head-to-head comparisons. The investigators of 2 trials provided information about adverse events, but they did not report any adverse events.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
Available evidence suggests that sealants are effective and safe to prevent or arrest the progression of noncavitated carious lesions compared with a control without sealants or fluoride varnishes. Further research is needed to provide information about the relative merits of the different types of sealant materials.
Topics: Adolescent; Child; Dental Caries; Dental Fissures; Humans; Molar; Pit and Fissure Sealants; Randomized Controlled Trials as Topic; Tooth, Deciduous
PubMed: 27470524
DOI: 10.1016/j.adaj.2016.06.003 -
Iranian Journal of Public Health Feb 2022Highly necessary to evaluate the effectiveness of preventive interventions to prioritize them at the community level. We aimed to systematically investigate the related... (Review)
Review
BACKGROUND
Highly necessary to evaluate the effectiveness of preventive interventions to prioritize them at the community level. We aimed to systematically investigate the related studies on the effects of fluoride varnish and fissure sealant on dental caries in 6-12 children.
METHODS
We searched PubMed, EMBASE, Web of Science, Cochrane Library and Scopus databases using Fluoride Varnish, Fissure Sealant, Caries, and Oral Health keywords. The timeframe selected to search for articles is from 2000 to Dec 2020. CMA software: 2 (Comprehensive Meta-Analysis) was used to perform the meta-analysis. The intervention groups in this study were fluoride varnish and fissure sealants, each of them compared to the control groups.
RESULTS
We included nine studies. In the intervention group 84,380 and control group 11,254 individuals were studied. Eight of the studies were Randomized Clinical Trial (RCT) and Field RCT, and two was non-RCT. In the overall Fluoride Varnish efficacy study, 4 were fully effective, 1 was ineffective, and all 4 were completely effective for Fissure Sealant. There was a significant difference between decayed, missing, and filled permanent teeth (DMFT) and decayed, missing, and filled primary teeth (dmft) indices in both interventions and comparison groups. Moreover, the mean difference of DMFT for Fluoride Varnish and Fissure Sealant in the intervention and control groups were -0.55 and -0.29, respectively (=0.00).
CONCLUSION
Due to the efficacy of fissure sealant and fluoride varnish in preventing dental caries in children aged 6-12 yr, these interventions can be considered as health priorities of societies and health systems interventions in countries.
PubMed: 35866130
DOI: 10.18502/ijph.v51i2.8680 -
Applied Health Economics and Health... Jan 2023To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis.
OBJECTIVES
To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis.
METHODS
Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal.
RESULTS
Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis.
CONCLUSIONS
Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.
Topics: Humans; Cost-Benefit Analysis; Cost-Effectiveness Analysis; Dental Caries; Periodontitis; Pit and Fissure Sealants; Fluoridation; Fluorides, Topical; Oral Hygiene; Health Education
PubMed: 36089630
DOI: 10.1007/s40258-022-00758-5 -
Journal of Dentistry Nov 2021This meta-analysis review aims to answer two questions: 1) What is the effectiveness of hydrophilic resin-based sealant (RBS) in preventing/arresting pits and fissures... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This meta-analysis review aims to answer two questions: 1) What is the effectiveness of hydrophilic resin-based sealant (RBS) in preventing/arresting pits and fissures caries in permanent teeth, and 2) What is the retention rate of a hydrophilic RBS as compared to alternative treatments.
DATA
Randomized control trials investigating the efficacy of hydrophilic RBS compared to any other (placebo) treatment for permanent teeth. Outcomes were retention rate and caries prevention/arresting.
SOURCES
A systematic search for eligible studies was conducted on six electronic databases (Scopus, Ovid MEDLINE, Ovid Embase, Cochrane; Web of Science, PubMed) from inception to March 2021. The Cochrane guidelines were used to classify the risk of bias.
STUDY SELECTION/RESULTS
A systematic literature search resulted in 290 studies. Thirteen articles met our inclusion criteria and were included in the systematic review. Six articles were identified as good or fair quality and were included in the quantitative analysis. Meta-analysis results indicated that there is no significant difference in retention (RR 1.01, 95% CI:0.96-1.07, P-value 0.66), (RR 1.03, 95% CI: 0.89-1.19, P-value 0.0009) at six and twelve months, respectively. Likewise, for caries prevention there is no significant difference (RR 0.97, 95% CI: 0.91-1.03, P-value 0.19), (RR 0.30, 95% CI: 0.91-1.03, P-value 0.30) at six and twelve months.
CONCLUSIONS
This meta-analysis showed no statistically significant difference between the hydrophilic RBS and alternative treatment options (such as conventional resin or glass ionomer) regarding retention or caries prevention at six- and twelve-month follow-up. Future studies are required to investigate longer-term outcomes.
Topics: Bias; Bibliometrics; Dental Caries; Dentition, Permanent; Humans; Pit and Fissure Sealants
PubMed: 34560227
DOI: 10.1016/j.jdent.2021.103816 -
Journal of the American Dental... Dec 2016The authors of this systematic review and meta-analysis had 2 aims: to evaluate fissure sealant retention with and without the use of a preparation method and to compare... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The authors of this systematic review and meta-analysis had 2 aims: to evaluate fissure sealant retention with and without the use of a preparation method and to compare fissure sealant retention using the preparation-only method before sealant placement with the conventional acid-etching procedure.
TYPES OF STUDIES REVIEWED
The authors conducted a literature search (from database inception through June 2, 2016) to identify studies for inclusion in this systematic review. The authors assessed the quality of the evidence with the modified Jadad scale and performed the meta-analysis by using a random-effects model.
RESULTS
The authors considered 12 studies (8 for the first part and 4 for the second part) that met the inclusion criteria for the systematic review and meta-analysis. In the analysis of the first part of the systematic review, the authors found that the preparation method before acid etching had a significant positive effect on fissure sealant retention (odds ratio, 3.262; 95% confidence interval, 1.782-5.971; P = .001). In the analysis of the second part of the systematic review, the authors found that there were no significant differences between the preparation-only method and the conventional acid-etching method in terms of fissure sealant retention (odds ratio, 1.241; 95% confidence interval, 0.534-2.888; P = .616).
CONCLUSIONS AND PRACTICAL IMPLICATIONS
The use of a preparation method before fissure sealant application can increase sealant retention. However, preparation alone cannot substitute the conventional acid-etching method before sealant placement.
Topics: Acid Etching, Dental; Dental Caries; Humans; Pit and Fissure Sealants; Surface Properties; Tooth Preparation
PubMed: 27666005
DOI: 10.1016/j.adaj.2016.08.003