Evidence-based dentistry
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Evidence-based dentistry · Dec 2013
CommentNo reliable evidence to guide initial arch wire choice for fixed appliance therapy.
The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase databases were searched. Conference proceedings and abstracts from the British Orthodontic Conference European Orthodontic Conference and the International Association for Dental Research were also searched together with the reference lists of identified studies. Study authors were contacted for additional information. ⋯ There is no reliable evidence from the trials included in this review that any specific initial arch wire material is better or worse than another with regard to speed of alignment or pain. There is no evidence at all about the effect of initial arch wire materials on the important adverse effect of root resorption. Further well-designed and conducted, adequately-powered RCTs are required to determine whether the performance of initial arch wire materials as demonstrated in the laboratory, makes a clinically important difference to the alignment of teeth in the initial stage of orthodontic treatment in patients.
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Evidence-based dentistry · Dec 2013
CommentFacemask therapy between ages six to ten years may lead to short term improvements for Class III malocclusions.
The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase databases were searched. ⋯ There is some evidence that the use of a facemask to correct prominent lower front teeth in children is effective when compared to no treatment on a short-term basis. However, in view of the general poor quality of the included studies, these results should be viewed with caution. Further randomised controlled trials with long follow-up are required.
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Evidence-based dentistry · Sep 2013
CommentToothbrushing may reduce ventilator-associated pneumonia.
The databases Embase, Medline, CINAHL, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, clinical trials.gov and controlled-trials.com were searched. Reference lists of reviewed articles and eligible trials were also searched, and toothpaste and toothbrush manufactures were contacted. ⋯ In summary, randomised trials to date show that toothbrushing is associated with a trend toward lower rates of VAP in intubated, mechanically ventilated critically ill patients. There is no clear difference between electric and manual toothbrushing. Toothbrushing has no effect on ICU mortality, hospital mortality, or ICU length of stay.
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Evidence-based dentistry · Sep 2013
CommentStrong evidence for the effectiveness of resin based sealants.
Cochrane Oral Health Group's Trials Register, CENTRAL, Medline via OVID, EMBASE via OVID; SCISEARCH, CAplus, INSPEC, NTIS and PASCAL via STN Easy and DARE, NHS EED, HTA (all to September/ November 2012) and ClinicalTrials.gov (to July 2012). There were no restrictions on language or date of publication. ⋯ Sealants compared with no sealants, on the occlusal surfaces of permanent molars in children and adolescents, are effective at reducing caries up to 48 months. There is less evidence for longer term follow-up and little for the relative effectiveness of sealing in less high caries risk children. No conclusions could be drawn on the relative effectiveness of different types of sealants.
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Evidence-based dentistry · Sep 2013
CommentOral hygiene regimes for mechanically ventilated patients that use chlorhexidine reduce ventilator-associated pneumonia.
The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, LILACS, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan Fang Database, OpenGrey and ClinicalTrials.gov databases were searched. Reference lists of identified articles were also scanned for relevant papers. There were no language restrictions. ⋯ Effective OHC is important for ventilated patients in intensive care. OHC that includes either chlorhexidine mouthwash or gel is associated with a 40% reduction in the odds of developing ventilator-associated pneumonia in critically ill adults. However, there is no evidence of a difference in the outcomes of mortality, duration of mechanical ventilation or duration of ICU stay. There is no evidence that OHC including both CHX and toothbrushing is different from OHC with CHX alone, and some weak evidence to suggest that povidone iodine mouthrinse is more effective than saline in reducing VAP. There is insufficient evidence to determine whether powered toothbrushing or other oral care solutions are effective in reducing VAP.