我国局部使用氟化物防龋效果的循证医学分析

目的:对氟化物防龋效果进行评价.方法:通过电子和手工检索收集我国1950-2005年氟化物防龋的临床研究文献,根据循证医学方法建立纳入和排除标准,采用Revman4.2软件对符合条件的所有研究结果进行Meta分析.结果:242篇氟化物防龋临床研究文献中,13篇文献符合纳入标准.文献中包括了5031名实验对象,平均样本量为387名.氟化物预防龋齿的Meta分析表明,RR为0.56,95%可信区间为0.50～0.62.结论:氟化物可以有效降低龋齿的发生率.     

我国窝沟封闭防龋效果的循征医学分析

目的:对窝沟封闭的防龋效果进行评价。方法:通过电子和手工检索收集我国1980～2005年窝沟封闭防龋的临床研究文献,根据循证医学方法建立纳入和排除标准,采用Revman4.2软件对符合条件的所有研究结果进行Meta分析。结果:196篇窝沟封闭防龋临床研究文献中,18篇文献符合纳入标准。文献中包括了7304名试验对象,平均样本量为406名。窝沟封闭预防龋齿的Meta分析表明,RR是0.19,95%可信区间为0.16～0.22。结论:窝沟封闭可以有效降低龋齿的发生率。     

深圳市宝安城区学龄前儿童使用氟化物预防龋病的监测报告

目的：评估学龄前儿童使用氟化物预防龋病的效果。方法：2005～2009年间,对宝安城区幼儿园使用氟化物情况进行监测,分析氟化物预防龋病的效果。结果：5年间共监测46279例学龄前儿童,有40851例使用了氟化物预防龋病,使用率88.27%。含氟漱口水的使用率为91.28%,误吞率5.63%;含氟凝胶使用率81.28%,误吞率3.17%;氟化泡沫使用率95.33%,误吞率1.10%;不同氟化物使用率和误吞率的差异有统计学意义（P=0.000）。患龋率从2005年的76.19%下降到2009年的45.91%;龋均从2005年的6.11颗下降到2009年的3.07颗;不同年份间患龋率的差异有统计学意义（P=0.000）。结论：2005～2009年宝安城区学龄前儿童氟化物预防龋病项目取得了肯定的成效,氟化物可以有效降低龋齿的发生率。     

《口腔医学》杂志2007年度有关信息的分析

目的通过对《口腔医学》2007年全年文献的回顾和分析,了解我国口腔临床医学的研究现状。方法阅读2007年《口腔医学》全年的文献,对各种信息进行了分类汇总,根据设计类型对临床一次性文献进行了分类,并对其中的试验性研究文章进行质量分析。结果《口腔医学》2007年全年的一次性文献274篇,基础和临床文献分别为108和166篇,以临床文献为主(60.58%)。在临床研究文献中,属于观察性、分析性和试验性的文献分别为97、9和60篇,观察性文献所占比例为36.14%,高于以往的报道。60篇观察性文献中,全都设有对照;统计方法应用得当者44篇;真正做到随机、盲法的分别只有4和2篇。结论我国口腔临床方面的研究水平近年来提高明显,但设计的科学性方面有待提高。     

“三明治修复技术”和复合树脂修复非龋性牙颈部缺损的临床疗效评估：系统综述和Meta分析

研究目的：比较三明治修复技术（玻璃离子水门汀[GIC]或树脂改性玻璃离子水门汀[RMGIC]垫底,复合树脂[CR]充填）和仅用复合树脂充填修复非龋性牙颈部缺损（NCCLs）充填体的保留率。材料与方法：检索以下数据库：the Cochrane Library,PubMed,Scopus和Web of Science。同时检索了灰色文献和IADR正在进行和未发表的摘要（1990-2017）。应用Cochrane风险评估工具评估纳入文献质量。应用随机效应模型对随访1、2、3年的相关结果进行meta分析。应用GRADE法进行证据质量评价。结果：最初共检索到3645篇文献。经过对题目、摘要和全文进行筛选,共纳入6篇文献。其中有3篇文献是对同一随机临床试验的随访研究,所以最终对4项研究进行分析。4项研究均未报道偏倚风险程度。在所有结果中,仅在随访3年时应用三明治修复技术的充填体脱落率低于仅应用复合树脂充填（风险比[RR]：7.5,;95% CI：2.1-27.2;p=0.002）。结论：本系统综述纳入研究数量有限,随访3年时应用三明治修复技术的充填体保留率高于仅应用复合树脂充填。缺损修复方式不影响次要结果。除充填体保留率的质量等级为中等,其他次要结果的质量等级都为低。     

年轻恒牙患龋预测快速法试验研究

目的了解用快速检测菌斑的方法预测3～5年后儿童龋病的发生情况的准确性。方法采用菌斑显示剂（2％品红）测定73位4—5岁儿童的牙面菌斑，根据菌斑多少及当前患龋情况（dmfs）两项指标来预测其3～5年后龋病发生情况，并与用当前患龋情况（dmfs）、唾液变链计数及唾液缓冲能力3项指标联合预测3-5年后龋病发生情况进行比较。结果用这两种方式进行预测的敏感性、特异性及预测可信度均差异无统计学意义（P〉0．05）。结论提示在大规模普查筛选龋高危儿童时可选用检测菌斑和乳牙患龋情况两项指标这一快速预测龋病的方法。     

文献计量学调查表明《口腔正畸学》为我国口腔正畸学首选核心期刊

为了使广大读者了解我国口腔正畸学方面研究状况，我们采用文献计量学方法（即文摘法），对国内本专业的期刊文献作了初步调查，即对1994—1996年南京医科大学编辑出版的《中国医学文摘口腔医学》中有关口腔正畸学方面的文献作了统计调查，从中找出核心期刊，供广大读者学习参阅。调查结果表明，1994－1996年3年中有ZI种期刊登载有关口腔正畸学方面的文献，共计341篇，其中载文量在6篇以上的有11种，依次为1．口腔正畸学（138）；2．中华口腔医学杂志（3）；3口腔医学（3）；4口腔医学纵横（3）；5．临床口腔医学杂志（27）；6现代口腔医学…     

血液透析患者龋病和牙周健康状况的系统评价

目的 对接受维持性血液透析的终末期肾病患者的龋病和牙周健康状况进行系统评价。方法 计算机检索中国学术期刊全文数据库（CNKI）、万方数据库、PubMed、Web of Science、Cochrane Library数据库,收集国内外公开发表的研究血液透析患者口腔健康状况的病例对照和横断面研究,检索时间截止2016年5月。由2名研究者根据纳入与排除标准对相关文献进行筛选,并对文献进行质量评价和提取数据,对同质研究采用Revman 5.3软件进行Meta分析。结果 研究最终纳入16篇文献,Meta分析结果显示,血液透析患者人群的牙菌斑指数（MD=0.62,95%CI为0.51~0.72）、牙石指数（MD=1.09,95%CI为0.56~1.63）、牙周袋深度（MD=0.63,95%CI为0.29~0.98）、附着丧失（MD=0.63,95%CI为0.56~0.69）均高于对照组（P<0.01）,而龋失补牙数（MD=1.12,95%CI为-1.08~3.32）与对照组无统计学差异（P=0.32）。结论 行血液透析治疗的终末期肾病患者的龋病状况与健康对照人群无明显差异,但口腔卫生和牙周状况较差,在临床治疗时需得到重视。     

国内防治放(化)疗所致口腔黏膜炎研究文献的循证医学分析

目的：评价国内口腔放疗和（或）化疗所致口腔黏膜炎文献的研究质量及治疗方法的有效性。方法：检索中国期刊网全文数据库（CNKI）和中国生物医学文献光盘数据库（CBMDisc）,按照国际循证医学标准对其中采取随机对照设计（randomized controlled trial,RCT）的有关口腔黏膜炎的疗效研究文献进行分析。结果：共检索到论著98篇,符合纳入标准的RCT文献22篇。从设计类型、诊断标准、疗效评定、不良反应等方面对上述文献进行分析。结论：我国治疗口腔黏膜炎的RCT文献无法进行Meta分析;粒细胞-巨噬细胞集落刺激因子（GM-CSF）具有较好的短期疗效。     

《上海口腔医学》2012—2016年载文分析

目的： 对《上海口腔医学》近5年发表的文献进行整理和分析，为期刊可持续发展提供参考。方法： 检索CNKI数据库，将《上海口腔医学》2012—2016年刊载文献的年、卷、期、作者、作者单位、基金、收稿日期、被引频次和下载频次逐条录入Excel表格，采用文献计量学方法对数据进行统计分析。结果： 《上海口腔医学》5年30期共载文789篇，第一作者共计702名，分布于29个省、自治区和直辖市，共计222家研究机构、重点实验室、医学高等院校及其附属医疗单位。排名前10的第一作者共发表论文37篇（4.69%），排名前10 的通信作者共发表论文88篇（11.15%）。789篇文献中，118篇（14.96%）获得国家级基金项目资助，339篇（42.97%）获得其他级别的基金项目支持。5年平均发表时滞282.44天（9.41个月）。总被引615篇，被引率77.95%；总被引频次2388次，总下载频次75866次。影响因子呈逐年上升趋势。结论： 《上海口腔医学》稿源充足，拥有固定的核心作者群和机构群，学科影响力强，社会知名度高。     

牙种植临床随机对照试验的报告质量评价

目的 应用改良Jadad评分标准和CONSORT（2010）声明评价2000-2012年发表的我国牙种植领域的随机对照试验（RCT）,了解我国牙种植临床试验报告质量的现状。方法 计算机检索中国生物医学文献数据库（CBM）、维普中文科技期刊数据库（VIP）和中国期刊全文数据库（CNKI）,外文数据库PubMed和EMBASE,同时配合手工检索2000-2012年我国19种口腔医学期刊,纳入牙种植领域的RCT。采用CONSORT（2010）和改良Jadad评分量表对纳入文献进行报告质量评价。结果 共纳入28篇相关RCT,其报告质量普遍不高,改良Jadad平均评分仅为（1.29±0.71）分,CONSORT（2010）的平均得分仅为（9.75±3.60）分。结论 目前我国牙种植领域的随机对照试验方法学质量普遍较低,报告质量也尚有一定差距。     

恒前牙外伤固定疗效国内临床试验的循证医学质量评价

目的：通过循证医学方法,评价近10年国内发表的关于使用各种固定方法治疗恒前牙外伤的临床试验质量。方法：搜索CNKI与万方数据库(2001—2011年),以“恒前牙外伤”作为主题词进行搜索,共获得245篇可能相关的文献,浏览摘要后,得到46篇关于恒前牙固定疗效的文献,对临床试验的设计进行分类评价,分别采用临床试验统一报告标准(CONSORT)和加强观察性流行病学研究报告声明(STROBE)所建立的临床试验评价标准进行质量评估。结果：46篇临床试验中,随机对照试验8篇,其余38篇均为观察性研究。绝大部分试验设计不够科学严谨,即使是随机对照试验,其随机方法、分配方式的隐藏、盲法的采用等方面并不完善,无法进行全面的方法学质量评价。结论：国内关于恒前牙外伤固定疗效临床试验的质量有待提高,需在试验设计和论文写作上加以完善。     

牙本质过敏症临床随机对照试验的报告质量评价

目的评价2000-2009年发表在19种中文口腔医学期刊上的治疗牙本质过敏症的临床随机对照试验（RCT）的报告质量,以了解牙本质过敏症RCT研究的报告现状以及影响报告质量的因素,并评价其能否为临床应用提供高质量证据。方法手工检索19种中文口腔医学期刊,纳入在2000-2009年发表的声明采用“随机”方法分组的牙本质过敏症RCT研究,采用国际公认的临床试验报告统一标准（CONSORT）评价报告质量,并采用单因素分析和多因素分析相结合的方法分析影响报告质量的因素。结果共纳入61篇牙本质过敏症RCT研究,其中45篇发表于中国科技论文统计源期刊,16篇发表于非统计源期刊。牙本质过敏症RCT研究的报告质量普遍不高,平均得分为（8.1±2.4）分。多元线性回归显示：改良Jadad评分量表得分（t=4.656,P=0.000）是影响牙本质过敏症RCT研究报告质量的主要因素,即内在真实性越好,报告质量越高。结论目前国内关于牙本质过敏症RCT研究的报告质量有待提高。笔者建议口腔医师在临床试验前完善RCT试验设计,并且按照CONSORT标准撰写论文,以提高论文的报告质量。     

Dental trauma: an evidence-based approach to care

Abstract – Background: One of the key aspects of improving the dental care we offer to our patients is in basing our practice on the best available evidence. Aim: The main purpose of this paper is to present some basic ways of searching reliable papers on Internet and to introduce some techniques to facilitate the development of strategic search skill to improve the quality of dental care, using dental trauma as an example. Materials and methods: After formulation of a clinical question on a dental trauma issue, a comparison was made between: data collected in PubMed using a given term; data collected in PubMed using the Medical Subject Headings vocabulary (Mesh) and data collected using the principles of evidence‐based research, all by an independent researcher. A number of papers searched about a clinical question on dental trauma and a brief commentary about each Internet research database is presented. The authors reported that the best sites available to perform the sample search were those produced by academic centers, professional organizations and government‐sponsored. To get evidence‐based clinical papers we did internet search on PubMed, Cochrane, Center of Evidence‐Based Dentistry and Knowledge Finder using the clinical question “Emergency Treatment for Avulsed Tooth”. Results: All searched databases were efficient for scientific journals, but when we used the PI strategy, the search seemed to be more relevant and specific. The Cochrane, Center of Evidence‐Based Dentistry and Knowledge Finder presented more reliable papers to answer our clinical question about dental trauma treatment. Conclusion: It is imperative that dentists understand the advantages of searching the Internet and learning to use it effectively to guide practice and assist their patients in their pursuit for better oral health.     

儿童龋病分级管理

儿童龋病分级管理模式是指通过临床检查与问卷调查,将儿童分为不同的患龋风险等级,并进行相应的个性化、精细化管理,以期达到降低儿童龋病患病率的目的。近年来,尽管我国卫生行政部门在儿童龋病防治方面投入了大量的人力和物力,但收效甚微。根据第四次全国口腔健康流行病学调查结果显示,我国儿童龋病患龋率仍处于较高水平。目前,国内已有不少文献对儿童龋病的风险评估进行了研究,但对其后的管理模式尚未有文献探讨。而国外已有文献对儿童龋病的管理模式进行了讨论,并且有些地区已将龋病分级管理的部分步骤应用于实践。文章将对儿童龋病分级管理模式进行论述,以期为我国儿童龋病的管理提供借鉴。     

Professional fluoride varnish treatment for caries control: a systematic review of clinical trials

The aim of this paper was systematically to evaluate the caries‐preventive effect of professional fluoride varnish treatments. A search of the literature for articles published between 1966 and August 2003 was carried out in electronic databases, reference lists of articles, and selected textbooks in accordance with the strategy of the Swedish Council on Technology Assessment in Health Care. Out of 302 identified papers, 24 randomized and controlled clinical trials comparing fluoride varnish with placebo, no active treatment or other fluoride preventive regimens of at least 2 years' study duration were included. The trials that met the inclusion criteria were assessed independently and systematically by at least two reviewers and scored from A to C according to predetermined criteria for methodology and performance. The main outcome measure was the preventive fraction expressed as a percentage. The results displayed limited evidence (evidence level 3) for the caries preventive effect of topical applications of fluoride varnishes in permanent teeth. The average prevented fraction was 30% (0–69%) when compared with untreated controls. Inconclusive evidence (evidence level 4) was found for fluoride varnish treatment in the primary dentition and in adults. This systematic review reinforces the need for future clinical research of high quality, incorporating modern concepts of clinical performance and evaluation to assess dental caries control using professional fluoride varnish.     

Quality of reporting randomised clinical trials in dental and medical research

OBJECTIVE: To assess 1) the quality of reporting randomised clinical trials in dental (RCT-Ds) and medical research (RCT-Ms), 2) the quality of RCT reports in relation to the journal impact factor, 3) the source of funding, and 4) the quality of RCT-Ds in different areas of dental research. DESIGN RANDOM: samples of 100 RCT-Ds and 100 RCT-Ms published in 1999 were evaluated for quality of reporting under blinded conditions with the Jadad quality assessment scale. In addition, correlation between the quality scores and journal impact factor or source of funding, as well as area of dental research were analysed. RESULTS: The quality of RCT-Ds and RCT-Ms published in 1999 was generally inadequate. The quality was largely equivalent in RCT-Ds and RCT-Ms. There was no correlation between the quality scores and the journal impact factor or the source of funding. Some differences were found in the quality scores between different areas of dental research. CONCLUSIONS: The results from these RCT-Ds and RCT-Ms show that most of them were imperfect in the reporting of methodology and trial conduct. There is a clear need to improve the quality of trial reporting in dental and medical research.     

Ozone and caries: a review of the literature

Ozone, either in gaseous form or as ozonated water, has been available for use as a treatment for dental caries for a decade. This paper reviews the literature on the subject by examining the findings of publications in the peer review literature. Eighteen papers were identified by a literature search. From the review of these, it was concluded that, while some laboratory studies and some short duration clinical studies have suggested that ozone may be effective in the treatment of root caries or killing of oral micro-organisms, the clinical evidence for the use of ozone in treatment of caries is not compelling.     

The evidence base for professional and self-care prevention - caries,erosion and sensitivity

Background

The aim of this conference paper was to examine the evidence base for primary and secondary prevention of dental caries, erosions and dentin hypersensitivity through professional and self-care measures.

Methods

A mapping of systematic reviews (SR) of literature was carried out in PubMed and the Cochrane library through April 2014 using established MeSH-terms and disease-related search words in various combinations. The search was restricted to SR's published in English or Scandinavian and all age groups were considered. The reference lists of the selected papers were hand-searched for additional review articles of potential interest. Meta-analyses, guidelines and treatment recommendations were considered only when SR's were lacking. In the event of updates or multiple systematic reviews covering the same topic, only the most recent article was included. No quality assessment of the systematic reviews was carried out. The quality of evidence was rated in four levels according to the GRADE scale.

Results

In total, 39 SR were included. For primary caries prevention, the quality of evidence was high for the use of fluoride toothpaste (with and without triclosan) and moderate for fluoride varnish and fissure sealants. The quality of evidence for fluoride gel, fluoride mouth rinse, xylitol gums and silver diamine fluoride (SDF) was rated as low. For secondary caries prevention and caries arrest, only fluoride interventions and SDF proved consistent benefits, although the quality of evidence was low. Likewise, the GRADE score for preventing erosions located in the enamel with fluoride supplements was low. The quality of evidence for various professional and self-care methods to prevent and manage dentine hypersensitivity was very low.

Conclusions

There are knowledge gaps in many domains of cariology and preventive dentistry that must be addressed and bridged through clinical research of good quality.