Effects of non-pharmacological and non-surgical interventions on health outcomes in systemic sclerosis: protocol for a living systematic review.

INTRODUCTION: Systemic sclerosis (SSc; scleroderma) is a rare, chronic, autoimmune disease with a high level of burden, a significant impact on the ability to carry out daily activities, and a considerable negative impact on health-related quality of life. Non-pharmacological interventions could be provided to potentially improve mental and physical health outcomes. However, the effectiveness of non-pharmacological interventions on health and well-being among individuals with SSc has not been well established. The proposed living systematic review aims to identify and evaluate randomised controlled trial (RCT) evidence on the effectiveness of non-pharmacological and non-surgical interventions on mental and physical health outcomes and on the delivery of such services in SSc. METHODS AND ANALYSIS: Eligible studies will be RCTs that examine non-pharmacological and non-surgical interventions aimed at improving health outcomes among individuals with SSc or the delivery of services intended to improve healthcare or support of people with SSc (eg, support groups). All RCTs included in a previous systematic review that sought studies published between 1990 and March 2014 will be evaluated for inclusion. Additional trials will be sought from January 2014 onwards using a similar, augmented search strategy developed by a health sciences librarian. We will search the MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library and Web of Science databases and will not restrict by language. Two independent reviewers will determine the eligibility of identified RCTs and will extract data using a prespecified standardised form in DistillerSR. Meta-analyses will be considered if ≥2 eligible RCTs report similar non-pharmacological interventions and comparable health outcomes. We will conduct a qualitative synthesis for interventions that cannot be synthesised via meta-analysis. ETHICS AND DISSEMINATION: We will post initial and ongoing results via a website, publish results periodically via peer-reviewed journal publication, and present results at patient-oriented events. PROSPERO REGISTRATION NUMBER: CRD42020219914.

CBCT is valuable for diagnosis of tooth fracture.

DATA SOURCES: PubMed, Embase, Web of Science, ProQuest Dissertations & Theses, CNKI and SIGLE databases. STUDY SELECTION: Two reviewers independently selected studies. Studies examining the diagnostic accuracy of CBCT for tooth fractures in vivo were considered. Only studies with a minimum of ten participants using a reference test of surgical exploration or extractions to establish the diagnosis of tooth fractures were included. DATA EXTRACTION AND SYNTHESIS: Data abstraction was carried out independently by two reviewers and study quality assessed using the Quality Assessment of Studies of Diagnostic Accuracy-2 (QUADAS-2) tool. The main study outcomes were sensitivity, specificity, positive likelihood ratio (LR), negative LR and summary receiver operating characteristic (SROC). RESULTS: Twelve studies were included in a meta-analysis. The pooled sensitivity was 0.92 (95% CI=0.89-0.94) and pooled specificity 0.85 (95% CI=0.75-0.92). The pooled positive and negative likelihood ratios were 5.68 (95% CI=3.42-9.45) and 0.13 (95% CI=0.09-0.18) respectively. The summary receiver operating characteristic was 0.94 (95% CI=0.90-0.98). The pooled prevalence of tooth fractures in patients with clinically suspected but periapical-radiography-undetected tooth fractures was 91% (95% CI = 83%-97%). Positive and negative predictive values were 0.98 and 0.43 (subgroup analysis: 0.98 and 0.28 for endodontically treated teeth; 0.99 and 0.77 for non endodontically treated teeth). CONCLUSIONS: We suggest that CBCT has a high diagnostic accuracy for tooth fractures and could be used in clinical settings. We can be very confident with positive test results but should be very cautious with negative test results. For patients with negative results, close follow-ups are recommended. The diagnostic accuracy of CBCT is similar among different types of tooth fractures, which should be interpreted with caution due to unavailability of data for subgroup analysis on horizontal and oblique tooth fractures.

Scleroderma and dentistry: every dentist is a scleroderma specialist.

Scleroderma is an autoimmune, rheumatoid factor-positive disease that may be localized or systemic, affecting the skin, lungs, kidneys, and cardiovascular system. Dental effects include xerostomia, microstomia, idiopathic resorption of tooth and bone, oral effects of medications, erosion and decay caused by gastroesophageal reflux disease (GERD), and poor oral hygiene due to physical and emotional effects of the disease. All dentists have the knowledge and ability to treat those suffering with scleroderma.