Reynolds Ian, Duane Brett
Dublin Dental University Hospital, Dublin, Eire.
Evid Based Dent. 2018 Mar 23;19(1):14-15. doi: 10.1038/sj.ebd.6401287.
Data sourcesMedline, Embase, OpenGrey, Journal of Clinical Periodontology, Journal of Periodontology and a hand search of the bibliographies of retrieved publications.Study selectionTwo reviewers screened the title and abstract of 1134 studies from the literature and selected 37 suitable publications for inclusion following full text analysis of 109 papers and agreement between both reviewers. The search included observational, epidemiological studies and clinical trials that fufilled the inclusion criteria. The publications assessed contained a periodontal clinical examination and a validated OHRQoL questionnaire. There were no language restrictions and the review was performed according to the MOOSE statement.Data extraction and synthesisData were extracted from each study applying the PECO format. The quality of the observational studies was evaluated by the Newcastle Ottawa Scale (NOS) and clinical trials by the (MINORS) methodological index for non-randomised studies. The Strength of Grading Taxonomy (SORT) was utilised to assess the level of evidence and strength of recommendation of the included studies. A meta-analysis was not undertaken due the heterogeneity of the included studies, therefore results were synthesised by applying a vote counting method.ResultsThirty-seven studies included in the review were evaluated by the vote counting method. According to NOS and MINORS the risk of bias was identified as moderate with most studies assessing 50% to 83% of the parameters established. A level two for quality of evidence and a level B for strength of recommendation were applicable for the relationship between clinically diagnosed periodontal disease and OHRQoL. The evidence level was consistent across the studies. Nineteen of the studies examined a distinct population group with respect to diagnosis of systemic disease, socioeconomic status, demographic background or periodontal diagnosis. Twenty-eight of the included studies reported an association between periodontal diseases and OHRQoL while eight of the publications highlighted a dose-response relationship between and extent and severity of periodontal disease and the impact on OHRQoL.ConclusionsThe findings support the association between clinically diagnosed periodontal diseases and subjectively assessed OHRQoL with a dose-response relationship demonstrated. In summation, periodontal diseases play a significant role in oral health and impact on the QoL of affected individuals. In publications that undertook a full mouth recording the results were more evident, therefore a comprehensive periodontal exam in conjunction with a validated OHRQoL questionnaire is recommended.
数据来源
医学文献数据库(Medline)、荷兰医学文摘数据库(Embase)、OpenGrey、《临床牙周病学杂志》、《牙周病学杂志》以及对检索到的出版物的参考文献进行手工检索。
研究选择
两名评审员筛选了文献中1134项研究的标题和摘要,在对109篇论文进行全文分析并经两名评审员达成一致后,选定37篇合适的出版物纳入研究。检索包括符合纳入标准的观察性研究、流行病学研究和临床试验。所评估的出版物包含牙周临床检查和经过验证的口腔健康相关生活质量(OHRQoL)问卷。无语言限制,本综述按照MOOSE声明进行。
数据提取与综合
采用PECO格式从每项研究中提取数据。观察性研究的质量通过纽卡斯尔渥太华量表(NOS)进行评估,临床试验通过非随机研究的方法学指数(MINORS)进行评估。利用证据分级分类强度(SORT)来评估纳入研究的证据水平和推荐强度。由于纳入研究的异质性,未进行荟萃分析,因此通过应用投票计数法综合结果。
结果
通过投票计数法对纳入本综述的37项研究进行了评估。根据NOS和MINORS,偏倚风险被确定为中度,大多数研究评估了所确定参数的50%至83%。临床诊断的牙周病与OHRQoL之间关系的证据质量为二级,推荐强度为B级。各研究的证据水平一致。其中19项研究针对全身疾病诊断、社会经济状况、人口统计学背景或牙周诊断等方面对不同人群组进行了研究。纳入的28项研究报告了牙周病与OHRQoL之间的关联,而8篇出版物强调了牙周病的范围和严重程度与对OHRQoL的影响之间的剂量反应关系。
结论
研究结果支持临床诊断的牙周病与主观评估的OHRQoL之间的关联,并证明了剂量反应关系。总之,牙周病在口腔健康中起着重要作用,并影响受影响个体的生活质量。在进行全口记录的出版物中,结果更为明显,因此建议结合经过验证的OHRQoL问卷进行全面的牙周检查。