Conduct a systematic review and meta-analysis on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts.
A panel of experts ...convened by the American Dental Association Council on Scientific Affairs conducted a search of PubMed (MEDLINE) and Embase for randomized controlled trials of SRP with or without the use of adjuncts with clinical attachment level (CAL) outcomes in trials at least 6 months in duration and published in English through July 2014. The authors assessed individual study bias by using the Cochrane Risk of Bias Tool and conducted meta-analyses to obtain the summary effect estimates and their precision and to assess heterogeneity. The authors used funnel plots and Egger tests to assess publication bias when there were more than 10 studies. The authors used a modified version of the US Preventive Services Task Force methods to assess the overall level of certainty in the evidence.
The panel included 72 articles on the effectiveness of SRP with or without the following: systemic antimicrobials, a systemic host modulator (subantimicrobial-dose doxycycline), locally delivered antimicrobials (chlorhexidine chips, doxycycline hyclate gel, and minocycline microspheres), and a variety of nonsurgical lasers (photodynamic therapy with a diode laser, a diode laser, neodymium:yttrium-aluminum-garnet lasers, and erbium lasers).
With a moderate level of certainty, the panel found approximately a 0.5-millimeter average improvement in CAL with SRP. Combinations of SRP with assorted adjuncts resulted in a range of average CAL improvements between 0.2 and 0.6 mm over SRP alone. The panel judged the following 4 adjunctive therapies as beneficial with a moderate level of certainty: systemic subantimicrobial-dose doxycycline, systemic antimicrobials, chlorhexidine chips, and photodynamic therapy with a diode laser. There was a low level of certainty in the benefits of the other included adjunctive therapies. The panel provides clinical recommendations in the associated clinical practice guideline.
A panel of experts convened by the American Dental Association Council on Scientific Affairs presents an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic ...periodontitis by means of scaling and root planing (SRP) with or without adjuncts.
The authors developed this clinical practice guideline according to the American Dental Association's evidence-based guideline development methodology. This guideline is founded on a systematic review of the evidence that included 72 research articles providing clinical attachment level data on trials of at least 6 months' duration and published in English through July 2014. The strength of each recommendation (strong, in favor, weak, expert opinion for, expert opinion against, and against) is based on an assessment of the level of certainty in the evidence for the treatment's benefit in combination with an assessment of the balance between the magnitude of the benefit and the potential for adverse effects.
For patients with chronic periodontitis, SRP showed a moderate benefit, and the benefits were judged to outweigh potential adverse effects. The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis. Although systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP, they were recommended at different strengths (in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials) because of the higher potential for adverse effects with higher doses of antimicrobials. The strengths of 2 other recommendations are weak: chlorhexidine chips and photodynamic therapy with a diode laser. Recommendations for the other local antimicrobials (doxycycline hyclate gel and minocycline microspheres) were expert opinion for. Recommendations for the nonsurgical use of other lasers as SRP adjuncts were limited to expert opinion against because there was uncertainty regarding their clinical benefits and benefit-to-adverse effects balance. Note that expert opinion for does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low.
The authors' objective in this systematic review was to describe the evidence for preventive and rehabilitative interventions for musculoskeletal disorders in oral health care.
The authors conducted ...systematic search, screening, and eligibility processes to identify experimental, quasiexperimental, observational, and survey research studies in which the investigators either directly evaluated or predicted the effects of preventive or rehabilitative interventions on the reduction of musculoskeletal symptoms in oral health care professionals.
The authors identified and screened 3,571 unique abstracts, assessed 256 full-text articles for eligibility, and included 34 articles in the review. Investigators in 17 experimental studies described the results of preventive or rehabilitation interventions and in 17 survey research studies predicted or correlated preventive or protective techniques to a reduction in musculoskeletal symptoms. The primary techniques evaluated in the studies included equipment modification, ergonomic training, and physical exercise.
The evidence suggests that magnification loupes and indirect-vision techniques have a positive effect on the reduction of musculoskeletal symptoms. In terms of evaluating intervention efficacy, other techniques have mixed evidence or are limited by low-level study design.
Remembering my friend Forrest, Jane L
Journal of dental hygiene
93, Issue:
3
Journal Article
Peer reviewed
Unlike those memorials that have recounted her life and the many contributions she made to dental hygiene education and research, or the recognition she received through many awards, this remembrance ...provides a more personal accounting of her work and our friendship. A final celebration of Denise's life will be held on June 29, 2019 (the day after her 65 th birthday!) in the Grand Rotunda of the Performing Arts Building, Idaho State University, Pocatello, ID. Jane L. Forrest, RDH, EdD is a Professor of Clinical Dentistry at the Herman Ostrow School of Dentistry of the University of Southern California, Los Angeles, CA; and the Director of the National Center for Dental Hygiene Research and Practice.
Previous position papers have confirmed associations between periodontal disease and adverse pregnancy outcomes. Causal associations have not been confirmed and have been the source of much confusion ...for the profession and public.
To investigate whether sufficient evidence exists for a causal relationship between periodontal disease and adverse pregnancy outcomes.
The PICO question was "For adults in good general health who are diagnosed with periodontal disease, will receiving non-surgical periodontal therapy (NSPT), as compared to not receiving non-surgical periodontal therapy, lower their risk for adverse pregnancy outcomes?" Only systematic reviews (SRs) with or without meta-analyses (MAs) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic Reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality.
Of 37 records retrieved for adverse pregnancy outcomes, 9 met the criteria for inclusion and were analysed. None showed that NSPT lowers the risk for adverse pregnancy outcomes.
Bradford Hill criteria analysis failed to support a causal relationship between periodontal disease and adverse pregnancy outcomes based on the most current evidence available.
Previous position papers have confirmed associations between periodontal disease and cardiovascular disease. Causal associations have not been confirmed and have been the source of much confusion for ...oral health professionals and the public.
To investigate whether sufficient evidence exists for a causal relationship between periodontal disease and cardiovascular disease.
The PICO question was "For adults in good general health who are diagnosed with periodontal disease, will receiving non-surgical periodontal therapy (NSPT), as compared to not receiving NSPT, lower their risk for cardiovascular diseases?" Only systematic reviews (SRs) with or without meta-analyses (MAs) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic Reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality.
Of 53 cardiovascular disease studies retrieved, 7 met the inclusion criteria, of which 6 contained MAs. Results were mixed for various periodontal interventions lowering the risk for cardiovascular outcomes. Only one SR used cardiovascular events as a direct outcome; the other 6 used various surrogate measures.
Bradford Hill criteria analysis failed to support a causal relationship between periodontal disease and cardiovascular disease.
Previous research has confirmed strong associations between periodontitis and diabetes mellitus (DM), supporting DM as a risk factor for periodontal disease and suggesting a bidirectional ...relationship. Causal relationships have not been confirmed.
The aim of this paper is to review the most current evidence of the nature of this relationship and examine whether non-surgical periodontal therapy (NSPT) significantly lowers glycemic (HbA1c) control.
The PICO question was, "For individuals with type 2 diabetes mellitus (T2DM) and periodontitis, will non-surgical periodontal therapy (NSPT), as compared to no treatment, improve the individual's glycemic control as measured by HbA1c." Only systematic reviews (SRs) with or without a meta-analysis (MA) of randomized controlled trials (RCTs) or umbrella reviews of SRs and MAs of RCTs published in the English language between 2007 and 2019 were included. Several databases were searched as per their protocols. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality.
Of 54 records retrieved, after elimination of duplicates and studies not meeting inclusion criteria, 5 SRs/MAs and 3 umbrella reviews of SRs/MAs were selected. All 5 SRs/MAs reported reductions in HbA1c levels 3 months following NSPT, but effect sizes were small and 2 were not statistically significant. The 3 umbrella reviews consistently reported small reductions in HbA1c, but high levels of heterogeneity and moderate to high risk of bias. The Bradford Hill criteria failed to support a causal relationship between periodontitis and T2DM.
Whether NSPT compared with no treatment in persons with T2DM improves the individual HbA1c remains unclear as does the exact nature of the relationship between periodontitis and T2DM.
Previous position papers have confirmed to varying degrees associations between periodontal microbes and respiratory tract infections such as nosocomial or hospital-acquired pneumonia (HAP), ...ventilator-associated pneumonia (VAP), and chronic obstructive pulmonary diseases (COPD). Causal relationships have not been confirmed and have been the source of much confusion for the medical and oral health professions.
To investigate whether sufficient evidence exists for a causal relationship between periodontal microbes and respiratory diseases, with a focus on HAP and VAP.
The PICO question was "For patients in hospitals, nursing homes or long-term care facilities who are at high risk for respiratory infections, will an oral care intervention such as toothbrushing, administration of antimicrobial agents, and/or professional care, as compared to no oral care intervention (or usual oral care) reduce the risk for respiratory infections?" Only systematic reviews (SRs) with or without a meta-analysis (MA) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality.
Of 47 respiratory studies retrieved, after elimination of duplicates and studies not meeting inclusion criteria, 10 SRs were selected, 9 of which included MAs. Although there was evidence that administration of chlorhexidine gluconate (CHX) reduced the risk for VAP, none existed for HAP. Limitations included inconsistencies among studies in population groups, CHX concentration, frequency of administration, number of applications, and insufficient evidence for use of povidone iodine or toothbrushing in ventilated patients. While some studies reported other patient-centred outcomes (i.e., ICU mortality, length of ICU stay or duration of mechanical ventilation), findings were positive only for cardiac surgery ventilated patients, who did not meet the inclusion criteria.
Bradford Hill criteria analysis failed to support a causal relationship between periodontal microbes/oral health care and respiratory diseases such as pneumonia.
Work-related musculoskeletal disorders are prevalent in dental hygienists. Although engineering controls and ergonomic training is available, it is unclear why this intransigent problem continues. ...One possible barrier is that a comprehensive, standardized protocol for evaluating dental hygiene work does not exist.
This study aimed to generate a valid and reliable observational protocol for the assessment of dental hygiene work.
An iterative process was used to establish and refine an ecologically valid video acquisition and observation protocol to assess key activities, tasks, and performance components of dental hygiene work.
Good inter-rater reliability was achieved across all variables when the final coding scheme was completed by three independent raters.
This work provides an exemplar of the process required to generate a comprehensive protocol for evaluating the work components of a particular job, and provides standardized nomenclature for use by scientists and practitioners interested in understanding and addressing the pervasive issue of work-related disorders in dental hygienists.
Purpose: Dental hygiene graduates often experience significant psychological stress while transitioning from the educational setting to clinical practice environments. The purpose of this study was ...to characterize the duration of dental hygiene activities and tasks and explore efficiency within appointments, by students in educational programs. Methods: Right-handed female dental hygiene students were recruited from two dental hygiene education programs. Each participant was video recorded while providing patient care during 3 sessions, once per term, over 3 consecutive terms. Activities, tasks, and student postures and positions were coded across the patient visit. Descriptive analyses were conducted to characterize overall durations and distributions across each category. Time spent on non-dental hygiene related activities was compared to other durations, as well as across the education/training time points and by patient type. Results: Fifty-three videos were analyzed from nineteen participants. The average patient visit length was 155.06 + or - 35.63 minutes; approximately half the visit was dedicated to instrumentation activities. Nearly 20% of the visit was categorized as activities or tasks unrelated to education or patient care. Although most participants completed the patient visit more quickly by the third time point, the percentage of non-dental hygiene activities did not decrease, and there were no associations between patient category type and the duration of the patient visit. Conclusion: Patient visits were roughly three times the length of the typical dental hygiene care appointment, indicating a disconnect between training and practice. In addition to spending more time on hand scaling tasks, participants spent a lot of time on equipment setup and interacting with or waiting for faculty members. These findings have implications for improving efficiency in educational settings, particularly to facilitate a successful transition to clinical practice. Keywords: dental hygiene students, clinical education, ergonomics, task analysis
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