Clinical interventions with various agents to prevent early childhood caries: A systematic review with network meta-analysis.

BACKGROUND: Dental caries is one of the most prevalent chronic diseases among preschool children globally. Different preventive agents and combinations have been studied. However, the rank of the effectiveness of clinical interventions is equivocal. AIM: To summarize and rank the effectiveness of clinical interventions using different agents for primary prevention of early childhood caries (ECC). DESIGN: Two reviewers independently searched PubMed, Embase, and Cochrane Library to identify randomized controlled trials with at least 12-month follow-up. The network meta-analysis (NMA) on different agents was based on a random-effects model and frequentist approach. Standardized mean differences (SMD) with 95% CI of the caries increment were calculated in terms of either dmft or dmfs and used in the NMA. Caries incidences at the child level were compared using odds ratios (ORs) with 95% CI. The effectiveness of the agents was ranked using the surface under the cumulative ranking curve (SUCRA). RESULTS: After screening 3807 publications and selection, the NMA finally included 33 trials. These trials used either a single or combination of agents such as fluorides, chlorhexidine, casein phosphopeptide-amorphous calcium phosphate, probiotics, xylitol, and triclosan. Compared with control, fluoride foam (FF; SMD -0.69, 95% CI: -1.06, -0.32) and fluoride salt (F salt; SMD -0.66, 95% CI: -1.20, -0.13) were effective in preventing caries increment. Probiotic milk plus low fluoride toothpaste (PMLFTP; OR 0.34, 95% CI: 0.15, 0.77), FF (OR 0.48, 95% CI: 0.37, 0.63), fluoride varnish (FV; OR 0.63, 95% CI: 0.48, 0.81), and fluoride varnish plus high fluoride toothpaste (FVHFTP; OR 0.73, 95% CI: 0.57, 0.93) were effectively preventing caries incidence. According to the SUCRA, FF ranked first in preventing caries increment, whereas PMLFTP ranked first in preventing caries incidence. CONCLUSION: Fluoride foam, F salt, PMLFTP, FV, and FVHFTP all effectively reduce caries increment or caries incidence in preschool children, but the evidence indicates low degree of certainty. Considering the relatively small number of studies, confidence in the findings, and limitations in the study, clinical practitioners and readers should exercise caution when interpreting the NMA results.

Methodology and outcome of trials involving older adults in UK care homes: A rapid review.

BACKGROUND: The United Kingdom (UK) has a well-developed health and social care system, and strong research governance. However, there is limited evidence to guide best research practice among vulnerable older people in care homes and there is no consensus on clinical trial methodology that is deliverable in this setting. OBJECTIVES: To review the literature on trials conducted among older adults residing in care homes within the UK and collate evidence on their methodological characteristics and outcomes. METHODS: A systematic rapid review methodology was employed. MEDLINE, EMBASE and CENTRAL were searched in two incremental stages: stage 1 searched for oral health-related trials conducted within the UK care homes up to July 2021, whereas stage 2 sought for general health-related trials in the same setting from 2011 to 2021. The quality of included studies was assessed using Cochrane's RoB 2 and ROBINS-I tools. Findings were summarised descriptively. RESULTS: Five oral health and 33 general health-related trials involving care home residents were included for analysis. The most common trial design was parallel group with two arms (n = 25) involving individual randomisation (n = 21). Consent was mainly obtained from residents and/or their proxies (n = 24), followed by residents only (n = 13) and care homes only (n = 1). Based on available data, the number needed to screen to recruit one participant ranged from 2 to 40 (median: 3; Q1-Q3: 2-9). Attrition rates ranged from 0% to 73% (median: 21%; Q1-Q3: 13%-32%) for follow-up periods between 1 and 52 weeks. The studies were of mixed methodological quality. CONCLUSION: This rapid review outlines the methodological characteristics and outcomes of trials conducted among older adults in UK care homes. The findings of this review provide valuable information to assist in navigating and designing future research in this complex setting.

Oral health-related quality of life (OHRQoL) after rehabilitation with removable partial dentures (RPDs): A systematic review and meta-analysis.

OBJECTIVES: To summarise evidence on the change in oral health-related quality of life (OHRQoL) before and after rehabilitation with removable partial dentures (RPDs) amongst partially edentulous adults. DATA: Studies assessing OHRQoL amongst patients aged ≥18 years, before and after rehabilitation with RPDs of any type and design, were included. The quality of included studies was evaluated using the Cochrane risk of bias tools. Meta-analysis was conducted using a random-effect model. SOURCES: MEDLINE, EMBASE and CENTRAL, up to March 29, 2022. STUDY SELECTION AND RESULTS: Thirteen studies were eligible and eight were included in the meta-analysis. The studies had moderate to serious risk of bias. There was a very low level of certainty that OHRQoL, as measured using OHIP-14, improved 3 months after RPDs were fitted (222 participants, MD: -12.0, 95% CI: -16.1, -7.9, p<0.001) and after 6 months (101 participants, MD: -10.5, 95% CI: -16.4, -4.6, p<0.001). At 12 months post-treatment, RPD rehabilitation did not result in statistically significant improvement in OHIP-14 scores (62 participants, MD: -12.7, 95% CI: -26.1, 0.6, p = 0.06). However, the assessment using OHIP-49 at 12 months showed significant improvement (87 participants, MD: -34.8, 95% CI: -41.9, -27.7, p<0.001), with low certainty of evidence. CONCLUSIONS: Based on the limited evidence available, this review found that RPD rehabilitation appear to improve OHRQoL in the short term up to 6 months, with a very low level of certainty. The long-term effect of RPD treatment on OHRQoL after 12 months is inconclusive. There is currently insufficient evidence on the effect of RPD treatment on OHRQoL. This review highlights the need for more and better quality studies. CLINICAL SIGNIFICANCE: Data on RPD outcomes are summarised, aiding clinicians in providing evidence-based patient-centred care that matches patients' needs and expectations. Recommendations for future research were also highlighted. REGISTRATION: PROSPERO CRD42022328606.