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Clinical Oral Investigations Feb 2022This network meta-analysis (NMA) assessed the antiplaque and anti-inflammatory efficacy of different sugar-free chewing gums (SFCG) as adjuncts to toothbrushing. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This network meta-analysis (NMA) assessed the antiplaque and anti-inflammatory efficacy of different sugar-free chewing gums (SFCG) as adjuncts to toothbrushing.
MATERIAL AND METHODS
PubMed, Scopus, EMBASE, Web of Science, and CENTRAL databases were searched up to February 2021 to identify randomized controlled trials, involving adults, comparing antiplaque and anti-inflammatory effects of SFCG, with different active ingredients, as adjunctive to mechanical control of biofilm, with a minimum of 7-day of follow-up. Plaque and gingival indexes were assessed. The risk of bias assessment was performed with the RoB 2.0 tool. NMA, and pairwise meta-analyses were performed for both dental plaque and gingival indexes.
RESULTS
Twelve studies were included, comprising 850 (antiplaque) and 1459 (gingival inflammation) subjects randomized into 9 interventions: (1) chlorhexidine; (2) chlorhexidine + xylitol (CHX+Xyl); (3) green tea + xylitol (GT+Xyl); (4) magnolia; (5) Lactobacillus reuteri; (6) vitamin C + xylitol; (7) vitamin + carbamide; (8) eucalyptus; and (9) negative control, sorbitol, gum base only, or no chewing gum. No statistically significant differences were detected among SFCG, with different active ingredients, for both antiplaque and anti-inflammatory efficacy (p > 0.05). However, SFCG with GT+XyL outperformed negative control gums regarding antiplaque efficacy (SMD, - 2.93; 95% CrI, - 0.45 to - 5.38). The SUCRA results showed that SFCG containing GT+Xyl was ranked first, for both antiplaque and anti-inflammatory outcomes.
CONCLUSION
SFCG containing GT+Xyl showed better antiplaque effect over negative controls. However, cautious interpretation is required due to the low number of direct comparisons arms. These shortcomings underscore the need for RCTs with mostly head-to-head comparison that provide more conclusive evidence.
CLINICAL RELEVANCE
There is no robust evidence for the clinical indications of sugar-free chewing gums as adjunct to toothbrushing for the control of biofilm or the treatment of gingivitis.
Topics: Adult; Chewing Gum; Dental Plaque; Gingivitis; Humans; Network Meta-Analysis; Toothbrushing; Xylitol
PubMed: 35072769
DOI: 10.1007/s00784-021-04264-1 -
International Journal of Dental Hygiene May 2023To systematically evaluate randomized controlled trials (RCTs) on whether a chewable toothbrush (CTB) is more effective than a manual toothbrush (MTB) in terms of... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To systematically evaluate randomized controlled trials (RCTs) on whether a chewable toothbrush (CTB) is more effective than a manual toothbrush (MTB) in terms of full-mouth dental plaque reduction in non-orthodontic children.
MATERIALS AND METHODS
Six databases were searched by two independent reviewers according to pre-specified eligibility criteria up to October 2022. No restrictions regarding language, date of publication and minimum follow-up period were imposed. The Cochrane Collaboration's Risk of Bias tool (RoB 2.0) was used for quality appraisal and GRADE for assessing the certainty of evidence. Random-effects pairwise meta-analysis compared the dental plaque change scores of CTB and MTB through mean differences (MDs) and associated confidence intervals (95% CI), and sensitivity analysis determined whether an individual study significantly affected the results.
RESULTS
Seven eligible RCTs were retrieved, including data of 310 children aged 8-14 years. Five RCTs present some concerns and two have high RoB. No significant difference was detected between toothbrushes in terms of Turesky modification of the Quigley-Hein plaque index reduction (MD = -0.04, 95% CI: -0.26-0.18), with overall very low certainty on evidence. The pooled estimate remains unchanged when any RCT is omitted.
CONCLUSION
There is very low-certainty evidence of no significant difference on plaque removal between MTB and CTB in non-orthodontic children. Due to unexplained high heterogeneity and low methodological quality of RCTs, we cannot determine the extent to which our finding reflects a true effect or bias arising from limitations of primary studies.
Topics: Child; Humans; Dental Plaque; Randomized Controlled Trials as Topic; Toothbrushing; Dental Plaque Index; Dental Care
PubMed: 36704825
DOI: 10.1111/idh.12671 -
BMC Oral Health Jul 2020This systematic review of randomized clinical trials aimed to evaluate the available evidence regarding the efficacy of propolis-based mouthwash on dental plaque and...
BACKGROUND
This systematic review of randomized clinical trials aimed to evaluate the available evidence regarding the efficacy of propolis-based mouthwash on dental plaque and gingival inflammation.
METHODS
PubMed, Scopus, and Web of Science databases were searched up to November 2019. Clinical trials that evaluated the efficacy of propolis mouthwashes compared with chlorhexidine (CHX) were included. The primary outcomes comprised dental plaque and/or gingival inflammation. Two authors assessed the risk of bias using the Cochrane tool. Due to marked heterogeneity of the available data, studies were assessed qualitatively, and no metaanalysis was performed.
RESULTS
Nine clinical trials, comprising 333 subjects, fulfilled the eligibility criteria. Most of the included studies showed high risk of bias. Overall, propolis mouthwashes showed good efficacy on plaque and gingivitis in all of the included studies. Out of the eight studies that reported on plaque index, 5 studies found equal efficacy of propolis and CHX in reducing plaque, two studies found superior efficacy in favor of CHX, while one study found superior efficacy in favor of propolis. Six studies assessed gingival inflammation outcome, four of which reported better results with propolis, while two studies reported comparable results.
CONCLUSIONS
The results suggest that propolis-based mouthwashes have potential benefits in reducing plaque and gingival inflammation. However, methodological limitations along with small sample sizes in some of the included studies weaken the strength of the evidence. Therefore, further well-designed clinical trials with large sample sizes and adequate follow-up period are recommended to discern the efficacy of propolis mouthwash on plaque and gingivitis.
Topics: Anti-Infective Agents, Local; Chlorhexidine; Cross-Over Studies; Dental Plaque; Dental Plaque Index; Double-Blind Method; Gingivitis; Humans; Inflammation; Mouthwashes; Propolis; Single-Blind Method
PubMed: 32650754
DOI: 10.1186/s12903-020-01185-5 -
Journal of Dentistry Dec 2020People with Cystic Fibrosis (PWCF) may be presumed to be at lower risk of periodontal disease due to long term antibiotic use but this has not been comprehensively... (Review)
Review
INTRODUCTION AND OBJECTIVES
People with Cystic Fibrosis (PWCF) may be presumed to be at lower risk of periodontal disease due to long term antibiotic use but this has not been comprehensively investigated. The oral hygiene and periodontal status of PWCF in comparison to the general population is not well established. The objective of this systematic review was to critically evaluate the literature on periodontal and oral hygiene status in PWCF to see if this group are at increased risk of periodontal disease (gingivitis or periodontitis).
DATA SOURCES
5 databases were searched: Scopus, MEDLINE, Embase, Cochrane Library and Web of Science.
STUDY SELECTION
The search resulted in 614 publications from databases with one more publication identified by searching bibliographies. 13 studies were included in the qualitative analysis.
CONCLUSIONS
The majority of studies showed better oral hygiene, with lower levels of gingivitis and plaque among people with Cystic Fibrosis (PWCF) than controls. Interestingly, despite this, many studies showed that PWCF had higher levels of dental calculus. Three studies found there was no difference in Oral Hygiene between PWCF and controls. One study found that PWCF aged between 6 and 9.5 years had increased levels of clinical gingivitis, and one study showed that PWCF with gingivitis had more bleeding on probing than people without CF. The vast majority of PWCF examined were children- only five studies included people over 18 years, and only one looked exclusively at adults. There is a need for further study into the periodontal health of PWCF- particularly those over the age of 18.
CLINICAL SIGNIFICANCE
There are currently no guidelines referring to oral care in PWCF. Studies have suggested that the oral cavity acts as a reservoir of bacteria which may colonise the lungs. If PWCF are at increased risk of periodontal disease, they should attend for regular screenings to facilitate early detection.
Topics: Adult; Child; Cystic Fibrosis; Dental Plaque; Gingivitis; Humans; Middle Aged; Oral Health; Oral Hygiene; Periodontal Diseases
PubMed: 33129998
DOI: 10.1016/j.jdent.2020.103509 -
Journal of Ethnopharmacology Jun 2021Salvadora persica L. chewing stick, commonly known as miswak is still being used as an oral hygiene tool for plaque control and prevention against gingivitis. Various... (Comparative Study)
Comparative Study Meta-Analysis
ETHNOPHARMACOLOGICAL RELEVANCE
Salvadora persica L. chewing stick, commonly known as miswak is still being used as an oral hygiene tool for plaque control and prevention against gingivitis. Various studies have reported on the therapeutics and prophylactic effects particularly on periodontal disease. This review aimed to evaluate the effectiveness of S. persica chewing stick compared to the standard toothbrush for anti-plaque and anti-gingivitis.
MATERIAL AND METHODS
A PRISMA-compliant systematic search of literature was done from the MEDLINE, CENTRAL, Science Direct, PubMed and Google Scholar. Literature that fulfilled eligibility criteria was identified. Data measuring plaque score and bleeding score were extracted. Qualitative and random-effects meta-analyses were conducted.
RESULTS
From 1736 titles and abstracts screened, eight articles were utilized for qualitative analysis, while five were selected for meta-analysis. The pooled effect estimates of SMD and 95% CI were -0.07 [-0.60 to 0.45] with an χ statistic of 0.32 (p = 0.0001), I = 80% as anti-plaque function and 95% CI were -2.07 [-4.05 to -0.10] with an χ statistic of 1.67 (p = 0.02), I = 82%.
CONCLUSION
S. persica chewing stick is a tool that could control plaque, comparable to a standard toothbrush. Further, it has a better anti-gingivitis effect and can be used as an alternative.
Topics: Dental Plaque; Gingivitis; Humans; Periodontitis; Plant Stems; Salvadoraceae; Toothbrushing
PubMed: 33513418
DOI: 10.1016/j.jep.2021.113882 -
The Journal of Prosthetic Dentistry Apr 2024High-performance polymers including polyetheretherketone (PEEK) and polyetherketoneketone (PEKK) have been used as substitutes for metal frameworks in dental prostheses.... (Review)
Review
STATEMENT OF PROBLEM
High-performance polymers including polyetheretherketone (PEEK) and polyetherketoneketone (PEKK) have been used as substitutes for metal frameworks in dental prostheses. However, the clinical performance of polymer-based frameworks is still uncertain.
PURPOSE
The purpose of this systematic review was to compare the clinical performance of PEEK and PEKK with that of metal frameworks for different dental prostheses.
MATERIAL AND METHODS
This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases and non-peer-reviewed literature (without language or follow-up restrictions) were searched for studies conducted before February 2022. Only clinical studies, either randomized clinical trials (RCTs) or nonrandomized clinical trials (N-RCTs), comparing the clinical performance of polymer and metal frameworks were included. The risk of bias and certainty of the evidence were assessed with the RoB 2.0, ROBINS-I, and GRADE. Biologic (plaque and gingival indices, probing depth, bleeding scores, implant stability quotient, marginal bone loss) and mechanical outcomes (ridge base relation, prosthetic marginal gap, and fracture) were assessed.
RESULTS
Only 9 studies (7 RCTs and 2 N-RCTs) were included, all with moderate to serious risk of bias and low to very low certainty of evidence. No meta-analysis was possible, but qualitative analysis revealed lower plaque and gingival indices, probing depth, and marginal bone loss, with higher survival rates for implant-supported fixed prostheses and overdentures fabricated with PEEK than for metal frameworks. No significant differences were found between groups for removable partial dentures. The marginal fit of PEEK frameworks was also better for single crowns. Three fractures were reported in the 3 PEKK fixed dental prostheses with cantilevers.
CONCLUSIONS
PEEK and PEKK seem to be promising materials for dental prostheses, with acceptable response from the periodontal tissue. However, further well-designed studies are necessary to better understand their clinical and long-term limitations.
Topics: Humans; Benzophenones; Crowns; Polymers; Polyethylene Glycols; Dental Plaque; Dental Prosthesis, Implant-Supported; Dental Implants
PubMed: 35422333
DOI: 10.1016/j.prosdent.2022.03.002 -
The Journal of Clinical Pediatric... Mar 2023This paper systematically evaluate the effects of probiotics on preventing caries in preschool children. The present systematic review was conducted following the... (Meta-Analysis)
Meta-Analysis
This paper systematically evaluate the effects of probiotics on preventing caries in preschool children. The present systematic review was conducted following the Transparent Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines and recorded in the International prospective register of systematic reviews (PROSPERO) database (registration no: CRD42022325286). Literature were screened from PubMed, Embase, Web of Sciences, China National Knowledge Infrastructure (CNKI), Wanfang and other databases from inception to April 2022 to identify randomized controlled trials on the clinical efficacies of probiotics in preventing dental caries in preschool children and extract relevant data. The meta-analysis was performed using the RevMan5.4 software and the Stata16. Cochrane handbook was used to assess the risk of bias. The Grading of Recommendations Assessment, Development and Evaluation (GRADEprofiler 3.6) was used to determine the evidence quality. A total of 17 randomized controlled trials were eligible, of which two trials had certain levels of bias and 15 had a low risk of bias. Evidence quality assessment showed that the included trials were of medium quality. The meta-analysis results showed that was associated with a reduced incidence ( = 0.005) and progression ( < 0.001) of caries in preschool children. Probiotics could reduce the number of high-level Streptococcus mutans in saliva ( 0.00001) but could not reduce the number of Streptococcus mutans in dental plaque nor the amount of Lactobacillus in the saliva and dental plaque. Current evidence shows that probiotics could prevent caries in preschool children, but was more effective in preventing caries than others. Although probiotics could reduce high levels of Streptococcus mutans in saliva, they could not reduce the amount of Lactobacillus in saliva and dental plaque.
Topics: Humans; Child, Preschool; Dental Caries; Dental Plaque; Dental Caries Susceptibility; Streptococcus mutans; Lactobacillus; Probiotics
PubMed: 36890746
DOI: 10.22514/jocpd.2023.014 -
The International Journal of Oral &... 2019There is uncertainty in the literature on whether the presence of keratinized tissue (KT) ameliorates the state of peri-implant tissue health. A systematic review and... (Meta-Analysis)
Meta-Analysis
PURPOSE
There is uncertainty in the literature on whether the presence of keratinized tissue (KT) ameliorates the state of peri-implant tissue health. A systematic review and meta-analysis was performed to synthesize evidence on the association between peri-implant keratinization, defined as adequate (≥ 2 mm) or inadequate (0 to 2 mm), and peri-implant health and stability, measured as tissue inflammation, plaque accumulation, tendency to bleeding, and probing depth (PD).
MATERIALS AND METHODS
This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and was registered on PROSPERO. According to predefined inclusion criteria, full papers for potentially eligible studies resulted from electronic databases (PubMed, Cochrane, and OpenGrey) and screening of titles/abstracts. Publication bias and risk of bias in primary studies were assessed. The primary outcome was gingival inflammation, measured with Gingival Index (GI) and modified Gingival Index (mGI). Additional outcomes were plaque accumulation (mPI/PI), bleeding (bleeding on probing/modified Bleeding Index), and PD. For each outcome, a random-effects meta-analysis was performed comparing the adequate group (≥ 2 mm, KT1) and the inadequate group (< 2 mm, KT0) KT width. The mean number of implants and proportion of mandibular implants were investigated as potential causes of heterogeneity using meta-regression. Sensitivity analysis was performed excluding low-quality studies.
RESULTS
From 362 screened studies, a total of 15 papers were included in the systematic review, and 8 articles were finally included in the meta-analysis. Heterogeneity was found for all outcomes. The main analysis showed a statistically significant association between adequate KT level and a lower mGI-GI (standard mean difference [SMD] KT1 vs KT0 = -1.25, 95% CI = -2.12 to 0.37, P = .01). For plaque accumulation (SMD = -1.18, 95% CI = -2.36 to 0.00, P = .05), bleeding (SD = -1.99, 95% CI = -4.60 to 0.61, P = .13), and PD (MD = -0.06, 95% CI = -0.13 to 0.01, P = .10), no statistically significant difference was detected; however, the trend of results was in favor of the KT1 group. The sensitivity analysis supported the main analysis conclusions.
CONCLUSION
The importance of having an adequate KT width around implants was confirmed by this review; adequate KT was significantly associated with less peri-implant inflammation evaluated qualitatively with mGI/GI. No difference was found for plaque accumulation and bleeding, but a positive trend was found favoring implants with adequate KT.
Topics: Dental Implants; Dental Plaque; Dental Plaque Index; Gingivitis; Humans; Periodontal Index
PubMed: 31711074
DOI: 10.11607/jomi.7622 -
The Journal of Evidence-based Dental... Jun 2021This systematic review aimed to evaluate the efficacy of interproximal plaque scores and gingival inflammation reduction of different toothbrush bristle stiffness and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review aimed to evaluate the efficacy of interproximal plaque scores and gingival inflammation reduction of different toothbrush bristle stiffness and end-shape.
METHODS
Randomized clinical trials evaluating the effect of different toothbrushes on interproximal plaque/gingivitis reduction, with a minimum follow-up of 1 week. MEDLINE-PubMed, Scopus and Embase were searched. Soft tapered-tip bristle toothbrushes were compared to soft end-rounded, medium (any end-shape), or hard (any end-shape) bristle toothbrushes. Two meta-analyses were performed for plaque and gingivitis reduction. For plaque index (PI) and gingival index (GI), a standard mean difference (SMD) and mean difference between baseline and 4 weeks were calculated, respectively. In all analyses, random effect models were used.
RESULTS
Nine studies were included. All included studies demonstrated statistically significant improvement, in at least one parameter, in favor of the tapered-tip bristle toothbrush compared to the end-rounded bristle toothbrush. When analyzing toothbrush stiffness, medium and hard toothbrushes presented significantly higher improvement when compared to soft toothbrushes in all parameters. In the meta-analyses, groups that used soft tapered-tip bristle toothbrushes demonstrated significant greater reductions in PI (SMD -2.64; 95% CI: -4.26 - -1.01) and in GI (MD -0.14; 95% CI: -0.18 - -0.10) when compared to soft end-rounded bristle toothbrushes.
CONCLUSION
It is concluded that, when considering interproximal surfaces, better results may be expected for tapered-tip bristle toothbrushes when compared to end-rounded bristles toothbrushes. Additionally, better results may be expected in medium or hard toothbrushes, regardless of the bristle end-shape, in non-interproximal cleaners.
Topics: Dental Plaque; Dental Plaque Index; Gingivitis; Humans; Periodontal Index; Toothbrushing
PubMed: 34391550
DOI: 10.1016/j.jebdp.2021.101548 -
Microscopy Research and Technique Feb 2024The purpose of this systematic review of meta-analysis was to compare the effectiveness of removing the smearing layer using EDTA versus Chitosan (Ch) and Chitosan... (Meta-Analysis)
Meta-Analysis Review
The comparative of chitosan and chitosan nanoparticle versus ethylenediaminetetraacetic acid on the smear layer removal: A systematic review and meta-analysis of in vitro study.
The purpose of this systematic review of meta-analysis was to compare the effectiveness of removing the smearing layer using EDTA versus Chitosan (Ch) and Chitosan nanoparticles (Ch-NPs). A search was performed in four electronic databases (Web of Science, PubMed, Scopus, and Cochrane). The included studies were assessed by two reviewers using Joanna Briggs Institute's critical appraisal checklist for the quasi-experimental studies. Outcomes obtained by scanning electron microscopy (SEM) and conventional methods were presented as standardized mean differences alongside 95% confidence intervals. Seven investigations employed 212 single-root teeth. In the apical section (p = .317, 95% CI = -0.820 to 0.266, Tau = 0.387), middle segment (p = .914, 95% CI = -1.019 to 0.912, Tau = 1.027), and coronal segment (p = .277, 95% CI = -1.008 to 0.289, Tau = 0.378). This meta-analysis found no difference between Ch, Ch-NPs, and EDTA in removing the smear layer in the three segments. This systematic review is designed to show evidence related to the PICO question, in which our outcome is smear layer removal and not the clinical success of such a treatment. RESEARCH HIGHLIGHTS: The study aimed to compare the effectiveness of chitosan and chitosan nanoparticles with ethylenediaminetetraacetic acid (EDTA) in removing the smear layer, a layer of debris and organic material on the tooth surface, through a systematic review and meta-analysis. The removal of the smear layer is crucial for successful dental treatments, as it enhances the adhesion of restorative materials and improves the penetration of antimicrobial agents into dentinal tubules. The researchers conducted a systematic review and meta-analysis, searching various databases of electron microscopy results for relevant in vitro studies comparing the effects of chitosan or chitosan nanoparticles with EDTA on smear layer removal. The results encourage further exploration of chitosan and chitosan nanoparticles for clinical use in dentistry, while considering their specific applications and long-term effects.
Topics: Humans; Edetic Acid; Chitosan; Smear Layer; Root Canal Preparation; Sodium Hypochlorite; Root Canal Irrigants; Microscopy, Electron, Scanning; Dental Pulp Cavity
PubMed: 37732467
DOI: 10.1002/jemt.24423