| 1. |
- Ageberg, Eva, et al.
(författare)
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Cocreating injury prevention training for youth team handball : bridging theory and practice
- 2022
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Ingår i: BMJ Open Sport and Exercise Medicine. - London : BMJ Publishing Group Ltd. - 2055-7647. ; 8:2
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Tidskriftsartikel (refereegranskat)abstract
- Although it is advocated that end-users are engaged in developing evidence-based injury prevention training to enhance the implementation, this rarely happens. The € Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)' uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT project, the current study aimed to describe the development of holistic injury prevention training specifically for youth handball players through using knowledge from both end-users (coaches and players) and researchers/handball experts. Employing action evaluation within participatory action research, the cyclical development process included three phases: research team preparation, handball expert-based preparation and end-user evaluation to develop injury prevention training incorporating both physical and psychological perspectives. To grow the knowledge of the interdisciplinary research team, rethinking was conducted within and between phases based on participants' contributions. Researchers and end-users cocreated examples of handball-specific exercises, including injury prevention physical principles (movement technique for upper and lower extremities, respectively, and muscle strength) combined with psychological aspects (increase end-user motivation, task focus and body awareness) to integrate into warm-up and skills training within handball practice. A cyclical development process that engaged researchers/handball experts and end-users to cocreate evidence-based, theory-informed and context-specific injury prevention training specifically for youth handball players generated a first pilot version of exercises including physical principles combined with psychological aspects to be integrated within handball practice. © 2022 BMJ Publishing Group. All rights reserved. © 2022 BMJ Publishing Group. All rights reserved.
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| 2. |
- Astvaldsdottir, Alfheiour, et al.
(författare)
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Arginine and Caries Prevention : A Systematic Review
- 2016
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Ingår i: Caries Research. - : S. Karger. - 0008-6568 .- 1421-976X. ; 50:4, s. 383-393
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Forskningsöversikt (refereegranskat)abstract
- Objectives: To evaluate the available evidence that the use of arginine-containing dental care products prevents the development of new caries lesions and the progression of existing lesions. Search Methods: We performed a systematic literature search of databases including PubMed, the Cochrane Library and EMBASE. Selection Criteria: We selected randomized controlled trials of treatment with arginine in fluoride-containing dental products measuring dental caries incidence or progression in children, adults and elderly subjects. Data Collection and Analysis: Two review authors independently assessed trials for risk of bias and evaluated overall study quality using the GRADE classification. Main Results: Due to conflicts of interest and weak transferability to Swedish conditions, no conclusions can be drawn from studies on the effects of arginine-fluoride toothpaste in children. Arginine-containing toothpaste costs about 40% more than basic fluoride toothpaste; to determine whether it is more cost-effective, the higher cost must be considered in relation to any additional caries-preventive effect. The literature review also disclosed some questionable research ethics: in several of the studies, the children in the control group used non-fluoride toothpaste. Toothpaste without fluoride is not as effective against dental caries as the standard treatment - fluoride toothpaste - which has a well -documented effect. This contravenes the fundamental principles of research ethics. Conclusion: At present there is insufficient evidence in support of a caries-preventive effect for the inclusion of arginine in toothpastes. More rigorous studies, and studies which are less dependent on commercial interests, are required. (C) 2016 S. Karger AG, Basel
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| 3. |
- Astvaldsdottir, Alfheidur, et al.
(författare)
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Longevity of posterior resin composite restorations in adults : A systematic review
- 2015
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Ingår i: Journal of Dentistry. - : Elsevier BV. - 0300-5712 .- 1879-176X. ; 43:8, s. 934-954
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Forskningsöversikt (refereegranskat)abstract
- Objective: To conduct a systematic review of the literature on the longevity of posterior resin composite restorations in adults. Material and methods: A systematic literature search was conducted according to predetermined criteria for inclusion and exclusion. The studies selected were prospective clinical trials with a minimum follow-up time of 4 years, 40 restorations per experimental group and an annual attrition rate of less than 5%. Initially, abstracts and full-text articles were assessed independently and the assessment was subsequently agreed on by five reviewers. The methodological quality of the studies was assessed according to the Swedish Council on Health Technology Assessment (SBU) standard checklist for determining the extent to which studies meet basic quality criteria. Results: In all, the literature search identified 4275 abstracts and 93 articles were read in fulltext. There were eighteen studies which met the criteria for inclusion, eight of which were included in the analysis. There were 80 failures of restorations with a total follow-up time at risk for failure of 62,030 months. The overall incidence rate for all causes of failure was 1.55 lost restorations per 100 restoration years. The most common biological reason for failure (a total of 31 restorations) was secondary caries, with or without fracture of the restoration. The quality of the evidence was low. Conclusions: In an efficacy setting, the overall survival proportion of posterior resin composite restorations is high. The major reasons for failure are secondary caries and restoration fracture which supports the importance of adequate follow-up time. Clinical significance: The overall survival proportion of posterior composite restorations was high, but the results cannot be extrapolated to an effectiveness setting. The importance of adequate follow-up time is supported by the finding that secondary caries often occurred after 3 years or later.
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| 4. |
- Astvaldsdottir, A., et al.
(författare)
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Oral health and dental care of older persons-A systematic map of systematic reviews
- 2018
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Ingår i: Gerodontology. - : Wiley. - 0734-0664 .- 1741-2358. ; 35:4, s. 290-304
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Forskningsöversikt (refereegranskat)abstract
- Objectives: To examine the current knowledge on oral health status and dental care of older persons through a systematic mapping of systematic reviews of low or moderate risk of bias. Background: Geriatric dentistry covers all aspects of oral health and oral care of older persons. Oral health is part of general health and contributes to a person's physical, psychological and social wellbeing. Methods: A literature search was performed in three different databases (PubMed, The Cochrane Library and Cinahl) within 12 domains: Dental caries, periodontitis, Orofacial pain and temporomandibular joint (TMJ) pain, mucosal lesions, oral motor function, dry mouth, halitosis, interaction between oral status and other medical conditions, ability to interrelate and communicate, quality of life, ethics and organisation of dental care for older persons. Systematic reviews were identified and scrutinised, highlighting scientific knowledge and knowledge gaps. Results: We included 32 systematic reviews of which 14 were judged to be of low/moderate risk of bias. Most of the domains lack systematic reviews with low or moderate risk of bias. In two of the domains evidence was identified; in institutionalised people aged 65 or older, effective oral hygiene can prevent pneumonia. Furthermore, there is an evidence of a relationship between malnutrition (protein energy-related malnutrition, PEM) and poor appetite and edentulousness. Conclusions: There is an urgent need for further research and evidence-based knowledge within most domains in geriatric dentistry and in other fields related to oral health and dental care for older persons striving for multi-disciplinary research programmes.
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| 5. |
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| 6. |
- Axelsson, Susanna, et al.
(författare)
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Economic aspects of the detection of occlusal dentine caries.
- 2009
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Ingår i: Acta odontologica Scandinavica. - : Informa UK Limited. - 1502-3850 .- 0001-6357. ; 67:1, s. 38-43
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the cost of true-positive occlusal dentine caries detection in permanent molars assessed by: (I) visual-tactile examination, (II) visual-tactile examination combined with bitewing radiographs, and (III) selective radiographic examination of patients with lesions detected clinically. A second aim was to analyse the different strategies when the costs of the subsequent restorative care are considered. METHODS: A model analysis was applied owing to the lack of original articles. Sensitivity and specificity were calculated from a systematic review and included in vitro and in vivo studies of medium and high quality. The direct costs for examinations and restorative care were extracted from the costs of the Public Dental Service in Sweden (2006). RESULTS: The diagnostic costs per true-positive finding were dependent on the occurrence of occlusal caries and increased with decreasing prevalence. The strategy by which radiographs were exposed selectively on the basis of findings from visual-tactile examination resulted in higher initial costs compared with the first and second strategies. When the costs of the subsequent restorative care were added, the selective strategy was most beneficial by up to 26% savings per true-positive diagnosis. However, with this selective strategy, more cases of true-positive dentine caries were assumed would remain undetected as compared with the combined strategy with visual-tactile examination and radiographs for all. CONCLUSIONS: The cost for a true-positive caries diagnosis was inversely related to caries occurrence, and different diagnostic strategies may display contrasting outcomes when subsequent restorative care is taken into account.
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| 7. |
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| 8. |
- Bergenholtz, Gunnar, 1939, et al.
(författare)
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Treatment of pulps in teeth affected by deep caries - A systematic review of the literature.
- 2013
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Ingår i: Singapore dental journal. - : World Scientific Pub Co Pte Lt. - 0377-5291. ; 34:1, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: This systematic review assesses the effect of methods commonly used to manage the pulp in cases of deep caries lesions, and the extent the pulp chamber remains uninfected and does not cause pulpal or periapical inflammatory lesions and associated tooth-ache over time.STUDY DESIGN: An electronic literature search included the databases PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews from January 1950 to March 2013. In addition, hand searches were carried out. Two reviewers independently evaluated abstracts and full-text articles. An article was read in full if at least one of the two reviewers considered the abstract potentially relevant. Altogether, 161 articles were read in full text. Of these, 24 studies fulfilled established inclusion criteria. Based on studies of at least moderate quality, the quality of evidence of each procedure was rated in four levels according to GRADE.RESULTS: No study reached the high quality level. Twelve were of moderate quality. The overall evidence was insufficient to assess which of indirect pulp capping, stepwise excavation, direct excavation and pulp capping/partial pulpotomy, pulpotomy or pulpectomy is the most effective treatment approach for teeth with deep caries.CONCLUSIONS: Because of the lack of good studies it is not possible to determine whether an injured pulp by deep caries can be maintained or whether it should be removed and replaced with a root canal filling. Both randomized studies and prospective observational studies are needed to investigate whether a pulp exposed to deep caries is best treated by measures intended to preserve it or by pulpectomy and root filling.
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| 9. |
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| 10. |
- Bohm-Starke, Nina, et al.
(författare)
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Development of a core outcome set for treatment studies for provoked vestibulodynia.
- 2024
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Ingår i: Journal of Sexual Medicine. - : Oxford University Press. - 1743-6095 .- 1743-6109. ; 21:6, s. 556-565
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is an inconsistency in treatment outcomes used in clinical trials for provoked vestibulodynia (PVD), which makes it impossible to compare the effects of different interventions.AIM: In this study, we completed the first step in creating a core outcome set (COS), defining what outcomes should be measured in clinical trials for PVD.METHODS: Identification of outcomes used in studies was done by extracting data from clinical trials in a recently published systematic review and via review of clinical trials for PVD registered on ClinicalTrials.gov. The COS process consisted of 2 rounds of Delphi surveys and a consensus meeting, during which the final COS was decided through a modified nominal group technique.OUTCOMES: Consensus on what outcomes to include in a COS for PVD.RESULTS: Forty scientific articles and 92 study protocols were reviewed for outcomes. Of those, 36 articles and 25 protocols were eligible, resulting in 402 outcomes, which were then categorized into 63 unique outcomes. Participants consisted of patients, relatives/partners of patients, health care professionals, and researchers. Out of 463 who registered for participation, 319 and 213 responded to the first and second surveys, respectively. The consensus meeting consisted of 18 members and resulted in 6 outcomes for the COS to be measured in all treatment trials regardless of intervention: insertional pain (nonsexual), insertional pain (sexual), provoked vulvar pain by pressure/contact, pain-related interference on one's life, pain interference on sexual life, and sexual function.CLINICAL IMPLICATIONS: Critical outcomes to be measured in clinical trials will allow for accurate comparison of outcomes across treatment interventions and provide solid treatment recommendations.STRENGTHS AND LIMITATIONS: The major strengths of the study are the adherence to methodological recommendations and the intentional focus on aspects of diversity of participating stakeholders (eg, status such as patients with lived experience and researchers, inclusiveness with respect to sexual identity), the latter of which will allow for broader application and relevance of the COS. Among the limitations of the study are the low rate of participants outside North America and Europe and the lower response rate (about 50%) for the second Delphi survey.CONCLUSION: In this international project, patients, health care professionals, and researchers have decided what critical outcomes are to be used in future clinical trials for PVD. Before the COS can be fully implemented, there is also a need to decide on how and preferably when the outcomes should be measured.
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| 11. |
- Cederlund, Andreas, et al.
(författare)
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Caries treatment in Swedish adults : effectiveness, costs and equity. A 4-year follow-up study of data from the Swedish national dental health register
- 2016
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Ingår i: Swedish Dental Journal. - : Swedish Dental Association. - 0347-9994. ; 40:2, s. 223-234
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Tidskriftsartikel (refereegranskat)abstract
- Planering och styrning av tandvård på nationell nivå bör baseras på utvärderingar av jämlik fördelning, effektivitet och kostnader. Med inrättandet av tandhälsoregistret vid Socialstyrelsen öppnas möjligheter för studier av tandvårdens processer och resultat. Syftet med studien var att utifrån två identifierade kohorter longitudinellt följa och analysera frekvens och kostnader för ny fyllning eller tandkrona på tidigare restaurerad tand (omgörningar) samt relationen mellan förebyggande tandvårdsåtgärder i relation till reparativ och restaurativ tandvård orsakad av karies. Med hjälp av tandhälsoregistret studerades två kohorter omfattande den vuxna befolkningen. En longitudinell modell användes för uppföljning. I den första kohorten följdes 1 878 887 tänder hos 1 088 923 patienter mellan 42 och 48 månader. I den andra kohorten följdes 1 703 147 patienter under en period av mellan 48 och 54 månader. Fördelning av tandvård för olika åldersgrupper visade att kohorterna var representativa för hela patientgruppen. Fördelning av tandvårdsbesök varierade mellan 140 och 160 räknat per 1 000 invånare trots olika geografiska förutsättningar. Resultaten baserade på den första kohorten visar att 76% av tänderna inte fick någon ytterligare åtgärd med fyllning eller tandkrona under uppföljningsperioden, och att för resterande 24% av tänderna fick 77% endast en ny åtgärd. Det förelåg ingen könsskillnad, däremot skillnader på upp till tre intakta tänder mellan olika regioner. Resultat från den andra kohorten visade heller ingen könsskillnad. De genomsnittliga kostnaderna för reparativa åtgärder på grund av karies ökade gradvis i relation till ökade kostnader för förebyggande åtgärder. Vidare var kostnaderna för reparativa åtgärder lägre ju längre tid som följde mellan förebyggande åtgärder. Det nationella tandhälsoregistret utgör en värdefull källa för forskning om tandvård. Longitudinella registerdata för reparationer och preventiva åtgärder kan användas för att studera effektivitet, kostnader och jämlik fördelning av tandvård. Resultaten har en potential för förbättrad styrning av tandvården.
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| 12. |
- Chiang, Huei-Min, et al.
(författare)
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Caries as experienced by adult caries active patients : a qualitative study
- 2019
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Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 77:1, s. 15-21
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: In the western world, increased oral health has resulted in a skewed occurrence of caries disease where relatively few individuals now account for most caries disease. This study examines how adults with recurrent caries activity experience caries disease and treatment.MATERIALS AND METHODS: The study is based on qualitative data from individual interviews, which were subjected to qualitative content analysis. The interviews were semi-structured and thematic and an interview guide was used that consisted of two main areas with open ended questions. Meaning units were condensed and labelled with a code which preserved the core content of the reduced text. Codes were assigned to different subcategories according to their similarities or differences. Subcategories formed categories which describe the manifest content of the text.RESULTS: The domain "experience with caries" consisted of four subcategories that formed the main category Caries - an unwelcomed acquaintance. The domain "experience with caries treatment" consisted of three subcategories that formed the category Caries treatment - pain for gain.CONCLUSION: Comprehensive non-operative treatment and close follow-ups should precede restorations; this would probably gain insight in how to avoid new cavities to a greater extent. If to be supportive, information and advice about self-care given to individuals with recurrent cavities should be delivered with respect to the patient's feelings about their experience of dental caries.
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| 13. |
- Davidson, Thomas, et al.
(författare)
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Cost-effectiveness of caries preventive interventions : a systematic review
- 2021
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Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 79:4, s. 309-320
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: The primary purpose of this study was to assess the cost-effectiveness of caries preventive interventions.MATERIAL AND METHODS: A systematic review was conducted, following the PRISMA Statement. Four electronic databases were searched (final search 16 March 2020). Studies fulfilling the inclusion criteria were independently critically appraised, by two reviewers in parallel. Data from each included study were extracted and tabulated: the analysis used a narrative approach to present the results of the estimated cost-effectiveness.RESULTS AND CONCLUSIONS: Twenty-six publications fulfilled the inclusion criteria and were of low or moderate risk of bias. Ten publications were economic evaluations, directly based on empirical studies, and the other 16 were modelling studies. Most of the studies concerned interventions for children and the most common were analyses of fluoride varnish and risk-based programs. Some of the studies showed both reduced cost and improved outcomes, but most studies reported that the improved outcome came with an additional cost. The results disclosed several cost-effectiveness evaluations of caries preventive interventions in the literature, but these target primarily children at high risk. There is a scarcity of studies specifically targeting adults and especially the elderly.
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| 14. |
- Davidson, Thomas, et al.
(författare)
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Reimbursement systems influence prosthodontic treatment of adult patients
- 2015
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Ingår i: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 73:6, s. 414-420
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate the influence of reimbursement system and organizational structure on oral rehabilitation of adult patients with tooth loss. Materials and methods. Patient data were retrieved from the databases of the Swedish Social Insurance Agency. The data consisted of treatment records of patients aged 19 years and above claiming reimbursement for dental care from July 1, 2007 until June 30, 2009. Before July 1, 2008, a proportionately higher level of subsidy was available for dental care in patients 65 years and above, but thereafter the system was changed, so that the subsidy was the same, regardless of the patient's age. Prosthodontic treatment in patients 65 years and above was compared with that in younger patients before and after the change of the reimbursement system. Prosthodontic treatment carried out in the Public Dental Health Service and the private sector was also analyzed. Results. Data were retrieved for 722,842 adult patients, covering a total of 1,339,915 reimbursed treatment items. After the change of the reimbursement system, there was a decrease in the proportion of items in patients 65 years and above in relation to those under 65. Overall, there was a minimal change in the proportion of treatment items provided by the private sector compared to the public sector following the change of the reimbursement system. Conclusions. Irrespective of service provider, private or public, financial incentive such as the reimbursement system may influence the provision of prosthodontic treatment, in terms of volume of treatment.
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| 15. |
- Davidson, Thomas, et al.
(författare)
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Time to Assess Cost-Effectiveness of Technologies in Dentistry
- 2016
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Ingår i: International Journal of Dentistry and Oral Health. - : SciForschen. - 2378-7090. ; 2:5
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Health economic evaluations provide decision makers with important information regarding the cost-effectiveness of technologies. However, such evaluations are still rare in most dental areas, and there is furthermore a need for methodological development in estimating costeffectiveness within dentistry. The purpose of this paper is to give an overview of methods used for estimating cost-effectiveness, and provide guidance for performing health economic evaluations within dentistry.Methods: Available health economics methods are discussed and analysed according to their usefulness when assessing cost-effectiveness in dentistry.Results: All types of health economic analyses may be suitable for evaluation in dentistry. It is most important that the outcome should be relevant to the decision problem. For this reason, various clinical outcomes are often used, such as DMFT or mm adjustment, number of infections, construction survival, etc. depending on what technology is assessed. It would be of value to also use quality-adjusted life-years (QALYs) as this is the most commonly used outcome measure in health economic evaluation, but this has rarely been done.Conclusion: There is a need for more health economic evaluations within dentistry to be able to use scarce resources efficiently. In this paper we discuss methods for how this can be done, with a focus on the use of outcome measures relevant for decision makers.
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| 16. |
- Fahlström, Gunilla, et al.
(författare)
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Etiska aspekter på insatser inom det sociala området: En vägledning för att identifiera relevanta etiska frågor
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Dessa vägledande frågor är framtagna med syftet att utgöra ett stöd för att identifiera och reflektera kring etiska aspekter vid systematisk utvärdering av insatser inom det sociala området, dvs. socialtjänst och funktionshinderområdet. Syftet är att frågorna ska minska risken för att missa relevanta etiska aspekter avseende specifika insatser. Underlaget är tänkt att användas som ett av flera steg i arbetet med etiska aspekter i SBU:s rapporter.
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| 17. |
- Frisk, Fredrik, 1971, et al.
(författare)
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Pulp exposures in adults--choice of treatment among Swedish dentists.
- 2013
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Ingår i: Swedish dental journal. - : Sveriges tandläkarförbund. - 0347-9994. ; 37:3, s. 153-60
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Tidskriftsartikel (refereegranskat)abstract
- This study comprises a survey of Swedish dentists'treatment preferences in cases of carious exposure of the dental pulp in adults.The survey was conducted as part of a comprehensive report on methods of diagnosis and treatment in endodontics, published in 2010 by the Swedish Council on Health Technology Assessment. A questionnaire was mailed to a random subsample of 2012 dental offices where one dentist at each office was requested to answer all questions. Each questionnaire contained one of three sets of questions about endodontic practice routines.Thus around one-third of the subsample received case-specific questions about treating carious exposure. Only general practitioners aged below 70 years were included.The final study sample comprised 412 participants.The dentists were presented with two case scenarios. In Case 1 a 22-year old patient had a deep carious lesion in tooth 36 and in Case 2 a 50-year old patient had a deep carious lesion in tooth 14.The participants were asked to nominate their treatment of choice: pulp capping, partial pulpotomy or pulpectomy. For Case 1, 17 per cent of the respondents selected pulpectomy; the corresponding rate for Case 2 was 47 per cent. Female gender and age group 25-49 years were predictive of selection of less invasive treatment options. However, according to recent guidelines (2011) from the National Board of Health and Wellfare, Swedish dentists are recommended to elect pulpectomy prior to pulp capping/partial pulpotomy when confronted with a tooth having a cariously exposed pulp in adults.
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| 18. |
- Heintz, Emelie, et al.
(författare)
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FRAMEWORK FOR SYSTEMATIC IDENTIFICATION OF ETHICAL ASPECTS OF HEALTHCARE TECHNOLOGIES: THE SBU APPROACH
- 2015
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Ingår i: International Journal of Technology Assessment in Health Care. - : Cambridge University Press. - 0266-4623 .- 1471-6348. ; 31:3, s. 124-130
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Assessment of ethical aspects of a technology is an important component of health technology assessment (HTA). Nevertheless, how the implementation of ethical assessment in HTA is to be organized and adapted to specific regulatory and organizational settings remains unclear. The objective of this study is to present a framework for systematic identification of ethical aspects of health technologies. Furthermore, the process of developing and adapting the framework to a specific setting is described. Methods: The framework was developed based on an inventory of existing approaches to identification and assessment of ethical aspects in HTA. In addition, the framework was adapted to the Swedish legal and organizational healthcare context, to the role of the HTA agency and to the use of non-ethicists. The framework was reviewed by a group of ethicists working in the field as well as by a wider set of interested parties including industry, interest groups, and other potential users. Results: The framework consists of twelve items with sub-questions, short explanations, and a concluding overall summary. The items are organized into four different themes: the effects of the intervention on health, its compatibility with ethical norms, structural factors with ethical implications, and long term ethical consequences of using the intervention. Conclusions: In this study, a framework for identifying ethical aspects of health technologies is proposed. The general considerations and methodological approach to this venture will hopefully inspire and present important insights to organizations in other national contexts interested in making similar adaptations.
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| 19. |
- Hultcrantz, Monica, et al.
(författare)
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The GRADE Working Group clarifies the construct of certainty of evidence
- 2017
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Ingår i: Journal of Clinical Epidemiology. - : Pergamon Press. - 0895-4356 .- 1878-5921. ; 87, s. 4-13
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To clarify the grading of recommendations assessment, development and evaluation (GRADE) definition of certainty of evidence and suggest possible approaches to rating certainty of the evidence for systematic reviews, health technology assessments, and guidelines. Study Design and Setting: This work was carried out by a project group within the GRADE Working Group, through brainstorming and iterative refinement of ideas, using input from workshops, presentations, and discussions at GRADE Working Group meetings to produce this document, which constitutes official GRADE guidance. Results: Certainty of evidence is best considered as the certainty that a true effect lies on one side of a specified threshold or within a chosen range. We define possible approaches for choosing threshold or range. For guidelines, what we call a fully contextualized approach requires simultaneously considering all critical outcomes and their relative value. Less-contextualized approaches, more appropriate for systematic reviews and health technology assessments, include using specified ranges of magnitude of effect, for example, ranges of what we might consider no effect, trivial, small, moderate, or large effects. Conclusion: It is desirable for systematic review authors, guideline panelists, and health technology assessors to specify the threshold or ranges they are using when rating the certainty in evidence. (C) 2017 The Authors. Published by Elsevier Inc.
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| 20. |
- Hultin, M., et al.
(författare)
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Oral Rehabilitation of Tooth Loss: A Systematic Review of Quantitative Studies of OHRQoL
- 2012
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Ingår i: International Journal of Prosthodontics. - : Quintessence. - 0893-2174 .- 1139-9791. ; 25:6, s. 543-552
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study aimed to review published quantitative studies for evidence regarding the influence of oral rehabilitation following total or partial tooth loss on self-perceived oral health-related quality of life (OHRQoL). Materials and Methods: Three databases were searched using specified indexing terms. The reference lists of relevant publications were also searched manually. Quality of evidence was classified according to GRADE guidelines as high, moderate, low, or very low. Results: The search yielded 2,138 titles and abstracts, 2,102 of which were of a quantitative study design. Based on pre-established criteria, the full-text versions of 322 articles were obtained. After data extraction and interpretation, 5 publications of high or moderate study quality remained. The results of these 5 studies showed positive effects of oral rehabilitation on OHRQoL. Two studies showed substantial improvements. Conclusions: This is a relatively new field of research; there are very few quantitative studies of how patients perceive OHRQoL following tooth loss and subsequent rehabilitation. While this review indicates that treatment has positive effects on quality of life, the scientific basis is insufficient to support general conclusions about the influence of various interventions on the OHRQoL of patients who have experienced total or partial tooth loss. To achieve a more comprehensive analysis, it is recommended that future studies be based on a combination of quantitative and qualitative methods, ie, questionnaires and semi-structured interviews. The follow-up period must also be appropriate for the specific intervention studied.
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| 21. |
- Häggman Henrikson, Birgitta, et al.
(författare)
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Pharmacological treatment of oro-facial pain : health technology assessment including a systematic review with network meta-analysis
- 2017
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Ingår i: Journal of Oral Rehabilitation. - Hoboken : John Wiley & Sons. - 1365-2842 .- 0305-182X. ; 44:10, s. 800-826
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Forskningsöversikt (refereegranskat)abstract
- This health technology assessment evaluated the efficacy of pharmacological treatment in patients with oro-facial pain. Randomised controlled trials were included if they reported pharmacological treatment in patients >= 18 years with chronic (>= 3 months) oro-facial pain. Patients were divided into subgroups: TMD-muscle [ temporomandibular disorders (TMD) mainly associated with myalgia]; TMD-joint (TMD mainly associated with temporomandibular joint pain); and burning mouth syndrome (BMS). The primary outcome was pain intensity reduction after pharmacological treatment. The scientific quality of the evidence was rated according to GRADE. An electronic search in PubMed, Cochrane Library, and EMBASE from database inception to 1 March 2017 combined with a handsearch identified 1552 articles. After screening of abstracts, 178 articles were reviewed in full text and 57 studies met the inclusion criteria. After risk of bias assessment, 41 articles remained: 15 studies on 790 patients classified as TMD-joint, nine on 375 patients classified as TMD-muscle and 17 on 868 patients with BMS. Of these, eight studies on TMD-muscle, and five on BMS were included in separate network meta-analysis. The narrative synthesis suggests that NSAIDs as well as corticosteroid and hyaluronate injections are effective treatments for TMD-joint pain. The network meta-analysis showed that clonazepam and capsaicin reduced pain intensity in BMS, and the muscle relaxant cyclobenzaprine, for the TMD-muscle group. In conclusion, based on a limited number of studies, evidence provided with network meta-analysis showed that clonazepam and capsaicin are effective in treatment of BMS and that the muscle relaxant cyclobenzaprine has a positive treatment effect for TMD-muscle pain.
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| 22. |
- Jacobsen, Thomas, 1954, et al.
(författare)
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Application of laser technology for removal of caries: A systematic review of controlled clinical trials
- 2011
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Ingår i: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 69:2, s. 65-74
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Forskningsöversikt (refereegranskat)abstract
- Objective. To evaluate the scientific evidence regarding laser technology for removal of carious tissue. Material and methods. A search for literature on the effect of treatment and on economic aspects of laser technology identified 23 papers. No relevant studies on economic aspects were found. Regarding the effect of treatment, 16 papers were selected for assessment according to established criteria. Results. Cavity preparation and caries excavation by erbium laser were evaluated in three studies of medium quality. The time required to remove carious tissue was evaluated in five studies assessed as being of medium quality for this outcome. In four studies the effect of laser treatment on the dental pulp was included as an outcome but, due to the short follow-up time, the quality was assessed as low. Two studies that included the longevity of the restoration as an outcome were also assessed as being of low quality because the follow-up time was inadequate. Patient response was evaluated in three studies, which were assessed as being of medium quality with respect to this outcome. Conclusions. There is limited scientific evidence that laser treatment is as effective as a rotary bur for removing carious tissue. Treatment time is prolonged. There is limited scientific evidence that adults prefer laser treatment. No conclusions can be drawn regarding biological or technical complications, children's perception of laser treatment or the cost-effectiveness of the method. © 2011 Informa Healthcare.
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| 23. |
- Jacobson, Stella, et al.
(författare)
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Top Ten Research Priorities For attention Deficit/Hyperactivity Disorder Treatment
- 2016
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Ingår i: International Journal of Technology Assessment in Health Care. - : Cambridge University Press. - 0266-4623 .- 1471-6348. ; 32:3, s. 152-159
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this project was to identify the ten most important research questions for attention deficit/hyperactivity disorder (ADHD) treatment as identified by people with ADHD together with personnel involved in the treatment of ADHD in school, health, and correction services. Methods: A working group consisting of consumers and personnel was established. The method for prioritization was primarily based on James Lind Alliance's guidebook, consisting of an interim priority setting exercise and a workshop. Results: The top ten list includes the risk of drug dependency later in life when treated with methylphenidate as a child, teacher support, multimodal therapy, comparisons between atomoxetine and methylphenidate, methylphenidate treatment in substance abusers, parental support programmes, supported conversation, computer-aided working memory training, psychoeducative treatment, and melatonin. Conclusions: We have shown that consumers and personnel can reach consensus on research priorities for treatments for ADHD. We encourage researchers and funders to consider the list for future studies.
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| 24. |
- Johansson, Krister, et al.
(författare)
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Effects of Bacterial Contamination on Dental Implants During Surgery : A Systematic Review
- 2017
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Ingår i: Implant Dentistry. - : Lippincott Williams & Wilkins. - 1056-6163 .- 1538-2982. ; 26:5, s. 778-789
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Forskningsöversikt (refereegranskat)abstract
- INTRODUCTION: Contamination during surgery negatively influences the prognosis of orthopaedic implants; however, it has not been proven whether contamination influences the success of dental implant treatment. The aim of the systematic review was to investigate if there exists evidence in the literature whether contamination of dental implants during surgery affects osseointegration and clinical success. MATERIALS AND METHODS: Four data bases were used for the literature search. Primary studies and reviews regarding both clinical and preclinical research were eligible. Rating of the summarized quality of the evidence was performed. RESULTS: Five preclinical studies were included. Because of the estimated high risk of bias in all included studies and extensive differences in study design between the included studies, meta-analysis was not performed and no reliable aggregated data could be extracted. CONCLUSIONS: It is suggested that the scientific evidence with regard to the current topic is insufficient. Further controlled studies are warranted.
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| 25. |
- Johansson, Krister, et al.
(författare)
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Impact of direct oral anticoagulants on bleeding tendency and postoperative complications in oral surgery : a systematic review of controlled studies
- 2023
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Ingår i: Oral surgery, oral medicine, oral pathology and oral radiology. - : Elsevier. - 2212-4403 .- 2212-4411. ; 135:3, s. 333-346
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The recommendations for the management of direct oral anticoagulants (DOACs) in oral surgery are inconsistent. The present review evaluated whether DOACs increase the risk of bleeding during oral surgery and postoperative complications.STUDY DESIGN: The patients undergoing oral surgery and receiving a DOAC were compared with the patients receiving a DOAC different from the exposure, a vitamin K antagonist (VKA), or no anticoagulant. Three electronic databases were searched for eligible clinical trials and systematic reviews. The risk of bias was assessed, data were extracted, a meta-analysis was done, and the Grading of Recommendations, Assessment, Development and Evaluations certainty-of-evidence ratings were determined.RESULTS: Three clinical trials comparing patients receiving DOAC medication with patients on a VKA were eligible. A meta-analysis of bleeding 7 days postoperatively detected no significant differences between patients continuing DOAC or VKA medication during and after surgery. All of the point estimates favored uninterrupted DOAC over VKA therapy. Tranexamic acid was topically administered to some patients.CONCLUSIONS: Based on an interpreted trend among 3 studies with mixed patient populations, the risk of bleeding during the first 7 postoperative days may be lower for patients on uninterrupted DOAC than VKA therapy (⨁⨁⭘⭘), but the effect size of the risk is unclear. 80 of 274 included patients experienced postoperative bleeding.
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| 26. |
- Kirkinen, Tita, et al.
(författare)
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Accuracy of the Swedish quality registry for caries and periodontal diseases (SKaPa) – evaluation in 6- and 12-year-olds in the region of Värmland, Sweden
- 2023
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Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 81:8, s. 615-621
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Tidskriftsartikel (refereegranskat)abstract
- Objectives This study evaluates the agreement of data on dental caries between electronic dental records and data retrieved from the national SKaPa-registry (Swedish Quality Registry for caries and periodontal disease), with special reference to e/M in deft/DMFT.Methods In a random sample of 500 6- and 12-year-old children having received dental care in 2014 in the county region of Värmland, Sweden, the diagnostic accuracy of data in electronic dental records with corresponding data obtained from the SKaPa-registry was compared by using Cohen’s Kappa and Intraclass correlation coefficient (ICC).Results For dft/DFT the Kappa was 0.95, and ICC 0.98 (total population). For deft/DMFT in the total population the Kappa was 0.80 and ICC 0.96. For 6-year-olds (deft) the Kappa was 0.89 and ICC 0.99 and for 12-year-olds (DMFT) the Kappa was 0.70, and ICC 0.83. The corresponding figures for Kappa and ICC when excluding individuals without caries (deft/DMFT = 0) were: Total population 0.63 and 0.94; 6-year-olds 0.79 and 0.99; 12-year-olds 0.42 and 0.68.Conclusion Agreement between data in the dental records and SKaPa was very high for dft/DFT confirming that transfer from the dental records to the SKaPa-registry is safe and correct. As the accuracy of deft/DMFT was considerably lower than for dft/DFT we advise against using deft/DMFT data from SKaPa for research purposes at this point.
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| 27. |
- Kirkinen, Tita
(författare)
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Dental health and dental care in children in out-of-home care
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- More than 26,000 children and young people are placed in out-of-home care in Sweden every year. Several studies show that children placed in out of home care have poorer health during childhood and are generally in poorer physical condition later in life. The overall aim of this thesis was to study dental health and dental care in children in out-of-home care (OHC), through registry-based research. Paper I was a registry-based study of dental health care utilisation among young adults who as children had been placed in societal out-of-home care. These young adults had more emergency dental visits and more extractions and fewer regular scheduled dental check-ups than their peers who had never experienced OHC.Paper II was a systematic review/HTA to evaluate organisational models intended to ensure that children and young people in out-of-home care will receive health and dental care. We were unable to identify any study, of low or medium risk of bias, which examined the effects of organisational models on provision of health and dental care for children and young people in foster care and in institutions.Papers III and IV were validation studies of the Swedish Quality Registry for Caries and Periodontal Diseases (SKaPa), undertaken to determine the accuracy of the registry and whether it was appropriate for application in the next study (Paper V) and for other research purposes. For dft/DFT, the validation studies showed high agreement between the data in the patient records and the SKaPa registry. However, e/M in deft/DMFT was shown to be uncertain.Paper V was a registry-based study linking different registries, to investigate dental health and dental care in children in OHC. This study showed that children in OHC have more caries and undergo fewer dental health assessments than those who have never been placed in OHC. There was a difference in dental health examinations before and after the year 2017, with higher frequencies of assessments after the legislative amendment in 2017. However, differences remain.
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| 28. |
- Klingberg, Gunilla, et al.
(författare)
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How old are you? : a systematic review investigating the relationship between age and mandibular third molar maturity
- 2023
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 18:5, s. 1-14
-
Forskningsöversikt (refereegranskat)abstract
- Introduction and objective: Radiographic evaluation of the maturity of mandibular third molars is a common method used for age estimation of adolescents and young adults. The aim of this systematic review was to examine the scientific base for the relationship between a fully matured mandibular third molar based on Demirjian's method and chronological age, in order to assess whether an individual is above or below the age of 18 years.Methods: The literature search was conducted in six databases until February 2022 for studies reporting data evaluating the tooth maturity using Demirjian´s method (specifically stage H) within populations ranging from 8 to 30 years (chronological age). Two reviewers screened the titles and abstracts identified through the search strategy independently. All studies of potential relevance according to the inclusion criteria were obtained in full text, after which they were assessed for inclusion by two independent reviewers. Any disagreement was resolved by a discussion. Two reviewers independently evaluated the risk of bias using the assessment tool QUADAS-2 and extracted the data from the studies with low or moderate risk of bias. Logistic regression was used to estimate the relationship between chronological age and proportion of subjects with a fully matured mandibular third molar (Demirjian´s tooth stage H).Results: A total of 15 studies with low or moderate risk of bias were included in the review. The studies were conducted in 13 countries and the chronological age of the investigated participants ranged from 3 to 27 years and the number of participants ranged between 208 and 5,769. Ten of the studies presented the results as mean age per Demirjian´s tooth stage H, but only five studies showed the distribution of developmental stages according to validated age. The proportion of subjects with a mandibular tooth in Demirjian´s tooth stage H at 18 years ranged from 0% to 22% among males and 0 to 16% in females. Since the studies were too heterogenous to perform a meta-analysis or a meaningful narrative review, we decided to refrain from a GRADE assessment.Conclusion: The identified literature does not provide scientific evidence for the relationship between Demirjian´s stage H of a mandibular third molar and chronologic age in order to assess if an individual is under or above the age of 18 years.
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| 29. |
- Klinge, Anna, et al.
(författare)
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Prophylactic antibiotics for staged bone augmentation in implant dentistry
- 2020
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Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 78:1, s. 64-73
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Forskningsöversikt (refereegranskat)abstract
- Background: The objective of the study was to assess the effect of prophylactic antibiotics on the outcome of bone augmentation and subsequent dental implant placement by combining the recommended quality assessment methods for systematic reviews and primary studies.Materials and methods: This is a complex systematic review in which systematic reviews as well as primary studies are scrutinised. A search of Medline (OVID), The Cochrane Library (Wiley) and EMBASE, PubMed and Health technology assessment (HTA) organisations as-well as a complementary hand-search was carried out. Selected primary studies were assessed using GRADE. Each study was reviewed by three authors independently.Results: Abstract screening yielded six potential systematic reviews allocated for full-text inspection. A total of ten primary studies were read in full-text. No relevant systematic reviews regarding the topic of this article were found. The quality assessment resulted in two primary studies with a moderate risk of bias. Of the two studies with a moderate risk of bias, one compared a single dose of clindamycin 600 mg preoperatively with the same preoperative dose followed by four doses of 300 mg every 6 h. The second study compared a single dose prophylaxis of two different types of antibiotic compounds.Conclusion: In conclusion, the scientific evidence regarding the use of antibiotic prophylaxis for reducing the risk of infection in conjunction with bone augmentation procedures during dental implant placement is very limited. The infection rate as compared to nonusage of prophylactic antibiotics, selection of the most suitable compound, and the optimal duration of prophylactic treatment is still unknown.
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| 30. |
- Klinge, Anna, et al.
(författare)
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The risk for infraposition of dental implants and ankylosed teeth in the anterior maxilla related to craniofacial growth, a systematic review
- 2021
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Ingår i: Acta Odontologica Scandinavica. - : Taylor & Francis. - 0001-6357 .- 1502-3850. ; 79:1, s. 59-68
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Tidskriftsartikel (refereegranskat)abstract
- Background The aim of the study was to evaluate a potential association between individuals with different craniofacial types or other exposures, and the risk of infraposition due to continued growth/eruption of adjacent teeth in the anterior maxilla. Materials and methods This is a systematic review in which primary studies as well as other systematic reviews are scrutinised. A search of PubMed (Medline), Scopus, Web of science and Health technology assessment (HTA) organisations and a complementary handsearch was carried out. Selected studies were read in full-text by several reviewers. The quality of the included primary studies was assessed using a protocol for assessment of risk of bias in exposure studies. Results The literature search resulted in 3,296 publications. Title and abstract screening yielded 25, whereof one systematic review, potential publications allocated for full-text inspection. The quality assessment resulted in a total of seven studies with a low/moderate risk of bias and four studies with a high risk of bias. Conclusion In conclusion, a long-term risk for infraposition of dental implants, or ankylosed teeth, among natural teeth can be observed in some cases. The predisposing factors are still not fully understood since the current scientific evidence is very limited.
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| 31. |
- Liebe-Harkort, Carola, 1966-
(författare)
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Oral Disease and Health Patterns : Dental and Cranial Paleopathology of the Early Iron Age Population at Smörkullen in Alvastra, Sweden
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In skeletal remains of ancient populations, evidence of dental and craniofacial pathology is often well preserved in the form of lesions on the teeth or bones. Meticulous, detailed recording of these lesions provides baseline data on which a realistic assessment can be made of the probable impact of dental diseases and its sequelae on health of these earlier populations. In the present thesis, dental and cranial pathology were recorded in the remains of an Iron Age population, with special reference to the possible impact of such conditions on general health and well-being. The skeletal remains had been excavated early last century from the burial ground Smörkullen, Alvastra, Östergötland, in Eastern Central Sweden: osteological analyses showed that the material comprised the remains of 65 subadult individuals and 104 adult individuals of both sexes. The dental status of most of the adult individuals was poor. Calculus, periodontitis, moderate and severe carious lesions and periapical infections were recorded. In contrast, subadult showed less evidence of dental disease. The results indicate that the perception of health in adults was probably negatively affected by their poor oral status. The dental status of subadults, on the other hand, was unlikely to have had a negative impact on their general well-being. A sex difference was observed in the material, males tending to more ongoing disease than females. Overall, the frequencies of both dental and cranial pathologies increased with age. Caries frequency in the material was noticeable higher than in numerous other studies in Scandinavian populations. Although the high caries rates at Smörkullen may be attributable to a diet rich in carbohydrates, the result may to some extent have been influenced by observer experience. Caries rates in other populations are likely to be under-estimated in comparison with Smörkullen. However, methodological factors alone cannot not explain all the observed differences. The recording of cranial pathologies disclosed malnutrition and upper respiratory problems in all age groups in the Smörkullen material. This most certainly affected their well-being. In some cases the pathology observed was directly associated with life-threatening conditions. Analyses of combinations of pathologies suggest that a combination of linear enamel hypoplasias and cribra orbitalia, mainly observed in those who died before the age of fifteen, may have been related to a lower probability of survival.
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| 32. |
- Liebe-Harkort, Carola, 1966-, et al.
(författare)
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Quantification of Dental Caries by Osteologist and Odontologists - A Validity and Reliability Study.
- 2010
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Ingår i: International journal of osteoarchaeology. - : Wiley. - 1047-482X .- 1099-1212. ; 20:Sep, s. 525-539
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Tidskriftsartikel (refereegranskat)abstract
- As in modern populations, dental caries in early populations is linked to diet and general health. In order to record not only advanced disease states with frank cavitation of teeth but also early lesions, indicating the presence of the disease in a population, it is important that the archaeologist can correctly detect and classify lesions of varying severity. The present study compares and contrasts quantification of dental caries by osteologists and odontologists. Four osteologists and four odontologists undertook visual and radiographic inspection of 61 teeth from three different sources: medieval, 19th century and modern. Separate sets of criteria were applied to disclose observer confidence in detecting a lesion and in estimating lesion extent. For validation of visual assessments, the teeth were sectioned. Radiographic assessments were validated by a specialist in dental radiography. The results disclosed that the odontologists in general showed greater sensitivity than the osteologists, correctly identifying carious lesions, but the osteologists had higher specificity, correctly identifying healthy teeth. Thus, the osteologists tend to overlook carious lesions (under-diagnosis), while the odontologists tend to incorrectly record lesions in healthy teeth (over-diagnosis). For both osteologists and odontologists, correct assessment was poorer for radiographs than for visual inspection.
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| 33. |
- Liebe-Harkort, Carola, 1966-, et al.
(författare)
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Visual and Radiographic Assessment of Dental Caries by Osteologists: A Validity and Reliability Study.
- 2011
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Ingår i: International journal of osteoarchaeology. - : Wiley. - 1047-482X .- 1099-1212. ; 21:1, s. 55-65
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Tidskriftsartikel (refereegranskat)abstract
- In the skeletal remains of earlier populations, the presence and severity of dental caries preserves evidence about general health and diet. The quality of the data collected on dental caries is highly dependent on the diagnostic skills of the examining osteologist. A major barrier to more detailed data is reliance on visual inspection only. The present study compared quantification of carious lesions by osteologists, using both visual and radiographic inspection. Four osteologists with varying experience of caries diagnosis registered the presence and extent of dental caries on the crown and root surfaces of 61 teeth sourced from three different samples: Archaeological, Anthropological and Modern. The teeth were subsequently sectioned to provide a control or standard reference. The interobserver differences were calculated as sensitivity (observer correctness in identifying teeth with caries disease). The two observers with more experience of dental paleopathology showed higher agreement with the standard reference than the other two observers, i.e. they correctly diagnosed more carious lesions. The most pronounced interobserver difference was for radiographic inspection of root surfaces. The recordings by the two experienced observers conformed much more closely with the standard reference than those of the less experienced observers. The results confirm that experience has a major influence on practical observations in dental paleopathology. The quality of collected data on dental caries could be enhanced by improving osteologists’ knowledge of the disease process and the application of uniform, unambiguous criteria for registration of carious lesions.
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| 34. |
- Lund, Bodil, et al.
(författare)
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Complex systematic review : Perioperative antibiotics in conjunction with dental implant placement
- 2015
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Ingår i: Clinical Oral Implants Research. - : John Wiley & Sons. - 0905-7161 .- 1600-0501. ; 26:Suppl 11, s. 1-14
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to revisit the available scientific literature regarding perioperative antibiotics in conjunction with implant placement by combining the recommended methods for systematic reviews and complex systematic reviews. MATERIAL AND METHODS: A search of Medline (OVID), The Cochrane Library (Wiley), EMBASE, PubMed and Health technology assessment (HTA) organizations was performed, in addition to a complementary hand-search. Selected systematic reviews and primary studies were assessed using GRADE and AMSTAR, respectively. A meta-analysis was performed. RESULTS: The literature search identified 846 papers of which 10 primary studies and seven systematic reviews were included. Quality assessment of the systematic reviews revealed two studies of moderate risk of bias and five with high risk of bias. The two systematic reviews of moderate risk of bias stated divergent numbers needed to treat (NNT) to prevent one patient from implant failure. Four of the primary studies comparing antibiotic prophylaxis with placebo were estimated to be of low, or moderate, risk of bias and subjected to meta-analysis. The NNT was 50 (pooled RR 0.39, 95% CI 0.18, 0.84; P = 0.02). None of these four studies individually show a statistical significant benefit of antibiotic prophylaxis. Furthermore, narrative analysis of the studies eligible for meta-analysis reveals clinical heterogeneity regarding intervention and smoking. CONCLUSION: Antibiotic prophylaxis in conjunction with implant placement reduced the risk for implant loss by 2%. However, the sub-analysis of the primary studies suggests that there is no benefit of antibiotic prophylaxis in uncomplicated implant surgery in healthy patient.
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| 35. |
- Mejàre, Ingegerd A., et al.
(författare)
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A Systematic Map of Systematic Reviews in Pediatric Dentistry : What Do We Really Know?
- 2015
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:2
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To identify, appraise and summarize existing knowledge and knowledge gaps in practice-relevant questions in pediatric dentistry. Methods A systematic mapping of systematic reviews was undertaken for domains considered important in daily clinical practice. The literature search covered questions in the following domains: behavior management problems/dental anxiety; caries risk assessment and caries detection including radiographic technologies; prevention and non-operative treatment of caries in primary and young permanent teeth; operative treatment of caries in primary and young permanent teeth; prevention and treatment of periodontal disease; management of tooth developmental and mineralization disturbances; prevention and treatment of oral conditions in children with chronic diseases/developmental disturbances/obesity; diagnosis, prevention and treatment of dental erosion and tooth wear; treatment of traumatic injuries in primary and young permanent teeth and cost-effectiveness of these interventions. Abstracts and full text reviews were assessed independently by two reviewers and any differences were solved by consensus. AMSTAR was used to assess the risk of bias of each included systematic review. Reviews judged as having a low or moderate risk of bias were used to formulate existing knowledge and knowledge gaps. Results Out of 81 systematic reviews meeting the inclusion criteria, 38 were judged to have a low or moderate risk of bias. Half of them concerned caries prevention. The quality of evidence was high for a caries-preventive effect of daily use of fluoride toothpaste and moderate for fissure sealing with resin-based materials. For the rest the quality of evidence for the effects of interventions was low or very low. Conclusion There is an urgent need for primary clinical research of good quality in most clinically-relevant domains in pediatric dentistry.
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| 36. |
- Mejare, I. A., et al.
(författare)
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Diagnosis of the condition of the dental pulp: a systematic review
- 2012
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Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 45:7, s. 597-613
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Tidskriftsartikel (refereegranskat)abstract
- Mejare IA, Axelsson S, Davidson T, Frisk F, Hakeberg M, Kvist T, Norlund A, Petersson A, Portenier I, Sandberg H, Tran ae us S, Bergenholtz G. Diagnosis of the condition of the dental pulp: a systematic review. International Endodontic Journal, 45, 597613, 2012. Abstract The aim of this systematic review was to appraise the diagnostic accuracy of signs/symptoms and tests used to determine the condition of the pulp in teeth affected by deep caries, trauma or other types of injury. Radiographic methods were not included. The electronic literature search included the databases PubMed, EMBASE, The Cochrane Central Register of Controlled Trials and Cochrane Reviews from January 1950 to June 2011. The complete search strategy is given in an Appendix S1 (available online as Supporting Information). In addition, hand searches were made. Two reviewers independently assessed abstracts and full-text articles. An article was read in full text if at least one of the two reviewers considered an abstract to be potentially relevant. Altogether, 155 articles were read in full text. Of these, 18 studies fulfilled pre-specified inclusion criteria. The quality of included articles was assessed using the QUADAS tool. Based on studies of high or moderate quality, the quality of evidence of each diagnostic method/test was rated in four levels according to GRADE. No study reached high quality; two were of moderate quality. The overall evidence was insufficient to assess the value of toothache or abnormal reaction to heat/cold stimulation for determining the pulp condition. The same applies to methods for establishing pulp status, including electric or thermal pulp testing, or methods for measuring pulpal blood circulation. In general, there are major shortcomings in the design, conduct and reporting of studies in this domain of dental research.
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| 37. |
- Mejare, I. A., et al.
(författare)
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Estimates of sensitivity and specificity of electric pulp testing depend on pulp disease spectrum: a modelling study
- 2015
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Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 48:1, s. 74-78
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Tidskriftsartikel (refereegranskat)abstract
- Aim To demonstrate how the spectrum of diseased pulps may influence sensitivity and specificity in diagnostic studies on pulp status. Methodology An original sample from a previous study consisting of 59 teeth scheduled for root canal treatment was used where the relationship between the response to electric pulp testing and the visual status of the pulp was evaluated. To alter the spectrum of diseased pulps, a hypothetical sample of asymptomatic teeth with deep caries lesions was added to the original sample. Sensitivity and specificity were then compared for the two samples. Results In the original sample of 59 teeth, sensitivity was 72% and specificity 90%. When the spectrum of diseased pulps was altered, sensitivity decreased to 67% and specificity increased to 97%. The change in disease spectrum also decreased the prevalence of necrotic pulps. Conclusions The spectrum of diseased pulps included in a diagnostic study on the accuracy of electric pulp testing, and indirectly also disease prevalence (here pulp necrosis), influences estimates of sensitivity and specificity. This implies that estimates of diagnostic accuracy from one study with a particular tooth population spectrum may not apply to another tooth population with a different disease spectrum.
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| 38. |
- Mensah, Tita, et al.
(författare)
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Organisational models of health services for children and adolescents in out-of-home care : Health technology assessment
- 2020
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 109:2, s. 250-257
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Forskningsöversikt (refereegranskat)abstract
- Aim: Decades of research confirm that children and adolescents in out‐of‐home care (foster family, residential care) have much greater health care needs than their peers. A systematic literature review was conducted to evaluate organisational health care models for this vulnerable group.Methods: A systematic literature search was undertaken of the following data‐bases: Academic Search Elite, CENTRAL, Cochrane Database of Systematic Reviews, Cinahl, DARE, ERIC, HTA, PsycInfo, Psychology and Behavioural Sciences Collection, PubMed, SocIndex. Randomised and non‐randomised controlled trials were to be included. Two pairs of reviewers independently assessed abstracts of the identified published papers. Abstracts meeting the inclusion criteria were ordered in full text. Each article was reviewed independently, by pairs of reviewers. A joint assessment was made based on the inclusion criteria and relevance. Cases of disagreement were resolved by consensus discussion.Results: No study with low or medium risk of bias was identified.Conclusion: In the absence of studies of acceptable quality, it is not possible to assess the impact of organisational models intended to ensure adequate health and dental care for children and adolescents in out‐of‐home care. Therefore, well‐designed follow‐up studies should be conducted following the implementation of such models.
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| 39. |
- Mensah, Tita, et al.
(författare)
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Swedish quality registry for caries and periodontal diseases (SKaPa) : validation of data on dental caries in 6- and 12-year-old children
- 2021
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Ingår i: BMC Oral Health. - : BioMed Central. - 1472-6831. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe Swedish Quality Registry for caries and periodontal disease (SKaPa) automatically collects data on caries and periodontitis from patients’ electronic dental records. Provided the data entries are reliable and accurate, the registry has potential value as a data source for registry-based research. The aim of this study was to evaluate the reliability and accuracy of the SKaPa registry information on dental caries in 6- and 12-year-old children.MethodThis diagnostic accuracy study compared dental caries data registered at an examination with dental health status registered in the patient’s electronic dental records, and with corresponding data retrieved from the SKaPa registry. Clinical examinations of 170 6- and 12-year-old children were undertaken by one of the researchers in conjunction with the children’s regular annual dental examinations where the number of teeth were registered, and dental caries was diagnosed using ICDAS II. Teeth with fillings were defined as filled and were added to the ICDAS II score and subsequently dft/DFT was calculated for each individual. Cohen’s Kappa, the intraclass correlation coefficient (ICC), and sensitivity and specificity were calculated to test the agreement of the ‘decayed and filled teeth’ in deciduous and permanent teeth (dft/DFT) from the three sources.ResultsCohen’s Kappa of the dft/DFT-values was calculated to 0.79 between the researcher and the patient record, to 0.95 between patient dental record and SKaPa, and to 0.76 between the researcher and SKaPa. Intraclass correlation coefficient (ICC) was calculated to 0.96 between the researcher and the patient journal, to 0.99 between the patient dental record vs. SKaPa, and to 0.95 between the researcher and SKaPa.ConclusionThe SKaPa registry information demonstrated satisfactory reliability and accuracy on dental caries in 6- and 12-year-old children and is a reliable source for registry-based research.
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| 41. |
- Naimi-Akbar, Aron, et al.
(författare)
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Antibiotic prophylaxis in orthognathic surgery : A complex systematic review
- 2018
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 13:1
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Forskningsöversikt (refereegranskat)abstract
- Objective In orthognathic surgery, antibiotics are prescribed to reduce the risk of postoperative infection. However, there is lack of consensus over the appropriate drug, the dose and duration of administration. The aim of this complex systematic review was to assess the effect of antibiotics on postoperative infections in orthognathic surgery. Methods Both systematic reviews and primary studies were assessed. Medline (OVID), The Cochrane Library (Wiley) and EMBASE (embase.com), PubMed (non-indexed articles) and Health Technology Assessment (HTA) publications were searched. The primary studies were assessed using GRADE and the systematic reviews by AMSTAR. Results Screening of abstracts yielded 6 systematic reviews and 36 primary studies warranting full text scrutiny. In total, 14 primary studies were assessed for risk of bias. Assessment of the included systematic reviews identified two studies with a moderate risk of bias, due to inclusion in the meta-analyses of primary studies with a high risk of bias. Quality assessment of the primary studies disclosed one with a moderate risk of bias and one with a low risk. The former compared a single dose of antibiotic with 24 hour prophylaxis using the same antibiotic; the latter compared oral and intravenous administration of antibiotics. Given the limited number of acceptable studies, no statistical analysis was undertaken, as it was unlikely to contribute any relevant information. Conclusion With respect to antibiotic prophylaxis in orthognathic surgery, most of the studies to date have been poorly conducted and reported. Thus scientific uncertainty remains as to the preferred antibiotic and the optimal duration of administration.
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| 42. |
- Nordenram, G., et al.
(författare)
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Qualitative studies of patients' perceptions of loss of teeth, the edentulous state and prosthetic rehabilitation: A systematic review with meta-synthesis
- 2013
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Ingår i: Acta Odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 71:3-4, s. 937-951
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Forskningsöversikt (refereegranskat)abstract
- Objective. To conduct a systematic review and meta-synthesis of qualitative studies addressing patients' perceptions of loss of teeth, edentulism and oral rehabilitation. Background. Qualitative studies can complement quantitative studies by achieving deep understanding of patients' subjective experiences of losing teeth and coping with edentulism. They can also explore the perception that the benefits of prosthetic rehabilitation extend far beyond primary clinical treatment goals of restoration of oral function. Materials and methods. The major data bases were searched extensively for relevant qualitative and quantitative studies, followed by manual searching of the reference lists of included publications. Two authors independently read all abstracts. Relevant papers were retrieved in full-text and included or excluded according to a specially designed protocol. The included articles were then appraised and rated for quality: high, moderate or low. Articles of low quality were excluded. Results. The database search yielded 36 abstracts of qualitative studies; manual search disclosed one further article. All were read in full-text by two independent authors: 28 were excluded. Of the remaining nine, two (assessed as of low quality) were excluded for further analysis. Meta-synthesis, based on seven studies, disclosed two major themes: loss of quality-of-life associated with losing teeth and restored quality-of-life after oral rehabilitation. Conclusions. In this relatively new field of research, there are few published papers. Nevertheless, the studies to date show that loss of teeth is associated not only with compromised oral function, but also loss of social status and diminished self-esteem. Oral rehabilitation has broad positive implications, restoring quality of life and self-worth.
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| 43. |
- Petersson, Arne, et al.
(författare)
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Radiological diagnosis of periapical bone tissue lesions in endodontics: a systematic review
- 2012
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Ingår i: International Endodontic Journal. - : Wiley. - 0143-2885 .- 1365-2591. ; 45:9, s. 783-801
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Tidskriftsartikel (refereegranskat)abstract
- Petersson A, Axelsson S, Davidson T, Frisk F, Hakeberg M, Kvist T, Norlund A, Mejare I, Portenier I, Sandberg H, Tranaeus S, Bergenholtz G. Radiological diagnosis of periapical bone tissue lesions in endodontics: a systematic review. International Endodontic Journal, 45, 783801, 2012. Abstract This systematic review evaluates the diagnostic accuracy of radiographic methods employed to indicate presence/absence and changes over time of periapical bone lesions. Also investigated were the leads radiographic images may give about the nature of the process and the condition of the pulp in nonendodontically treated teeth. Electronic literature search included the databases PubMed, Embase and CENTRAL from January 1950 to June 2011. All languages were accepted provided there was an abstract in English. The MeSH terms were Cone beam computed tomography (CBCT), Radiography, panoramic, Periapical diseases, Dental pulp diseases, Sensitivity and specificity, receiver operating characteristics (ROC) curve, Cadaver, Endodontics and Radiography dental. Two reviewers independently assessed abstracts and full text articles. An article was read in full text if at least one of the two reviewers considered an abstract to be potentially relevant. Altogether, 181 articles were read in full text. The GRADE approach was used to assess the quality of evidence of each radiographic method based on studies of high or moderate quality. Twenty-six studies fulfilled criteria set for inclusion. None was of high quality; 11 were of moderate quality. There is insufficient evidence that the digital intraoral radiographic technique is diagnostically as accurate as the conventional film technique. The same applies to CBCT. No conclusions can be drawn regarding the accuracy of radiological examination in identifying various forms of periapical bone tissue changes or about the pulpal condition.
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| 44. |
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| 45. |
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| 47. |
- Tranæus, Sofia
(författare)
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Clinical application of QLF and DIAGNOdent : two new methods for quantification of dental caries
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- General aim: The general objective of this thesis was to evaluate the clinical performance of two new methods for quantification of dental caries - the Quantitative Light-induced Fluorescence method (QLF) and KaVo DIAGNOdent. Materials and methods: In Paper I, in vivo measurements with QLF on teeth scheduled for extraction, were compared with transverse microradiography (TMR), and tested for intra-operator reliability. In Paper II, the QLF method was applied to monitor active white spot lesions over a period of 6 months in a randomised, controlled study. In Paper IV, the QLF method was tested for intra- and inter-operator reliability in vivo for the capturing part as well as the image analysis part of the method. In Paper III, KaVo DIAGNOdent and QLF were validated with TMR and histology for mineral loss and lesion depth. In Paper V, DIAGNOdent readings of occlusal surfaces were compared with visual inspection, and bitewing radiography, before validation by assessment of lesion depth. In a second part of the study, DIAGNOdent was validated with QLF as reference standard for assessment of lesion depth on smooth OBS surfaces. Intra- and inter-operator reliability were tested in both parts of the study. Validation: In vitro, both QLF and DIAGNOdent showed good correlation with lesion depth on smooth surfaces, while the QLF method showed higher correlation with mineral loss. Sensitivity and specificity were excellent for QLF and good for DIAGNOdent. In vivo, DIAGNOdent showed low sensitivity for deep dentinal caries on occlusal surfaces when balanced to acceptable specificity. Validated with QLF as reference standard, DIAGNOdent readings of smooth surfaces showed a satisfactory correlation OBS on. Reliability tests on smooth surfaces showed excellent results for both the QLF method and DIAGNOdent in terms of inter- and intra-operator agreement. For occlusal surfaces, DIAGNOdent showed a very good intra-operator agreement, and a good inter-operator and inter-device agreement. Clinical application: In Paper M data obtained by the QLF method showed significant differences over time in the test group (PTR + fluoride varnish) as well as the control group (PTR) regarding lesion area and average change in fluorescence. There was also a significant intergroup difference regarding average change in fluorescence and a tendency towards intergroup difference for lesion area. Despite the fact that the QLF method consists of several steps, both the inter- and intra- operator reliability were excellent. Measurements with the DIAGNOdent (one-step system) are easier to perform, and for operator agreement the results for both methods were excellent. However, because of its closer correlation with mineral content, QLF is the preferred method for scientific purposes such as monitoring de- or remineralisation. Conclusions: 1) The Quantitative Light-induced Fluorescence method may be of value for longitudinal monitoring, e.g. for assessment of the effects of different caries preventive programmes and the method per se may further boost motivation and compliance by the subjects. 2) Under clinical conditions, the DIAGNOdent device showed excellent intra-operator agreement and good inter- operator agreement for measurements of carious lesions on smooth surfaces and good intra- and inter-operator agreement for lesions on occlusal surfaces. 3) With respect to clinical cut-off thresholds for dentinal caries on occlusal surfaces, no definite recommendations for DIAGNOdent could be made on the basis of data obtained in these studies.
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| 48. |
- Twetman, Svante, et al.
(författare)
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Adjunct methods for caries detection: A systematic review of literature.
- 2013
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Ingår i: Acta odontologica Scandinavica. - : Informa UK Limited. - 1502-3850 .- 0001-6357. ; 71:3-4, s. 388-397
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective. To assess the diagnostic accuracy of adjunct methods used to detect and quantify dental caries. Study design. A systematic literature search for relevant papers was conducted with pre-determined inclusion and exclusion criteria. Abstracts and full text articles were assessed independently by two reviewers. The study characteristics were compiled in tables and quality graded according to the QUADAS tool. The level of evidence for each diagnostic technology (fiber-optic methods, fluorescence methods, electrical methods) was based on studies of high or moderate quality according to the GRADE approach. Results. Twenty-five reports fulfilled the inclusion criteria. One study was of high quality, 10 were graded as moderate, while the remaining 14 reports were of low quality. Electrical methods (ECM) and laser fluorescence (DIAGNOdent) displayed sensitivities and specificities around 70-80% regarding occlusal dentin lesions with a mean Youden's index of 0.52-0.54. The mean accuracy of laser fluorescence for detecting enamel and dentin lesions was 0.68 and 0.91, respectively. The heterogeneity of the published reports hampered the analysis. Conclusions. There was insufficient scientific evidence for diagnostic accuracy regarding fiber-optic methods and quantitative light-induced fluorescence (+OOO). The electrical methods and laser fluorescence could be useful adjuncts to visual-tactile and radiographic examinations, especially on occlusal surfaces in permanent and primary molars, but evidence was graded as limited (++OO). No conclusions could be drawn regarding the cost-effectiveness of the methods. There is an obvious need to standardize study designs for in vitro and in vivo validation of the different methods.
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| 49. |
- Österberg, Marie, et al.
(författare)
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Knowledge Gaps in Oral and Maxillofacial Surgery : a Systematic Mapping
- 2017
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Ingår i: International Journal of Technology Assessment in Health Care. - : Cambridge University Press. - 0266-4623 .- 1471-6348. ; 33:1, s. 93-102
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Forskningsöversikt (refereegranskat)abstract
- Objectives: The aim of this study was to evaluate available knowledge and identify knowledge gaps within the field of oral and maxillofacial surgery, by systematically collecting and evaluating systematic reviews. Twelve specific domains were selected: surgical removal of teeth, antibiotic and corticosteroid prophylaxis, orofacial infections, dental and facial trauma, orthognathic surgery, reconstructive surgery, benign tumors, cysts, premalignant lesions, oral complications of treatment of malignant tumors, hyperbaric oxygen therapy, temporomandibular joint surgery, cost effectiveness of different surgical treatments, and ethics. Methods: The literature search, covering four databases, was conducted during September 2014: PubMed, The Cochrane library, Centre for Reviews and Dissemination and EBSCO dentistry and oral science source. Retrieved systematic reviews were quality assessed by AMSTAR. Results: In all, 1,778 abstracts were identified, of which 200 met the inclusion criteria. Forty-five systematic reviews were assessed as of high to moderate quality. The results disclosed some existing evidence in a few domains, such as surgical removal of teeth and implant survival after sinus lifts. However, in all domains, the search revealed a large number of knowledge gaps. Also of concern was the lack of data regarding health economics and ethics. Conclusions: In conclusion, there is a need for well-conducted clinical research in the fields of oral and maxillofacial surgery.
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