Clinical practice guideline adaptation for risk-based caries management in 18-55 year-old Iranian adults

PURPOSE

To adapt an evidence-based clinical practice guideline (CPG) for risk-based management of caries in 18-55 year-old Iranian adults.

METHODS

A multidisciplinary adaptation team reviewed evidence-based guidelines such as the NICE, SIGN, and ADA according to the defined clinical questions. In addition, databases such as the PubMed and Google Scholar were searched and CPGs were screened and appraised using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) tool. Clinical scenarios were developed and their level of evidence, clinical advantage and adaptability were assessed. Following a two-round ranking by experts, the final recommendations were selected using the RAND-UCLA appropriateness method.

RESULTS

Of 17 CPGs, 5 were selected as the source guidelines for adaptation. To assess the risk of caries in the adult population, reduced Cariogram (without saliva tests) and CAMBRA were suggested as diagnostic tools. In addition, 53 risk-based recommendations on the preventive care (including the use of fluoride toothpaste, fluoride, and chlorhexidine mouthwash, at home and in-office fluoride gel, fluoride varnish, mouth buffering, and sealant), operative intervention threshold, and follow-up interval were adapted for Iranian adults.

CONCLUSIONS

A guideline was adapted for risk-based management of dental caries in Iranian adults. This helps local dentists in decision making and promoting oral health of adults. Further research is needed to assess the external validity and feasibility of the adapted guideline in the Iranian population.

Deciduous dentition approximal caries lesion progression and regression following preventive treatment: literature review

The objective of this review was to investigate rates of caries lesion progression, arrest, and regression in approximal surfaces of deciduous teeth following secondary preventive interventions in order to inform caries management protocols. Studies published in English and other languages from 1960 till February 2017 were searched in electronic databases. Inclusion criteria were: randomized controlled clinical trials and longitudinal studies that involved non-invasive preventive treatment. We excluded: in vivo studies and incidence studies. 805 potential articles were located, of 38 full text reviews, 10 were included. Two types of studies were found; those reporting the mean percentage of lesion progression as progression estimate and those reporting the survival rate of lesions presented as the mean or median survival time in months as survival estimate. Weak evidence suggests it would appear that the most effective secondary preventive intervention was one involving a combination of silver fluoride and stannous fluoride, but this has not been substantiated. To inform treatment protocols better, it is recommended (i) that new well-designed RCTs are conducted to test the effectiveness of different forms of fluoride to arrest lesion progression in deciduous teeth and (ii) to continue ongoing research into the caries preventive effects of approximal surface sealants.

Dental pain and its determinants in an adult population in Tehran, Iran, Urban HEART-2

OBJECTIVE

To assess the prevalence of dental pain in the past year among adults in Tehran-Iran, and its determinants.

BASIC RESEARCH DESIGN

Cross-sectional population study.

PARTICIPANTS

A sample of 20,322 adults (18-64 years old).

METHODS

A questionnaire survey was conducted across the 22 districts using the multi-stage random sampling method. Data were analysed applying the complex samples method. Multiple logistic regression analysis was used to adjust the effects of other variables on the outcome variable as dental pain in the past year.

RESULTS

Overall, 19,645 individuals with a mean age of 39.9 (SD=12.5) years responded. Dental pain in the past year was reported by about one sixth (14%) of subjects and associated with being widowed/divorced (OR 1.45, 95%CI 1.07-1.97, p=0.016), married (OR 1.24, 95%CI 1.04-1.47, p=0.016), Azari minority (OR 1.2, 95%CI 1.05-1.37, p=0.009) and having dental visit in the past year (OR 2.6, 95%CI 2.29-2.95,p⟨0.001). Older subjects (OR 0.76, 95%CI 0.59-0.97, p= 0.029), those with a high economic status (OR 0.84, 95%CI 0.72-0.98, p=0.03), good (OR 0.75, 95%CI 0.58-0.96, p=0.023) or moderate oral health behaviour (OR 0.79, 95%CI 0.62-0.99, p=0.042), and good self-perceived oral health (OR 0.52, 95%CI 0.45-0.61, pp⟨0.001) were less likely to report dental pain.

CONCLUSIONS

Dental pain in the past year was associated with being married/widowed, being a minority, and visiting a dentist in the past year. Older subjects and those with a high socio-economic status, good/moderate oral health behaviour, and good self-perceived oral health were less likely to report dental pain.

Knowledge of and attitudes towards periodontal health among adults in Tehran

Determining what people know and believe about periodontal health and disease is important in order to establish prevention practices. This study aimed to assess knowledge of and attitudes towards periodontal health among adults in Tehran, Islamic Republic of Iran. We conducted a cross-sectional face-to-face interview survey in 2011 of 791 adults aged 18-50 years using a stratified, multistage sampling method. We recorded demographic characteristics including age, sex, education, marital status, employment and economic status (housing density). The lowest percentage of correct answers was related to the definition of dental plaque (11.6%) and the highest was for the role of the dental visit in prevention (92.8%). Female sex, university education and higher economic status were significantly associated with a higher mean score on periodontal health knowledge. The regression analysis showed that positive attitudes were associated with higher periodontal health knowledge and having university education. In this study positive attitudes towards prevention were related to better knowledge.

Oral health literacy and information sources among adults in Tehran, Iran

OBJECTIVE

To assess oral health literacy level and oral health information of Iranian adults in Tehran, and to determine the factors related to oral health literacy.

BASIC RESEARCH DESIGN

A cross-sectional population study.

PARTICIPANTS

A random sample of 1,031 adults in Tehran, Iran.

METHODS

Oral health literacy was measured using an oral health adult literacy questionnaire (OHL-AQ). Variation in use of information sources by socio-economic and demographic background was estimated by odds ratios. A multiple linear regression model served to determine predictor factors of OHL-AQ scores controlling for characteristics of the subjects and number of information sources.

RESULTS

The mean OHL-AQ score was 10.5 (sd 3.0). Women (p < 0.001), younger (p < 0.001), and better educated participants (p < 0.001) had higher OHL-AQ scores. The most common sources of oral health information were dentists (52.6%), and TV/Radio (49.5%). According to the regression model, females (p = 0.001), high educational level (p < 0.001), and use of multiple information sources (two sources p = 0.01, three sources or more p = 0.002) were the main predictor factors of OHL-AQ scores.

CONCLUSIONS

The average oral health literacy level of Iranian adults was low. Disseminating evidence-based oral health care information from multiple sources including TV/radio, dentists, and other health professionals in different settings should improve public oral health literacy.

Common Perceptions of Periodontal Health and Illness among Adults: A Qualitative Study

Objective. Our aim was to explore perceptions of periodontal health and illness and to examine attitudes and beliefs regarding prevention of gum diseases among Iranian adults. Methods. Our qualitative approach included focus-group discussions among adults aged 18 and above based on convenient and purposive sampling in Tehran. Transcripts of the four focus-group discussions were analyzed by two independent reviewers using a content analysis method. Results. Two major themes in the analyses emerged: the common perception of periodontal health and illness and the attitude towards prevention. The study demonstrated the subjects' good understanding of prevention of periodontal disease, but their lack of knowledge of the aetiology of the diseases, and an inability to differentiate aetiology, symptoms, and prevention of dental caries and periodontal disease. Conclusion. This study revealed a need for oral health education among Iranian adults to improve their knowledge and change their attitudes to achieve deeper understanding of the aetiology and prevention of periodontal disease. Health promotion programs should address misconceptions about prevention of gum disease.

Dental students' knowledge and perceptions of non-invasive dental caries management

BACKGROUND

An evidence-based, risk-specific, and non-invasive modality for caries management was implemented in the University of Sydney dentistry curriculum. This study reviews its impact on student learning outcomes and their perceptions of the efficacy of a risk-based caries management.

METHODS

One hundred and nine Year 3 and Year 4 students were invited to complete a questionnaire to assess their understanding of the protocols and their perceptions of both the education process and value of the non-invasive treatment modality.

RESULTS

A response rate of 93% Year 3 and 46% Year 4 students was obtained. They correctly identified high and low risk cases but Year 3 students were inclined to misclassify medium risk cases. Most understood correctly that enamel lesions should be arrested and remineralized but were often more radical in dealing with dentine lesions. Students who believed the protocols were useful and who spent more time on preventive care were less likely to restore enamel and dentine lesions.

CONCLUSIONS

A modest level of knowledge concerning application of the non-invasive caries management system to paper-based clinical case studies was demonstrated. Protocol misinterpretation may reflect inconsistent instruction by some clinical tutors. It is hoped that the promulgation of evidence-based dentistry will overcome these barriers in future.

The Caries Management System: an evidence-based preventive strategy for dental practitioners. Application for adults

In the absence of effective caries preventive methods, operative care became established as the means for caries control in general practice. Water fluoridation resulted in a declining caries incidence which decreased further following the advent of fluoridated toothpaste. The challenge today is to develop a non-invasive model of practice that will sustain a low level of primary caries experience in the younger generation and reduce risk of caries experience in the older generations. The Caries Management System is a ten step non-invasive strategy to arrest and remineralize early lesions. The governing principle of this system is that caries management must include consideration of the patient at risk, the status of each lesion, patient management, clinical management and monitoring. Both dental caries risk and treatment are managed according to a set of protocols that are applied at various steps throughout patient consultation and treatment. The anticipated outcome of implementing the Caries Management System in general dental practice is reduction in caries incidence and increased patient satisfaction. Since the attainment and maintenance of oral health is determined mainly by controlling both caries and periodontal disease, the implementation of the Caries Management System in general practice will promote both outcomes.

Impact of complementary oral enzyme application on the postoperative treatment results of breast cancer patients--results of an epidemiological multicentre retrolective cohort study

PURPOSE

[corrected] To evaluate the impact of postoperative treatment with an oral enzyme (OE) preparation given complementary to an antineoplastic therapy in patients with breast cancer.

METHODS

The design of this epidemiological study was a retrolective cohort analysis with parallel groups. Design and conduct of the study were performed to current standards for prospective, controlled clinical trials. A cohort of 2,339 breast cancer patients undergoing surgical intervention and radio-, chemo- or hormonal therapy were studied in 216 centres. Of the 2,339 patients, 1,283 received complementary treatment with OE and 1,056 did not receive OE. Patients with other complementary medications were excluded and the final analysis was performed with the data from 649 patients, of whom 239 (37%) were additionally treated with OE (test group) and 410 (63%) without OE (control group). The median follow-up time for the test group was 485 days and for the control group 213 days. The primary endpoint of the study was to determine whether complementary treatment with OE can reduce typical disease- or therapy-associated signs and symptoms (gastrointestinal symptoms, mental symptoms, dyspnoea, headache, tumour pain, cachexia, skin disorders, infections, and side effects associated with the antineoplastic therapy) in patients with breast cancer. Imbalances for causal effects (covariates) were adjusted for by means of the propensity score. Outcome analysis was performed by estimating the linear regression between change in symptom score and propensity score with all data and using this regression line to calculate the change in symptom score which would be expected for each patient. Tumour-associated events (recurrence, metastasis, and death) were evaluated in terms of the number of events observed and time to event. The safety of treatment with OE was analysed in terms of the number and severity of adverse events, their duration, treatment and outcome.

RESULTS

For all symptoms except tumour pain, the adjusted mean improvement in symptom scores was larger in the test group than in the control group. The adjusted difference was statistically significant for all symptoms, except tumour pain and infections. The results show that the typical disease- and therapy-associated signs and symptoms in patients on complementary therapy with OE during postoperative treatment were significantly less. For 75% of the test group and 55% of the control group the physician recorded "no signs and symptoms". A clear reduction in the side effects of radiotherapy and chemotherapy was documented in 74% of the test group and 55% of the control group. Analysis of survival, recurrence, and metastasis demonstrated a reduced number of events in the test group. There was evidence of a beneficial influence of OE on time to event, although the median observation time was too short in these breast cancer patients to draw definite conclusions. The safety component was judged in 98% of the test group and 76% of the control group as "very good" or "good". In the total sample of 2,339 patients, the rate of OE-associated adverse reactions was 3.2%. All side effects were mild to moderate gastrointestinal symptoms.

CONCLUSION

Complementary treatment of breast cancer patients with OE improves the quality of life by reducing signs and symptoms of the disease and the side effects of adjuvant antineoplastic therapies. This epidemiological retrolective cohort analysis provides evidence that the patients may also gain benefit by a prolongation of the time to event for cancer recurrence, metastasis and survival. OE was generally well tolerated.

Symptomatic treatment of brain tumor patients with sodium selenite, oxygen, and other supportive measures

Patients (16 women and 16 men) with brain tumors previously treated conservatively by surgery, radiation, and/or chemotherapy with typical symptoms of increased intracranial pressure were consecutively enrolled to test the effects of pharmacological dosages of sodium selenite (selenase) in conjunction with other supportive therapies (biological response modifiers, detoxification, chemotherapy, immunotherapy, oxygen therapy). The rationale for the use of sodium selenite was that the whole-blood selenium levels were subnormal in 70% of the patients on admission. Patients also frequently presented abnormal levels of other minerals, especially lowered sodium and elevated potassium levels, which appears to be characteristic of brain tumor patients. Sodium selenite was administered by infusion at dosages of 1000 microg Se in physiological saline/d for 4-8 wk. In 76% of the patients, a definite, and in 24% a slight improvement of the general condition and a decrease in symptoms, such as nausea, emesis, headache, vertigo, unsteady gait, speech disorders, and Jacksonian seizures, were observed. In all treated patients, improvements of erythrocyte, hemoglobin, and thrombocyte counts were observed. Additional beneficial effects were noted in the patients receiving the oxygen therapy. It is concluded that the sodium selenite can be employed with oxygen therapy and other supportive measures in the management of brain tumor patients.