-
Evidence-based Dentistry Sep 2022Introduction This systematic review and meta-analysis was conducted to analyse published literature related to clinical decisions made by practising... (Meta-Analysis)
Meta-Analysis Review
Introduction This systematic review and meta-analysis was conducted to analyse published literature related to clinical decisions made by practising orthodontists.Methods A modified approach for reporting items for systematic reviews and meta-analyses was adopted for this review. A total of 20 articles were identified containing 53 datasets related to clinical decisions, such as treatment needs, extractions, surgery, or specific approaches. Once the random effect models were prepared, meta-regression was utilised to study the distribution, prevalence and professional experience.Results In total, 25% variance was observed between orthodontists and 33% among orthodontists using identical records to make the same treatment decisions. It was also observed that raters were more in agreement on the presence of certain conditions rather than their absence. Orthodontic residents were found to be more consistent in their decision-making process when compared to students or orthodontists.Conclusion It was observed from the findings of this study that there was low consistency in the clinical decisions being made by orthodontists using common records. One of the reasons that could be responsible for this finding was the presence of established mental frameworks among orthodontists.
Topics: Humans; Orthodontists; Systematic Reviews as Topic
PubMed: 36151290
DOI: 10.1038/s41432-022-0807-0 -
The Cochrane Database of Systematic... May 2021Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current understanding of IPV as a profoundly gendered issue, perpetrated most often by men against women. IPV may result in substantial physical and mental health impacts for survivors. Women affected by IPV are more likely to have contact with healthcare providers (HCPs) (e.g. nurses, doctors, midwives), even though women often do not disclose the violence. Training HCPs on IPV, including how to respond to survivors of IPV, is an important intervention to improve HCPs' knowledge, attitudes and practice, and subsequently the care and health outcomes for IPV survivors.
OBJECTIVES
To assess the effectiveness of training programmes that seek to improve HCPs' identification of and response to IPV against women, compared to no intervention, wait-list, placebo or training as usual.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase and seven other databases up to June 2020. We also searched two clinical trials registries and relevant websites. In addition, we contacted primary authors of included studies to ask if they knew of any relevant studies not identified in the search. We evaluated the reference lists of all included studies and systematic reviews for inclusion. We applied no restrictions by search dates or language.
SELECTION CRITERIA
All randomised and quasi-randomised controlled trials comparing IPV training or educational programmes for HCPs compared with no training, wait-list, training as usual, placebo, or a sub-component of the intervention.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures outlined by Cochrane. Two review authors independently assessed studies for eligibility, undertook data extraction and assessed risks of bias. Where possible, we synthesised the effects of IPV training in a meta-analysis. Other analyses were synthesised in a narrative manner. We assessed evidence certainty using the GRADE approach.
MAIN RESULTS
We included 19 trials involving 1662 participants. Three-quarters of all studies were conducted in the USA, with single studies from Australia, Iran, Mexico, Turkey and the Netherlands. Twelve trials compared IPV training versus no training, and seven trials compared the effects of IPV training to training as usual or a sub-component of the intervention in the comparison group, or both. Study participants included 618 medical staff/students, 460 nurses/students, 348 dentists/students, 161 counsellors or psychologists/students, 70 midwives and 5 social workers. Studies were heterogeneous and varied across training content delivered, pedagogy and time to follow-up (immediately post training to 24 months). The risk of bias assessment highlighted unclear reporting across many areas of bias. The GRADE assessment of the studies found that the certainty of the evidence for the primary outcomes was low to very low, with studies often reporting on perceived or self-reported outcomes rather than actual HCPs' practices or outcomes for women. Eleven of the 19 included studies received some form of research grant funding to complete the research. Within 12 months post-intervention, the evidence suggests that compared to no intervention, wait-list or placebo, IPV training: · may improve HCPs' attitudes towards IPV survivors (standardised mean difference (SMD) 0.71, 95% CI 0.39 to 1.03; 8 studies, 641 participants; low-certainty evidence); · may have a large effect on HCPs' self-perceived readiness to respond to IPV survivors, although the evidence was uncertain (SMD 2.44, 95% CI 1.51 to 3.37; 6 studies, 487 participants; very low-certainty evidence); · may have a large effect on HCPs' knowledge of IPV, although the evidence was uncertain (SMD 6.56, 95% CI 2.49 to 10.63; 3 studies, 239 participants; very low-certainty evidence); · may make little to no difference to HCPs' referral practices of women to support agencies, although this is based on only one study (with 49 clinics) assessed to be very low certainty; · has an uncertain effect on HCPs' response behaviours (based on two studies of very low certainty), with one trial (with 27 participants) reporting that trained HCPs were more likely to successfully provide advice on safety planning during their interactions with standardised patients, and the other study (with 49 clinics) reporting no clear impact on safety planning practices; · may improve identification of IPV at six months post-training (RR 4.54, 95% CI 2.5 to 8.09) as in one study (with 54 participants), although three studies (with 48 participants) reported little to no effects of training on identification or documentation of IPV, or both. No studies assessed the impact of training HCPs on the mental health of women survivors of IPV compared to no intervention, wait-list or placebo. When IPV training was compared to training as usual or a sub-component of the intervention, or both, no clear effects were seen on HCPs' attitudes/beliefs, safety planning, and referral to services or mental health outcomes for women. Inconsistent results were seen for HCPs' readiness to respond (improvements in two out of three studies) and HCPs' IPV knowledge (improved in two out of four studies). One study found that IPV training improved HCPs' validation responses. No adverse IPV-related events were reported in any of the studies identified in this review.
AUTHORS' CONCLUSIONS
Overall, IPV training for HCPs may be effective for outcomes that are precursors to behaviour change. There is some, albeit weak evidence that IPV training may improve HCPs' attitudes towards IPV. Training may also improve IPV knowledge and HCPs' self-perceived readiness to respond to those affected by IPV, although we are not certain about this evidence. Although supportive evidence is weak and inconsistent, training may improve HCPs' actual responses, including the use of safety planning, identification and documentation of IPV in women's case histories. The sustained effect of training on these outcomes beyond 12 months is undetermined. Our confidence in these findings is reduced by the substantial level of heterogeneity across studies and the unclear risk of bias around randomisation and blinding of participants, as well as high risk of bias from attrition in many studies. Further research is needed that overcomes these limitations, as well as assesses the impacts of IPV training on HCPs' behavioral outcomes and the well-being of women survivors of IPV.
Topics: Adult; Bias; Dentists; Female; Health Personnel; Humans; Intimate Partner Violence; Medical Staff; Midwifery; Nursing Staff; Psychology; Randomized Controlled Trials as Topic; Social Workers; Students, Health Occupations
PubMed: 34057734
DOI: 10.1002/14651858.CD012423.pub2 -
Health Technology Assessment... Jun 2020Impacted third molars are third molars that are blocked, by soft tissue or bone, from fully erupting through the gum. This can cause pain and disease. The treatment...
BACKGROUND
Impacted third molars are third molars that are blocked, by soft tissue or bone, from fully erupting through the gum. This can cause pain and disease. The treatment options for people with impacted third molars are removal or retention with standard care. If there are pathological changes, the current National Institute for Health and Care Excellence guidance states that the impacted third molar should be removed.
OBJECTIVE
The objective of this study was to appraise the clinical effectiveness and cost-effectiveness of the prophylactic removal of impacted mandibular third molars compared with retention of, and standard care for, impacted third molars.
METHODS
Five electronic databases were searched (1999 to 29 April 2016) to identify relevant evidence [The Cochrane Library (searched 4 April 2016 and 29 April 2016), MEDLINE (searched 4 April 2016 and 29 April 2016), EMBASE (searched 4 April 2016 and 29 April 2016), EconLit (searched 4 April 2016 and 29 April 2016) and NHS Economic Evaluation Database (searched 4 April 2016)]. Studies that compared the prophylactic removal of impacted mandibular third molars with retention and standard care or studies that assessed the outcomes from either approach were included. The clinical outcomes considered were pathology associated with retention, post-operative complications following extraction and adverse effects of treatment. Cost-effectiveness outcomes included UK costs and health-related quality-of-life measures. In addition, the assessment group constructed a de novo economic model to compare the cost-effectiveness of a prophylactic removal strategy with that of retention and standard care.
RESULTS
The clinical review identified four cohort studies and nine systematic reviews. In the two studies that reported on surgical complications, no serious complications were reported. Pathological changes due to retention of asymptomatic impacted mandibular third molars were reported by three studies. In these studies, the extraction rate for retained impacted mandibular third molars varied from 5.5% to 31.4%; this variation can be explained by the differing follow-up periods (i.e. 1 and 5 years). The findings from this review are consistent with the findings from previous systematic reviews. Two published cost-effectiveness studies were identified. The authors of both studies concluded that, to their knowledge, there is currently no economic evidence to support the prophylactic removal of impacted mandibular third molars. The results generated by the assessment group's lifetime economic model indicated that the incremental cost-effectiveness ratio per quality-adjusted life-year gained for the comparison of a prophylactic removal strategy with a retention and standard care strategy is £11,741 for people aged 20 years with asymptomatic impacted mandibular third molars. The incremental cost per person associated with prophylactic extraction is £55.71, with an incremental quality-adjusted life-year gain of 0.005 per person. The base-case incremental cost-effectiveness ratio per quality-adjusted life-year gained was found to be robust when a range of sensitivity and scenario analyses were carried out.
LIMITATIONS
Limitations of the study included that no head-to-head trials comparing the effectiveness of prophylactic removal of impacted mandibular third molars with retention and standard care were identified with the assessment group model that was built on observational data. Utility data on impacted mandibular third molars and their symptoms are lacking.
CONCLUSIONS
The evidence comparing the prophylactic removal of impacted mandibular third molars with retention and standard care is very limited. However, the results from an exploratory assessment group model, which uses available evidence on symptom development and extraction rates of retained impacted mandibular third molars, suggest that prophylactic removal may be the more cost-effective strategy.
FUTURE WORK
Effectiveness evidence is lacking. Head-to-head trials comparing the prophylactic removal of trouble-free impacted mandibular third molars with retention and watchful waiting are required. If this is not possible, routine clinical data, using common definitions and outcome reporting methods, should be collected.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42016037776.
FUNDING
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 24, No. 30. See the NIHR Journals Library website for further project information.
Topics: Cost-Benefit Analysis; Humans; Molar, Third; Treatment Outcome; United Kingdom
PubMed: 32589125
DOI: 10.3310/hta24300 -
Journal of Oral Rehabilitation Oct 2023Tooth wear (TW) prevalence is high and increasing and has important consequences on the patient's quality of life. Knowledge of risk factors is crucial to promote... (Review)
Review
BACKGROUND
Tooth wear (TW) prevalence is high and increasing and has important consequences on the patient's quality of life. Knowledge of risk factors is crucial to promote diagnosis, prevention strategies and timely interceptive treatment. Many studies have identified TW risk factors.
OBJECTIVE
This scoping review aims to map and describe suspected available factors associated with TW in permanent dentition based on quantitative measurement.
METHODS
The scoping review was conducted using the PRISMA extension of the Scoping Reviews checklist. The search was conducted in October 2022 from the Medline® (PubMed® interface) and Scopus® databases. Two independent reviewers selected and characterised the studies.
RESULTS
2702 articles were identified for assessment of titles and abstracts, and 273 articles were included in the review. The results show a need to standardise TW measurement indices and the study design. The included studies highlighted various factors, classified into nine domains: sociodemographic factors, medical history, drinking habits, eating habits, oral hygiene habits, dental factors, bruxism and temporomandibular disorders, behavioural factors, and stress. Results related to chemical TW (erosion) risk factors underline the importance of eating disorders, gastroesophageal reflux and lifestyle, particularly drinking and eating behaviours, which supports developing public health information campaigns and interventions. Besides chemical, this review identifies evidence of several mechanical TW risk factors, such as toothbrushing and bruxism; the influence of this last factor needs to be further explored.
CONCLUSIONS
TW management and prevention require a multidisciplinary approach. Dentists are in the first line to detect associated diseases such as reflux or eating disorders. Consequently, practitioners' information and guideline diffusion should be promoted, and a TW risk factors checklist (the ToWeR checklist) is proposed to help diagnostic approaches.
Topics: Humans; Bruxism; Dentition, Permanent; Tooth Erosion; Quality of Life; Tooth Wear; Tooth Attrition; Risk Factors; Gastroesophageal Reflux
PubMed: 37147932
DOI: 10.1111/joor.13489 -
Journal of Dentistry Nov 2023To identify the prevalence of Awake Bruxism (AB). (Review)
Review
OBJECTIVES
To identify the prevalence of Awake Bruxism (AB).
SOURCES
The electronic search was done in Embase, PubMed/MEDLINE, LILACS, Livivo, Scopus, and Web of Science databases up to January 2nd, 2023. The search strategies combined terms such as "bruxism," "awake," and related terms when conducting searches in databases. Grey literature was consulted through Google Scholar, ProQuest, and OpenGrey.
STUDY SELECTION
Two independent reviewers participated in the study selection stages and included observational studies assessing the prevalence of AB, detected using reporting feedback (self or family report), clinical examination, and/or instrumental methods, regardless of the sex and age of the population.
DATA
Methodological quality was assessed using the Joanna Briggs Institute's checklist for prevalence studies. Ratio meta-analyses were performed using R Statistics software.
RESULTS
From a total of 3,083 studies identified by the searches on databases, 322 articles were reviewed the full-text and a total of 81 (quantitative synthesis) and 83 (narrative synthesis) studies were included. Only fifteen studies reached complete methodological quality. Two overall meta-analyses were performed, grouped based on convenience and population-based samples. The overall prevalence for possible AB was 32.08 % and 16.16 %, respectively. For the subgroup analyses, the prevalence rate showed a wide variation in different studied populations, approximately 14 %-32 % for women and 19 %-30 % for men, for population-based and convenience studies, respectively.
CONCLUSION
Possible AB prevalence was set from 16 % to 32 %. Studies with probable AB and definitive AB are still necessary.
CLINICAL SIGNIFICANCE
Studying the prevalence of waking bruxism is of interest to both dentists and patients. Knowing the probability of patients having awake bruxism allows the dentist to offer comprehensive preventive approaches to patients, avoiding deleterious consequences resulting from this condition. The present study reveals that the condition of bruxism during wakefulness is present in one out of every six adult patients studied. In pediatric patients, although this condition seems to be equally present, not enough studies were found to support this information for probable and definitive bruxism.
Topics: Male; Adult; Humans; Female; Child; Bruxism; Wakefulness; Prevalence
PubMed: 37739056
DOI: 10.1016/j.jdent.2023.104715 -
Journal of Clinical Medicine Jan 2023The aim of this study was o determine the relationship between sleep bruxism (SB) and sleep apnea-hypopnea syndrome (SAHS) at the pathophysiological level, the risk... (Review)
Review
The aim of this study was o determine the relationship between sleep bruxism (SB) and sleep apnea-hypopnea syndrome (SAHS) at the pathophysiological level, the risk factors, as well as the common signs and symptoms. A search was carried out using the databases PubMed, Web of Science, Scopus, and the Cochrane Library together with the Boolean equation "bruxism" AND "sleep apnea" AND "relation*"; the systematic search strategy limited the results to English language articles published from 2013 until December 2021. This review was conducted in accordance with the PRISMA statement. Nine articles were reviewed to relate SAHS and SB at different levels: two were systematic reviews (22%) and seven were research studies (78%). According to the literature reviewed, SB and SAHS occur simultaneously in 21.0% to 41.3% of cases. There are signs and symptoms that are common to both SAHS and SB. Rhythmic masticatory muscle activity (RMMA) precedes an SAHS event in 25% of subjects with SB, in contrast to 55% of the general population. SB and SAHS seem to have a certain concomitance, ranging between 20% and 40%, and they also share some risk factors such as advanced age, obesity, smoking, and alcohol consumption. Dentists should be aware of this relationship, as part of a multidisciplinary team, for early diagnosis.
PubMed: 36769558
DOI: 10.3390/jcm12030910 -
The Journal of Evidence-based Dental... Sep 2022Burnout syndrome has negative consequences on the dentist's health and performance during work. This systematic review aimed to assess the prevalence of Burnout syndrome... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Burnout syndrome has negative consequences on the dentist's health and performance during work. This systematic review aimed to assess the prevalence of Burnout syndrome in dentists.
METHODS
Searches were carried out in Medline, Scopus, Web of Science, PsycINFO, EMBASE, LILACS databases, and searches in the gray literature on January 27, 2021. There were no restrictions on language and search period. For the diagnosis of Burnout, only studies that used the Maslach burnout inventory questionnaire and its subscales emotional exhaustion (EE), depersonalization (DP), and reduced personal accomplishment (PA) were included. Proportion meta-analyses were performed using the Stata 13.0 software.
RESULTS
A total of 37 articles were included in the narrative and 31 in quantitative syntheses. The overall prevalence of Burnout syndrome in dentists was 13% (95% confidence interval [CI]: 0.006-0.21; I²: 97.07%) and the total prevalence in the subscales EE, DP, and PA, were, respectively: 28% (95% CI: 0.24-0.32; I²: 20.70%), 18% (95% CI: 0.08-0.28; I²: 85.61%) and 10% (95% CI: 0.08-0.13; I²: 0%). About the levels of Burnout syndrome in the subscales, 25% (95% CI: 0.19-0.31; I² 92.58%) presented high EE, 18% (95% CI: 0.10-0.26; I² 96.62%) high DP and 32% (95% 0.20-0.45; I² 97.86%) low PA. About continuous data, the mean of EE, DP and PA was respectively 17.90 (95% CI: 9.36-26.43; I² 94.8), 6.93 (95% CI: 3.41-10.45; I² 80.2) and, 34.69 (95% CI: 23.82-45.55; I² 98.8). No study presented all the positive criteria of the Joanna Briggs Institute Critical Appraisal checklist.
CONCLUSION
In conclusion, there was a considerable prevalence of burnout syndrome in dentists, mainly in the subscale of emotional exhaustion.
Topics: Burnout, Professional; Burnout, Psychological; Dentists; Humans; Prevalence; Surveys and Questionnaires
PubMed: 36162888
DOI: 10.1016/j.jebdp.2022.101724 -
Journal of Oral Rehabilitation May 2023It is important for dentists to know if the presence of snoring is associated with the presence of other dental sleep conditions (e.g. obstructive sleep apnea [OSA],... (Review)
Review
BACKGROUND
It is important for dentists to know if the presence of snoring is associated with the presence of other dental sleep conditions (e.g. obstructive sleep apnea [OSA], sleep bruxism [SB], gastroesophageal reflux disease [GERD], xerostomia and oro-facial pain). If so, dentists could play a significant role in the early recognition and management of these conditions.
OBJECTIVES
This systematic review aimed to: (i) investigate the associations between the presence of snoring and the presence of other dental sleep conditions; and (ii) determine if it is clinically relevant that dentists assess snoring in their population.
METHODS
The literature search was performed in PubMed and Embase.com in collaboration with a medical librarian. Studies were eligible if they employed regression models to assess whether snoring was associated with other dental sleep conditions, and/or investigated the incidence of snoring in patients with other dental sleep conditions and vice versa.
RESULTS
Of the 5299 retrieved references, 36 eligible studies were included. The available evidence indicates that the presence of snoring is associated with higher probabilities of OSA, GERD and headache. Due to limited evidence and conflicting findings, the currently available articles are not indicative of associations between the presence of snoring and the presence of SB and oral dryness.
CONCLUSION
Within the limitations of this study, it can be concluded that the presence of snoring is associated with higher probabilities of OSA, GERD and headache. Therefore, it is clinically relevant that dentists assess snoring in their patient population.
Topics: Humans; Snoring; Sleep; Sleep Apnea, Obstructive; Gastroesophageal Reflux; Sleep Bruxism; Headache; Sleep Wake Disorders; Xerostomia
PubMed: 36691754
DOI: 10.1111/joor.13422 -
Caries Research 2022Identification of the association between Early Childhood Caries (ECC) and Iron Deficiency Anaemia (IDA) will aid paediatricians and paediatric dentists to enhance... (Meta-Analysis)
Meta-Analysis
Identification of the association between Early Childhood Caries (ECC) and Iron Deficiency Anaemia (IDA) will aid paediatricians and paediatric dentists to enhance health promotion measures to reduce the related morbidity in children. This systematic review aims to determine an evidence-based association between ECC and IDA. A systematic search was carried out from MEDLINE via PubMed, EMBASE, LILACS, Cochrane Oral Health Group's Specialized Register, CINAHL via EBSCO, Web of Science, and Scopus up to May 2020. Hand searching and grey literature screening were also conducted. Cross-sectional, case-control, and cohort studies in English language which assessed the association was included. Two reviewers independently assessed the study quality and extracted the outcome data. A total of 1,434 studies were identified. Fourteen studies qualified for qualitative review and 7 of them for a meta-analysis. In comparison with children not affected by ECC, those affected had an increased likelihood of IDA (OR = 6.07 [3.61, 10.21]). The meta-analysis showed no statistical difference when comparing blood parameters (Hb, MCV, and serum ferritin) in children with and without ECC. This systematic review demonstrates an association between ECC and increased odds of IDA rather than it being the cause for IDA. Further longitudinal studies with robust methodology are required to determine an evidence-based association.
Topics: Anemia, Iron-Deficiency; Child; Child, Preschool; Cross-Sectional Studies; Dental Caries; Dental Caries Susceptibility; Humans; Iron Deficiencies
PubMed: 34749377
DOI: 10.1159/000520442 -
BMC Oral Health Sep 2023Tooth extraction is a common procedure performed by oral and maxillofacial surgeons or dentists, often resulting in dental fear and anxiety. The use of relaxing music,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Tooth extraction is a common procedure performed by oral and maxillofacial surgeons or dentists, often resulting in dental fear and anxiety. The use of relaxing music, audiovisuals, and virtual reality (VR) technologies has been employed to reduce dental anxiety. This network meta-analysis (NMA) aimed to assess the comparative effectiveness of relaxing music, audiovisuals, and VR in reducing dental anxiety associated with tooth extraction.
METHODS
Four electronic databases were searched up to March 8, 2023, to identify randomized controlled trials (RCTs) evaluating different multimedia interventions, including the application of using relaxing music, audiovisuals, and VR technologies for dental anxiety. Studies utilizing various anxiety scales for tooth extraction were considered eligible. The pooled standard mean difference (SMD) and 95% confidence interval (CI) of anxiety scale scores were analyzed using Bayesian NMA.
RESULTS
A total of 11 RCTs were included in this NMA. The Bayesian NMA results demonstrated that relaxing music (SMD = -0.64, 95% CI: -1.04, -0.25) and VR (SMD = -0.54, 95% CI: -1.08, -0.02) were associated with a reduction in dental anxiety, while audiovisuals (SMD = -0.34, 95% CI: -0.97, 0.33) required further consideration. Ranking probabilities indicated that relaxing music might be the most acceptable method for individuals with dental anxiety. The frequentist NMA yielded consistent rankings in a sensitivity analysis.
CONCLUSIONS
Relaxing music shows the greatest potential for reducing dental anxiety related to tooth extraction when compared to other multimedia interventions.
Topics: Humans; Dental Anxiety; Music; Music Therapy; Network Meta-Analysis; Tooth Extraction
PubMed: 37735362
DOI: 10.1186/s12903-023-03407-y