含氟涂料防龋效果的系统评价

为了解含氟涂料防龋应用的循证医学证据,检索了Cochrane图书馆含氟涂料防龋效果的系统评价。对含氟涂料实用性、有效性、安全性、患者接受性、副作用以及同其他氟化物、防龋剂的比较或联合应用等方面进行综述总结。有限研究证据的汇总结果对很多问题不能明确回答,同时还缺乏患者接受性和含氟涂料副作用等方面的研究数据。     

A systematic review of selected caries prevention and management methods

A systematic review of the periodic scientific literature was undertaken to determine the strength of the evidence for the efficacy of professional caries preventive methods applied to high risk individuals, and the efficacy of professionally applied methods to arrest or reverse non-cavitated carious lesions. An initial search identified 1435 articles, of which 27 were eventually included in the review. Among the 22 studies addressing the prevention of carious lesions in caries-active or high risk individuals, the strength of the evidence was judged to be fair for fluoride varnishes and insufficient for all other methods. Among the seven studies addressing the management of non-cavitated carious lesions, the strength of the evidence for efficacy was judged to be insufficient for all methods. The results do not indicate that the preventive and management methods reviewed are not efficacious; rather, they demonstrate that not enough is known to determine the efficacy of the methods. Suggestions for strengthening the limited evidence base involve the following: i) increasing the number of studies that examine prevention among high risk individuals and non-surgical management of non-cavitated lesions, ii) including a wider variety of subject ages, iii) targeting aspects of the efficacy questions not yet addressed, iv) strengthening research methods employed in the studies, and v) reporting methods and outcomes more completely.     

Systematic reviews of topical fluorides for dental caries: a review of reporting practice

This paper aims to assess systematic reviews on the caries-preventive effect of topical fluorides, identifying key content and reporting quality issues to be considered by researchers planning a review in this area. Published systematic reviews and meta-analyses of any topical fluoride intervention for caries control were included. Relevant databases were searched (December 2009), along with reference lists of included publications. Thirty-eight reports were identified and assessed. A majority of these focused on the child/adolescent population, fluoride toothpastes, no treatment/placebo comparisons, and had caries increment as the main outcome. Complete reporting of eligibility criteria (PICOS) was uncommon, except in Cochrane reviews. Less than half reported searching multiple sources and only one third reported a search strategy. Duplicate study selection and data extraction was reported in 27 (71%) and 16 (42%) reviews, respectively; quality assessment of included studies was not reported in one third of the reviews. Meta-analysis was reported in 20 (52%) reviews, with six not reporting the methods of synthesis used, 17 formally assessing heterogeneity, and 12 reporting analyses for its exploration. This study shows that some content features have been covered more often than others in existing fluoride reviews, while some relevant features are yet to be addressed. Also, reporting of several methodological aspects are below an acceptable level, except for Cochrane reviews. Current reporting guidelines for systematic reviews of interventions (e.g. PRISMA) and sources of high-quality existing reviews (e.g. The Cochrane Library) should be closely followed to enhance the validity and relevance of future topical fluoride reviews.     

Saliva and dental caries: diagnostic tests for normal dental practice.

Salivary diagnostics is now entering the surgery of the modern dentist, although no test yet available is so specific and sensitive that caries can be diagnosed from saliva samples only. The present tests are useful for estimating the caries activity due to bad dietary habits (salivary lactobacilli), establishing the presence of infection (salivary mutans streptococci), and identification of salivary yeasts for the determination of the medical condition of the patient. Buffer capacity reveals the most important host response factor acting against caries, while measures of flow rate form the diagnostic basis for treatment planning. These tests, alone or in combination, are now so easy to perform that they should be used in every dental practice.     

Clinical decision-making for dental caries management.

Scientific information on diagnosis, prevention, and management of dental caries and associated indicators of risk continues to increase rapidly. Patients vary in clinically important ways, however, and uncertainty affects our understanding of risk; diagnostic and prognostic information; efficacy and effectiveness of many preventive, diagnostic, and treatment alternatives; and outcomes associated with clinical strategies. Consequently, challenges abound for clinicians to identify, evaluate, and incorporate new information, patient preferences, and uncertainties into clinical practice. Clinical decision-making--an analytical approach that makes explicit use of information to quantify probabilities and outcomes to analyze decisions under conditions of uncertainty--can provide a framework to analyze the impact of uncertainty of clinical information. Diagnostic, effectiveness, and outcome information is quantified and combined in an explicit way to serve as a tool for clinicians, not as a replacement for clinical judgment or experience. Such an approach has the potential to improve clinical practice and help dentists do their jobs better by structuring the decision problem and assessing probabilities and utilities. Clinical decision-making also helps dentists communicate with each other by identifying clinical controversies, thereby characterizing how and why disagreements may arise and what additional data may be needed to address a clinical question.     

Biological methods of dental caries prevention. A review

A number of measures by which tooth resistance could be increased or by which potentially cariogenic bacteria could be eliminated or their deleterious effects minimized are discussed. Many of them have proved valuable at the individual patient level but cannot be applied as a public health measure.     

Systematic review of conservative operative caries management strategies.

The relationship between cavity preparation extension and restoration longevity is examined through a systemic review of the available evidence on specific conservative, operative caries-management strategies. Evidence tables are provided for three specific techniques in the permanent dentition: 1) the proximal "tunnel" restoration, 2) the proximal "box-only" restoration, and 3) the preventive resin restoration. In the primary dentition, the clinical trials involving the proximal box-only restoration, most of which involved glass-ionomer materials, are reviewed. In the permanent dentition, the evidence reveals low effectiveness for "tunnel" restorations, limited but supportive results for proximal-only restorations, and generally favorable outcomes for the occlusal composite resin-sealant restoration. The weak link in the latter is the overlying fissure sealant, which requires adequate ongoing maintenance. Conservative operative strategies in the primary dentition have not been uniformly successful, and deleterious material effects dominate restoration performance. This systematic review concludes that operative conservatism per se does not guarantee increased restoration longevity and that all restorations are vulnerable to caries recurrence, material failures, and technical deficiencies. The more successful conservative strategies are expected to enhance tooth longevity, provided concomitant caries control is effective.     

Socioeconomic status and selected behavioral determinants as risk factors for dental caries.

The purpose of this review is to summarize a systematic review evaluating the evidence regarding the association between the incidence and prevalence of dental caries and: 1) socioeconomic status; 2) tooth-brushing; and 3) the use of the baby bottle. Literature was drawn from two databases, Medline and EmBase. Because of limited resources, we did not conduct hand-searching or search unpublished studies. Three thousand one hundred thirty-eight abstracts were identified, 358 reviewed, and 272 papers included in the systematic review. There is fairly strong evidence for an inverse relationship between SES and the prevalence of caries among children less than twelve years of age. The evidence for this relationship is weaker for older children and for adults because of the relatively small number of studies and methodological limitations. There is weak evidence that tooth-brushing prevents dental caries, but it is uncertain whether the effects of tooth-brushing are due to use of a fluoride dentifrice or from mechanical removal of plaque. Finally, the evidence for the relationship between prolonged use of the baby bottle and dental caries is weak. More studies directly aimed at analyzing the relationship between SES and dental caries are needed to identify factors associated with SES that contribute to dental caries risk. Tooth-brushing should continue to be recommended as a measure to prevent dental caries, particularly using a fluoride dentifrice. Recommendations regarding bottle use should continue until clear evidence about the relationship between prolonged bottle use and dental caries can be obtained.     

Preventive versus restorative management of dental caries

Dental caries is a preventable disease and established lesions can become arrested. Traditional restorative treatment has many shortcomings and there is a need for dentists to manage carious lesions as far as possible by preventive means. Patients should be motivated to accept responsibility for changing the environment of their teeth so that the calcium and phosphate balance favours remineralization, but the dentist should still make use of therapeutic fissure sealants or place restorations when necessary. As long as dentists continue to be obsessed with a restorative approach to caries management, the repeat restoration cycle with its accompanying escalating costs seems likely to continue. The implications of this change in philosophy are enormous, for areas of the world where oral care services are comprehensive, and for countries like South Africa where services are still being developed in some regions.     

Effect of different diagnostic thresholds on dental caries calibration

OBJECTIVES: (a) To analyze the intra- and inter-examiner reproducibility (reliability) of a calibration trial, at different diagnostic thresholds of dental caries; (b) to verify the accuracy (benchmark validity) though sensitivity (S), specificity (SP), positive (PPV) and negative predictive (NPV) values. PARTICIPANTS: A group of dental examiners (n=11), who had previous experience in epidemiological surveys and six to seven-year-old children. Children were selected according to the dmft and dental caries activity. METHODS: Theoretical and clinical training and calibration exercises were arranged for a total of 28 hours. WHO criteria including the active initial lesions (IL) were used. MAIN OUTCOME MEASURES: WHO and WHO+IL diagnostic thresholds according to tooth and dental surface. RESULTS: Excellent mean results of intra and inter-examiner Kappa values were found for both diagnostic thresholds, according to tooth and surface, during the calibration phase. The most relevant errors were related to IL diagnosis and to the first permanent molars. When assessed against a benchmark examiner, moderate to high validity values were observed (0.71-1.00), with some loss mainly for sensitivity and positive predictive value, when including IL. CONCLUSION: It was possible and feasible to use the proposed methodology of this study in epidemiological surveys, even with the inclusion of IL. However, further examiner calibration studies are still needed in order to improve and establish a methodology of calibration with this new diagnostic threshold.     

Systematic review and meta-analysis of diagnostic studies of proximal surface caries

Clinical Oral Investigations - This systematic review and meta-analysis aimed to assess the diagnostic accuracy and reliability of commonly used caries detection methods for proximal caries...     

颌骨牙源性囊肿袋形术/减压术引流装置的设计与临床应用

 颌骨牙源性囊肿是一组来源于与牙发生相关组织的病变，上皮衬里的囊腔包含液体或半流体。由于囊腔内的压力、骨吸收因子释放及上皮增生引起囊肿不断增大，导致颌骨膨隆、牙松动移位，面部畸形及咬合功能障碍。牙源性囊肿的袋形术/减压术是一种简单易行而有效的保守性治疗方法。成功的治疗需要术后采用不同引流装置保持囊肿引流。较大的囊肿常在术后配戴囊肿塞或阻塞器，而较小的病变则通过减压管保守引流。大多数病例是在袋形术/减压术后囊肿缩小时二期行囊肿刮除术，可减少邻近结构的损伤或手术并发症，仅少数病例中袋形术作为惟一的治疗方式。文章简要介绍了袋形术/减压术的相关治疗机制以及多种引流装置的设计与临床应用。     

Saliva and dental caries.

A study of saliva and its tooth-protective components reveals at least four important functions of saliva: (1) buffering ability, (2) a cleansing effect, (3) antibacterial action, and (4) maintenance of a saliva supersaturated in calcium phosphate. Several salivary constituents subserve one or more of these functions. Research has yielded important information about organic and inorganic secretory products. It is also clear that saliva as a unique biologic fluid has to be considered in its entirety to account fully for its effects on teeth. Saliva is greater then the sum of its parts. One reason for this is that salivary components display redundancy of function, each often having more than one function. This redundancy, however, does not imply that proteins that share functional roles all contribute to the same degree. For instance, when comparing proteins that inhibit calcium phosphate precipitation, statherin and acidic proline-rich proteins are most potent, whereas histatins, cystatins, and mucins appear to play lesser roles. The complex interaction between proteins is another major factor contributing to saliva's function. In this regard, heterotypic complexes of various proteins have been shown to form on hydroxyapatite. Mucin binding to other salivary proteins, including proline-rich proteins, histatins, cystatins, and statherin, is well documented. The complexes, whether adsorbed to the tooth surface or in saliva, have important implications for bacterial clearance, selective bacterial aggregation on the tooth surface, and control of mineralization and demineralization. Finally, proteolytic activity of saliva generates numerous products whose biologic activities are often different from their parent compounds. Fluoride is another important component of saliva that is discussed separately in other articles in this issue. The ability of saliva to deliver fluoride to the tooth surface constantly makes salivary fluoride an important player in caries protection largely by promoting remineralization and reducing demineralization. Some key properties of salivary components discussed in this article are listed in Table 1. Saliva is well adapted to protection against dental caries. Saliva's buffering capability; the ability of the saliva to wash the tooth surface, to clear bacteria, and to control demineralization and mineralization; saliva's antibacterial activities; and perhaps other mechanisms all contribute to its essential role in the health of teeth. The fact that the protective function of saliva can be overwhelmed by bacterial action indicates the importance of prevention and therapy as in other infectious diseases. The knowledge of functional properties of saliva as well as those of its separate components may permit a better assessment of dental caries susceptibility. Future research is essential to characterize more fully salivary components and their interactions and how these affect the caries process. With such knowledge, the use of modified oral molecules as therapeutic agents may become a reality. Equally intriguing is the prospect of influencing the secretion of salivary components by greater knowledge and control over the secretory processes responsible for the delivery of those components.