Effect of xylitol versus sorbitol: a quantitative systematic review of clinical trials

Objectives: This study aimed to appraise, within the context of tooth caries, the current clinical evidence and its risk for bias regarding the effects of xylitol in comparison with sorbitol. Methods: : Databases were searched for clinical trials to 19 March 2011. Inclusion criteria required studies to: test a caries‐related primary outcome; compare the effects of xylitol with those of sorbitol; describe a clinical trial with two or more arms, and utilise a prospective study design. Articles were excluded if they did not report computable data or did not follow up test and control groups in the same way. Individual dichotomous and continuous datasets were extracted from accepted articles. Selection and performance/detection bias were assessed. Sensitivity analysis was used to investigate attrition bias. Egger’s regression and funnel plotting were used to investigate risk for publication bias. Results: : Nine articles were identified. Of these, eight were accepted and one was excluded. Ten continuous and eight dichotomous datasets were extracted. Because of high clinical heterogeneity, no meta‐analysis was performed. Most of the datasets favoured xylitol, but this was not consistent. The accepted trials may be limited by selection bias. Results of the sensitivity analysis indicate a high risk for attrition bias. The funnel plot and Egger’s regression results suggest a low publication bias risk. External fluoride exposure and stimulated saliva flow may have confounded the measured anticariogenic effect of xylitol. Conclusions: : The evidence identified in support of xylitol over sorbitol is contradictory, is at high risk for selection and attrition bias and may be limited by confounder effects. Future high‐quality randomised controlled trials are needed to show whether xylitol has a greater anticariogenic effect than sorbitol.     

The effectiveness of a toothpaste containing triclosan and polyvinyl-methyl ether maleic acid copolymer in improving plaque control and gingival health: a systematic review

OBJECTIVE: To compare the effectiveness of triclosan/copolymer and fluoride dentifrices in improving plaque control and gingival health. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE (1986 to March 2003) and EMBASE (1986 to March 2003). Personal files and the reference lists of all articles were checked for further studies. SELECTION CRITERIA: Trials were selected if they met the following criteria: random allocation of participants; participants were adults with plaque and gingivitis; unsupervised use of dentifrices for at least 6 months; and primary outcomes - plaque and gingivitis after 6 months. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted information. For each plaque and gingivitis index, the mean differences for each study were pooled as weighted mean differences (WMDs) with the appropriate 95% confidence intervals (CIs) using the random effect models. MAIN RESULTS: Sixteen trials provided data for the meta-analysis. The triclosan/copolymer dentifrice significantly improved plaque control compared with a fluoride dentifrice, with a WMD of -0.48 (95% CI: -0.64 to -0.32) for the Quigley-Hein index and WMD of -0.15 (95% CI: -0.20 to -0.09) for the plaque severity index. When compared with a fluoride dentifrice, the triclosan/copolymer dentifrice significantly reduced gingivitis with WMDs -0.26 (95% CI: -0.34 to -0.18) and -0.12 (95% CI: -0.17 to -0.08) for the Loe and Silness index and gingivitis severity index, respectively.     

Effect of platelet-rich plasma on bone regeneration in dentistry: a systematic review

Objective: To review systematically the reported effects of platelet‐rich plasma (PRP) on bone regeneration. Material and methods: Up to June 2006, MEDLINE and Cochrane databases were explored with different combinations of three search terms: ‘PRP’, ‘bone regeneration’, ‘dentistry’ and their synonyms. Inclusion criteria: human controlled clinical trials designed to treat maxillofacial bony defects with application of PRP (test) or without PRP (control), including at least five patients with a follow‐up period of more than 3 months and using clinical assessment, radiography, histology and/or histomorphometry for evaluation. Literature search, selection of eligible articles and data extraction were carried out independently by two readers. Results: The literature search revealed 108 references, of which 17 were selected for further analysis. Finally, nine articles fulfilling the inclusion criteria were selected for systematically review. Owing the substantial heterogeneity of the studies it was not possible to analyze the data statistically. An attempt was made to compare results from studies that used similar outcome measures by calculating and adding confidence intervals to the data presented in the original papers. Differences in treatment effects for periodontal defects in terms of clinical attachment level (CAL) were significant (ranging from 0.8 to 3.2 mm). The reported effects of PRP in sinus elevation (compared with their controls) were <10%. Conclusion: We found evidence for beneficial effects of PRP in the treatment of periodontal defects. Evidence for beneficial effects of PRP in sinus elevation appeared to be weak. No conclusions can be drawn about other applications of PRP in dentistry.     

Essential oils compared to chlorhexidine with respect to plaque and parameters of gingival inflammation: a systematic review

Background: The purpose of this review is to systematically evaluate the effects of an essential‐oil mouthwash (EOMW) compared to a chlorhexidine mouthwash with respect to plaque and parameters of gingival inflammation. Methods: PubMed/MEDLINE and Cochrane CENTRAL databases were searched for studies up to and including September 2010 to identify appropriate articles. A comprehensive search was designed, and the articles were independently screened for eligibility by two reviewers. Articles that evaluated the effects of the EOMW compared to chlorhexidine mouthwash were included. Where appropriate, a meta‐analysis was performed, and weighted mean differences (WMDs) were calculated. Results: A total of 390 unique articles were found, of which 19 articles met the eligibility criteria. A meta‐analysis of long‐term studies (duration ≥4 weeks) showed that the chlorhexidine mouthwash provided significantly better effects regarding plaque control than EOMW (WMD: 0.19; P = 0.0009). No significant difference with respect to reduction of gingival inflammation was found between EOMW and chlorhexidine mouthwash (WMD: 0.03; P = 0.58). Conclusion: In long‐term use, the standardized formulation of EOMW appeared to be a reliable alternative to chlorhexidine mouthwash with respect to parameters of gingival inflammation.     

Current status of the reporting quality of abstracts in systematic reviews related to implant dentistry: a literature survey

The aim of this study was to assess the reporting quality of abstracts in systematic reviews (SRs) related to implant dentistry and to assess the possible factors associated with the reporting quality. Abstracts of SRs in the field of implant dentistry, published in the last 5 years, were searched. The reporting quality was assessed and scored using the PRISMA for Abstracts checklist (PRISMA-A). The overall PRISMA-A score (OPS) and relative score (OPS%) per review were calculated according to adherence to the criteria presented in the checklist. Multivariable linear regression was performed to identify possible factors associated with reporting quality. Overall, 310 SRs were eligible for this study. Based on the maximum PRISMA-A score (score of 12), the mean OPS was 6.5 and OPS% was 54.2%. The items ‘title’, ‘objectives’, and ‘number of included studies’ were those most frequently reported in the abstracts, while the items ‘registration’ and ‘funding’ were the least reported. According to multivariable linear regression, the geographical origin of the articles was the only factor associated with better quality of abstract reporting, with higher OPS for SRs from Europe when compared to North America (coefficient 0.73; P = 0.049). The reporting quality of abstracts in SRs related to implant dentistry is suboptimal and needs to be improved. Journals should encourage adherence to reporting checklists in SRs.     

Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review

This systematic review aims to identify and review the best available evidence to answer the clinical question ‘What are the incidence and the factors influencing the development of osteoradionecrosis after tooth extraction in irradiated patients?’. A systematic review of published articles on post-irradiation extraction was performed via electronic search of the Medline, Ovid, Embase and Cochrane Library databases. Additional studies were identified by manual reference list search. Evaluation and critical appraisal were done in 3 stages by two independent reviewers and any disagreement was resolved by discussion with a third party. 19 articles were selected for the final analysis. The total incidence of osteoradionecrosis after tooth extraction in irradiated patients was 7%. When extractions were performed in conjunction with prophylactic hyperbaric oxygen, the incidence was 4% while extraction in conjunction with antibiotics gave an incidence of 6%. This systematic review found that while the incidence of osteoradionecrosis after post-irradiation tooth extractions is low, the extraction of mandibular teeth within the radiation field in patients who received a radiation dose higher than 60 Gy represents the highest risk of developing osteoradionecrosis. Based on weak evidence, prophylactic hyperbaric oxygen is effective in reducing the risk of developing osteoradionecrosis after post-radiation extractions.     

The risk factors related to bruxism in children: A systematic review and meta-analysis

ObjectiveThis systematic review was performed to determine the risk factors related to bruxism in children.DesignThis systematic review was conducted with reporting in agreement to the PRISMA statement and according to guidelines from the Cochrane Handbook for Systematic Reviews of Interventions. We conducted a systematic search of seven online databases, with the last search updated on 1st October 2016. The seven databases were Pubmed, Embase, Cochrane Library database, Web of Science, CNKI, CBM, and WF. The included trial type were RCT, cohort studies, and case-control studies, and bruxism symptoms were assessed by questionnaires and examinations. Eighteen out of the 5637 initially identified studies met the inclusion and exclusion criteria.Resultsgender, age, gene, mixed position, anxiety, the nervous, secondhand smoke, high psychological reactions, responsibility, move a lot during sleep, sleeps with mouth open, snores loudly, restless sleep, sleep hours, sleep with light on, noise in room, headache, biting, cheeks tonus, perioral musculature participation, conduct problems, peer problems, emotional symptoms, mental health problems, birth weight, occupation of family head, maternal marital status, hyperactivity, family income seemed to have statistical significance from the present systematic review and meta-analysis.ConclusionsThe risk factors related to bruxism were as follows: Male, gene, mixed position, moves a lot, anxiety, the nervous, psychological reactions, responsibility, secondhand smoke, snore loudly, restless sleep, sleep with light on, noise in room, “sleep hours, ≤8 h”, headache, objects biting, conduct problems, peer problems, emotional symptoms and mental health problems.