Biomedical subjects

A M Glenny

Publications and source records attributed to A M Glenny.

At least 19 recordsLinked to original sources

PubMed2006

Screening programmes for the early detection and prevention of oral cancer.

BACKGROUND: Screening programmes for major cancers, such as breast and cervical cancer have effectively decreased the mortality rate and helped to reduce the incidence of these cancers. Although oral cancer is a global health problem with increasing incidence and mortality rates, no national population-based screening programmes for oral cancer have been implemented. To date there is debate on whether to employ screening methods for oral cancer in the daily routine work of health providers. OBJECTIVES: To assess the effectiveness of current screening methods in decreasing oral cancer mortality. SEARCH STRATEGY: Electronic databases (MEDLINE, CANCERLIT, EMBASE, the Cochrane Central Register of Controlled Trials; 1966 to July 2005, The Cochrane Library - Issue 3, 2005), bibliographies, handsearching of specific journals and contact authors were used to identify published and unpublished data. SELECTION CRITERIA: Randomised controlled trials of screening for oral cancer or precursor oral lesions using visual examination, toluidine blue, fluorescence imaging or brush biopsy. DATA COLLECTION AND ANALYSIS: The search found 112 citations and these have been reviewed. One randomised controlled trial of screening strategies for oral cancer was identified as meeting the review's inclusion criteria. Validity assessment, data extraction and statistics evaluation were undertaken by two independent review authors. MAIN RESULTS: One 10-year randomised controlled trial has been included (n = 13 clusters: 191,873 participants). There was no difference in the age-standardised oral cancer mortality rates for the screened group (16.4/100,000 person-years) and the control group (20.7/100,000 person-years). Interestingly, a significant 34% reduction in mortality was recorded in high-risk subjects between the intervention cohort (29.9/100,000 person-years) and the control arm (45.4/100,000). However, this study has some methodological weaknesses. Additionally, the study did not provide any information related to costs, quality of life or even harms of screening from false-positive or false-negative findings. AUTHORS' CONCLUSIONS: Given the limitation of evidence (only one included randomised controlled trial) and the potential methodological weakness of the included study, it is valid to say that there is insufficient evidence to support or refute the use of a visual examination as a method of screening for oral cancer using a visual examination in the general population. Furthermore, no robust evidence exists to suggest that other methods of screening, toluidine blue, fluorescence imaging or brush biopsy, are either beneficial or harmful. Future high quality studies to assess the efficacy, effectiveness and costs of screening are required for the best use of public health resources. In addition, studies to elucidate the natural history of oral cancer, prevention methods and the effectiveness of opportunistic screening in high risk groups are needed. Future studies on improved treatment modalities for oral cancer and precancer are also required.

Humans↗

PubMed2006

Adhesives for fixed orthodontic bands.

BACKGROUND: Orthodontic treatment involves using fixed or removable appliances (dental braces) to correct the positions of teeth. It has been shown that the quality of treatment result obtained with fixed appliances is much better than with removable appliances. Fixed appliances are, therefore, favoured by most orthodontists for treatment. The success of a fixed orthodontic appliance depends on the metal attachments (brackets and bands) being attached securely to the teeth so that they do not become loose during treatment. Brackets are usually attached to the front and side teeth, whereas bands (metal rings that go round the teeth) are more commonly used on the back teeth (molars). A number of adhesives are available to attach bands to teeth and it is important to understand which group of adhesives bond most reliably, as well as reducing or preventing dental decay during the treatment period. OBJECTIVES: To evaluate the effectiveness of the adhesives used to attach bands to teeth during fixed appliance treatment, in terms of:(1) how often the bands come off during treatment; and(2) whether they protect the banded teeth against decay during fixed appliance treatment. SEARCH STRATEGY: Electronic databases were searched: the Cochrane Oral Health Group's Trials Register (July 2005), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to July 2005) and EMBASE (1980 to July 2005). A search of the internet was also undertaken. There was no restriction with regard to publication status or language of publication. SELECTION CRITERIA: Randomised and controlled clinical trials (RCTs and CCTs) (including split-mouth studies) of adhesives used to attach orthodontic bands to molar teeth were selected. Patients with full arch fixed orthodontic appliance(s) who had bands attached to molars were included. DATA COLLECTION AND ANALYSIS: All review authors were involved in study selection, validity assessment and data extraction without blinding to the authors, adhesives used or results obtained. All disagreements were resolved by discussion. MAIN RESULTS: Five RCTs and three CCTs were identified as meeting the review's inclusion criteria. All the included trials were of split-mouth design. Four trials compared chemically cured zinc phosphate and chemically cured glass ionomer; three trials compared chemically cured glass ionomer cement with light cured compomer; one trial compared chemically cured glass ionomer with a chemically cured glass phosphonate. Data analysis was often inappropriate within the studies meeting the inclusion criteria. AUTHORS' CONCLUSIONS: There is insufficient high quality evidence with regard to the most effective adhesive for attaching orthodontic bands to molar teeth. Further RCTs are required.

Adhesives↗

PubMed2006

Opinions and attitudes of the UK's GDPs and specialists in oral surgery, oral medicine and surgical dentistry on oral cancer screening.

OBJECTIVE: To survey two broad areas of oral cancer awareness and management of patients at risk of oral cancer by specialists in oral surgery, oral medicine, surgical dentistry and general dental practitioners (GDPs) in the UK. The first of these included knowledge and awareness of aetiological factors, changing patterns of disease, and screening/detection programmes including their effectiveness. The second included oral cancer detection methods, advice on avoidance of high-risk activity and self-examination, and referral pattern of GDPs. DESIGN AND METHOD: A pretested, 44-item questionnaire, a covering letter, a brief outline of the research protocol and return, stamped envelope were mailed in March 2003. A sample of 200 GDPs whose names were obtained from the General Dental Council's main list and 305 dental specialist names obtained from specialist's list in surgical dentistry, oral medicine and oral surgery were selected randomly. Information on oral cancer awareness and practice, screening practice and education was obtained. RESULTS: The response rate was 66.9%. The knowledge of the dental specialists was consistent with that in reports of current aetiological studies on oral cancer. However there were gaps in the GDP's knowledge and ascertainment of oral cancer risk factors. Over 70% of the dental specialists provided counselling advice on the risks of tobacco and alcohol habits compared with 41.2% of GDPs. More GDPs (52.4%) than specialists (35.4%) believed that oral cancer screening on a national basis would be effective in decreasing the mortality of oral cancer. Over 95% of all respondents used a visual examination for oral cancer screening and 89.9% of all respondents strongly believed that visual screening is effective in the early detection of oral cancer. CONCLUSION: The results showed that GDPs had knowledge gaps in their awareness of oral cancer risk factors and the application of preventive measures. Most dental health providers in the UK perform visual screening of the oral mucosa for their patients. Opinion was equivocal as to whether a nationally based screening programme similar to cervical cancer would be effective in improving the mortality and morbidity of oral cancer.

Adolescent↗

PubMed2005

Fluoridated milk for preventing dental caries.

BACKGROUND: Dental caries remains a major public health problem in most industrialised countries, affecting 60% to 90% of school children and the vast majority of adults. Milk provides a relatively cost-effective vehicle for fluoride in the prevention of dental caries. OBJECTIVES: To determine the effectiveness of fluoridated milk, as a means of delivering fluoride on a community basis, for preventing dental caries. SEARCH STRATEGY: We searched Cochrane Oral Health Group Trials Register (28 April 2005), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to 17 May 2005), OLDMEDLINE (1950 to 1965), EMBASE (1980 to 2005 week 20), LILACS (1982 to 17 May 2005), BBO (1986 to 17 May 2005), SIGLE (1980 to 17 May2005), Digital Dissertations (1861 to 17 May 2005) and reference lists of relevant articles. Attempts were made to identify both unpublished and ongoing studies. There were no language restrictions. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials (RCTs), with an intervention or follow-up period of at least 3 years, comparing fluoridated milk with non-fluoridated milk. Primary outcome was change in caries experience, as measured by changes in decayed, missing and filled figures on tooth (dmft/DMFT) and surface (dmfs/DMFS). DATA COLLECTION AND ANALYSIS: Inclusion decisions, data extraction and quality assessment were carried out independently and in duplicate. Study authors were contacted for additional information where necessary. MAIN RESULTS: Two RCTs involving 353 children were included. For permanent teeth, after 3 years there was a significant reduction in the DMFT (78.4%, P < 0.05) between the test and control groups in one trial, but not in the other. The latter study only showed a significant reduction in the DMFT until the fourth (35.5%, P < 0.02) and fifth (31.2%,P < 0.05) years. For primary teeth, again there was a significant reduction in the dmft (31.3%, P< 0.05) between the test and control groups after 3 years in one study, but not in the other. The results could not be pooled because of the difference in concentration of fluoride in the milk. AUTHORS' CONCLUSIONS: There are insufficient studies with good quality evidence examining the effects of fluoridated milk in preventing dental caries. However, the included studies suggested that fluoridated milk was beneficial to school children, especially their permanent dentition. The data need to be supplemented by further RCTs to provide the highest level of evidence for practice.

Animals↗

PubMed2005

Manual versus powered toothbrushing for oral health.

BACKGROUND: Removing dental plaque may play a key role maintaining oral health. There is conflicting evidence for the relative merits of manual and powered toothbrushing in achieving this. OBJECTIVES: To compare manual and powered toothbrushes in relation to the removal of plaque, the health of the gingivae, staining and calculus, dependability, adverse effects and cost. SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register (to 17/06/2004) and Central Register of Controlled Trials (The Cochrane Library Issue 2, 2004); MEDLINE (January 1966 to week 2 June 2004); EMBASE (January 1980 to week 2 2004) and CINAHL (January 1982 to week 2 June 2004). Manufacturers were contacted for additional data. SELECTION CRITERIA: Trials were selected for the following criteria: design-random allocation of participants; participants - general public with uncompromised manual dexterity; intervention - unsupervised manual and powered toothbrushing for at least 4 weeks. Primary outcomes were the change in plaque and gingivitis over that period. DATA COLLECTION AND ANALYSIS: Six authors independently extracted information. The effect measure for each meta-analysis was the standardised mean difference (SMD) with 95% confidence intervals (CI) using random-effects models. Potential sources of heterogeneity were examined, along with sensitivity analyses for quality and publication bias. For discussion purposes SMD was translated into percentage change. MAIN RESULTS: Forty-two trials, involving 3855 participants, provided data. Brushes with a rotation oscillation action removed plaque and reduced gingivitis more effectively than manual brushes in the short term and reduced gingivitis scores in studies over 3 months. For plaque at 1 to 3 months the SMD was -0.43 (95% CI: -0.72 to -0.14), for gingivitis SMD -0.62 (95% CI: -0.90 to -0.34) representing an 11% difference on the Quigley Hein plaque index and a 6% reduction on the Loe and Silness gingival index. At over 3 months the SMD for plaque was -1.29 (95% CI: -2.67 to 0.08) and for gingivitis was -0.51 (-0.76 to -0.25) representing a 17% reduction on the Ainamo Bay bleeding on probing index. There was heterogeneity between the trials for the short-term follow up. Sensitivity analyses revealed the results to be robust when selecting trials of high quality. There was no evidence of any publication bias. No other powered designs were as consistently superior to manual toothbrushes.Cost, reliability and side effects were inconsistently reported. Any reported side effects were localised and temporary. AUTHORS' CONCLUSIONS: Powered toothbrushes with a rotation oscillation action reduce plaque and gingivitis more than manual toothbrushing. Observation of methodological guidelines and greater standardisation of design would benefit both future trials and meta-analyses.

Dental Devices, Home Care↗

PubMed2005

Interventions for the treatment of burning mouth syndrome.

BACKGROUND: The complaint of a burning sensation in the mouth can be said to be a symptom of other disease or a syndrome in its own right of unknown aetiology. In patients where no underlying dental or medical causes are identified and no oral signs are found, the term burning mouth syndrome (BMS) should be used. The prominent feature is the symptom of burning pain which can be localised just to the tongue and/or lips but can be more widespread and involve the whole of the oral cavity. Reported prevalence rates in general populations vary from 0.7% to 15%. Many of these patients show evidence of anxiety, depression and personality disorders. OBJECTIVES: The objectives of this review are to determine the effectiveness and safety of any intervention versus placebo for relief of symptoms and improvement in quality of life and to assess the quality of the studies. SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register (20 October 2004), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2004), MEDLINE (January 1966 to October 2004), EMBASE (January 1980 to October). Clinical Evidence Issue No. 10 2004, conference proceedings and bibliographies of identified publications were searched to identify the relevant literature, irrespective of language of publication. SELECTION CRITERIA: Studies were selected if they met the following criteria: study design - randomised controlled trials (RCTs) and controlled clinical trials (CCTs) which compared a placebo against one or more treatments; participants - patients with burning mouth syndrome, that is, oral mucosal pain with no dental or medical cause for such symptoms; interventions - all treatments that were evaluated in placebo-controlled trials; primary outcome - relief of burning/discomfort. DATA COLLECTION AND ANALYSIS: Articles were screened independently by two reviewers to confirm eligibility and extract data. The reviewers were not blinded to the identity of the studies. The quality of the included trials was assessed independently by two reviewers, with particular attention given to allocation concealment, blinding and the handling of withdrawals and drop outs. Due to both clinical and statistical heterogeneity statistical pooling of the data was inappropriate. MAIN RESULTS: Nine trials were included in the review. The interventions examined were antidepressants (two trials), cognitive behavioural therapy (one trial), analgesics (one trial), hormone replacement therapy (one trial), alpha-lipoic acid (three trials) and anticonvulsants (one trial). Diagnostic criteria were not always clearly reported. Out of the nine trials included in the review, only three interventions demonstrated a reduction in BMS symptoms: alpha-lipoic acid (three trials), the anticonvulsant clonazepam (one trial) and cognitive behavioural therapy (one trial). Only two of these studies reported using blind outcome assessment. Although none of the other treatments examined in the included studies demonstrated a significant reduction in BMS symptoms, this may be due to methodological flaws in the trial design, or small sample size, rather than a true lack of effect. AUTHORS' CONCLUSIONS: Given the chronic nature of BMS, the need to identify an effective mode of treatment for sufferers is vital. However, there is little research evidence that provides clear guidance for those treating patients with BMS. Further trials, of high methodological quality, need to be undertaken in order to establish effective forms of treatment for patients suffering from BMS.

Analgesics↗

PubMed2005

Interventions for replacing missing teeth: denture chewing surface designs in edentulous people.

BACKGROUND: When constructing complete dentures for edentulous patients, ultimately patient satisfaction is key. Complete dentures can be produced with different types of occlusal schemes (chewing surfaces) and it is widely accepted that the occlusal scheme for complete dentures has a direct influence upon their success. OBJECTIVES: To assess the relative effectiveness of differing occlusal schemes for complete dentures with regard to patient satisfaction. The null hypothesis is that there is no difference in terms of patient satisfaction between different designs of chewing surfaces for complete dentures. SEARCH STRATEGY: Several electronic databases were searched in order to identify relevant trials: Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to week 2 April 2004), OLDMEDLINE (1953 to 1965), EMBASE (1980 to week 16 2004),Zetoc (1993 to December 2003), SIGLE (1980 to December 2003), SCI (Science Citation Index) (1945 to 04 April 2004 ). Reference lists of identified, relevant trials and review articles were scanned. Unpublished data were sought through personal contact with experts in the field. There was no language restriction. SELECTION CRITERIA: Randomised or quasi-randomised controlled clinical trials (RCTs), recruiting edentulous adults, and comparing complete dentures produced with different occlusal schemes with regard to patient satisfaction and masticatory function. DATA COLLECTION AND ANALYSIS: The quality assessment of the included trials was undertaken independently and in duplicate by two reviewers based initially on what was written in the articles. Data were extracted by two reviewers independently. Disagreements were discussed and a third reviewer consulted as necessary. Authors were contacted for clarification or missing information. Data were excluded until further clarification if agreement could not be reached. MAIN RESULTS: 1076 titles and abstracts were identified through the electronic searches. Thirteen trials were thought to be potentially relevant. Ten of these studies were subsequently excluded following further analysis. Two trials require further information from the author before being considered eligible for inclusion. Only one cross-over trial (n = 30), comparing lingualised teeth and zero-degree teeth, fully met the review's inclusion criteria. Twenty patients preferred the lingualised denture, five the zero-degree denture and five patients had no preference. There was a statistically significant difference in favour of the lingualised denture with an odds ratio of 10 (95% confidence interval 2.04 to 48.96). AUTHORS' CONCLUSIONS: There is weak evidence that it may be advantageous, for dentists providing a complete denture service, to prescribe prosthetic posterior teeth with cusps to improve patient satisfaction compared to providing cuspless teeth. However, this conclusion may only be made tentatively until further well conducted trials comparing different occlusal schemes for complete dentures are undertaken.

Adult↗

PubMed2005

Indirect comparisons of competing interventions.

OBJECTIVES: To survey the frequency of use of indirect comparisons in systematic reviews and evaluate the methods used in their analysis and interpretation. Also to identify alternative statistical approaches for the analysis of indirect comparisons, to assess the properties of different statistical methods used for performing indirect comparisons and to compare direct and indirect estimates of the same effects within reviews. DATA SOURCES: Electronic databases. REVIEW METHODS: The Database of Abstracts of Reviews of Effects (DARE) was searched for systematic reviews involving meta-analysis of randomised controlled trials (RCTs) that reported both direct and indirect comparisons, or indirect comparisons alone. A systematic review of MEDLINE and other databases was carried out to identify published methods for analysing indirect comparisons. Study designs were created using data from the International Stroke Trial. Random samples of patients receiving aspirin, heparin or placebo in 16 centres were used to create meta-analyses, with half of the trials comparing aspirin and placebo and half heparin and placebo. Methods for indirect comparisons were used to estimate the contrast between aspirin and heparin. The whole process was repeated 1000 times and the results were compared with direct comparisons and also theoretical results. Further detailed case studies comparing the results from both direct and indirect comparisons of the same effects were undertaken. RESULTS: Of the reviews identified through DARE, 31/327 (9.5%) included indirect comparisons. A further five reviews including indirect comparisons were identified through electronic searching. Few reviews carried out a formal analysis and some based analysis on the naive addition of data from the treatment arms of interest. Few methodological papers were identified. Some valid approaches for aggregate data that could be applied using standard software were found: the adjusted indirect comparison, meta-regression and, for binary data only, multiple logistic regression (fixed effect models only). Simulation studies showed that the naive method is liable to bias and also produces over-precise answers. Several methods provide correct answers if strong but unverifiable assumptions are fulfilled. Four times as many similarly sized trials are needed for the indirect approach to have the same power as directly randomised comparisons. Detailed case studies comparing direct and indirect comparisons of the same effect show considerable statistical discrepancies, but the direction of such discrepancy is unpredictable. CONCLUSIONS: Direct evidence from good-quality RCTs should be used wherever possible. Without this evidence, it may be necessary to look for indirect comparisons from RCTs. However, the results may be susceptible to bias. When making indirect comparisons within a systematic review, an adjusted indirect comparison method should ideally be used employing the random effects model. If both direct and indirect comparisons are possible within a review, it is recommended that these be done separately before considering whether to pool data. There is a need to evaluate methods for the analysis of indirect comparisons for continuous data and for empirical research into how different methods of indirect comparison perform in cases where there is a large treatment effect. Further study is needed into when it is appropriate to look at indirect comparisons and when to combine both direct and indirect comparisons. Research into how evidence from indirect comparisons compares to that from non-randomised studies may also be warranted. Investigations using individual patient data from a meta-analysis of several RCTs using different protocols and an evaluation of the impact of choosing different binary effect measures for the inverse variance method would also be useful.

Bias↗

PubMed2004

Stabilisation splint therapy for temporomandibular pain dysfunction syndrome.

BACKGROUND: Pain dysfunction syndrome (PDS) is the most common temporomandibular disorder (TMD). There are many synonyms for this condition including facial arthromylagia, TMJ dysfunction syndrome, myofacial pain dysfunction syndrome, craniomandibular dysfunction and myofacial pain dysfunction. The aetiology of PDS is multifactorial and many different therapies have been advocated. OBJECTIVES: To establish the effectiveness of stabilisation splint therapy in reducing symptoms in patients with pain dysfunction syndrome. SEARCH STRATEGY: Electronic databases (including the Cochrane Oral Health Group's Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); The Cochrane Library Issue 2, 2003; MEDLINE (1966 to June 2001); EMBASE (1966 to June 2001)) were searched. Handsearching of relevant journals was undertaken and reference lists of included studies screened. Experts in the field were contacted to identify unpublished articles. There was no language restriction. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials (RCTs), in which splint therapy was compared concurrently to no treatment, other occlusal appliances, or any other active intervention. DATA COLLECTION AND ANALYSIS: Data extraction was carried out independently and in duplicate. Validity assessment of the included trials was carried out at the same time as data extraction. Discrepancies were discussed and a third reviewer consulted. The author of the primary study was contacted where necessary. The studies were grouped according to treatment type and duration of follow up. MAIN RESULTS: Twenty potentially relevant RCTs were identified. Eight trials were excluded leaving 12 RCTs for analysis. Stabilisation splint therapy was compared to: acupuncture, bite plates, biofeedback/stress management, visual feedback, relaxation, jaw exercises, non-occluding appliance and minimal/no treatment. There was no evidence of a statistically significant difference in the effectiveness of stabilisation splint therapy (SS) in reducing symptoms in patients with pain dysfunction syndrome compared with other active treatments. There is weak evidence to suggest that the use of SS for the treatment of PDS may be beneficial for reducing pain severity, at rest and on palpation, when compared to no treatment. REVIEWER'S CONCLUSIONS: There is insufficient evidence either for or against the use of stabilisation splint therapy for the treatment of temporomandibular pain dysfunction syndrome. This review suggests the need for further, well conducted RCTs that pay attention to method of allocation, outcome assessment, large sample size, and enough duration of follow up. A standardisation of the outcomes of the treatment of PDS should be established in the RCTs.

Acupuncture Therapy↗

PubMed2004

Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palate.

BACKGROUND: Cleft lip and cleft palate are common birth defects, affecting about one baby of every 700 born. Feeding these babies is an immediate concern and there is evidence of delay in growth of children with a cleft as compared to those without clefting. In an effort to combat reduced weight for height, a variety of advice and devices are recommended to aid feeding of babies with clefts. OBJECTIVES: This review aims to assess the effects of these feeding interventions in babies with cleft lip and/or palate on growth, development and parental satisfaction. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials register (June 2001), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to May 24th 2004), EMBASE (1980 to August 7th 2002), CINAHL (1982 to August 7th 2002), PsychINFO (1967 to August 13th 2002), AMED (1985 to August 13th 2002). Attempts were made to identify both unpublished and ongoing studies. There was no restriction with regard to language of publication. SELECTION CRITERIA: Studies were included if they were randomised controlled trials (RCTs) of feeding interventions for babies born with cleft lip, cleft palate or cleft lip and palate up to the age of 6 months (from term). DATA COLLECTION AND ANALYSIS: Studies were assessed for relevance independently and in duplicate. All studies meeting the inclusion criteria were data extracted and assessed for validity independently by each member of the review team. Authors were contacted for clarification or missing information whenever possible. MAIN RESULTS: Four RCTs with a total of 232 babies, were included in the review. Comparisons made within the RCTs were squeezable versus rigid feeding bottles (two studies), breastfeeding versus spoon-feeding (one study) and maxillary plate versus no plate (one study). No statistically significant differences were shown for any of the primary outcomes when comparing bottle types, although squeezable bottles were less likely to require modification. No statistically significant difference was shown for infants fitted with a maxillary plate compared to no plate. A statistically significant difference in weight (kg) at 6 weeks post-surgery was shown in favour of breastfeeding when compared to spoon-feeding (mean difference 0.47; 95% CI: 0.20, 0.74). REVIEWERS' CONCLUSIONS: Squeezable bottles appear easier to use than rigid feeding bottles for babies born with clefts of the lip and/or palate, however, there is no evidence of a difference in growth outcomes between the bottle types. There is weak evidence that babies should be breastfed rather than spoon-fed following surgery for cleft lip. No evidence was found to assess the use of any types of maternal advice and/or support for these babies.

Cleft Lip↗

PubMed2004

Direct versus indirect veneer restorations for intrinsic dental stains.

BACKGROUND: Patients with discoloured teeth frequently present to the dentist requesting restorations designed to improve their appearance. For teeth that are sound, this might include the use of a veneer restoration. The veneer acts as a thin layer of a material covering the labial surface of a tooth and can be applied directly to the tooth, or by using indirect methods. OBJECTIVES: To examine the effectiveness of direct versus indirect laminate veneer restorations. SEARCH STRATEGY: The following electronic databases were searched: The Cochrane Oral Health Group's Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library Issue 3, 2002), MEDLINE (1980 to 19/11/2002) and EMBASE (1980 to 19/11/2002). There was no restriction on language. SELECTION CRITERIA: All randomised controlled trials (RCTs) of participants with permanent anterior teeth suitable for restorations using laminate veneers, comparing direct (different composite materials) and indirect techniques for making dental veneers. The indirect restorations may be either composite or porcelain. The primary outcome was restoration failure. DATA COLLECTION AND ANALYSIS: Assessment of relevance and validity and data extraction were conducted in triplicate. Authors of the primary studies were contacted to provide additional information as necessary. MAIN RESULTS: Six full publications were screened as being potentially relevant to the review, only one trial was found to meet the review's inclusion criteria. Although the trial met the review's inclusion criteria with regard to participant characteristics, interventions and outcomes assessed, problems with the reporting of the data prevented any statistical analysis of the results. REVIEWER'S CONCLUSIONS: There is no reliable evidence to show a benefit of one type of veneer restoration (direct or indirect) over the other with regard to the longevity of the restoration.

Dental Veneers↗

PubMed2004

A survey of current practice with regard to oral care for children being treated for cancer.

The aim of the study was to establish current UK oral care practice for children with cancer. A telephone survey of all 22 United Kingdom Children's Cancer Study Group (UKCCSG) centres was undertaken. Nineteen (86%) of the centres reported using guidelines/protocols for mouth care. The use of routine preventive oral care therapies showed the greatest variation between centres. Four centres (18%) did not use any prophylactic oral care therapy other than basic oral hygiene, whereas seven (32%) routinely used a combination of three or more agents. Chlorhexidine was the most frequently administered prophylactic therapy (17/22 centres, 77%), followed by nystatin (11/22 centres, 50%). There was little variation in advice given to parents/patients on basic oral hygiene. Regarding dental check-ups, 9/22 centres (41%) recommended children to attend a hospital-linked dental clinic. Only at 8/22 centres (36%) did children undergo a dental check-up before commencing cancer treatment. The survey identified significant variation in preventive oral care therapies and dental check-ups at the UKCCSG centres. Attention needs to be given to establishing evidence based, effective strategies.

Cancer Care Facilities↗

PubMed2004

Healing of oral lichenoid lesions after replacing amalgam restorations: a systematic review.

OBJECTIVE: We sought to systematically review the literature related to oral lichenoid lesions (OLLs) and amalgam restorations. STUDY DESIGN: Cohort and case-controlled studies (no randomized controlled trials or controlled clinical trials available) were reviewed with respect to inclusion criteria and data on patients with OLLs, treatment interventions, and the measurement of outcomes. RESULTS: Fourteen cohort and 5 case-controlled trials met the criteria. The study population consisted of 1158 patients (27% male and 73% female; age range, 23-79 years). From 16% to 91% of patients had positive patch test results for at least 1 mercury compound. Of 1158 patients, 636 had to have their restorations replaced. The follow-up period ranged from 2 months to 9 1/2 years. Complete healing ranged from 37.5% to 100%. The greatest improvements were seen in lesions in close contact with amalgam. CONCLUSIONS: Protocols must be standardized to obtain valid results. The replacement of amalgam restorations can result in the resolution or improvement of OLLs. Patch testing seems to be of limited value. The topographic relationship between an OLL and an amalgam restoration is a useful--but not conclusive--marker.

Adult↗

PubMed2003

Pulp treatment for extensive decay in primary teeth.

BACKGROUND: Dental decay in primary teeth remains a considerable health problem. Where decay extends to involve the dental pulp, pulp treatment techniques are often used to manage both symptomatic and symptom free teeth. OBJECTIVES: To assess the relative effectiveness of: various pulp treatment techniques in retaining primary molar teeth with decay involving the pulp for at least 12 months; pulp treatment techniques and extractions in avoiding long term sequelae. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (August 2002); the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2002); MEDLINE (January 1966 to August 2002); EMBASE (1980 to August 2002); Science Citation Index Expanded (1981 to August 2002); Social Science Citation Index (1981 to August 2002); Index to Scientific and Technical Proceedings (1982 to August 2002); System for Information on Grey Literature in Europe (August 2002). Key journals were handsearched. There was no restriction on language of publication. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials (RCTs) comparing different pulp treatment techniques (with each other, with extraction or with no treatment) for extensive decay in primary molar teeth. Primary outcomes were extractions following pulp treatment and long term effects. DATA COLLECTION AND ANALYSIS: Data extraction and quality assessment were carried out independently and in duplicate. Authors were contacted for additional information where necessary. MAIN RESULTS: Eighty-two studies were identified but only three were suitable for inclusion. Nine studies meeting the inclusion criteria but with inappropriate study design or analysis are also described. Included trials investigated formocresol pulpotomy, ferric sulphate pulpotomy, electrosurgical pulpotomy or zinc oxide eugenol pulpectomy in symptom free, cariously exposed teeth. Data were unavailable on long term effects. Data on extraction following pulp treatment was available in all three studies and in two studies there was no statistically significant difference between the treatments. The difference seen in the other study, where more teeth treated by ferric sulphate pulpotomy were extracted compared to zinc oxide eugenol pulpectomy, must be viewed with caution. REVIEWER'S CONCLUSIONS: Based on the available RCTs, there is no reliable evidence supporting the superiority of one type of treatment for pulpally involved primary molars. No conclusions can be made as to the optimum treatment or techniques for pulpally involved primary molar teeth due to the scarcity of reliable scientific research. High quality RCTs, with appropriate unit of randomisation and analysis are needed.

Controlled Clinical Trials as Topic↗

PubMed2003

Screening programmes for the early detection and prevention of oral cancer.

BACKGROUND: Although the second half of the last century has generated a rich and complex body of knowledge, the burden of oral cancer is still largely present. As with other cancers, there has been a strong debate whether screening strategies for oral cancer such as visual examination, the use of toluidine blue or newer methods such as brush biopsy or fluorescence imaging are effective in reducing the mortality rate associated with oral cancer. OBJECTIVES: To assess the effectiveness of current screening methods in decreasing oral cancer mortality. SEARCH STRATEGY: Electronic databases (MEDLINE, CANCERLIT, EMBASE, the Cochrane Central Register of Controlled Trials; 1966 to September 2002, The Cochrane Library - Issue 2, 2002), bibliographies, handsearching of specific journals and contact authors were used to identify published and unpublished data. SELECTION CRITERIA: Randomised controlled trials of screening for oral cancer or potentially premalignant oral lesions using visual examination, toluidine blue, fluorescence imaging or brush biopsy. DATA COLLECTION AND ANALYSIS: The search found 100 citations and these have been reviewed. One randomised controlled trial of screening strategies for oral cancer was identified as meeting the review's inclusion criteria. Validity assessment, data extraction and statistics evaluation have been undertaken by two independent reviewers. MAIN RESULTS: One ongoing randomised controlled trial has been included (n = 13 clusters: 153,708 eligible subjects, 130,799 included subjects). There was no difference in the age-standardised oral cancer mortality rates for the screened group (21.2/1000,000 person years) and the control group (21.3/100,000 person years). However this study has some methodological weaknesses. REVIEWER'S CONCLUSIONS: Given the limitation of evidence (only one included randomised controlled trial) and the potential methodological weakness in the included study, it is valid to say that there is no evidence to support or refute the use of a visual examination as a method of screening for oral cancer using a visual examination in the general population. Furthermore, no robust evidence exists to suggest other methods of screening, toluidine blue, fluorescence imaging or brush biopsy, are either beneficial or harmful. Further cost-effective, high quality studies to assess the efficacy and effectiveness of screening are required. In addition, studies to elucidate the natural history of oral cancer, prevention methods and the effectiveness of opportunistic screening in high risk groups are needed.

Humans↗

PubMed2003

The assessment of systematic reviews in dentistry.

The aim of this study was to assess the quality of systematic reviews of effectiveness of interventions in dentistry. The Database of Abstracts of Reviews of Effectiveness and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews examining the effectiveness of interventions for oral, dental and craniofacial disorders and diseases. Sixty-five reviews were identified and assessed independently by two reviewers. The area most frequently evaluated within the reviews was pain relief/prevention (20/65, 31%) followed by caries and oral medicine. The quality assessment of the identified systematic reviews highlighted key areas where improvements could be made. One major weakness of the reviews was that the search strategies employed were not always adequate. Only 12 reviews (19%) demonstrated an attempt to identify all relevant studies. Other areas of weakness include the screening and quality assessment of primary studies, the pooling of data and examination of heterogeneity, and the interpretation of findings. This investigation shows that the quality of systematic reviews in dentistry could be improved. If future clinical decisions are to be based upon systematic reviews, it is imperative that the reviews address clinically relevant, focused questions and follow a 'transparent', well-designed protocol.

Databases, Bibliographic↗

PubMed2002

An updated systematic review of interventions to improve health professionals' management of obesity.

The objective of this article was twofold (1) to determine the existence and effectiveness of interventions to improve health professionals' management of obesity or the organization of care for overweight and obese people; and (2) to update a previous systematic review on this topic with new or additional studies. The study design was a systematic review of intervention studies, undertaken according to standard methods developed by the Cochrane Effective Practice and Organization of Care (EPOC) Group. Participants were trained health care professionals and overweight and obese patients. The measurements were objective measures of health professionals' practice and behaviours, and patient outcomes including satisfaction, behaviour, psychological factors, disease status, risk factors and measures of body weight, fat, or body mass index (BMI). Twelve studies were included in the original review. A further six were included in this update. Six of the 18 studies were randomized controlled trials of health professional-oriented interventions (such as the use of reminders and training) and one was a controlled before-and-after study to improve collaboration between a hospital clinic and general practitioners (GPs). Ten randomized controlled trials and two controlled clinical trials of interventions comparing either the deliverer of weight-loss interventions or the setting of the delivery of the intervention, were identified. The heterogeneity and generally limited quality of identified studies make it difficult to provide recommendations for improving health professionals' obesity management. To conclude, at present, there are few solid leads about improving obesity management, although reminder systems, brief training interventions, shared care, inpatient care and dietitian-led treatments may all be worth further investigation. Therefore, decisions for the improvement of provision of services must be based on the existing evidence on interventions with patients and good clinical judgement. Further research is needed to identify cost-effective strategies for improving the management of obesity. A full version of this review (including detailed descriptions of the included studies and their methodological quality, and results and excluded studies tables) is available in the Cochrane Library. The Cochrane Library is a database of systematic review and other evidence on the effects of health care, continuously updated as new information emerges. It is available on CD ROM from Update Software. For further information see: http://www.update-software.com/cochrane.

Clinical Competence↗

PubMed2001

Interventions for the treatment of burning mouth syndrome.

BACKGROUND: The complaint of a burning sensation in the mouth can be said to be a symptom of other disease or a syndrome in its own right of unknown aetiology. In patients where no underlying dental or medical causes are identified and no oral signs are found, the term burning mouth syndrome (BMS) should be used. The prominent feature is the symptom of burning pain which can be localised just to the tongue and/or lips but can be more widespread and involve the whole of the oral cavity. Reported prevalence rates in general populations vary from 0.7% to 15%. Many of these patients show evidence of anxiety, depression and personality disorders. OBJECTIVES: The objectives of this review are to determine the effectiveness and safety of any intervention versus placebo for relief of symptoms and improvement in quality of life and to assess the quality of the studies. SEARCH STRATEGY: Electronic databases (The Cochrane Library, the Cochrane Oral Health Group's Specialised Register, MEDLINE, EMBASE), Clinical Evidence Issue No. 3, conference proceedings and bibliographies of identified publications were searched to identify the relevant literature, irrespective of language of publication. SELECTION CRITERIA: Studies were selected if they met the following criteria: study design - randomised controlled trials (RCTs) and controlled clinical trials (CCTs) which compared a placebo against one or more treatments; participants - patients with burning mouth syndrome, that is, oral mucosal pain with no dental or medical cause for such symptoms; interventions - all treatments that were evaluated in placebo-controlled trials; primary outcome - relief of burning/discomfort DATA COLLECTION AND ANALYSIS: Articles were screened independently by two reviewers to confirm eligibility and extract data. The reviewers were not blinded to the identity of the studies. The quality of the included trials was assessed independently by two reviewers, with particular attention given to allocation concealment, blinding and the handling of withdrawals and drop-outs. Due to differences in patient type, treatment and outcome measures, statistical pooling of the data was inappropriate. MAIN RESULTS: Six trials were included in the review. The interventions examined were antidepressants (two trials), cognitive behavioural therapy (one trial), analgesics (one trial), hormone replacement therapy (one trial) and vitamin complexes (one trial). The participants included in the six identified trials reported suffering from BMS from six months to 20 years. Diagnostic criteria were not always clearly reported. Out of the six trials included in the review, only two interventions demonstrated a reduction in BMS symptoms; vitamin complexes and cognitive behavioural therapy. Neither of these studies reported using blind outcome assessment. Although none of the other treatments examined in the included studies demonstrated a significant reduction in BMS symptoms, this may be due to methodological flaws in the trial design, or small sample size, rather than a true lack of effect. REVIEWER'S CONCLUSIONS: Given the chronic nature of BMS, the need to identify an effective mode of treatment for sufferers is vital. However, there is little research evidence that provides clear guidance for those treating patients with BMS. Further trials, of high methodological quality, need to be undertaken in order to establish effective forms of treatment for patients suffering from BMS.

Analgesics↗