Behaviour support in dentistry: A Delphi study to agree terminology in behaviour management.

OBJECTIVES: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e-Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. METHODS: Following a registered protocol, a modified e-Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. RESULTS: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. DISCUSSION: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care.

Limited evidence on best material for retrograde root fillings.

Data sourcesCochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline Ovid, Embase Ovid, LILACS, BIREME Virtual Health Library, OpenSIGLE, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, Chinese BioMedical Literature Database, VIP (in Chinese), China National Knowledge Infrastructure and Sciencepaper Online. No restrictions on language or date of publication were placed.Study selectionRandomised controlled trials (RCTs) that compared different retrograde filling materials, with clinical or radiological assessment for success over a minimum follow-up period of 12 months.Data extraction and synthesisTwo review authors extracted data independently and in duplicate, and subsequently carried out risk of bias assessment for each eligible study following Cochrane methodological guidelines. Original trial authors were contacted for any missing information.ResultsSix randomised controlled trials were included, with 916 participants involving 988 teeth. All these studies had a high risk of bias. Comparisons of five different retrograde filling materials were undertaken, including MTA versus intermediate restorative material (IRM), MTA versus super ethoxybenzoic acid cement (Super-EBA), Super-EBA versus IRM, dentine-bonded resin composite versus glass ionomer cement and glass ionomer cement versus amalgam.Grouping of data from different studies was minimal and provided limited evidence for each comparison. All studies showed a risk ratio of approximately one, indicating that there is weak or little evidence that any of the materials are superior. All of the studies displayed very low quality of evidence. None of these studies reported adverse events.ConclusionsCurrently there is insufficient evidence to determine which material is preferable for retrograde filling. Further high-quality RCTs are required for this.