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Detection and diagnosis of caries—typically undertaken through a visual-tactile examination, often with supporting radiographic investigations—is commonly regarded as being broadly effective at detecting caries that has progressed into dentine and reached a threshold where restoration is necessary. With earlier detection comes an opportunity to stabilize disease or even remineralize the tooth surface, maximizing retention of tooth tissue and preventing a lifelong cycle of restoration. We undertook a formal comparative analysis of the diagnostic accuracy of different technologies to detect and inform the diagnosis of early caries using published Cochrane systematic reviews. Forming the basis of our comparative analysis were 5 Cochrane diagnostic test accuracy systematic reviews evaluating fluorescence, visual or visual-tactile classification systems, imaging, transillumination and optical coherence tomography, and electrical conductance or impedance technologies. Acceptable reference standards included histology, operative exploration, or enhanced visual assessment (with or without tooth separation) as appropriate. We conducted 2 analyses based on study design: a fully within-study, within-person analysis and a network meta-analysis based on direct and indirect comparisons. Nineteen studies provided data for the fully within-person analysis and 64 studies for the network meta-analysis. Of the 5 technologies evaluated, the greatest pairwise differences were observed in summary sensitivity points for imaging and all other technologies, but summary specificity points were broadly similar. For both analyses, the wide 95% prediction intervals indicated the uncertainty of future diagnostic accuracy across all technologies. The certainty of evidence was low, downgraded for study limitations, inconsistency, and indirectness. Summary estimates of diagnostic accuracy for most technologies indicate that the degree of certitude with which a decision is made regarding the presence or absence of disease may be enhanced with the use of such devices. However, given the broad prediction intervals, it is challenging to predict their accuracy in any future "real world" context. [ABSTRACT FROM AUTHOR]

The aim was to produce evidence-based guidelines on mouth care for children, teenagers and young adults receiving chemotherapy and/or radiotherapy. Systematic reviews were undertaken and research was graded according to the methods of the Scottish Intercollegiate Guidelines Network. Where no relevant research was identified, an opinion-gathering process was undertaken. ‘Best practice’ recommendations were developed with regard to appropriate dental care and basic oral hygiene. An evaluation of oral assessment tools identified seven which had been assessed for reliability and/or validity. Only Eilers’ Oral Assessment Guide was felt to be relevant for daily clinical practice. A variety of interventions have been used for the management of oral mucositis, candidiasis, xerostomia and herpes simplex virus; few are supported by research evidence. Careful oral management of children treated for cancer can improve the quality of life during treatment. The guidelines have the potential to improve patient care by promoting interventions of proven benefit and discouraging use of ineffective or potentially harmful practices which may result in adverse patient outcomes. [Copyright &y& Elsevier]

DATA SOURCES: MEDLINE, Embase, Cinahl, Scientific Citation Index and Health CD databases. Reference lists of relevant and the journals Pain and “Community Dentistry and Oral Epidemiology” were handsearched. STUDY SELECTION: Observational studies (cross-sectional surveys, cohorts case-control studies) and previous literature reviews of adult populations over 18 year of age were included. Oro-facial pain (OFP) was defined as pain located in the face, dental pain was excluded. DATA EXTRACTION AND SYNTHESIS: A standardised checklist was used to assess the methodological quality of each study by two reviewers before an attempt was made to summarise the results. The median quality score was 70% of the maximum attainable score. Due to methodological issues, it was not possible to pool the data on the prevalence of OFP. RESULTS: 59 studies were evaluated. Age, gender and psychological factors were found to be associated with OFP, however there was not enough information on other factors such as local mechanical and co-morbidities to draw any reliable conclusions. None of the factors fully fulfilled criteria for causality (Table 1 Table 1Percentage of studies reporting factors which are possibly associated with OFP.Percentage of studies reporting factors which are possibly associated with OFP.Cross-sectionalCohortAge6833Gender7367Socio-economic characteristics2450Education1117Geographic area11-Income/social class1117Race/ethnicity5-Marital status5-Psychosocial factors1150General state of health1117Pain other than OFP1617Headache2450Denture status27-Number of teeth1917Parafunction1433Joint clicking1617Other1617). CONCLUSIONS: There is a need for good quality epidemiological studies of adequate sample size of OFP in the general population. To enable comprehensive examination of the aetiology of OFP, it is necessary to address a broad range of factors, eg demography and life-style, local mechanical factors, medical history and psychological factors. Data on potential confounders and effect modifiers should also be collected and adjusted for in the statistical analysis.Evidence-Based Dentistry (2003) 4, 83-84. doi:10.1038/sj.ebd.6400227 [ABSTRACT FROM AUTHOR]

To achieve the goal of summarizing evidence of treatment effectiveness accurately, systematic reviews require rigorous methods to reduce bias and random error. This study identified 65 systematic reviews of interventions for oral, dental and craniofacial disorders. Each review was assessed by a clinician and a methodologist. Twenty reviews focused on pain, 7 each on caries and oral medicine, 6 on periodontics and 5 each on oral surgery and TMJ disorders. The subject of 35 reviews was treatment; of 11, prevention; and of 7, treatment with adverse events. Assessors found that 56 reviews addressed a clearly focused question, and 48 looked for studies appropriate to their question.