High certainty evidence is stable and trustworthy, whereas evidence of moderate or lower certainty may be equally prone to being unstable.

OBJECTIVES: To assess to what extent the overall quality of evidence indicates changes to observe intervention effect estimates when new data become available. METHODS: We conducted a meta-epidemiological study. We obtained evidence from meta-analyses of randomized trials of Cochrane reviews addressing the same health-care question that was updated with inclusion of additional data between January 2016 and May 2021. We extracted the reported effect estimates with 95% confidence intervals (CIs) from meta-analyses and corresponding GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessments of any intervention comparison for the primary outcome in the first and the last updated review version. We considered the reported overall quality (certainty) of evidence (CoE) and specific evidence limitations (no, serious or very serious for risk of bias, imprecision, inconsistency, and/or indirectness). We assessed the change in pooled effect estimates between the original and updated evidence using the ratio of odds ratio (ROR), absolute ratio of odds ratio (aROR), ratio of standard errors (RoSE), direction of effects, and level of statistical significance. RESULTS: High CoE without limitations characterized 19.3% (n = 29) out of 150 included original Cochrane reviews. The update with additional data did not systematically change the effect estimates (mean ROR 1.00; 95% CI 0.99-1.02), which deviated 1.06-fold from the older estimates (median aROR; interquartile range [IQR]: 1.01-1.15), gained precision (median RoSE 0.87; IQR 0.76-1.00), and maintained the same direction with the same level of statistical significance in 93% (27 of 29) of cases. Lower CoE with limitations characterized 121 original reviews and graded as moderate CoE in 30.0% (45 of 150), low CoE in 32.0% (48 of 150), and very low CoE in 18.7% (28 of 150) reviews. Their update had larger absolute deviations (median aROR 1.12 to 1.33) and larger gains in precision (median RoSE 0.78-0.86) without clear and consistent differences between these categories of CoE. Changes in effect direction or statistical significance were also more common in the lower quality evidence, again with a similar extent across categories (without change in 75.6%, 64.6%, and 75.0% for moderate, low, very low CoE). As limitations increased, effect estimates deviated more (aROR 1.05 with zero, 1.11 with one, 1.25 with two, 1.24 with three limitations) and changes in direction or significance became more frequent (93.2% stable with no limitations, 74.5% with one, 68.2% with two, and 61.5% with three limitations). CONCLUSION: High-quality evidence without methodological deficiencies is trustworthy and stable, providing reliable intervention effect estimates when updated with new data. Evidence of moderate and lower quality may be equally prone to being unstable and cannot indicate if available effect estimates are true, exaggerated, or underestimated.

How different attributes are weighted in professionals' decision-making in Pediatric Dentistry-a protocol for guiding discrete choice experiment focused on shortening the evidence-based practice implementation for dental care.

BACKGROUND: Important evidence has been constantly produced and needs to be converted into practice. Professional consumption of such evidence may be a barrier to its implementation. Then, effective implementation of evidence-based interventions in clinical practice leans on the understanding of how professionals value attributes when choosing between options for dental care, permitting to guide this implementation process by maximizing strengthens and minimizing barriers related to that. METHODS: This is part of a broader project investigating the potential of incorporating scientific evidence into clinical practice and public policy recommendations and guidelines, identifying strengths and barriers in such an implementation process. The present research protocol comprises a Discrete Choice Experiment (DCE) from the Brazilian oral health professionals' perspective, aiming to assess how different factors are associated with professional decision-making in dental care, including the role of scientific evidence. Different choice sets will be developed, either focusing on understanding the role of scientific evidence in the professional decision-making process or on understanding specific attributes associated with different interventions recently tested in randomized clinical trials and available as newly produced scientific evidence to be used in clinical practice. DISCUSSION: Translating research into practice usually requires time and effort. Shortening this process may be useful for faster incorporation into clinical practice and beneficial to the population. Understanding the context and professionals' decision-making preferences is crucial to designing more effective implementation and/or educational initiatives. Ultimately, we expect to design an efficient implementation strategy that overcomes threats and potential opportunities identified during the DCEs, creating a customized structure for dental professionals. TRIAL REGISTRATION: https://osf.io/bhncv .

Risk of bias and methodological critical appraisal in systematic reviews of non- and micro-invasive caries management for primary and permanent teeth.

INTRODUCTION: Paediatric dentistry should rely on evidence-based clinical decisions supported by high-quality, unbiased systematic reviews (SRs). Therefore, the purpose of this study was to systematically evaluate the methodological quality and risk of bias of SRs focused on non- and micro-invasive treatment for caries lesions in primary and permanent teeth. METHODS: A comprehensive search was conducted in multiple databases, including MEDLINE/PubMed, Scopus, Web of Science, EMBASE, Epistemonikos, and ProQuest, up to March 2023 to identify relevant systematic reviews (SRs) focused on non- and micro-invasive caries treatment. Two independent reviewers extracted data from the included SRs and assessed the methodological quality and risk of bias using the AMSTAR 2 and ROBIS tools, respectively. RESULTS: A total of 39 SRs were included in the analysis. Among these, 27 SRs (69.2%) were assessed as having critically low methodological quality, 11 SRs (28.2%) were considered to have low methodological quality and only one SR was rated as high-quality. The primary concern identified was the absence of protocol registration before the commencing the study, observed in 33 SR when using the AMSTAR 2 tool. According to the ROBIS tool, 21 studies (53.8%) were categorised as low risk of bias, 10 (25.6%) as high risk and eight (20.5%) as unclear risk of bias. CONCLUSION: Our analysis revealed that SRs focused on non- and micro-invasive treatment for caries in children and adolescents had critically low methodological quality according to the AMSTAR 2 tool but demonstrated a low risk of bias based on the ROBIS tool. These findings highlight the importance of emphasizing prospective protocol registration, clear reporting of statistical analyses, and addressing potential bias implications within this topic. By addressing these issues, we can enhance the quality of SRs and ensure that clinical decisions rely on unbiased and trustworthy evidence. Registry DOI: 10.17605/OSF.IO/AR4MS.

Health professionals' recommendations on the use of fluoride varnish for caries prevention in preschool children.

BACKGROUND: Fluoride varnish (FV) is widely recommended for caries prevention in preschool children, despite its anticaries benefits being uncertain and modest. Dentists often report using clinical practice guidelines (CPGs) as a source of scientific information. AIM: To identify and analyze recommendations for clinical practice on the use of FV for caries prevention in preschool children and to assess the methodological quality of the CPG on this topic. DESIGN: Two researchers independently used 12 search strategies and searched the first five pages of Google Search™ and three guideline databases for recommendations freely available to health professionals on the use of FV for caries prevention in preschoolers. Then, they retrieved and recorded recommendations that met the eligibility criteria and extracted the data. A third researcher resolved disagreements. Each included CPG was appraised using the AGREE II instrument. RESULTS: Twenty-nine documents were included. Recommendations varied according to age, patients' caries risk, and application frequency. Of the six CPGs, only one scored above 70% in the AGREE II overall assessment. CONCLUSION: Recommendations on the use of FV lacked scientific evidence, and CPGs were of poor quality. Application of FV is widely recommended despite recent evidence showing an uncertain, modest, and possibly not clinically relevant anticaries benefit. Dentists should be aware that it is necessary to critically appraise CPGs since they may be of poor quality.

Economic evaluation of fluoride varnish application in preschoolers: A systematic review.

BACKGROUND: Fluoride varnish (FV) is a convenient way of professionally applying fluoride in preschoolers. However, its modest anticaries effect highlights the need for economic evaluations. AIM: To assess economic evaluations reporting applications of FV to reduce caries incidence in preschoolers. DESIGN: We included full economic evaluations with preschool participants, in which the intervention was FV and the outcome was related to dentin caries. We searched in CENTRAL; MEDLINE via PubMed; WEB OF SCIENCE; EMBASE; SCOPUS; LILACS; BBO; and BVS Economia em saúde, OpenGrey, and EconoLit. Clinical trial registers, thesis and dissertations, and meeting abstracts were hand searched, as well as 11 dental journals. Risk of bias in the included studies was assessed using the Philips' and Drummond's (full and simplified) tools. RESULTS: Titles and abstracts of 2871 articles were evaluated, and 200 were read in full. Eight cost-effectiveness studies were included: five modeling and three within-trial evaluations. None of the studies gave sufficient information to allow a thorough assessment using the bias tools. We did not combine the results of the studies due to the great heterogeneity among them. Four studies reported that FV in preschool children was a cost-effective measure, but in one of these studies, sealants and fluoride toothpaste were more cost-effective measures than the varnish, and three studies used limited data that compromised the generalizability of their results. The other four studies showed a large increase in costs due to the application of varnish and/or low cost-effectiveness. CONCLUSION: We did not find convincing overall evidence that applying FV in preschoolers is an anticaries cost-effective measure. The protocol of this systematic review is available at Open Science Framework (https://osf.io/xw5va/).

Efficacy and safety of hemodialysis strategies for pregnant women with chronic kidney disease: Systematic review.

Pregnancy in chronic kidney disease (CKD) women is relatively rare, and the less risky choice of hemodialysis is unknown. The objective of this systematic review was to identify, systematically evaluate and summarize the available evidence on the efficacy and safety of hemodialysis strategies for pregnant CKD women. Sensitive search strategies were applied to six databases without data or language restrictions. Comparative (randomized and non-randomized) studies were prioritized. Two reviewers independently selected, extracted, and critically evaluated data from studies. The risk of bias assessment was performed using the ROBINS-I tool, considering the study design (non-randomized comparative observational studies). The certainty of the evidence was assessed using the GRADE approach. From 7210 references identified, six retrospective cohort studies were included (576 women). The effects of intensive hemodialysis (over 20 h/week) are uncertain for maternal and neonatal mortality (Peto odds ratio [OR] 0.85; 95% confidence interval [95% CI] 0.26-2.80), miscarriage (Peto OR 0, 38; 95% CI 0.12-1.23), stillbirths (Peto OR 0, 56; 95% CI 0.13-2.31), preterm birth (Peto OR 0.87; 95% CI 0.33-2.28), low birth weight (Peto OR 0.71; 95% CI 0.20-2.50) and congenital anomalies rates. The certainty of the evidence was very low due to studies methodological limitations and effect estimates imprecision. The uncertainty about intensive versus conventional hemodialysis effects for pregnant women with CKD and the imprecision in the estimated effects precludes any recommendation. The strategy choice must consider treatment availability, costs, and maternal social aspects until future studies provide more reliable evidence. PROSPERO CRD42021259237.

Does the use of fiber posts increase the fracture resistance of simulated immature teeth? A systematic review.

This systematic review aimed to assess if the use of fiber posts reinforces weakened immature teeth. A systematic review was conducted of laboratory studies that evaluated the fracture resistance of simulated immature teeth restored with fiber posts compared to teeth restored exclusively with resin. An electronic search was performed using the following databases: PubMed/MEDLINE, Web of Science, Scopus and LILACS, BBO, and grey literature. Two independent researchers screened the titles and abstracts of the retrieved studies for relevance to the research question. Subsequently, the full texts of potentially relevant studies were screened based on the exclusion criteria. Ten out of 1792 unique records were included in this systematic review. Risk of bias was assessed using an adapted tool based on the Cochrane risk of bias tool. The laboratory studies included in this systematic review were performed on both human and bovine teeth. Eight studies concluded that fiber posts reinforce the structure of weakened roots, and two studies reported that fiber posts did not strengthen the radicular structure compared to teeth exclusively restored with resin composite. The highly heterogeneous data made it challenging to synthesize the results into a summary estimate, and thus no meta-analysis was undertaken. A summary effect could not be estimated without a meta-analysis. Although the laboratory literature suggests that fiber posts reinforce the structure of immature teeth, the results should be interpreted with caution, as most of the studies had an unclear or high risk of bias.

High quality (certainty) evidence changes less often than low-quality evidence, but the magnitude of effect size does not systematically differ between studies with low versus high-quality evidence.

RATIONALE, AIMS, AND OBJECTIVES: It is generally believed that evidence from low quality of evidence generate inaccurate estimates about treatment effects more often than evidence from high (certainty) quality evidence (CoE). As a result, we would expect that (a) estimates of effects of health interventions initially based on high CoE change less frequently than the effects estimated by lower CoE (b) the estimates of magnitude of effect size differ between high and low CoE. Empirical assessment of these foundational principles of evidence-based medicine has been lacking. METHODS: We reviewed the Cochrane Database of Systematic Reviews from January 2016 through May 2021 for pairs of original and updated reviews for change in CoE assessments based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. We assessed the difference in effect sizes between the original versus updated reviews as a function of change in CoE, which we report as a ratio of odds ratio (ROR). We compared ROR generated in the studies in which CoE changed from very low/low (VL/L) to moderate/high (M/H) versus M/H to VL/L. Heterogeneity and inconsistency were assessed using the tau and I2 statistic. We also assessed the change in precision of effect estimates (by calculating the ratio of standard errors) (seR), and the absolute deviation in estimates of treatment effects (aROR). RESULTS: Four hundred and nineteen pairs of reviews were included of which 414 (207 × 2) informed the CoE appraisal and 384 (192 × 2) the assessment of effect size. We found that CoE originally appraised as VL/L had 2.1 [95% confidence interval (CI): 1.19-4.12; p = 0.0091] times higher odds to be changed in the future studies than M/H CoE. However, the effect size was not different (p = 1) when CoE changed from VL/L → M/H [ROR = 1.02 (95% CI: 0.74-1.39)] compared with M/H → VL/L (ROR = 1.02 [95% CI: 0.44-2.37]). Similar overlap in aROR between the VL/L → M/H versus M/H → VL/L subgroups was observed [median (IQR): 1.12 (1.07-1.57) vs. 1.21 (1.12-2.43)]. We observed large inconsistency across ROR estimates (I2 = 99%). There was larger imprecision in treatment effects when CoE changed from VL/L → M/H (seR = 1.46) than when it changed from M/H → VL/L (seR = 0.72). CONCLUSIONS: We found that low-quality evidence changes more often than high CoE. However, the effect size did not systematically differ between the studies with low versus high CoE. The finding that the effect size did not differ between low and high CoE indicate urgent need to refine current EBM critical appraisal methods.

Oral manifestations of congenital Zika virus infection in children with microcephaly: 18-month follow-up case series.

AIMS: To describe oral manifestations in children born with microcephaly attributed to congenital Zika virus syndrome (CZS). METHODS: Data was collected in semiannual intervals from 2017 to 2019, by oral exams of the children and interview with caregivers at a Public Dental Center in Rio de Janeiro, Brazil. A single calibrated examiner performed clinical examinations. RESULTS: Of 38 eligible children, 34 were followed-up from 12 to 30 months of age, 20 boys and 14 girls. The mean age of emergence of their first primary tooth was 12.4 months (SD = 2.9). By 30 months of age only 14.7% (n = 5) had complete primary dentition. Alteration in the sequence of tooth emergence was observed in 41.1% (n = 14). Radiographic examination demonstrated dental agenesis (14.7% n = 5). Dental developmental alterations (38.2%, n = 13), enamel defects (14.7%, n = 5), eruption cysts/hematoma (23.5%, n = 8), gingival bleeding (55.8%, n = 19), narrow palate, and bruxism (64.7%, n = 22) were also observed. No child had dental caries. CONCLUSION: Children with microcephaly attributed to CZS presented oral manifestations early in life.

Um ano de e-mails não solicitados: o modus operandi de revistas e editoras predatórias / One year of unsolicited e-mails: the modus operandiof predatory journals and publishers

Objetivo: Quantificar, caracterizar e analisar e-mails de revistas predatórias (RP) recebidos por uma pesquisadora da área de odontologia. Materiais e métodos: E-mails recebidos em 2019 e suspeitos de serem potencialmente predatórios foram pré-selecionados. O checklist do Ottawa Hospital Research Institute (OHRI) para identificar RP biomédicas suspeitas foi aplicado, incluindo os seguintes critérios: taxa/preço de publicação (TP), fator de impacto falso, a revista estar listada no Directory of Open Access Journals (DOAJ) e no Committee on Publication Ethics (COPE). Também foram extraídas informações sobre a falta de um fator de impacto no Journal Citations Reports, endereço de contato de e-mail não afiliado à revista, linguajar lisonjeiro, citação pessoal e/ou de um artigo, link de cancelamento de inscrição do tipo unsubscribe, estar listado no catálogo atual da National Library of Medicine (NLM) e estar indexado no Medline. Resultados: Um total de 2.812 e-mails suspeitos não solicitados foram recebidos e 1.837 requisitaram algum tipo de manuscrito; entre eles, 1.751 preencheram algum critério do OHRI. Menos da metade (780/1.837, 42%) referiu-se a alguma área da odontologia. A TP mediana foi de US$ 399. Um falso fator de impacto foi mencionado em 11% (201/1.837) dos e-mails e 27% (504/1.837) correspondiam a periódicos atualmente listados no catálogo da NLM. Os periódicos listados no DOAJ e COPE enviaram 89 e-mails. Conclusão: A campanha editorial das RP, sob a forma de e-mails, foi intensa e recorrente. Os pesquisadores devem estar bem informados sobre o modus operandi das RP para proteger sua própria reputação como autores, assim como a reputação da ciência

Objectives: To quantify, characterize and analyze e-mail from predatory journals (PJ) received by an academic in dentistry. Materials and methods: E-mails received in 2019 and suspected of being potentially predatory were pre-selected. The Ottawa Hospital Research Institute (OHRI) checklist was applied to identify the suspected biomedical PJ, including the following criteria: article processing charge (APC), fake impact factor, the journal being listed in the Directory of Open Access Journals (DOAJ) and the Committee on Publication Ethics (COPE). We also extracted information on the lack of an impact factor on Journal Citations Reports, non-journal affiliated contact e-mail address, flattering language, article and/or personal citation, unsubscribe link, being listed in the National Library of Medicine (NLM) current catalog and indexed on Medline. Results: A total of 2,812 unsolicited suspected e-mails were received, and 1,837 requested some sort of manuscript; among these, 1,751 met some of the OHRI criteria. Less than half (780/1,837, 42%) referred to some area of dentistry. The median APC was US$399. A false impact factor was mentioned in 11% (201/1,837) of the e-mails, and 27% (504/1,837) corresponded to journals currently listed in the NLM catalog. Journals listed in DOAJ and COPE sent 89 e-mails. Conclusions: The email campaign from PJ was high and recurrent. Researchers should be well informed about PJ' modus operandi to protect their own reputation as authors and that of science.

One year of unsolicited e-mails: The modus operandi of predatory journals and publishers.

OBJECTIVES: To quantify, characterize and analyze e-mail from predatory journals (PJ) received by an academic in dentistry. METHODS: E-mails received in 2019 and suspected of being potentially predatory were pre-selected. The Ottawa Hospital Research Institute (OHRI) checklist was applied to identify the suspected biomedical PJ, including the following criteria: article processing charge (APC), fake impact factor, the journal being listed in the Directory of Open Access Journals (DOAJ) and the Committee on Publication Ethics (COPE). We also extracted information on the lack of an impact factor on Journal Citations Reports, non-journal affiliated contact e-mail address, flattering language, article and/or personal citation, unsubscribe link, being listed in the National Library of Medicine (NLM) current catalog and indexed on Medline. RESULTS: A total of 2812 unsolicited suspected e-mails were received, and 1837 requested some sort of manuscript; among these, 1751 met some of the OHRI criteria. Less than half (780/1837, 42 %) referred to some area of dentistry. The median APC was US$399. A false impact factor was mentioned in 11 % (201/1837) of the e-mails, and 27 % (504/1837) corresponded to journals currently listed in the NLM catalog. Journals listed in DOAJ and COPE sent 89 e-mails. CONCLUSIONS: The email campaign from PJ was high and recurrent. Researchers should be well informed about PJ' modus operandi to protect their own reputation as authors and that of science. CLINICAL SIGNIFICANCE: Peer review and established academic practices and etiquette contribute to ensuring scientific progress, which is essential to protect the health of patients in particular and of people in general. Predatory journals constitute a threat to peer review and scientific etiquette and, as such, may hinder scientific progress and public health.

Prevalence of dental anxiety in children and adolescents globally: A systematic review with meta-analyses.

BACKGROUND: Dental anxiety (DA) negatively impacts oral health-related quality of life, and patients with DA usually require more dental treatment time. AIM: To describe the global prevalence of DA in children and adolescents and to examine the influence of individual factors (age, sex, and caries experience) and variables related to DA measurement on pooled prevalence. DESIGN: Systematic review with meta-analyses of observational studies published between 1985 and 2020 (PROSPERO CRD42014013879). RESULTS: Searches yielded 1207 unique records; 224 full-text articles were screened, and 50 studies were used in the qualitative and quantitative synthesis. No study was considered as having high methodological quality according to 'The Joanna Briggs Institute assessment tool'. Overall pooled DA prevalence was 23.9% (95% CI 20.4, 27.3). Pooled prevalence in preschoolers, schoolchildren, and adolescents was as follows: 36.5% (95% CI 23.8, 49.2), 25.8% (95% CI 19.5, 32.1), and 13.3% (95% CI 9.5, 17.0), respectively. DA was significantly more prevalent in preschool children (one study) and schoolchildren (two studies) with caries experience and in female adolescents (one study). The scale used for DA assessment was shown to influence pooled prevalence in preschoolers and adolescents. CONCLUSION: DA is a frequent problem in 3- to 18-year-olds worldwide, more prevalent in schoolchildren and preschool children than in adolescents.

Risk communication in the context of clinical research.

Physicians and dentists usually make clinical decisions and recommendations without a clear understanding of the meaning of the numbers regarding the accuracy of diagnostic tests and the efficacy of treatments. This critical review aimed to identify problems in the communication of diagnostic test accuracy and treatment benefits and to suggest strategies to improve risk communication in these contexts. Most clinical decisions are taken under uncertainty. Health professionals cannot predict the outcome in one individual patient. This uncertainty invites these professionals to make decisions based on heuristics, which gives rise to several cognitive biases. Cognitive biases are automatic and unconscious, so how is it possible to mitigate their undesirable effects on risk interpretation in the context of clinical practice? Some forms of risk communication reinforce cognitive bias, while others weaken them. Maybe one of the most difficult obstacles to overcome is the difficulty to think with numbers. This difficulty probably arises from a mismatch of ancestral adaptations of the brain having to deal with modern environments, which are quite different from the ancestral ones. There are two quite common, but bad, forms of risk communication: the conditional probability and the relative risk reduction or efficacy. People, including physicians and dentists, are confused with this kind of information. The main methods discovered so far to facilitate a clearer understanding are to emphasize the base rates of the events and to use absolute numbers, that is to use natural frequencies, instead of percentages and conditional probabilities.

Strategies to deal with the COVID-19 pandemic.

The World Health Organization declared a COVID-19 pandemic on March 11, 2020, when there were 4,293 confirmed cumulative deaths. By May 17, 2020 this number increased to 315,005. The risk of death is higher above the age of 60, but there are many deaths below 60 (for example, in Sao Paulo, 25%). Due to the lack of a vaccine or specific treatment, there are at least three types of interventions used in the first wave of this pandemic: increased alertness and hygiene (e.g. Sweden); identification and isolation of infected people and their contacts (e.g. South Korea); lockdown (e.g. Italy). These interventions are complementary. Choices of the right mix of interventions will vary from society to society and in the same society at different times. The search for a miracle drug is dangerous because it is based on the mistaken belief that any treatment option is better than "nothing". Brazilian society will not be able to maintain lockdown for a long period. Naturally, in the near future, regardless of the advice from scientists, doctors and authorities, commerce, services and schools will reopen. In order to implement any strategy aimed to control the pandemic and preserve the economy, the country needs leadership that centralizes and coordinates actions. Unfortunately, the Brazilian government is not fulfilling this role; on the contrary, it is a hindrance. This negative leadership and lack of coordination are causing many deaths and are severely damaging the lives of survivors by delaying the resuming of economic and social activities.

Strategies to deal with the COVID-19 pandemic

Abstract The World Health Organization declared a COVID-19 pandemic on March 11, 2020, when there were 4,293 confirmed cumulative deaths. By May 17, 2020 this number increased to 315,005. The risk of death is higher above the age of 60, but there are many deaths below 60 (for example, in Sao Paulo, 25%). Due to the lack of a vaccine or specific treatment, there are at least three types of interventions used in the first wave of this pandemic: increased alertness and hygiene (e.g. Sweden); identification and isolation of infected people and their contacts (e.g. South Korea); lockdown (e.g. Italy). These interventions are complementary. Choices of the right mix of interventions will vary from society to society and in the same society at different times. The search for a miracle drug is dangerous because it is based on the mistaken belief that any treatment option is better than "nothing". Brazilian society will not be able to maintain lockdown for a long period. Naturally, in the near future, regardless of the advice from scientists, doctors and authorities, commerce, services and schools will reopen. In order to implement any strategy aimed to control the pandemic and preserve the economy, the country needs leadership that centralizes and coordinates actions. Unfortunately, the Brazilian government is not fulfilling this role; on the contrary, it is a hindrance. This negative leadership and lack of coordination are causing many deaths and are severely damaging the lives of survivors by delaying the resuming of economic and social activities.

Risk communication in the context of clinical research

Abstract Physicians and dentists usually make clinical decisions and recommendations without a clear understanding of the meaning of the numbers regarding the accuracy of diagnostic tests and the efficacy of treatments. This critical review aimed to identify problems in the communication of diagnostic test accuracy and treatment benefits and to suggest strategies to improve risk communication in these contexts. Most clinical decisions are taken under uncertainty. Health professionals cannot predict the outcome in one individual patient. This uncertainty invites these professionals to make decisions based on heuristics, which gives rise to several cognitive biases. Cognitive biases are automatic and unconscious, so how is it possible to mitigate their undesirable effects on risk interpretation in the context of clinical practice? Some forms of risk communication reinforce cognitive bias, while others weaken them. Maybe one of the most difficult obstacles to overcome is the difficulty to think with numbers. This difficulty probably arises from a mismatch of ancestral adaptations of the brain having to deal with modern environments, which are quite different from the ancestral ones. There are two quite common, but bad, forms of risk communication: the conditional probability and the relative risk reduction or efficacy. People, including physicians and dentists, are confused with this kind of information. The main methods discovered so far to facilitate a clearer understanding are to emphasize the base rates of the events and to use absolute numbers, that is to use natural frequencies, instead of percentages and conditional probabilities.

Fluoride Varnish and Dental Caries in Preschoolers: A Systematic Review and Meta-Analysis.

The aim of this study was to assess the effectiveness of fluoride varnish (FV) in reducing dentine caries at the patient, tooth, and surface levels as well as caries-related hospitalizations in preschoolers. We performed a systematic review of clinical trials of FV, alone or associated with an oral health program, compared with placebo, usual care, or no intervention. Bibliographical search included electronic searches of seven databases, registers of ongoing trials, and meeting abstracts, as well as hand searching. We performed random-effects meta-analyses and calculated confidence and prediction intervals. The search yielded 2,441 records; 20 trials were included in the review and 17 in at least one meta-analysis. Only one study had low risk of bias in all domains. We found no study reporting on caries-related hospitalizations. At the individual level, the pooled relative risk was 0.88 (95% confidence interval [CI] 0.81, 0.95); this means that in a population of preschool children with 50% caries incidence, we need to apply fluoride varnish in 17 children to avoid new caries in one child. At the tooth level, the pooled weighted mean difference was -0.30 (95% CI -0.69, 0.09) and at the surface level -0.77 (95% CI -1.23, -0.31). Considering the prediction intervals, none of the pooled estimates were statistically significant. We conclude that FV showed a modest and uncertain anticaries effect in preschoolers. Cost-effectiveness analyses are needed to assess whether FV should be adopted or abandoned by dental services.

Prevalence of self-reported gingival bleeding in a representative sample of the Brazilian adolescent population.

AIM: To estimate the prevalence of self-reported gingival bleeding in a representative sample of 12- to 17-year-old Brazilian adolescents. MATERIALS AND METHODS: Sociodemographic and oral health information were obtained through a self-administered questionnaire of the Study of Cardiovascular Risk Factors in Adolescents. The adolescents answered "yes" or "no" to the question "Do your gums bleed?" RESULTS: 74,589 of the 102,327 eligible adolescents answered the questionnaire and 18.4% (95% CI 17.5-19.3) reported having bleeding gums. The prevalence of self-reported gingival bleeding varied as following: 21.4% (95% CI 20.3-22.6) in girls and 15.3% (95% CI 14.3-16.4) in boys; 20.5% (95% CI 19.2-21.8) in older and 17.5% (95% CI 16.4-18.6) in younger adolescents; 20.6% (95% CI 18.5-22.9) in Black people and 17.1% (95% CI 16.1-18.1) in White people. Regarding mother's level of education, the prevalences were 18.1% (95% CI 16.2-20.3), 17.6% (95% CI 16.4-18.9) and 19.3% (95% CI 17.9-20.9) for high, middle and low levels, respectively. For socioeconomic status, the equivalent figures were 16.4% (95% CI 14.3-18.7), 18.4% (95% CI 17.5-19.4) and 23.0% (95% CI 17.3-29.9). CONCLUSION: Nearly one in five Brazilian adolescents reported having gingival bleeding, which might not be a serious condition, but reflect the disease and the adolescents' perception of oral health status.

Searching and selecting the best evidence efficiently: a tool for clinicians, professors and dental students / Como buscar e selecionar a melhor evidência de forma eficiente: uma ferramenta para cirurgiões-dentistas, professores e alunos de odontologia

ABSTRACT The aim of this article was to offer an efficient systematic search strategy appropriate for clinicians, professors and dental students, for when they have a question regarding the effectiveness of clinical intervention. We adapted the "6-S System" proposed for Medicine in order to build a search strategy focused on oral health, which is speedy, easy to use and arrives at the appropriate evidence. With a focus on validity and search efficiency, the following searching sequence is proposed: critical abstracts of systematic reviews (SR) of randomized controlled trials (RCTs), SR of RCTs, critical abstracts of RCTs, and RCTs. These can be searched in the Cochrane library; evidence-based journals; websites and blogs; and in Pubmed using the tool Clinical Queries. This strategy can enhance the ability to quickly retrieve evidence that is important to dental education, clinical practice and delivery of oral health care. The adoption of strategies such as the one proposed in this paper is likely to increase evidence based dental practice.

RESUMO O objetivo deste artigo foi apresentar uma estratégia de busca sistemática e eficiente, apropriada para cirurgiões-dentistas, professores e alunos de Odontologia, para ser utilizada quando eles tiverem dúvidas sobre a efetividade de uma intervenção clínica. O sistema proposto para a Medicina, chamado de "Sistema 6-S", foi adaptado para que uma estratégia de busca com foco na Odontologia fosse construída. Essa estratégia é fácil e rápida de usar e alcança a melhor evidência científica disponível. A sequência de busca proposta, com foco na validade da evidência e eficiência da busca, consiste em: resumos críticos de revisões sistemáticas (RS) de ensaios controlados randomizados (ECR), RS de ECR, resumos críticos de ECR e, por último, ECR. A busca por esses artigos pode ser feita na biblioteca Cochrane; em revistas de odontologia baseada em evidência; sites da Internet e blogs; e no Pubmed através da ferramenta "Clinical Queries". Essa estratégia pode aprimorar a habilidade de obter rapidamente evidência importante para informar a prática clínica, a educação em Odontologia e o cuidado em saúde bucal. A adoção de estratégias como a proposta neste artigo pode aumentar a prática da Odontologia Baseada em Evidência.