Mejàre Ingegerd A, Klingberg Gunilla, Mowafi Frida K, Stecksén-Blicks Christina, Twetman Svante H A, Tranæus Sofia H
Swedish Council on Health Technology Assessment, Stockholm, Sweden.
Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, Malmö, Sweden.
PLoS One. 2015 Feb 23;10(2):e0117537. doi: 10.1371/journal.pone.0117537. eCollection 2015.
To identify, appraise and summarize existing knowledge and knowledge gaps in practice-relevant questions in pediatric dentistry.
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.
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.
There is an urgent need for primary clinical research of good quality in most clinically-relevant domains in pediatric dentistry.
识别、评估和总结儿童牙科实践相关问题中的现有知识和知识空白。
对日常临床实践中被认为重要的领域进行系统评价的系统映射。文献检索涵盖以下领域的问题：行为管理问题/牙科焦虑；龋齿风险评估和龋齿检测，包括放射技术；乳牙和年轻恒牙龋齿的预防和非手术治疗；乳牙和年轻恒牙龋齿的手术治疗；牙周疾病的预防和治疗；牙齿发育和矿化障碍的管理；患有慢性病/发育障碍/肥胖症儿童口腔疾病的预防和治疗；牙侵蚀和牙齿磨损的诊断、预防和治疗；乳牙和年轻恒牙创伤性损伤的治疗以及这些干预措施的成本效益。两名评审员独立评估摘要和全文综述，任何分歧通过协商解决。使用AMSTAR评估每项纳入的系统评价的偏倚风险。被判定为低或中度偏倚风险的综述用于阐述现有知识和知识空白。
在81篇符合纳入标准的系统评价中，38篇被判定为低或中度偏倚风险。其中一半涉及龋齿预防。每日使用含氟牙膏预防龋齿的效果证据质量高，基于树脂材料的窝沟封闭证据质量中等。其余干预措施效果的证据质量低或非常低。
儿童牙科大多数临床相关领域迫切需要高质量的初级临床研究。
