Applying basic math to periodontal decision-making.

Evidence-based dentistry involves making the best decision for patient care when presented with uncertainty and choice. Biostatistical tools help measure and analyze the level of uncertainty so that dentists can make confident clinical decisions concerning individual patient care. Biostatistical analysis complemented with the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) tool can assist clinicians in transferring evidence to clinical practice.

Not all Desensitizing Toothpastes Perform Equally Well.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Network Meta-Analysis on the Effect of Desensitizing Toothpastes on Dentine Hypersensitivity. Hu ML, Zheng G, Lin H, Yang M, Zhang YD, Han JM. J Dent 2019;88:103170. SOURCE OF FUNDING: National Natural Science Foundation of China (81771119). TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Managing post endodontic treatment pain by eliminating occlusal contacts.

Data sources Forty-four adult patients (32 female : 12 males) with irreversible pulpitis with periapical periodontitis on a mandibular posterior tooth, who were undergoing a two-visit endodontic treatment protocol, were randomly divided into two groups. The intervention group (n = 22) had occlusal surface reduced on the treated tooth and a control group (n = 22) did not.Data The primary outcome was pain intensity after endodontic treament, which was measured on a visual-analogue-scale (VAS). This was measured 6, 12, 24 and 48 hours after the first visit, and 6, then 12 hours after the second visit.The study also investigated the proportion of patients who took post-operative analgesic tablets.Results Pain intensity 12 hours after the first and second visits were statistically significantly lower in the intervention group compared to the control group. The proportion of patients who recorded taking analgesics was not significantly different between the two groups.Conclusions Occlusal reduction seems to reduce levels of post root- treatment pain in posterior mandibular teeth 12 hours postopertively, but otherwise makes little difference.

Cold pulp testing is the simplest and most accurate of all dental pulp sensibility tests.

Data sources PubMed, Scopus and Web of Science.Study selection Cohort (retrospective and prospective) and cross-sectional clinical studies investigating the diagnostic accuracy of the cold pulp test (CPT), heat pulp test (HPT), electric pulp test (EPT), laser Doppler flowmetry (LDF) and pulp oximeter (PO). Pulpal diagnosis was confirmed by histological analysis, direct clinical observations (access cavity) or evidence of root canal filling (to confirm nonvital teeth).Data extraction and synthesis The diagnostic test's sensitivity (Sn), specificity (Sp), accuracy, positive predictive value (PPV) and negative predictive value (NPV) were extracted or calculated from the raw data of each included study. The test's outcomes were binary. A true positive (TP) was considered to have occurred when the diagnostic instrument correctly tested positive for a non-vital pulp and true negative (TN) when it correctly tested negative for a vital pulp based on a standard reference test. A false positive (FP) and false negative (FN) occurred when the test incorrectly tested positive on a vital pulp and incorrectly tested negative on a non-vital pulp, respectively. Accuracy, PPV and NPV were adjusted (Adj.Accuracy, Adj.PPV and Adj.NPV respectively) based on a standardised total disease (non-vital pulps) prevalence (Prev.) of 42.8%. Pool estimates for all five dental pulp vitality diagnostic variables (Sn, Sp, Adj.Accuracy, Adj.PPV and Adj.NPV) were generated with a meta-analysis using a random effects model. Included studies were assessed as either high, moderate or low quality based on the Quality Assessment of Diagnostic Accuracy Studies tool.Results Twenty-eight studies met the inclusion criteria. The pooled Sn, Sp, Adj.Accuracy, Adj.PPV and Adj.NPV for each test are given in the Table 1. Heterogeneity between studies was significant for CPT, HPT and EPT; it was mild to moderate for LDF and PO. All but three studies were determined to be of low quality, with only one assessed as high quality.Conclusions The most accurate dental pulp tests are the LDF and PO, with the HPT least accurate. CPT has generally high diagnostic accuracy and can be considered the primary pulp testing method in clinical practice.

Simple Approaches for Establishing an Evidence-Based Dental Practice.

Constructing an evidence-based dental practice requires leadership, commitment, technology support, and time, as well as skill practice in searching, appraising, and organizing evidence. In mastering the skills of evidence-based dentistry, clinicians can implement high-quality science into practice through a variety of opportunities including the development of clinical care guidelines, procedural technique protocols, and electronic dental record auto-note templates, as well as treatment planning, care prioritization, and case presentation. The benefits of building an evidence-based dental practice are many, including improvements in patient care and satisfaction, increased treatment predictability and confidence in care approaches, as well as potential cost savings.

Impact of Evidence-Based Dentistry Workshops on Educators' Use of Evidence in Teaching and Practice: A Pilot Study.

The aims of this pilot study were to evaluate the short-term impact of evidence-based dentistry (EBD) workshops on educators' use of clinical evidence in their clinical practice and educational activities and to identify barriers they encountered in implementing evidence in their teaching and clinical practice. Between April 2012 and January 2014, a series of EBD workshops was delivered to 31 dental faculty members and postdoctoral students at three Canadian dental schools. Survey I, assessing participants' perceptions of various aspects of the workshops, was administered immediately following the workshops. Survey II, evaluating the impact of the workshops on participants' EBD implementation, was conducted 10 to 31 months after their completion. Survey I was completed by all 31 participants (100% response rate); their mean scores ranged from 3.94 to 4.65 on a five-point scale. Survey II was completed by 20 participants (64.5% response rate; five postdoctoral students and 15 faculty members), using an online 20-item questionnaire. Of the respondents, 19 (95%) reported implementing EBD in their professional activities at that time, and 14 (70%) stated that the workshops had positively helped with EBD implementation. Eight respondents (40%) reported having experienced barriers to EBD implementation, while 15 (75%) reported that their patients/students welcomed use of EBD. The respondents reported believing that strategies such as increasing EBD education and dissemination and improving quality and accessibility of evidence would facilitate the transition to EBD practice. Reported barriers to EBD implementation included resistance and criticism from colleagues, difficulty in changing current practice model, and lack of time.

Laser Therapy has Minimal Clinical Efficacy at Reducing Postsurgical Complications After the Removal of Impacted Mandibular Third Molars.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Efficacy of adjuvant laser therapy in reducing postsurgical complications after the removal of impacted mandibular third molars: A systematic review update and meta-analysis. Dawdy J, Halladay J, Carrasco-Labra A, Araya I, Yanine N, Brignardello-Petersen R. J Am Dent Assoc 2017;148(12):887-902.e884. SOURCE OF FUNDING: None of the authors reported any disclosures TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Caries risk and number of restored surfaces have impact on the survival of posterior composite restorations.

DATA SOURCES: Cochrane Library, PubMed, the Web of Science (ISI) and Scopus. STUDY SELECTION: Longitudinal studies of direct class II or classes I and II restorations in permanent dentition of at least five years duration, a minimum of 20 restorations at final recall and the original datasets available were considered. Only English language studies were included. Two reviewers screened titles independently. DATA EXTRACTION AND SYNTHESIS: Multivariate Cox regression method to analyse the variables of interest and hazard ratios with respective 95% confidence intervals were determined. The annual failure rate (AFR) of the investigated restorations and subgroups was calculated. RESULTS: Twelve studies, nine prospective and three retrospective were included. A total of 2,816 restorations (2,585 Class II and 231 Class I restorations) were included in the analysis. Five hundred and sixty-nine restorations failed during the observation period, and the main reasons for failure were caries and fracture. Regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces. The overall annual failure rate at five years and ten years was 1.8% and 2.4% respectively. The rates were higher in high-caries-rate individuals at 3.2% and 4.6% respectively. CONCLUSIONS: The conclusion of the present meta-analysis of 12 clinical studies based on raw data is that caries risk and number of restored surfaces play a significant role in restoration survival, and that, on average, posterior resin composite restorations show a good survival, with annual failure rates of 1.8% at five years and 2.4% after ten years of service.

Defective amalgam restorations--repair or replace?

DATA SOURCES: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, BIOSIS via Web of Knowledge, Web of Science and Opengrey databases were searched. In addition researchers and experts in the field were contacted to trace unpublished or ongoing studies. No restrictions were placed on the language or date of publication. STUDY SELECTION: Randomised controlled trials (including split-mouth studies), involving replacement and repair of amalgam restorations in adults with a defective molar restoration in permanent molar or premolar teeth were to be considered. DATA EXTRACTION AND SYNTHESIS: Two review authors independently assessed titles and abstracts for each article identified by the searches in order to decide whether the article was likely to be relevant. Full papers were obtained for relevant articles and both review authors studied these. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis. RESULTS: The search strategy retrieved 201 potentially eligible studies after de-duplication. After examination of the titles and abstracts, full texts of the relevant studies were retrieved but none of these met the inclusion criteria of the review. CONCLUSIONS: There are no published randomised controlled trials relevant to this review question. There is therefore a need for methodologically sound randomised controlled trials that are reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement (www.consort-statement.org/). Further research also needs to explore qualitatively the views of patients on repairing versus replacement and investigate themes around pain, distress and anxiety, time and costs.