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New Cochrane Systematic Reviews — Cochrane Oral Health Group
THE COCHRANE REVIEW
New Cochrane Systematic Reviews — Cochrane Oral Health Group The Cochrane Oral Health Group in Issue 4, October 2007, of The Cochrane Library published 4 systematic reviews and 4 systematic review updates. The abstracts for these reviews are below. For a full list of reviews/protocols published by the Cochrane Oral Health Group, please visit their Web site (www.ohg.cochrane.org/). If you are interested in contributing to the work of the Cochrane Oral Health Group please contact Luisa Fernandez, Cochrane Oral Health Group, MANDEC, School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, UK. Tel: +44 161 275 7819, Fax: +44 161 275 7815, E-mail: [email protected]
SYSTEMATIC REVIEWS INTERVENTIONS FOR THE TREATMENT OF ORAL AND OROPHARYNGEAL CANCERS: SURGICAL TREATMENT. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006205. DOI: 10.1002/ 14651858.CD006205.pub2. Oliver RJ, Clarkson JE, Conway DI, Glenny A, Macluskey M, Pavitt S, Sloan P, The CSROC Expert Panel, Worthington HV. BACKGROUND: Oral and oropharyngeal cancers can be managed by surgery alone or with any combination of radiotherapy, chemotherapy, and immunotherapy/ biotherapy. Opinions on the surgical treatment, the optimal combinational therapy, and the sequence of treatments in combinational therapy vary enormously. OBJECTIVES: To determine which surgical treatment modalities for oral and oropharyngeal cancers lead to the best outcomes compared with other surgical, radiotherapy, chemotherapy, or immunotherapy/biotherapy combinations. SEARCH STRATEGY: Electronic search of the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE, OLDMEDLINE, EMBASE, AMED, and the National Cancer Trials Database. Reference lists from relevant articles were searched and the authors of eligible trials were contacted. Date of the most recent searches: July 2007. SELECTION CRITERIA: Randomized controlled trials of surgery alone or in combination with chemotherapy, radiotherapy, or immunotherapy/biotherapy for the treatment of primary oral or oropharyngeal cancer or both.
DATA COLLECTION AND ANALYSIS: A minimum of 2 review authors conducted data extraction. Risk ratios were calculated for dichotomous outcomes at different time intervals, and hazard ratios were extracted or calculated for disease-free survival, total mortality, and diseaserelated mortality. Additional information from trial authors was sought. Data on adverse events were collected from the trial reports. MAIN RESULTS: Thirty-one trials satisfied the inclusion criteria, only 13 of which were assessed as low risk of bias. Trials were grouped into 12 main comparisons. There were no trials that compared different surgical modalities of the primary tumor itself. However, there were a number of trials comparing different approaches to managing the cervical lymph nodes. The majority of treatment regimens under evaluation were surgery in combination with other modalities. As individual treatment regimens within each comparison varied, meta-analysis was inappropriate in most instances. Only 2 trials could be pooled, comparing concomitant radio/chemotherapy (with surgery) versus radiotherapy (with surgery). A statistically significant difference was shown for disease-free survival (hazard ratio 0.77, 95% confidence interval (CI): 0.64 to 0.92) and total mortality (hazard ratio 0.78, 95% CI: 0.64 to 0.95) in favor of the concomitant chemotherapy and radiotherapy (with surgery) arm. No other treatment regimens showed consistent statistically significant results across the outcomes measured. AUTHORS’ CONCLUSIONS: There is some evidence that concomitant radio/chemotherapy (with surgery) is more effective than radiotherapy (with surgery) and may benefit outcomes in patients with more advanced oral and oropharyngeal cancers. As these trials were based on head and neck studies, future studies should evaluate this treatment regimen specifically in oral and
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oropharyngeal cancers separately and also address tumor staging and its impact on outcomes. In general, future studies are encouraged to evaluate site-specific and stage-specific data for oral and oropharyngeal cancers. Future trials should include healthrelated quality of life assessment as an outcome measure. There is a need for a consolidated standardized approach to reporting adverse events.
OCCLUSAL SPLINTS FOR TREATING SLEEP BRUXISM (TOOTH GRINDING). Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005514. DOI: 10.1002/ 14651858.CD005514.pub2. Macedo CR, Silva AB, Machado MA, Saconato H, Prado GF.
was combined in a meta-analysis. No statistically significant differences between the occlusal splint and control groups were found in the meta-analyses. AUTHORS’ CONCLUSIONS: There is not sufficient evidence to state that the occlusal splint is effective for treating sleep bruxism. Indication of its use is questionable with regard to sleep outcomes, but it may be that there is some benefit with regard to tooth wear. This systematic review suggests the need for further investigation in more controlled RCTs that pay attention to method of allocation, outcome assessment, large sample size, and sufficient duration of follow up. The study design must be parallel to eliminate the bias provided by studies of crossover type. A standardization of the outcomes of the treatment of sleep bruxism should be established in the RCTs.
BACKGROUND: Sleep bruxism is an oral activity characterized by teeth grinding or clenching during sleep. Several treatments for sleep bruxism have been proposed such as pharmacological, psychological, and dental. OBJECTIVES: To evaluate the effectiveness of occlusal splints for the treatment of sleep bruxism with alternative interventions, placebo, or no treatment.
SINGLE VERSUS MULTIPLE VISITS FOR ENDODONTIC TREATMENT OF PERMANENT TEETH. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005296. DOI: 10.1002/ 14651858.CD005296.pub2. Figini L, Lodi G, Gorni F, Gagliani M.
SEARCH STRATEGY: We searched the Cochrane Oral Health Group’s Trials Register (to May 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1); MEDLINE (1966 to May 2007); EMBASE (1980 to May 2007); LILACS (1982 to May 2007); Biblioteca Brasileira de Odontologia (1982 to May 2007); Dissertations, Theses, and Abstracts (1981 to May 2007); and handsearched abstracts of particular importance to this review. Additional reports were identified from the reference lists of retrieved reports and from article reviews about treating sleep bruxism. There were no language restrictions.
BACKGROUND: Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, tooth cracks or chips, or dental trauma. Successful RoCT is characterized by an absence of symptoms and clinical signs in teeth without radiographic evidence of periodontal involvement. The success of RoCT depends on a series of variables related to the preoperative condition of the tooth, as well as the endodontic procedures.
SELECTION CRITERIA: We selected randomized or quasi-randomized controlled trials (RCTs), in which splint therapy was compared concurrently to no treatment, other occlusal appliances, or any other intervention in participants with sleep bruxism. 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 review author consulted. The author of the primary study was contacted when necessary. MAIN RESULTS: Thirty-two potentially relevant RCTs were identified. Twenty-four trials were excluded. Five RCTs were included. Occlusal splint was compared to palatal splint, mandibular advancement device, transcutaneous electric nerve stimulation, and no treatment. There was just one common outcome (arousal index), which 46
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OBJECTIVES: To compare the effectiveness of singleand multiple-visit RoCT, measured as tooth extraction due to endodontic problems and radiological success. To assess the difference in short- and long-term complications between single- and multiple-visit RoCT. SEARCH STRATEGY: The following databases were searched for relevant trials: Cochrane Oral Health Group’s Trials Register, CENTRAL, MEDLINE, and EMBASE. Handsearching was performed for the major oral medicine journals. References of included studies and reviews were checked. Endodontics experts were contacted through E-mail. No language limitations were imposed. Date of last search was 6 March 2007. SELECTION CRITERIA: Randomized and quasi-randomized controlled trials of patients needing RoCT were included. Surgical endodontic treatment was excluded. The outcomes considered were the number of teeth extracted for endodontic problems; radiological March 2008
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success after at least 1 year, that is, absence of any periapical radiolucency; postoperative pain; painkiller use; swelling; or sinus track formation. DATA COLLECTION AND ANALYSIS: Data were collected using a specific extraction form. The validity of included studies was assessed on the basis of allocation concealment, blindness of the study, and loss of participants. Data were analyzed by calculating risk ratios. When valid and relevant data were collected, a meta-analysis of the data was undertaken. MAIN RESULTS: Twelve randomized controlled trials were included in the review. Four studies had a low risk of bias, 4 a moderate risk, and another 4 had a high risk of bias. The frequency of radiological success and immediate postoperative pain were not significantly different between single- and multiple-visit RoCT. Patients undergoing single-visit RoCT reported a higher frequency of painkiller use and swelling, but the results for swelling were not significantly different between the 2 groups. We found no study that included tooth loss and sinus track formation among its primary outcomes. AUTHORS’ CONCLUSIONS: No difference exists in the effectiveness of RoCT, in terms of radiological success, between single- and multiple-visit RoCT. Most short- and long-term complications are also similar in terms of frequency, although patients undergoing a single visit may experience a slightly higher frequency of swelling and are significantly more likely to take painkillers.
ULTRASONIC VERSUS HAND INSTRUMENTATION FOR ORTHOGRADE ROOT CANAL TREATMENT OF PERMANENT TEETH. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006384. DOI: 10.1002/ 14651858.CD006384.pub2. Sequeira P, Fedorowicz Z, Nasser M, Pedrazzi V. BACKGROUND: Endodontic treatment of root canals or root canal treatment is a frequently performed dental procedure and is carried out on teeth in which irreversible pulpitis has led to necrosis (death) of the dental pulp (nerve). Removal of the necrotic tissue remnants and cleaning and shaping of the root canal are important phases of root canal treatment. Treatment options include the use of hand and rotary instruments and methods using ultrasonic or sonic equipment. OBJECTIVES: The objectives of this review were to determine the relative clinical effectiveness of ultrasonic versus hand instrumentation for orthograde root canal treatment of permanent teeth. SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Volume 8, Number 1
Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE. We searched the reference lists of relevant articles and a personal database of trial reports in an attempt to locate additional published and unpublished trials. No language restriction was applied. The last electronic search was conducted in September 2006. SELECTION CRITERIA: Randomized controlled trials involving people older than 18 with single and multiple permanent teeth with a completely formed apex and with no evidence of internal resorption requiring root canal treatment were included. Patients undertaking retreatment of a tooth were excluded. DATA COLLECTION AND ANALYSIS: Screening of eligible studies was conducted in duplicate and independently by 2 review authors. Results were to be expressed as fixed or random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. MAIN RESULTS: No eligible randomized controlled trials were identified. AUTHORS’ CONCLUSIONS: This review illustrates that there are no published or ongoing randomized controlled clinical trials relevant to this review question and that there is currently insufficient evidence for the effectiveness of ultrasonic instrumentation used alone for orthograde root canal treatment. Future randomized controlled trials might focus more closely on evaluating the effectiveness of hand instrumentation compared with hand instrumentation and adjunctive ultrasonic instrumentation.
SYSTEMATIC REVIEW UPDATES INTERVENTIONS FOR PREVENTING ORAL MUCOSITIS FOR PATIENTS WITH CANCER RECEIVING TREATMENT. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000978. DOI: 10.1002/ 14651858.CD000978.pub3. Worthington HV, Clarkson JE, Eden OB. BACKGROUND: Treatment of cancer is increasingly more effective but is associated with short- and long-term side effects. Oral side effects remain a major source of illness despite the use of a variety of agents to prevent them. One of these side effects is oral mucositis (mouth ulcers). OBJECTIVES: To evaluate the effectiveness of prophylactic agents for oral mucositis in patients with cancer receiving treatment, compared with other potentially active interventions, placebo, or no treatment. SEARCH STRATEGY: The Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Cochrane Reviews
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Controlled Trials (CENTRAL), MEDLINE, and EMBASE were searched. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted to identify trials and obtain additional information. Date of most recent searches: June 2006: CENTRAL (The Cochrane Library 2006, Issue 2). SELECTION CRITERIA: Trials were selected if they met the following criteria: design—random allocation of participants; participants—anyone with cancer receiving chemotherapy or radiotherapy treatment for cancer; interventions—agents prescribed to prevent oral mucositis; outcomes—prevention of mucositis, pain, amount of analgesia, dysphagia, systemic infection, length of hospitalisation, cost, and patient quality of life. DATA COLLECTION AND ANALYSIS: Information regarding methods, participants, interventions, and outcome measures and results were independently extracted, in duplicate, by 2 review authors. Authors were contacted for details of randomization and withdrawals and a quality assessment was carried out. The Cochrane Collaboration statistical guidelines were followed and risk ratios (RR) calculated using random-effects models. MAIN RESULTS: Two hundred and seventy-seven studies were eligible. One hundred and eighty-eight were excluded for various reasons, usually as there was no useable information on mucositis. Of the 89 useable studies, all had data for mucositis comprising 7523 randomized patients. Interventions evaluated were acyclovir, allopurinol mouthrinse, aloe vera, antibiotic pastille or paste, benzydamine, beta carotene, calcium phosphate, chamomile, Chinese medicine, chlorhexidine, etoposide, folinic acid, glutamine, granulocyte/macrophage colony-stimulating factor (GM-CSF), histamine gel, honey, hydrolytic enzymes, ice chips, iseganan, keratinocyte GF, misonidazole, pilocarpine, pentoxifylline, povidone, prednisone, propantheline anticholinergic, prostaglandin, sucralfate, systemic antibiotic clarithromycin, traumeel, and zinc sulphate. Of the 33 interventions included in trials, 12 showed some evidence of a benefit (albeit sometimes weak) for either preventing or reducing the severity of mucositis. Interventions where there was more than one trial in the meta-analysis finding a significant difference when compared with a placebo or no treatment were: Amifostine, which provided minimal benefit in preventing mild and moderate mucositis, with RR values of 0.95 (95% confidence interval [CI] 0.92 to 0.98) and 0.88 (95% CI 0.80 to 0.98); Chinese medicine showed a benefit at all 3 dichotomies of mucositis with RR values of 0.44 (95% CI 0.20 to 0.96), 0.44 (95% CI 0.33 to 0.59), and 0.16 (95% CI 0.07 to 0.35) for increasing levels of mucositis severity; hydrolytic enzymes reduced moderate and severe mucositis with RR values of 0.52 (95% CI 0.36 to 0.74) and 0.17 (95% CI 0.06 to 0.52); and
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ice chips prevented mucositis at all levels with RR values of 0.64 (95% CI 0.50 to 0.82), 0.38 (95% CI 0.23 to 0.62), and 0.24 (95% CI 0.12 to 0.48).
Other interventions showing some benefit with only one study were benzydamine, calcium phosphate, etoposide bolus, honey, iseganan, oral care, and zinc sulphate. The general reporting of randomized controlled trials (RCTs), especially concealment of randomization, was poor. However, the assessments of the quality of the randomization improved when the authors provided additional information. AUTHORS’ CONCLUSIONS: Several of the interventions were found to have some benefit at preventing or reducing the severity of mucositis associated with cancer treatment. The strength of the evidence was variable and implications for practice include consideration that benefits may be specific for certain cancer types and treatment. There is a need for well-designed and conducted trials with sufficient numbers of participants to perform subgroup analyses by type of disease and chemotherapeutic agent.
INTERVENTIONS FOR REPLACING MISSING TEETH: DIFFERENT TYPES OF DENTAL IMPLANTS. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003815. DOI: 10.1002/ 14651858.CD003815.pub3. Esposito M, Murray-Curtis L, Grusovin MG, Coulthard P, Worthington HV. BACKGROUND: Dental implants are available in different materials and shapes and with different surface characteristics. In particular, numerous implant surface modifications have been developed for enhancing clinical performance. OBJECTIVES: To test the null hypothesis of no difference in clinical performance between various rootformed osseointegrated dental implant types. SEARCH STRATEGY: We searched the Cochrane Oral Health Group’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE. Handsearching included several dental journals. We checked the bibliographies of relevant clinical trials and review articles for studies outside the handsearched journals. We wrote to authors of the identified randomized controlled trials (RCTs), to more than 55 oral implant manufacturers; we used personal contacts and we asked on an Internet discussion group in an attempt to identify unpublished or ongoing RCTs. No language restriction was applied. The last electronic search was conducted on 13 June 2007. SELECTION CRITERIA: All RCTs of oral implants comparing osseointegrated implants with different March 2008
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materials, shapes, and surface properties having a follow up of at least 1 year. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials, and data extraction were conducted in duplicate and independently by 2 review authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). MAIN RESULTS: Forty different RCTs were identified. Sixteen of these RCTs, reporting results from a total of 771 patients, were suitable for inclusion in the review. Eighteen different implant types were compared with a follow up ranging from 1 to 5 years. All implants were made in commercially pure titanium and had different shapes and surface preparations. On a ‘‘per patient’’ rather than ‘‘per implant’’ basis no significant differences were observed between various implant types for implant failures. There were statistically significant differences for perimplant bone level changes on intraoral radiographs in 3 comparisons in 2 trials. In one trial there was more bone loss only at 1 year for IMZ implants (Friedrichsfeld AG Mannheim, Germany) compared to Bra˚nemark (mean difference 0.60 mm; 95% CI 0.01 to 1.10) and to ITI implants (Institut Straumann AG, Waldenburg, Switzerland) (mean difference 0.50 mm; 95% CI 0.01 to 0.99). In the other trial Southern implants displayed more bone loss at 5 years than Steri-Oss implants (mean difference 0.35 mm; 95% CI 0.70 to 0.01). However this difference disappeared in the metaanalysis. More implants with rough surfaces were affected by perimplantitis (RR 0.80; 95% CI 0.67 to 0.96) meaning that turned implant surfaces had a 20% reduction in risk of being affected by perimplantitis over a 3-year period. AUTHORS’ CONCLUSIONS: Based on the available results of RCTs, there is limited evidence showing that implants with relatively smooth (turned) surfaces are less prone to lose bone due to chronic infection (perimplantitis) than implants with rougher surfaces. On the other hand, there is no evidence showing that any particular type of dental implant has superior long-term success. These findings are based on a few RCTs, often at high risk of bias, with few participants and relatively short follow up periods. More RCTs should be conducted, with follow-up of at least 5 years including a sufficient number of patients to detect a true difference. Such trials should be reported according to the CONSORT recommendations (http://www.consort-statement.org/).
RECALL INTERVALS FOR ORAL HEALTH IN PRIMARY CARE PATIENTS. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD004346. DOI: 10.1002/ 14651858.CD004346.pub3. Beirne P, Clarkson JE, Worthington HV. Volume 8, Number 1
BACKGROUND: The frequency with which patients should attend for a dental check-up and the potential effects on oral health of altering recall intervals between check-ups have been the subject of ongoing international debate for almost 3 decades. Although recommendations regarding optimal recall intervals vary between countries and dental health care systems, 6-monthly dental checkups have traditionally been advocated by general dental practitioners in many developed countries. OBJECTIVES: To determine the beneficial and harmful effects of different fixed recall intervals (for example 6 months versus 12 months) for the following different types of dental check-up: (1) clinical examination only; (2) clinical examination plus scale and polish; (3) clinical examination plus preventive advice; and (4) clinical examination plus preventive advice plus scale and polish. To determine the relative beneficial and harmful effects between any of these different types of dental check-up at the same fixed recall interval. To compare the beneficial and harmful effects of recall intervals based on clinicians’ assessment of patients’ disease risk with fixed recall intervals. To compare the beneficial and harmful effects of no recall interval/patient-driven attendance (which may be symptomatic) with fixed recall intervals. SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE. Reference lists from relevant articles were scanned and the authors of some papers were contacted to identify further trials and obtain additional information. Date of most recent searches: 5 March 2007. SELECTION CRITERIA: Trials were selected if they met the following criteria: design—random allocation of participants; participants—all children and adults receiving dental check-ups in primary care settings, irrespective of their level of risk for oral disease; interventions—recall intervals for the following different types of dental check-ups: (1) clinical examination only; (2) clinical examination plus scale and polish; (3) clinical examination plus preventive advice; (4) clinical examination plus scale and polish plus preventive advice; (5) no recall interval/patient driven attendance (which may be symptomatic); (6) clinician risk-based recall intervals; outcomes—clinical status outcomes for dental caries (including, but not limited to, mean dmft/DMFT (decayed, missing and filled permanent teeth), dmfs/DMFS (decayed, missing and filled permanent surfaces) scores, caries increment, filled teeth (including replacement restorations), early carious lesions arrested or reversed); periodontal disease (including, but not limited to, plaque, calculus, gingivitis, periodontitis, change in probing depth, attachment level); oral mucosa (presence or absence of mucosal lesions, potentially malignant lesions, cancerous lesions, size and stage of cancerous lesions at diagnosis). In Cochrane Reviews
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addition, the following outcomes were considered where reported: patient-centered outcomes, economic cost outcomes, other outcomes such as improvements in oral health knowledge and attitudes, harms, changes in dietary habits, and any other oral health–related behavioral change. DATA COLLECTION AND ANALYSIS: Information regarding methods, participants, interventions, outcome measures, and results were independently extracted, in duplicate, by 2 review authors. Authors were contacted, where deemed necessary and where possible, for further details regarding study design and for data clarification. A quality assessment of the included trial was carried out. The Cochrane Collaboration’s statistical guidelines were followed. MAIN RESULTS: Only one study (with 188 participants) was included in this review and was assessed as having a high risk of bias. This study provided limited data for dental caries outcomes (dmfs/DMFS increment) and economic cost outcomes (reported time taken to provide examinations and treatment). AUTHORS’ CONCLUSIONS: There is insufficient evidence from randomized controlled trials (RCTs) to draw any conclusions regarding the potential beneficial and harmful effects of altering the recall interval between dental check-ups. There is insufficient evidence to support or refute the practice of encouraging patients to attend for dental check-ups at 6-monthly intervals. It is important that high-quality RCTs are conducted for the outcomes listed in this review in order to address the objectives of this review.
ROUTINE SCALE AND POLISH FOR PERIODONTAL HEALTH IN ADULTS. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD004625. DOI: 10.1002/ 14651858.CD004625.pub3. Beirne P, Worthington HV, Clarkson JE. BACKGROUND: Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of ‘‘routine scaling and polishing’’ and the ‘‘optimal’’ frequency at which it should be provided. OBJECTIVES: The main objectives were to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; and to compare the effects of routine scaling and polishing provided by a dentist or professionals complementary to dentistry (PCD) (dental therapists or dental hygienists) on periodontal health. 50
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SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted where possible to identify trials and obtain additional information. Date of most recent searches: 5 March 2007. SELECTION CRITERIA: Trials were selected if they met the following criteria: design—random allocation of participants; participants—anyone with an erupted permanent dentition who was judged to have received a ‘‘routine scale and polish’’ (as defined in this review); interventions—‘‘routine scale and polish’’ (as defined in this review) and routine scale and polish provided at different time intervals; outcomes—tooth loss, plaque, calculus, gingivitis, bleeding and periodontal indices, changes in probing depth, attachment change, patientcentered outcomes, and economic outcomes. DATA COLLECTION AND ANALYSIS: Information regarding methods, participants, interventions, outcome measures, and results were independently extracted, in duplicate, by 2 review authors. Authors were contacted where possible and where deemed necessary for further details regarding study design and for data clarification. A quality assessment of all included trials was carried out. The Cochrane Collaboration’s statistical guidelines were followed and both standardized mean differences and mean differences were calculated as appropriate using random-effects models. MAIN RESULTS: Nine studies were included in this review. All studies were assessed as having a high risk of bias. Two split-mouth studies provided data for the comparison between scale and polish versus no scale and polish. One study, involving patients attending a recall program following periodontal treatment, found no statistically significant differences for plaque, gingivitis, and attachment loss between experimental and control units at each time point during the 1-year trial. The other study, involving adolescents in a developing country with high existing levels of calculus who had not received any dental treatment for at least 5 years, reported statistically significant differences in calculus and gingivitis (bleeding) scores between treatment and control units at 6, 12, and 22 months (in favor of ‘‘scale and polish units’’) following a single scale and polish provided at baseline to treatment units. For comparisons between routine scale and polish provided at different time intervals, there were some statistically significant differences in favor of scaling and polishing provided at more frequent intervals: 2 weeks versus 6 months, 2 weeks versus 12 months (for the outcomes plaque, gingivitis, pocket depth, and attachment change); and 3 months versus 12 months (for the outcomes plaque, calculus, and gingivitis). March 2008
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There were no studies comparing the effects of scaling and polishing provided by dentists or professionals complementary to dentistry. AUTHORS’ CONCLUSIONS: The research evidence is of insufficient quality to reach any conclusions regard-
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ing the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals. High-quality clinical trials are required to address the basic questions posed in this review.
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New Cochrane Systematic Reviews — Cochrane Oral Health Group The Cochrane Oral Health Group in Issue 4, October 2007, of The Cochrane Library published 4 systematic reviews and 4 systematic review updates. The abstracts for these reviews are below. For a full list of reviews/protocols published by the Cochrane Oral Health Group, please visit their Web site (www.ohg.cochrane.org/). If you are interested in contributing to the work of the Cochrane Oral Health Group please contact Luisa Fernandez, Cochrane Oral Health Group, MANDEC, School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, UK. Tel: +44 161 275 7819, Fax: +44 161 275 7815, E-mail: [email protected]
SYSTEMATIC REVIEWS INTERVENTIONS FOR THE TREATMENT OF ORAL AND OROPHARYNGEAL CANCERS: SURGICAL TREATMENT. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006205. DOI: 10.1002/ 14651858.CD006205.pub2. Oliver RJ, Clarkson JE, Conway DI, Glenny A, Macluskey M, Pavitt S, Sloan P, The CSROC Expert Panel, Worthington HV. BACKGROUND: Oral and oropharyngeal cancers can be managed by surgery alone or with any combination of radiotherapy, chemotherapy, and immunotherapy/ biotherapy. Opinions on the surgical treatment, the optimal combinational therapy, and the sequence of treatments in combinational therapy vary enormously. OBJECTIVES: To determine which surgical treatment modalities for oral and oropharyngeal cancers lead to the best outcomes compared with other surgical, radiotherapy, chemotherapy, or immunotherapy/biotherapy combinations. SEARCH STRATEGY: Electronic search of the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE, OLDMEDLINE, EMBASE, AMED, and the National Cancer Trials Database. Reference lists from relevant articles were searched and the authors of eligible trials were contacted. Date of the most recent searches: July 2007. SELECTION CRITERIA: Randomized controlled trials of surgery alone or in combination with chemotherapy, radiotherapy, or immunotherapy/biotherapy for the treatment of primary oral or oropharyngeal cancer or both.
DATA COLLECTION AND ANALYSIS: A minimum of 2 review authors conducted data extraction. Risk ratios were calculated for dichotomous outcomes at different time intervals, and hazard ratios were extracted or calculated for disease-free survival, total mortality, and diseaserelated mortality. Additional information from trial authors was sought. Data on adverse events were collected from the trial reports. MAIN RESULTS: Thirty-one trials satisfied the inclusion criteria, only 13 of which were assessed as low risk of bias. Trials were grouped into 12 main comparisons. There were no trials that compared different surgical modalities of the primary tumor itself. However, there were a number of trials comparing different approaches to managing the cervical lymph nodes. The majority of treatment regimens under evaluation were surgery in combination with other modalities. As individual treatment regimens within each comparison varied, meta-analysis was inappropriate in most instances. Only 2 trials could be pooled, comparing concomitant radio/chemotherapy (with surgery) versus radiotherapy (with surgery). A statistically significant difference was shown for disease-free survival (hazard ratio 0.77, 95% confidence interval (CI): 0.64 to 0.92) and total mortality (hazard ratio 0.78, 95% CI: 0.64 to 0.95) in favor of the concomitant chemotherapy and radiotherapy (with surgery) arm. No other treatment regimens showed consistent statistically significant results across the outcomes measured. AUTHORS’ CONCLUSIONS: There is some evidence that concomitant radio/chemotherapy (with surgery) is more effective than radiotherapy (with surgery) and may benefit outcomes in patients with more advanced oral and oropharyngeal cancers. As these trials were based on head and neck studies, future studies should evaluate this treatment regimen specifically in oral and
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oropharyngeal cancers separately and also address tumor staging and its impact on outcomes. In general, future studies are encouraged to evaluate site-specific and stage-specific data for oral and oropharyngeal cancers. Future trials should include healthrelated quality of life assessment as an outcome measure. There is a need for a consolidated standardized approach to reporting adverse events.
OCCLUSAL SPLINTS FOR TREATING SLEEP BRUXISM (TOOTH GRINDING). Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005514. DOI: 10.1002/ 14651858.CD005514.pub2. Macedo CR, Silva AB, Machado MA, Saconato H, Prado GF.
was combined in a meta-analysis. No statistically significant differences between the occlusal splint and control groups were found in the meta-analyses. AUTHORS’ CONCLUSIONS: There is not sufficient evidence to state that the occlusal splint is effective for treating sleep bruxism. Indication of its use is questionable with regard to sleep outcomes, but it may be that there is some benefit with regard to tooth wear. This systematic review suggests the need for further investigation in more controlled RCTs that pay attention to method of allocation, outcome assessment, large sample size, and sufficient duration of follow up. The study design must be parallel to eliminate the bias provided by studies of crossover type. A standardization of the outcomes of the treatment of sleep bruxism should be established in the RCTs.
BACKGROUND: Sleep bruxism is an oral activity characterized by teeth grinding or clenching during sleep. Several treatments for sleep bruxism have been proposed such as pharmacological, psychological, and dental. OBJECTIVES: To evaluate the effectiveness of occlusal splints for the treatment of sleep bruxism with alternative interventions, placebo, or no treatment.
SINGLE VERSUS MULTIPLE VISITS FOR ENDODONTIC TREATMENT OF PERMANENT TEETH. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005296. DOI: 10.1002/ 14651858.CD005296.pub2. Figini L, Lodi G, Gorni F, Gagliani M.
SEARCH STRATEGY: We searched the Cochrane Oral Health Group’s Trials Register (to May 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1); MEDLINE (1966 to May 2007); EMBASE (1980 to May 2007); LILACS (1982 to May 2007); Biblioteca Brasileira de Odontologia (1982 to May 2007); Dissertations, Theses, and Abstracts (1981 to May 2007); and handsearched abstracts of particular importance to this review. Additional reports were identified from the reference lists of retrieved reports and from article reviews about treating sleep bruxism. There were no language restrictions.
BACKGROUND: Root canal treatment (RoCT), or endodontic treatment, is a common procedure in dentistry. The main indications for RoCT are irreversible pulpitis and necrosis of the dental pulp caused by carious processes, tooth cracks or chips, or dental trauma. Successful RoCT is characterized by an absence of symptoms and clinical signs in teeth without radiographic evidence of periodontal involvement. The success of RoCT depends on a series of variables related to the preoperative condition of the tooth, as well as the endodontic procedures.
SELECTION CRITERIA: We selected randomized or quasi-randomized controlled trials (RCTs), in which splint therapy was compared concurrently to no treatment, other occlusal appliances, or any other intervention in participants with sleep bruxism. 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 review author consulted. The author of the primary study was contacted when necessary. MAIN RESULTS: Thirty-two potentially relevant RCTs were identified. Twenty-four trials were excluded. Five RCTs were included. Occlusal splint was compared to palatal splint, mandibular advancement device, transcutaneous electric nerve stimulation, and no treatment. There was just one common outcome (arousal index), which 46
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OBJECTIVES: To compare the effectiveness of singleand multiple-visit RoCT, measured as tooth extraction due to endodontic problems and radiological success. To assess the difference in short- and long-term complications between single- and multiple-visit RoCT. SEARCH STRATEGY: The following databases were searched for relevant trials: Cochrane Oral Health Group’s Trials Register, CENTRAL, MEDLINE, and EMBASE. Handsearching was performed for the major oral medicine journals. References of included studies and reviews were checked. Endodontics experts were contacted through E-mail. No language limitations were imposed. Date of last search was 6 March 2007. SELECTION CRITERIA: Randomized and quasi-randomized controlled trials of patients needing RoCT were included. Surgical endodontic treatment was excluded. The outcomes considered were the number of teeth extracted for endodontic problems; radiological March 2008
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success after at least 1 year, that is, absence of any periapical radiolucency; postoperative pain; painkiller use; swelling; or sinus track formation. DATA COLLECTION AND ANALYSIS: Data were collected using a specific extraction form. The validity of included studies was assessed on the basis of allocation concealment, blindness of the study, and loss of participants. Data were analyzed by calculating risk ratios. When valid and relevant data were collected, a meta-analysis of the data was undertaken. MAIN RESULTS: Twelve randomized controlled trials were included in the review. Four studies had a low risk of bias, 4 a moderate risk, and another 4 had a high risk of bias. The frequency of radiological success and immediate postoperative pain were not significantly different between single- and multiple-visit RoCT. Patients undergoing single-visit RoCT reported a higher frequency of painkiller use and swelling, but the results for swelling were not significantly different between the 2 groups. We found no study that included tooth loss and sinus track formation among its primary outcomes. AUTHORS’ CONCLUSIONS: No difference exists in the effectiveness of RoCT, in terms of radiological success, between single- and multiple-visit RoCT. Most short- and long-term complications are also similar in terms of frequency, although patients undergoing a single visit may experience a slightly higher frequency of swelling and are significantly more likely to take painkillers.
ULTRASONIC VERSUS HAND INSTRUMENTATION FOR ORTHOGRADE ROOT CANAL TREATMENT OF PERMANENT TEETH. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006384. DOI: 10.1002/ 14651858.CD006384.pub2. Sequeira P, Fedorowicz Z, Nasser M, Pedrazzi V. BACKGROUND: Endodontic treatment of root canals or root canal treatment is a frequently performed dental procedure and is carried out on teeth in which irreversible pulpitis has led to necrosis (death) of the dental pulp (nerve). Removal of the necrotic tissue remnants and cleaning and shaping of the root canal are important phases of root canal treatment. Treatment options include the use of hand and rotary instruments and methods using ultrasonic or sonic equipment. OBJECTIVES: The objectives of this review were to determine the relative clinical effectiveness of ultrasonic versus hand instrumentation for orthograde root canal treatment of permanent teeth. SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Volume 8, Number 1
Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE. We searched the reference lists of relevant articles and a personal database of trial reports in an attempt to locate additional published and unpublished trials. No language restriction was applied. The last electronic search was conducted in September 2006. SELECTION CRITERIA: Randomized controlled trials involving people older than 18 with single and multiple permanent teeth with a completely formed apex and with no evidence of internal resorption requiring root canal treatment were included. Patients undertaking retreatment of a tooth were excluded. DATA COLLECTION AND ANALYSIS: Screening of eligible studies was conducted in duplicate and independently by 2 review authors. Results were to be expressed as fixed or random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. MAIN RESULTS: No eligible randomized controlled trials were identified. AUTHORS’ CONCLUSIONS: This review illustrates that there are no published or ongoing randomized controlled clinical trials relevant to this review question and that there is currently insufficient evidence for the effectiveness of ultrasonic instrumentation used alone for orthograde root canal treatment. Future randomized controlled trials might focus more closely on evaluating the effectiveness of hand instrumentation compared with hand instrumentation and adjunctive ultrasonic instrumentation.
SYSTEMATIC REVIEW UPDATES INTERVENTIONS FOR PREVENTING ORAL MUCOSITIS FOR PATIENTS WITH CANCER RECEIVING TREATMENT. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000978. DOI: 10.1002/ 14651858.CD000978.pub3. Worthington HV, Clarkson JE, Eden OB. BACKGROUND: Treatment of cancer is increasingly more effective but is associated with short- and long-term side effects. Oral side effects remain a major source of illness despite the use of a variety of agents to prevent them. One of these side effects is oral mucositis (mouth ulcers). OBJECTIVES: To evaluate the effectiveness of prophylactic agents for oral mucositis in patients with cancer receiving treatment, compared with other potentially active interventions, placebo, or no treatment. SEARCH STRATEGY: The Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Cochrane Reviews
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Controlled Trials (CENTRAL), MEDLINE, and EMBASE were searched. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted to identify trials and obtain additional information. Date of most recent searches: June 2006: CENTRAL (The Cochrane Library 2006, Issue 2). SELECTION CRITERIA: Trials were selected if they met the following criteria: design—random allocation of participants; participants—anyone with cancer receiving chemotherapy or radiotherapy treatment for cancer; interventions—agents prescribed to prevent oral mucositis; outcomes—prevention of mucositis, pain, amount of analgesia, dysphagia, systemic infection, length of hospitalisation, cost, and patient quality of life. DATA COLLECTION AND ANALYSIS: Information regarding methods, participants, interventions, and outcome measures and results were independently extracted, in duplicate, by 2 review authors. Authors were contacted for details of randomization and withdrawals and a quality assessment was carried out. The Cochrane Collaboration statistical guidelines were followed and risk ratios (RR) calculated using random-effects models. MAIN RESULTS: Two hundred and seventy-seven studies were eligible. One hundred and eighty-eight were excluded for various reasons, usually as there was no useable information on mucositis. Of the 89 useable studies, all had data for mucositis comprising 7523 randomized patients. Interventions evaluated were acyclovir, allopurinol mouthrinse, aloe vera, antibiotic pastille or paste, benzydamine, beta carotene, calcium phosphate, chamomile, Chinese medicine, chlorhexidine, etoposide, folinic acid, glutamine, granulocyte/macrophage colony-stimulating factor (GM-CSF), histamine gel, honey, hydrolytic enzymes, ice chips, iseganan, keratinocyte GF, misonidazole, pilocarpine, pentoxifylline, povidone, prednisone, propantheline anticholinergic, prostaglandin, sucralfate, systemic antibiotic clarithromycin, traumeel, and zinc sulphate. Of the 33 interventions included in trials, 12 showed some evidence of a benefit (albeit sometimes weak) for either preventing or reducing the severity of mucositis. Interventions where there was more than one trial in the meta-analysis finding a significant difference when compared with a placebo or no treatment were: Amifostine, which provided minimal benefit in preventing mild and moderate mucositis, with RR values of 0.95 (95% confidence interval [CI] 0.92 to 0.98) and 0.88 (95% CI 0.80 to 0.98); Chinese medicine showed a benefit at all 3 dichotomies of mucositis with RR values of 0.44 (95% CI 0.20 to 0.96), 0.44 (95% CI 0.33 to 0.59), and 0.16 (95% CI 0.07 to 0.35) for increasing levels of mucositis severity; hydrolytic enzymes reduced moderate and severe mucositis with RR values of 0.52 (95% CI 0.36 to 0.74) and 0.17 (95% CI 0.06 to 0.52); and
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ice chips prevented mucositis at all levels with RR values of 0.64 (95% CI 0.50 to 0.82), 0.38 (95% CI 0.23 to 0.62), and 0.24 (95% CI 0.12 to 0.48).
Other interventions showing some benefit with only one study were benzydamine, calcium phosphate, etoposide bolus, honey, iseganan, oral care, and zinc sulphate. The general reporting of randomized controlled trials (RCTs), especially concealment of randomization, was poor. However, the assessments of the quality of the randomization improved when the authors provided additional information. AUTHORS’ CONCLUSIONS: Several of the interventions were found to have some benefit at preventing or reducing the severity of mucositis associated with cancer treatment. The strength of the evidence was variable and implications for practice include consideration that benefits may be specific for certain cancer types and treatment. There is a need for well-designed and conducted trials with sufficient numbers of participants to perform subgroup analyses by type of disease and chemotherapeutic agent.
INTERVENTIONS FOR REPLACING MISSING TEETH: DIFFERENT TYPES OF DENTAL IMPLANTS. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003815. DOI: 10.1002/ 14651858.CD003815.pub3. Esposito M, Murray-Curtis L, Grusovin MG, Coulthard P, Worthington HV. BACKGROUND: Dental implants are available in different materials and shapes and with different surface characteristics. In particular, numerous implant surface modifications have been developed for enhancing clinical performance. OBJECTIVES: To test the null hypothesis of no difference in clinical performance between various rootformed osseointegrated dental implant types. SEARCH STRATEGY: We searched the Cochrane Oral Health Group’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE. Handsearching included several dental journals. We checked the bibliographies of relevant clinical trials and review articles for studies outside the handsearched journals. We wrote to authors of the identified randomized controlled trials (RCTs), to more than 55 oral implant manufacturers; we used personal contacts and we asked on an Internet discussion group in an attempt to identify unpublished or ongoing RCTs. No language restriction was applied. The last electronic search was conducted on 13 June 2007. SELECTION CRITERIA: All RCTs of oral implants comparing osseointegrated implants with different March 2008
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materials, shapes, and surface properties having a follow up of at least 1 year. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials, and data extraction were conducted in duplicate and independently by 2 review authors. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). MAIN RESULTS: Forty different RCTs were identified. Sixteen of these RCTs, reporting results from a total of 771 patients, were suitable for inclusion in the review. Eighteen different implant types were compared with a follow up ranging from 1 to 5 years. All implants were made in commercially pure titanium and had different shapes and surface preparations. On a ‘‘per patient’’ rather than ‘‘per implant’’ basis no significant differences were observed between various implant types for implant failures. There were statistically significant differences for perimplant bone level changes on intraoral radiographs in 3 comparisons in 2 trials. In one trial there was more bone loss only at 1 year for IMZ implants (Friedrichsfeld AG Mannheim, Germany) compared to Bra˚nemark (mean difference 0.60 mm; 95% CI 0.01 to 1.10) and to ITI implants (Institut Straumann AG, Waldenburg, Switzerland) (mean difference 0.50 mm; 95% CI 0.01 to 0.99). In the other trial Southern implants displayed more bone loss at 5 years than Steri-Oss implants (mean difference 0.35 mm; 95% CI 0.70 to 0.01). However this difference disappeared in the metaanalysis. More implants with rough surfaces were affected by perimplantitis (RR 0.80; 95% CI 0.67 to 0.96) meaning that turned implant surfaces had a 20% reduction in risk of being affected by perimplantitis over a 3-year period. AUTHORS’ CONCLUSIONS: Based on the available results of RCTs, there is limited evidence showing that implants with relatively smooth (turned) surfaces are less prone to lose bone due to chronic infection (perimplantitis) than implants with rougher surfaces. On the other hand, there is no evidence showing that any particular type of dental implant has superior long-term success. These findings are based on a few RCTs, often at high risk of bias, with few participants and relatively short follow up periods. More RCTs should be conducted, with follow-up of at least 5 years including a sufficient number of patients to detect a true difference. Such trials should be reported according to the CONSORT recommendations (http://www.consort-statement.org/).
RECALL INTERVALS FOR ORAL HEALTH IN PRIMARY CARE PATIENTS. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD004346. DOI: 10.1002/ 14651858.CD004346.pub3. Beirne P, Clarkson JE, Worthington HV. Volume 8, Number 1
BACKGROUND: The frequency with which patients should attend for a dental check-up and the potential effects on oral health of altering recall intervals between check-ups have been the subject of ongoing international debate for almost 3 decades. Although recommendations regarding optimal recall intervals vary between countries and dental health care systems, 6-monthly dental checkups have traditionally been advocated by general dental practitioners in many developed countries. OBJECTIVES: To determine the beneficial and harmful effects of different fixed recall intervals (for example 6 months versus 12 months) for the following different types of dental check-up: (1) clinical examination only; (2) clinical examination plus scale and polish; (3) clinical examination plus preventive advice; and (4) clinical examination plus preventive advice plus scale and polish. To determine the relative beneficial and harmful effects between any of these different types of dental check-up at the same fixed recall interval. To compare the beneficial and harmful effects of recall intervals based on clinicians’ assessment of patients’ disease risk with fixed recall intervals. To compare the beneficial and harmful effects of no recall interval/patient-driven attendance (which may be symptomatic) with fixed recall intervals. SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE. Reference lists from relevant articles were scanned and the authors of some papers were contacted to identify further trials and obtain additional information. Date of most recent searches: 5 March 2007. SELECTION CRITERIA: Trials were selected if they met the following criteria: design—random allocation of participants; participants—all children and adults receiving dental check-ups in primary care settings, irrespective of their level of risk for oral disease; interventions—recall intervals for the following different types of dental check-ups: (1) clinical examination only; (2) clinical examination plus scale and polish; (3) clinical examination plus preventive advice; (4) clinical examination plus scale and polish plus preventive advice; (5) no recall interval/patient driven attendance (which may be symptomatic); (6) clinician risk-based recall intervals; outcomes—clinical status outcomes for dental caries (including, but not limited to, mean dmft/DMFT (decayed, missing and filled permanent teeth), dmfs/DMFS (decayed, missing and filled permanent surfaces) scores, caries increment, filled teeth (including replacement restorations), early carious lesions arrested or reversed); periodontal disease (including, but not limited to, plaque, calculus, gingivitis, periodontitis, change in probing depth, attachment level); oral mucosa (presence or absence of mucosal lesions, potentially malignant lesions, cancerous lesions, size and stage of cancerous lesions at diagnosis). In Cochrane Reviews
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addition, the following outcomes were considered where reported: patient-centered outcomes, economic cost outcomes, other outcomes such as improvements in oral health knowledge and attitudes, harms, changes in dietary habits, and any other oral health–related behavioral change. DATA COLLECTION AND ANALYSIS: Information regarding methods, participants, interventions, outcome measures, and results were independently extracted, in duplicate, by 2 review authors. Authors were contacted, where deemed necessary and where possible, for further details regarding study design and for data clarification. A quality assessment of the included trial was carried out. The Cochrane Collaboration’s statistical guidelines were followed. MAIN RESULTS: Only one study (with 188 participants) was included in this review and was assessed as having a high risk of bias. This study provided limited data for dental caries outcomes (dmfs/DMFS increment) and economic cost outcomes (reported time taken to provide examinations and treatment). AUTHORS’ CONCLUSIONS: There is insufficient evidence from randomized controlled trials (RCTs) to draw any conclusions regarding the potential beneficial and harmful effects of altering the recall interval between dental check-ups. There is insufficient evidence to support or refute the practice of encouraging patients to attend for dental check-ups at 6-monthly intervals. It is important that high-quality RCTs are conducted for the outcomes listed in this review in order to address the objectives of this review.
ROUTINE SCALE AND POLISH FOR PERIODONTAL HEALTH IN ADULTS. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD004625. DOI: 10.1002/ 14651858.CD004625.pub3. Beirne P, Worthington HV, Clarkson JE. BACKGROUND: Many dentists or hygienists provide scaling and polishing for patients at regular intervals, even if those patients are considered to be at low risk of developing periodontal disease. There is debate over the clinical effectiveness and cost effectiveness of ‘‘routine scaling and polishing’’ and the ‘‘optimal’’ frequency at which it should be provided. OBJECTIVES: The main objectives were to determine the beneficial and harmful effects of routine scaling and polishing for periodontal health; to determine the beneficial and harmful effects of providing routine scaling and polishing at different time intervals on periodontal health; and to compare the effects of routine scaling and polishing provided by a dentist or professionals complementary to dentistry (PCD) (dental therapists or dental hygienists) on periodontal health. 50
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SEARCH STRATEGY: We searched the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE. Reference lists from relevant articles were scanned and the authors of eligible studies were contacted where possible to identify trials and obtain additional information. Date of most recent searches: 5 March 2007. SELECTION CRITERIA: Trials were selected if they met the following criteria: design—random allocation of participants; participants—anyone with an erupted permanent dentition who was judged to have received a ‘‘routine scale and polish’’ (as defined in this review); interventions—‘‘routine scale and polish’’ (as defined in this review) and routine scale and polish provided at different time intervals; outcomes—tooth loss, plaque, calculus, gingivitis, bleeding and periodontal indices, changes in probing depth, attachment change, patientcentered outcomes, and economic outcomes. DATA COLLECTION AND ANALYSIS: Information regarding methods, participants, interventions, outcome measures, and results were independently extracted, in duplicate, by 2 review authors. Authors were contacted where possible and where deemed necessary for further details regarding study design and for data clarification. A quality assessment of all included trials was carried out. The Cochrane Collaboration’s statistical guidelines were followed and both standardized mean differences and mean differences were calculated as appropriate using random-effects models. MAIN RESULTS: Nine studies were included in this review. All studies were assessed as having a high risk of bias. Two split-mouth studies provided data for the comparison between scale and polish versus no scale and polish. One study, involving patients attending a recall program following periodontal treatment, found no statistically significant differences for plaque, gingivitis, and attachment loss between experimental and control units at each time point during the 1-year trial. The other study, involving adolescents in a developing country with high existing levels of calculus who had not received any dental treatment for at least 5 years, reported statistically significant differences in calculus and gingivitis (bleeding) scores between treatment and control units at 6, 12, and 22 months (in favor of ‘‘scale and polish units’’) following a single scale and polish provided at baseline to treatment units. For comparisons between routine scale and polish provided at different time intervals, there were some statistically significant differences in favor of scaling and polishing provided at more frequent intervals: 2 weeks versus 6 months, 2 weeks versus 12 months (for the outcomes plaque, gingivitis, pocket depth, and attachment change); and 3 months versus 12 months (for the outcomes plaque, calculus, and gingivitis). March 2008
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There were no studies comparing the effects of scaling and polishing provided by dentists or professionals complementary to dentistry. AUTHORS’ CONCLUSIONS: The research evidence is of insufficient quality to reach any conclusions regard-
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ing the beneficial and adverse effects of routine scaling and polishing for periodontal health and regarding the effects of providing this intervention at different time intervals. High-quality clinical trials are required to address the basic questions posed in this review.
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