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/).

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.

A systematic review of the effects of supervised toothbrushing on caries incidence in children and adolescents.

BACKGROUND: The anticaries effect of supervised toothbrushing, irrespective of the effect of fluoride toothpaste, has not been clearly determined yet. AIM: To assess the effects of supervised toothbrushing on caries incidence in children and adolescents. DESIGN: A systematic review of controlled trials was performed (CRD42014013879). Electronic and hand searches retrieved 2046 records, 112 of which were read in full and independently assessed by two reviewers, who collected data regarding characteristics of participants, interventions, outcomes, length of follow-up and risk of bias. RESULTS: Four trials were included and none of them had low risk of bias. They were all carried out in schools, but there was great variation regarding children's age, fluoride content of the toothpaste, baseline caries levels and the way caries incidence was reported. Among the four trials, two found statistically significant differences favouring supervised toothbrushing, but information about the magnitude and/or the precision of the effect estimate was lacking and in one trial clustering effect was not taken into consideration. No meta-analysis was performed due to the clinical heterogeneity among the included studies and differences in the reporting of data. CONCLUSIONS: There is no conclusive evidence regarding the effectiveness of supervised toothbrushing on caries incidence.

Oral health-related quality of life changes in patients with severe Class III malocclusion treated with the 2-jaw surgery-first approach.

INTRODUCTION: In this nonrandomized prospective study, we compared the effects of the surgery-first approach with conventional 2-jaw orthognathic surgery on skeletal Class III patients' oral health-related quality of life (OHRQoL), quality of the orthodontic outcome, and average treatment duration. METHODS: The sample consisted of 16 patients with severe skeletal Class III malocclusion, who needed 2-jaw orthognathic surgery: 8 were treated with the surgery-first approach, and 8 were treated with the traditional orthodontic-surgical approach. OHRQoL was assessed by using the Orthognathic Quality of Life Questionnaire (OQLQ) and the Oral Health Impact Profile-short version (OHIP-14). Malocclusion severity and esthetic self-perception were assessed with the Index of Orthodontic Treatment Need. Dental health status was determined using the Decayed, Missing and Filled Teeth Index. Tests were repeated at 7 times: baseline, 1 month after appliance placement, and 3 months, 6 months, 1 year, and 2 years after the beginning of the treatment; and for both groups, there was an also evaluation stage after the orthognathic surgery. RESULTS: After 2 years, the surgery-first group showed a significant decrease in malocclusion severity (P <0.001) and had significant reductions in OQLQ (P <0.001) and OHIP-14 scores (P <0.001). These changes began after the orthognathic surgery and were progressive throughout the evaluation periods. In the traditional orthodontic-surgical approach group, after 2 years of monitoring, all patients were still in the preoperative orthodontic preparation phase, and their malocclusion severity increased significantly, thereby resulting in a not statistically significant worsening of their OHRQoL (OHIP-14, P = 0.89; OQLQ, P = 0.11). CONCLUSIONS: OHRQoL improved significantly in a linear trend of progressive improvements in all severe Class III patients who had the surgery-first approach after the surgical procedure through 2 years of follow-up, as their malocclusion and esthetic self-perception also improved.

Semiannual Fluoride Applications in Low-Risk Toddlers May Not Be More Effective Than Toothbrushing Instruction and Dietary Counseling in Controlling Dental Caries.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Effectiveness of early preventive intervention with semiannual fluoride varnish application in toddlers living in high-risk areas: A stratified cluster-randomized controlled trial. Anderson M, Dahlöf G, Twetman S, Jansson L, Bergenlid AC, Grindefjord M. Caries Res 2016;50(1):17-23. SOURCE OF FUNDING: The study was commissioned and supported by Stockholm County Council and Karolinska Institutet. TYPE OF STUDY/DESIGN: Non-blinded, cluster-randomized controlled field trial with two parallel arms.

Are fluoride releasing dental materials clinically effective on caries control?

OBJECTIVES: (1) To describe caries lesions development and the role of fluoride in controlling disease progression; (2) to evaluate whether the use of fluoride-releasing pit and fissure sealants, bonding orthodontic agents and restorative materials, in comparison to a non-fluoride releasing material, reduces caries incidence in children or adults, and (3) to discuss how the anti-caries properties of these materials have been evaluated in vitro and in situ. METHODS: The search was performed on the Cochrane Database of Systematic Reviews and on Medline via Pubmed. RESULTS: Caries is a biofilm-sugar dependent disease and as such it provokes progressive destruction of mineral structure of any dental surface - intact, sealed or restored - where biofilm remains accumulated and is regularly exposed to sugar. The mechanism of action of fluoride released from dental materials on caries is similar to that of fluoride found in dentifrices or other vehicles of fluoride delivery. Fluoride-releasing materials are unable to interfere with the formation of biofilm on dental surfaces adjacent to them or to inhibit acid production by dental biofilms. However, the fluoride released slows down the progression of caries lesions in tooth surfaces adjacent to dental materials. This effect has been clearly shown by in vitro and in situ studies but not in randomized clinical trials. SIGNIFICANCE: The anti-caries effect of fluoride releasing materials is still not based on clinical evidence, and, in addition, it can be overwhelmed by fluoride delivered from dentifrices.

Fluoride Varnish Applications in Preschoolers and Dental Fluorosis in Permanent Incisors: Results of a Nested-cohort Study Within a Clinical Trial.

PURPOSE: To compare the prevalence and severity of fluorosis in the permanent maxillary incisors of children who had participated in a two-year randomized placebo-controlled clinical trial on fluoride varnish application in the primary dentition and to assess children's esthetic perception of their teeth. METHODS: Parents of 200 one- to four-year-old children who had received biannual applications of fluoride or placebo varnish were contacted four years after the end of the trial. Two calibrated examiners assessed dental fluorosis using the Thylstrup and Fejerskov index (TF) and interviewed the children regarding their perceptions of teeth appearance. RESULTS: Fluorosis (TF equals at least one) and esthetically objectionable fluorosis (TF equals at least three) were observed in 38 (30.9 percent) and eight (6.5 percent) children, respectively. There was no statistically significant difference in fluorosis prevalence between children who had received fluoride or placebo varnish. Children's responses regarding the esthetic perceptions of their teeth showed no statistically significant difference between children with and without fluorosis. CONCLUSIONS: Fluoride varnish applications in preschoolers were not associated with any level of fluorosis in their permanent maxillary incisors. The fluorosis found in this study did not influence the children's esthetic perception of their teeth.

Children's Toothbrushing Practices Recommended on the Internet by Pediatric Dentistry Associations.

PURPOSE: The purpose of this study was to describe online recommendations by North and South American National Associations of Pediatric Dentistry (NAPD), intended for laypersons, concerning children's toothbrushing practices. METHODS: In February 2015, the International Association of Pediatric Dentistry (IAPD) website and the Latin American Association of Pediatric Dentistry (ALOP) Facebook webpage were searched to identify which countries had NAPD. Attempts were made to obtain the electronic addresses of ALOP national member societies, and Google and Facebook were used to identify NAPD not found using the previous strategies. RESULTS: Of the 35 countries in North and South America, 19 had NAPD that were shown on the Internet, and 11 of them provided data for the study. All NAPD gave advice on fluoride concentrations in toothpaste and when to start toothbrushing; most made recommendations on the amount of toothpaste, toothbrushing frequency, and when to brush, and a few gave advice on toothbrushing supervision and rinsing after toothbrushing. There was no consensus on most of the recommendations that were evaluated. CONCLUSIONS: Only a few National Associations of Pediatric Dentistry from the Americas provide online information for parents and laypersons concerning children's toothbrushing practices. Of the information provided, some are either controversial, outdated or lack scientific evidence.

Translation and cross-cultural adaptation of an instrument designed for the assessment of quality of life in orthognatic patients.

INTRODUCTION: The Orthognathic Quality of Life Questionnaire (OQLQ) was developed in 2000 and validated in 2002, aiming at assessing the impact and the benefits of orthosurgical treatment on patients' quality of life. OBJECTIVE: Cross-culturally translate into Brazilian Portuguese and back-translate into English a quality of life instrument, assuring maintenance of its properties. METHODS: At first, equivalence of concepts and items was discussed by a group of specialists who scrutinized all questionnaire items. Additionally, four patients in need of orthosurgical treatment were interviewed by means of the focus group methodology. Relevance of the questionnaire items was assured prior to its translation which was carried out by two translators who worked independently. Both translations were tested in 20 patients and then consolidated. The consolidated questionnaire version was back-translated into English by two translators who worked independently, and the consolidated back-translation was assessed by the authors of the original questionnaire as well as by the researchers. RESULTS: The OQLQ was translated into Brazilian Portuguese. This translation was tested in a pilot study comprising 12 patients, aged between 16 and 34 years old. CONCLUSION: The OQLQ Brazilian Portuguese translation proves to be an appropriate instrument to assess the impact of dentofacial deformities on the quality of life of patients in the Brazilian public health system and who are in need of orthosurgical treatment.

Psychometric properties of the Brazilian version of the Orthognathic Quality of Life Questionnaire.

PURPOSE: To assess the construct validity and reliability of the Brazilian version of the Orthognathic Quality of Life Questionnaire (B-OQLQ). MATERIALS AND METHODS: A cross-sectional study was performed, and 101 patients in need of orthodontic-surgical treatment were recruited at a public hospital (Hospital Universitário Pedro Ernesto) and a public dental school (Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro). The B-OQLQ was self-completed. The mean age of the participants was 26.51 ± 9.25 years, and most were female (58.42%; n = 59). The construct validity was assessed using Spearman's correlation coefficient between the B-OQLQ and the Oral Health Impact Profile (OHIP-14) scores and between the B-OQLQ and subjective health indicators' scores. The reliability was assessed in terms of internal consistency and stability (test-retest) using Cronbach's alpha and the intraclass correlation coefficient (ICC), respectively. RESULTS: Significant correlations were found between the B-OQLQ scores and the following: OHIP-14 total score (rs = 0.70, P < .001), perception of oral health (rs = -0.24, P = .02), single-item evaluation of quality of life (rs = -0.29, P = .03), satisfaction with physical appearance (rs = -0.40, P < .001), and satisfaction with facial appearance (rs = -0.39, P = .0001). Cronbach's alpha and the ICC was 0.95 and 0.90, respectively. The domains of B-OQLQ causing the most effect on the quality of life included "social aspects of deformity" (13.0 ± 10.54) and "facial aesthetics" (11.81 ± 6.23). CONCLUSIONS: The Brazilian version of the OQLQ was shown to be valid and reliable with good psychometric properties and might thus be considered an appropriate tool to assess the effect of dentofacial deformities on the quality of life of individuals with this condition.

A systematic review and meta-analysis of the effects of fluoride toothpastes on the prevention of dental caries in the primary dentition of preschool children.

OBJECTIVES: To assess the effects of fluoride (F) toothpastes on the prevention of dental caries in the primary dentition of preschool children. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A search for randomized or quasi-randomized clinical trials was carried out, without idiom restraints, in six electronic databases, registers of ongoing trials, meeting abstracts, dentistry journals and reference lists of potentially eligible studies. The search yielded 1932 records and 159 full-text articles were independently read by two examiners. Data regarding characteristics of participants, interventions, outcomes, length of follow-up and potential of bias were independently extracted by two examiners on the basis of predetermined criteria. Any disagreement was solved by consensus after consulting a third examiner. Pooled prevented fractions (PF) and relative risks (RR) were estimated separately for studies testing low F toothpastes (<600 ppm) and those testing standard F toothpastes (1000­1500 ppm). RESULTS: Eight clinical trials fulfilled the inclusion criteria and most of them compared F toothpastes associated with oral health education against no intervention. When standard F toothpastes were compared to placebo or no intervention, significant caries reduction at surface (PF = 31%; 95% CI 18­43; 2644 participants in five studies), tooth (PF = 16%; 95% CI 8­25; 2555 participants in one study) and individual (RR = 0.86; 95% CI 0.81­0.93; 2806 participants in two studies) level were observed. Low F toothpastes were effective only at surface level (PF = 40%; 95% CI 5­75; 561 participants in two studies). CONCLUSION: Standard F toothpastes are effective in reducing dental caries in the primary teeth of preschool children and thus their use should be recommended to this age group.

A systematic review of root canal filling materials for deciduous teeth: is there an alternative for zinc oxide-eugenol?

The aim of this systematic review was to determine whether there is a root canal filling for deciduous teeth equally or more effective than zinc oxide-eugenol cement (ZOE). Six clinical trials selected for inclusion were independently reviewed by two researchers. Only two showed statistically significant different success rates between the test and the control groups. One found that an iodoform paste with calcium hydroxide (IP + Ca) performed better than ZOE, and the other found that ZOE performed similarly to IP + Ca. The other four studies compared ZOE with an iodoform paste (IP), a calcium hydroxide cement (Ca(OH)(2)), or IP + Ca. In these trials, the success rates in the ZOE groups were slightly lower than in the other groups. There seems to be no convincing evidence to support the superiority of any material over ZOE, and both ZOE and IP + Ca appear to be suitable as root canal fillings for deciduous teeth.

Inconsistencies in recommendations on oral hygiene practices for children by professional dental and paediatric organisations in ten countries.

BACKGROUND: Some of the basic dental health practices that are recommended to the public by professionals are not evidence based. Incorrect oral health messages may adversely affect children's oral health behaviours. AIM: To identify and list the recommendations concerning children's oral hygiene practices provided by dental and paediatric organisations, and to assess how these recommendations relate to the scientific evidence currently available. DESIGN: Cross-sectional. The authors contacted professional organisations in ten countries requesting items (brochures, leaflets or folders) containing messages on children's oral hygiene practices. They then listed these recommendations and assessed how they related to scientific evidence obtained from systematic reviews available at PubMed and the Cochrane Library. RESULTS: Fifty-two of 59 (88%) organisations responded to our request and 24 dental health education materials were submitted to the authors. They mentioned recommendations on oral hygiene practices for children, such as toothbrushing frequency, supervision and technique; when to start and how long toothbrushing should last; toothbrush design and replacement; flossing; gums/teeth wiping; tongue cleaning; type and amount of toothpaste and advice on toothpaste ingestion. The search at PubMed and the Cochrane Library resulted in 11 systematic reviews addressing these topics. CONCLUSIONS: Several oral hygiene messages delivered by professional organisations showed inconsistencies and lacked scientific support.

Survey of Brazilian governmental health agencies shows conflicting recommendations concerning oral hygiene practices for children.

The aims of this study were to detect whether recommendations concerning oral hygiene practices for children among Brazilian health agencies are consistent and to verify whether possible inconsistencies in these recommendations might be associated with an apparent gap in the scientific evidence. Fifty-four Brazilian health agencies were contacted by mail or electronic mail and were asked to send any material containing recommendations on oral hygiene practices aimed at children. A search was subsequently carried out on the Cochrane Oral Health Review Group and PubMed-Clinical Queries websites in order to assess the scientific evidence available on this subject. Forty (74%) agencies answered and 21 materials containing oral hygiene recommendations were obtained. Eleven pertinent systematic reviews were identified. This preliminary study detected some conflicting and not evidence-based oral hygiene messages, which emphasizes the need to carry out and disseminate systematic reviews on these controversial issues in order to bridge the gap between knowledge and practice.

Oral health-related quality of life and orthodontic treatment seeking.

INTRODUCTION: The aim of this study was to assess oral health-related quality of life (OHQOL) in adolescents who sought orthodontic treatment. A comparison between these adolescents and their age-matched peers who were not seeking orthodontic treatment provided an assessment of the role of OHQOL in treatment seeking. METHODS: The sample consisted of 225 subjects, 12 to 15 years of age; 101 had sought orthodontic treatment at a university clinic (orthodontic group), and 124, from a nearby public school, had never undergone or sought orthodontic treatment (comparison group). OHQOL was assessed with the Brazilian version of the short form of the oral health impact profile, and malocclusion severity was assessed with the index of orthodontic treatment need. RESULTS: Simple and multiple logistic regression analysis showed that those who sought orthodontic treatment reported worse OHQOL than did the subjects in the comparison group (P <0.001). They also had more severe malocclusions as shown by the index of orthodontic treatment need (P = 0.003) and greater esthetic impairment, both when analyzed professionally (P = 0.008) and by self-perception (P <0.0001). No sex differences were observed in quality of life impacts (P = 0.22). However, when the orthodontic group was separately evaluated, the girls reported significantly worse impacts (P = 0.05). After controlling for confounding (dental caries status, esthetic impairment, and malocclusion severity), those who sought orthodontic treatment were 3.1 times more likely to have worse OHQOL than those in the comparison group. CONCLUSIONS: Adolescents who sought orthodontic treatment had more severe malocclusions and esthetic impairments, and had worse OHQOL than those who did not seek orthodontic treatment, even though severely compromised esthetics was a better predictor of worse OHQOL than seeking orthodontic treatment.

Oral health-related quality of life in orthognathic surgery patients.

INTRODUCTION: In the last decade, an increasing number of studies focusing on the impact of oral deformities and illnesses on quality of life have been published. Our goal was to evaluate the impact of oral problems on quality of life in 3 groups of adult patients in need of orthognathic-surgical treatment. METHODS: A total of 117 patients were recruited from the Clinic of Oral and Maxillofacial Surgery of the State University of Rio de Janeiro in Brazil: 20 in the initial phase, 70 in the presurgical phase (presurgical orthodontic preparation), and 27 in the postsurgical phase. The impact of treatment phase on oral health-related quality of life was evaluated with the oral health impact profile (OHIP-14). OHIP-14 scores were calculated by an additive method, and the participants were divided on the basis of level of impact into 2 groups: high impact (scores, >11) and low impact (scores, < or =11). RESULTS: Compared with patients in the postsurgical phase, those who needed orthognathic surgical treatment but had not yet begun it and those who were in the presurgical phase of treatment were 6.48 and 3.14 times more likely, respectively, to experience a negative impact of their oral condition. CONCLUSIONS: Among those undergoing or anticipating orthognathic-surgical treatment, orthognathic surgery positively affects the patients' quality of life.