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Caries Research 2010Our purpose was to systematically review the literature on the effectiveness of chlorhexidine varnish for preventing dental caries in children and adolescents and to... (Review)
Review
AIMS
Our purpose was to systematically review the literature on the effectiveness of chlorhexidine varnish for preventing dental caries in children and adolescents and to determine its effectiveness compared to fluoride varnish.
METHODS
MEDLINE, EMBASE and the Cochrane Library were searched through December 2009 to identify relevant randomised trials with blind outcome assessment and a minimum duration of 1 year. The search was later updated in MEDLINE and the Cochrane Library to March 19th, 2010. Risk of bias of the included trials was assessed. The primary outcome was the caries increment.
RESULTS
Twelve trials met the inclusion criteria for the review. There was considerable variation between trials in the concentration and frequency of application of the chlorhexidine varnish, in baseline caries levels and in background exposure to fluoride. Six parallel-group trials reported no statistically significant difference in caries increment in permanent teeth with the application of chlorhexidine varnish compared to placebo or no treatment. The results of 4 split-mouth trials were conflicting: 2 trials found no significant difference in caries increment and 2 reported statistically significant results in favour of chlorhexidine varnish. One trial of the effect of chlorhexidine varnish in primary teeth demonstrated a statistically significant reduction in caries increment. The results of 1 trial comparing chlorhexidine varnish with fluoride varnish for preventing caries in adolescents were equivocal.
CONCLUSION
Evidence regarding the effectiveness of chlorhexidine varnish for preventing caries is inconclusive. Further well-conducted randomised trials are required before chlorhexidine varnish can be recommended for caries prevention.
Topics: Administration, Topical; Adolescent; Anti-Infective Agents, Local; Cariostatic Agents; Child; Child, Preschool; Chlorhexidine; Dental Care for Children; Dental Caries; Humans; Outcome Assessment, Health Care; Pit and Fissure Sealants
PubMed: 20606432
DOI: 10.1159/000315346 -
Journal of Oral Science Sep 2009The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement (GIC) in relation to resin-based... (Meta-Analysis)
Meta-Analysis Review
The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement (GIC) in relation to resin-based fissure sealants. Nine English and two Portuguese databases were searched (15 January 2008). Randomized clinical trials and systematic reviews were considered for inclusion. Trial exclusion criteria were: drop-out rates > 33%; no randomization; baseline differences in groups not statistically adjusted; and no clinically important outcomes were presented. Two authors reviewed the articles independently. The outcome measure for the caries preventive effect was caries absence on sealed teeth. Of the 112 identified articles, 25 were selected for review. Of these, 14 were excluded and 11 accepted (8 trials; 3 systematic reviews). The accepted reviews provided no evidence of superiority of either sealant material. Six trials were included for meta-analysis. The pooled odds ratio was 0.96, 95% CI 0.62-1.49, indicating no difference in the caries-preventive effect of GIC and resin-based fissure sealant material. This systematic review with meta-analysis found no evidence that either material was superior to the other in the prevention of dental caries. Thus, both materials appear equally suitable for clinical application as a fissure sealant material.
Topics: Dental Caries; Glass Ionomer Cements; Humans; Pit and Fissure Sealants; Resin Cements
PubMed: 19776504
DOI: 10.2334/josnusd.51.373 -
Journal (Canadian Dental Association) Mar 2008Recently, there has been increased interest in the in vivo release of dental sealant components, such as bisphenol A (BPA), which has the potential to bind the estrogen... (Review)
Review
BACKGROUND
Recently, there has been increased interest in the in vivo release of dental sealant components, such as bisphenol A (BPA), which has the potential to bind the estrogen receptors of relevant cells at subtoxic concentrations in vitro, impairing the development, health and reproductive systems of wildlife. The purpose of this systematic review was to investigate whether the placement of pit and fissure sealant materials causes toxicity, and thus harms patients.
METHODS
The literature search (from the earliest record up to March 2007) for relevant articles was done with Ovid MEDLINE, CINAHL and other bibliographic databases.
RESULTS
A total of 377 articles were identified by the literature search; relevance was determined by examining the title and abstract of the articles. Eleven original studies met the inclusion criteria. These articles were read in full and scored independently by 2 reviewers.
RECOMMENDATIONS
The evidence suggests that patients are not at risk for exposure to BPA from the use of dental sealants. To reduce the potential, if any, for BPA toxicity from sealants, dental providers should use a mild abrasive, such as pumice, either on a cotton applicator or in a prophy cup; have older children and adolescents gargle with tepid water for 30 seconds; or wash the sealant surface for 30 seconds with an air-water syringe while suctioning fluids and debris from a child"s mouth.
Topics: Adolescent; Adult; Benzhydryl Compounds; Bisphenol A-Glycidyl Methacrylate; Child; Estrogens, Non-Steroidal; Humans; Phenols; Pit and Fissure Sealants; Silicates; Surface Properties
PubMed: 18353205
DOI: No ID Found -
Journal (Canadian Dental Association) Mar 2008To investigate the evidence for sealants as a means to prevent caries in children and adolescents and, in the presence of suitable supporting evidence, to develop a... (Review)
Review
OBJECTIVES
To investigate the evidence for sealants as a means to prevent caries in children and adolescents and, in the presence of suitable supporting evidence, to develop a protocol for the application of sealants.
METHODS
Previous systematic reviews on this topic were used as the basis for the current review. Ovid MEDLINE, CINAHL and several other relevant bibliographic databases were searched for English-language articles, with human subjects, published from 2000 to 2007.
RESULTS
A total of 303 articles were identified by the literature search; relevance was determined by examining the title and abstract of the articles. Thirty-eight original research studies met the inclusion criteria. These articles were read in full and scored independently by 2 reviewers, and evidence was extracted for development of recommendations.
RECOMMENDATIONS
The following recommendations are based on the evidence gathered in this review: 1. Sealants should be placed on all permanent teeth without cavitation (i.e., teeth that are free of caries, teeth that have deep pit and fissure morphology, teeth with "sticky" fissures or teeth with stained grooves) as soon after eruption as isolation can be achieved. 2. Sealants should not be placed on partially erupted teeth or teeth with cavitation or caries of the dentin. 3. Sealants should be placed on the primary molars of children who are susceptible to caries (i.e., those with a history of caries). 4. Sealants should be placed on first and second molars within 4 years after eruption. 5. Resin-based sealants should be preferred, until such time as glass ionomer cements with better retention capacity are developed. 6. Sealants should be placed as part of an overall prevention strategy based on assessment of caries risk.
Topics: Adolescent; Child; Composite Resins; Cost-Benefit Analysis; DMF Index; Dental Caries; Dental Caries Susceptibility; Glass Ionomer Cements; Humans; Pit and Fissure Sealants; Practice Guidelines as Topic; Vulnerable Populations
PubMed: 18353204
DOI: No ID Found -
Health Technology Assessment... May 2006To assess the effectiveness and cost-effectiveness of HealOzone (CurOzone USA Inc., Ontario, Canada) for the management of pit and fissure caries, and root caries. The... (Review)
Review
OBJECTIVES
To assess the effectiveness and cost-effectiveness of HealOzone (CurOzone USA Inc., Ontario, Canada) for the management of pit and fissure caries, and root caries. The complete HealOzone procedure involves the direct application of ozone gas to the caries lesion on the tooth surface, the use of a remineralising solution immediately after application of ozone and the supply of a 'patient kit', which consists of toothpaste, oral rinse and oral spray all containing fluoride.
DATA SOURCES
Electronic databases up to May 2004 (except Conference Papers Index, which were searched up to May 2002).
REVIEW METHODS
A systematic review of the effectiveness of HealOzone for the management of tooth decay was carried out. A systematic review of existing economic evaluations of ozone for dental caries was also planned but no suitable studies were identified. The economic evaluation included in the industry submission was critically appraised and summarised. A Markov model was constructed to explore possible cost-effectiveness aspects of HealOzone in addition to current management of dental caries.
RESULTS
Five full-text reports and five studies published as abstracts met the inclusion criteria. The five full-text reports consisted of two randomised controlled trials (RCTs) assessing the use of HealOzone for the management of primary root caries and two doctoral theses of three unpublished randomised trials assessing the use of HealOzone for the management of occlusal caries. Of the abstracts, four assessed the effects of HealOzone for the management of occlusal caries and one the effects of HealOzone for the management of root caries. Overall, the quality of the studies was modest, with many important methodological aspects not reported (e.g. concealment of allocation, blinding procedures, compliance of patients with home treatment). In particular, there were some concerns about the choice of statistical analyses. In most of the full-text studies analyses were undertaken at lesion level, ignoring the clustering of lesions within patients. The nature of the methodological concerns was sufficient to raise doubts about the validity of the included studies' findings. A quantitative synthesis of results was deemed inappropriate. On the whole, there is not enough evidence from published RCTs on which to judge the effectiveness of ozone for the management of both occlusal and root caries. The perspective adopted for the study was that of the NHS and Personal Social Services. The analysis, carried out over a 5-year period, indicated that treatment using current management plus HealOzone cost more than current management alone for non-cavitated pit and fissure caries (40.49 pounds versus 24.78 pounds), but cost less for non-cavitated root caries ( 14.63 pounds versus 21.45 pounds). Given the limitations of the calculations these figures should be regarded as illustrative, not definitive. It was not possible to measure health benefits in terms of quality-adjusted life-years, due to uncertainties around the evidence of clinical effectiveness, and to the fact that the adverse events avoided are transient (e.g. pain from injection of local anaesthetic, fear of the drill). One-way sensitivity analysis was applied to the model. However, owing to the limitations of the economic analysis, this should be regarded as merely speculative. For non-cavitated pit and fissure caries, the HealOzone option was always more expensive than current management when the probability of cure using the HealOzone option was 70% or lower. For non-cavitated root caries the costs of the HealOzone comparator were lower than those of current management only when cure rates from HealOzone were at least 80%. The costs of current management were higher than those of the HealOzone option when the cure rate for current management was 40% or lower. One-way sensitivity analysis was also performed using similar NHS Statement of Dental Remuneration codes to those that are used in the industry submission. This did not alter the results for non-cavitated pit fissure caries as the discounted net present value of current management remained lower than that of the HealOzone comparator ( 22.65 pounds versus 33.39 pounds).
CONCLUSIONS
Any treatment that preserves teeth and avoids fillings is welcome. However, the current evidence base for HealOzone is insufficient to conclude that it is a cost-effective addition to the management and treatment of occlusal and root caries. To make a decision on whether HealOzone is a cost-effective alternative to current preventive methods for the management of dental caries, further research into its clinical effectiveness is required. Independent RCTs of the effectiveness and cost-effectiveness of HealOzone for the management of occlusal caries and root caries need to be properly conducted with adequate design, outcome measures and methods for statistical analyses.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Cost-Benefit Analysis; Dental Caries; Female; Health Surveys; Humans; Male; Middle Aged; Ozone; Randomized Controlled Trials as Topic; Root Caries; State Medicine; Treatment Outcome; United Kingdom
PubMed: 16707073
DOI: 10.3310/hta10160