Mohammad O Sharif

MOMENT -- Management of Otitis Media with Effusion in Cleft Palate: protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey

BackgroundCleft palate (CP) has an incidence of approximately 1 in 700. Children with CP are also susceptible to otitis media with effusion (OME), with approximately 90% experiencing nontrivial OME. There are several approaches to the management of OME in children with CP. The Management of Otitis Media with Effusion in Children with Cleft Palate (MOMENT) study is a feasibility study that includes the development of a core outcome set for use in future trials of the management of OME in children with CP.Methods/DesignThe MOMENT study will include a systematic review of the literature to identify a list of outcomes that have previously been reported. This list of outcomes will be used in a Delphi study with cleft clinicians. The Delphi study is anticipated to include three rounds. The first round will ask clinicians to score the outcome list and to add any outcomes they think are relevant. The second round involves presentation of scores according to stakeholder group and the opportunity for participants to rescore outcomes. To ensure that the opinion of parents and children are sought, qualitative interviews will be completed with a purposive sample in parallel. In the final round of the Delphi process, participants will be shown the distribution of scores, for each outcome, for all stakeholder groups separately as well as a summary of the results concerning outcomes from the qualitative interviews with parents. A final consensus meeting will be held with all stakeholders, including parents and children, to review outcomes.DiscussionA core outcome set represents the minimum that should be measured in a clinical trial for a particular condition. The MOMENT study will aim to identify a core outcome set that can be used in future trials of the management of OME, improving the consistency of research in this clinical area.

An AMSTAR assessment of the methodological quality of systematic reviews of oral healthcare interventions published in the Journal of Applied Oral Science (JAOS)

Background Systematic reviews are not an assembly of anecdotes but a distillation of current best available evidence on a particular topic and as such have an important role to play in evidence-based healthcare. A substantial proportion of these systematic reviews focus on interventions, and are able to provide clinicians with the opportunity to understand and translate the best available evidence on the effects of these healthcare interventions into clinical practice. The importance of systematic reviews in summarising and identifying the gaps in evidence which might inform new research initiatives is also widely acknowledged. Their potential impact on practice and research makes their methodological quality especially important as it may directly influence their utility for clinicians, patients and policy makers. The objectives of this study were to identify systematic reviews of oral healthcare interventions published in the Journal of Applied Oral Science (JAOS) and to evaluate their methodological quality using the evaluation tool, AMSTAR. Methods Potentially eligible systematic reviews in JAOS were identified through an electronic search of the Scientific Electronic Library Online (SciELO). Details of the relevant aspects of methodology as reported in these systematic reviews were extracted from the full text publications. Methodological quality was assessed independently by two reviewers using the AMSTAR questionnaire. Results Five systematic reviews were identified, one of which was subsequently excluded as it was a review of a diagnostic test. Summary AMSTAR scores for the four included reviews were: 1, 5, 2 and 4 out of a maximum score of 11 (range 1-5, mean 3) with only one of the reviews scoring 5. Conclusion AMSTAR evaluation of the methodological quality of the relatively small number of systematic reviews published in JAOS illustrated that there was room for improvement. Pre-publication and editorial appraisal of future systematic reviews might benefit from the application of tools such as AMSTAR and is to be recommended.

Contemporary dental practice in the UK in 2008: indirect restorations and fixed prosthodontics

Objectives To investigate, by postal questionnaire, various aspects of primary dental care provision in the United Kingdom. Additionally, to compare the results of this survey with a similar survey completed four years previously.Methods A questionnaire containing 89 questions was sent to 1,000 general dental practitioners selected at random from databases of practitioners throughout the United Kingdom. Non-responders were sent another questionnaire after a period of four weeks had elapsed.Results Overall a response rate of 66.2% was achieved. Amalgam was the preferred material for the core build up of vital teeth for 65% of the respondents. Dentine pins were still being used by practitioners, with stainless steel pins being preferred by 34% of respondents. 39.7% of dentists that had graduated between 0-10 years previously reported using no pins. Indirect posts were still used most widely, by 55% of the practitioners in the study, with increasing use of fibre posts noted (34%). Addition cured silicone impression materials were still the most frequently used impression material (71%) with reduced use (10%) of condensation cured silicone impression materials recorded. Glass ionomer luting cements (48%) and zinc phosphate (28%) were the most commonly used luting cements.Conclusions Within the limitations of this study, the following conclusions can be drawn: amalgam is still the preferred material for the core build-up of vital teeth; dentine pins are still used widely, but not by younger practitioners; fibre posts are being increasingly used by practitioners; addition cured silicone is still the most widely used impression material; traditional glass ionomer cements are still the most widely used luting cements; veneers are still the preferred indirect restoration for restoring anterior teeth; and CAD/CAM systems are increasingly being used by practitioners.

Effectiveness of arginine-containing toothpastes in treating dentine hypersensitivity: A systematic review

OBJECTIVES To evaluate by way of a systematic review the effectiveness of arginine-containing desensitising toothpastes in comparison to control agents in reducing dentine hypersensitivity. DATA SOURCES Electronic databases were searched including: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS (30/03/2012). Reference lists of eligible studies and systematic reviews were cross-checked in an attempt to identify additional studies. Strategies to identify grey literature were employed. STUDY SELECTION INCLUSION CRITERIA Controlled Clinical Trials (CCTs) and Randomised Controlled Trials (RCTs) comparing arginine-containing desensitising toothpastes to non-arginine-containing control toothpastes. Two review authors independently screened the titles and abstracts of studies identified. Data collection forms were completed for included studies. OUTCOMES Changes in sensitivity to tactile and air-blast stimuli. A subjective assessment of sensitivity was also sought. CONCLUSION Data identified indicates a potential role for arginine-containing toothpastes in managing dentine hypersensitivity. However, this conclusion is based on small sample sizes and the studies identified did not follow patients up in the medium to long term. The authors recommend that there is a need for well-designed RCTs to be conducted prior to any definitive recommendations being made. CLINICAL SIGNIFICANCE Dentine hypersensitivity is a common condition. Its multi-factorial aetiology has led to several treatment modalities being advocated. The continued introduction of new desensitising agents suggests that no product has yet proven ultimately successful. Arginine-containing toothpastes have recently been introduced, this article systematically reviews the evidence relating to their effectiveness.

A Clinical Study Comparing the Efficacy and Sensitivity of Home vs Combined Whitening

This randomized clinical study assessed efficacy in terms of color change and production of sensitivity after home whitening alone and home whitening supplemented with in-office bleaching. Thirty-six subjects (aged 19 to 58 years) were randomly assigned to one of three different treatment groups: (A) home whitening for two weeks, with 16% carbamide peroxide in custom-made trays; (B) home whitening for two weeks, with 16% carbamide peroxide in custom-made trays supplemented with in-office bleaching with 9% hydrogen peroxide (in the same trays); or (C) home whitening for two weeks, with 16% carbamide peroxide in custom-made trays supplemented with in-office bleaching with 27% hydrogen peroxide (in the same trays). The efficacy of tooth whitening was assessed by determining the color change associated with the six upper anterior teeth using a value-ordered shade guide. Sensitivity was self-assessed with the use of a visual analog scale (VAS). Tooth shade and sensitivity were assessed at the following points: pretreatment; immediately after the home whitening phase; immediately after the in-office phase (groups B and C); and one week post active treatment. At the one week follow-up visit, subjects in group A had a mean (SD) color change of 5.9 (1.83) (teeth were lighter) immediately after cessation of treatment (p<0.01). Subjects in groups B and C experienced a greater change in mean (SD) shade immediately following their respective in-office treatments of 5.1 (1.53) and 5.4 (1.55). However, within one week, the shade of these teeth regressed to a similar degree to that achieved by subjects treated in group A. Overall, no significant difference in shade change or sensitivity was produced between the three groups. Investigators concluded that the in-office element of combined whitening produced no significant difference in tooth color or sensitivity when compared with home whitening alone.

Evaluation of the basic erosive wear examination (BEWE) for use in general dental practice

Objective The basic erosive wear examination (BEWE) is a relatively new index proposed for the screening and recording of tooth wear in adults. The aim of this study was to test the validity and reliability of the BEWE.Design Cross sectional study of a sample of 164 adult patients.Setting General dental practice in East Lancashire, UK in 2010.Subjects Patients attending for routine examination or treatment.Main outcome measures By screening patients with the BEWE and comparing the results to the established tooth wear index (TWI) the sensitivity and specificity of the BEWE was established.Results The BEWE predicted moderate to severe wear (BEWE grade 3) with a sensitivity of 48.6% and a specificity of 96.1%, and predicted severe wear with a sensitivity of 90.9% and a specificity of 91.5% (also BEWE score 3). Inter- and intra-examiner reliability for the BEWE were both moderate (κw = 0.43 and 0.57 respectively).Conclusion(s) BEWE scores show a similar distribution to TWI scores and the examination is an effective screening test for severe tooth wear. The moderate levels of examiner reliability suggests the BEWE scores should be interpreted with some caution.

Estimating the need for dental sedation. 4. Using IOSN as a referral tool.

Objective In this article we report on the use of the IOSN as a referral tool in primary care and the need for sedation in the referred patient population (as determined by the IOSN score).Setting Four centres in the North West of England (primary care) accepting referrals for treatment with the aid of sedation participated in this study.Design A service evaluation.Subjects (materials) and methods The four were provided with IOSN referral forms, operator and patient questionnaires. The centres distributed IOSN forms to referrers as a means of recommending patients for sedation. All patients receiving treatment under sedation (having been referred for treatment through the IOSN form) were asked to complete the patient questionnaire. The individual operator who undertook the treatment under sedation was asked to complete the operator questionnaire. Data were entered into SPSS and the IOSN score noted. Statistical analyses of the data utilised descriptives and comparisons between groups using the Chi Squared test.Results Seventy-eight percent of the patients (n = 140) in this study were receiving treatment with sedation appropriately according to the principals of the IOSN. Patients deemed by the IOSN tool to have a low need for sedation were less likely to cancel their appointment if sedation had not been given. The majority of patients were female (70%) and the majority of operators and patients reported the IOSN forms acceptable for use.Conclusions This study provides support for using the IOSN as a tool for organising sedation referral. The majority of operators and patients reported the IOSN forms acceptable for use.

Repair or replacement of restorations: do we accept built in obsolescence or do we improve the evidence?

Introduction Controversy surrounds decisions on whether to repair or replace defective dental restorations. The concept of built-in obsolescence, ie periodic replacement of dental restorations, is largely accepted as the modus operandi if not the default mode in restorative care. In this article we examine the current best available evidence underpinning the effectiveness of replacement versus repair of direct amalgam and resin composite restorations.Method This article builds on two recent Cochrane systematic reviews which have reported on the evidence base supporting the effectiveness of replacement versus repair of amalgam and direct resin composites and translates the results of their research conclusions into recommendations for the dental clinician.Results As no relevant randomised controlled trials (RCTs) were identified in either of these systematic reviews, the evidence regarding the effectiveness of repair versus replacement of amalgam and composite restorations is weak and incomplete. The evidence as it currently stands seems to favour repair over replacement, but this is insufficient to make firm recommendations.Conclusion In view of the absence of high level evidence there is a need for further well designed RCTs. To add value to the evidence base these trials should be conducted in a general practice setting which will strengthen the generalisability and applicability of the research conclusions and enable dentists and patients to make informed decisions.

A clinical study comparing the efficacy of light activated in-surgery whitening versus in-surgery whitening without light activation.

OBJECTIVES This randomised controlled clinical trial assessed the efficacy of color change and sensitivity after in surgery whitening with and without light activation. METHODS Twenty two patients were randomly assigned to one of two different groups: Group A--in-surgery bleaching with light activated 25% hydrogen peroxide gel followed by 2 weeks at home, night time bleaching with 10% carbamide peroxide gel in a customised bleaching tray. Group B--in-surgery bleaching with 25% hydrogen peroxide without light activation followed by 2 weeks at home, night time bleaching with 10% carbamide peroxide gel in a customised bleaching tray. The efficacy of tooth whitening was assessed by determining the color change associated with the six maxillary anterior teeth. Sensitivity was self-assessed with the use of a visual analogue scale (VAS). RESULTS Overall, there was no significant difference in shade change between the two groups immediately after the in surgery whitening phase, and at one or two weeks post in surgery treatment. With regard to sensitivity immediately following the in surgery whitening participants in Group B reported a significantly higher level of sensitivity in comparison to Group A (p=0.03). CONCLUSIONS There was no significant difference between the shade improvements achieved by the two whitening protocols tested throughout the 2-week period of the study (p>0.05). There was no statistical significant difference in sensitivity at the one and two week review periods, however, immediately after treatment participants in Group B reported a significantly higher level of sensitivity than participants in Group A (p=0.03).

The perspectives of children and young people living with cleft lip and palate : a review of qualitative literature

Objective To explore the experiences of children and young people with cleft lip and/or palate (CL/P) in relation to being treated for and living with this condition. Design A systematic review of qualitative research. Electronic databases and hand-searching were employed to identify relevant studies. The review centered on studies examining the views or experiences of young patients first-hand. Any study using a qualitative/mixed method design was eligible for inclusion. Results From 184 potential references, 38 papers were read in full, from which only two studies of young people met all the reviews inclusion criteria. Common reasons for exclusion were not being a qualitative study, not focusing on CL/P, or data coming from parents only. A further two papers provided a retrospective account of childhood with CL/P from interviews with adults. Their suitability for the reviews aims was limited, but they were discussed. Conclusions This review demonstrates that there is a paucity of evidence about the experiences of young people living with CL/P. No studies of children and only two studies of young people met all inclusion criteria. Identified papers implied that more attention is needed within families and services to help young people manage everyday difficulties such as bullying and self-consciousness due to facial difference.