ORAL HEALTH
A Closer Look at Diagnosis in Clinical Dental Practice
A four-part article, "A Closer Look at Diagnosis in Clinical Dental Practice," examines the role of science in diagnosis in the Journal of the Canadian Dental Association. Diagnosis may be the most important skill that a dentist has in determining treatment and should be a skill that is reimbursed. As dentistry moves to a medical model for treatment, appropriate diagnosis will be a critical issue for the future. The articles are available at the following Web sites: http://www.cda-adc.ca/jcda/vol-70/issue-4/251.pdf; http://www.cda-adc.ca/jcda/vol-70/issue-5/313.pdf; http://www.cda-adc.ca/jcda/vol-70/issue-6/388.html; and http://www.cda-adc.ca/jcda/vol-70/issue-7/470.pdf.
Key issues discussed are reliability, or the ability of the same or another dentist to produce the same results; validity, or the extent to which a criterion, its interpretation, and specific uses of a diagnostic procedure affect results; and sensitivity and specificity. Sensitivity is the percentage of people whom you correctly diagnose as having disease (100 percent of people with caries you correctly diagnose). Specificity of a diagnostic technique is the percentage of people who are correctly diagnosed with no decay (e.g., no caries for 100 percent of people diagnosed with no caries). Ideal diagnostic techniques are reliable, valid, and both sensitive and specific. With the second article addressing the role of operator standards against a gold standard, the third article looks at these measures with regard to diagnosis of caries by radiographic techniques; 60 percent false positive for diagnosis of occlusal caries with conventional radiograph (editor's note!), according to the authors' review. The fourth article examines other devices such as apex locators, vitality tests, and shade guide. The authors note that the dependability of the measurements from many diagnostic devices remains to be established.
Evidence-Based Review of Antimicrobials With Scaling Shows Positive Effects for Administration of
Local Agents
A recent evidence-based review for clinical guidelines from available dental literature was conducted by the Federal Agency for Health Research and Quality (AHRQ) on the use of antimicrobials along with scaling and root planing. Antibiotics and antimicrobials were separately analyzed, and separate analyses were conducted for systemically and locally delivered treatments, including irrigants, gels, ointments, microcapsules, and impregnated strips, chips, and fibers. (Effectiveness of Antimicrobial Adjuncts to Scaling and Root-Planing Therapy for Periodontitis: Evidence-Based Review of Antimicrobials at http://www.ahrq.gov/clinic/epcsums/periosum.htm.) The study concluded that locally applied tetracycline, minocycline, and chlorhexidine demonstrated statistically significant results in reducing periodontal depth in moderately large studies, with improvements ranging from 0.3 mm to 0.6 mm. Review of other locally delivered medicaments was inconclusive, except for hydrogen peroxide which showed promising results.
Are Evidence-Based Reviews in Dentistry Systematic and Transparent?
Evidence-based dentistry (EBD) is defined as "an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences," according to the American Dental Association (ada.org). However, recently, who does the EBD and how it is done has been examined by British colleagues (see the abstract on the following page). Bottom line: Read and evaluate for yourself how the EBD was done before changing how you practice. Dust off that book on methodology if necessary to examine the criteria used and whether it makes sense to you.
SOURCE: Richard D.; Centre for Evidence-Based Dentistry, Oxford, UK. The quality of systematic reviews in dentistry. Evidence Based Dent 2004; 5(1):17.
Data sources: Sources of reviews were the Database of Reviews of Effectiveness (DARE) and completed systematic reviews registered by the Cochrane Oral Health Group in the Cochrane Library.
Study selection: All systematic reviews that examined the effectiveness of interventions for oral, dental, and craniofacial disorders and diseases were eligible for inclusion.
Data extraction and synthesis: A quality assessment checklist was completed for each study.
Results: A total of 115 studies were identified, of which 65 were relevant to the review. The area most frequently evaluated within the reviews was pain relief or prevention (20 out of 65; i.e., 31 percent), followed by caries and oral medicine. The quality assessment of the systematic reviews identified highlighted key areas where improvements could be made. One major weakness was that the search strategies employed in reviews were not always adequate: Only 12 reviews (19 percent) demonstrated an attempt to identify all relevant studies. Other areas of weakness include the screening and quality assessment of primary studies, the pooling of data and examination of heterogeneity, and the interpretation of findings.
Conclusions: The quality of systematic reviews in dentistry could be improved. If future clinical decisions are to be based upon systematic reviews, it is imperative that reviews address clinically relevant, focused questions and follow a transparent, well-designed protocol.
Report Cites Child Dental Care Utilization
AHRQ has published a report on dental-care utilization and expenditures — "Dental Services: Use, Expenses, and Sources of Payment, 1996-2000," Research Findings #20, based on the Medical Expenditure Panel Survey. The report is available at http://www.healthinschools.org/2004/may27_alert.asp.
WOMEN'S HEALTH
Women and Health Insurance Coverage
Across the United States, two-thirds of women ages 18 to 64 have employer-sponsored health insurance plans, with 40 percent of these women with dependent coverage. While nearly 16 million women — or 18 percent of women ages 18 to 64 — have no health insurance, about 12 million low-income women, or 9 percent of women ages 18 to 64, use Medicaid for their health insurance. Additional details on health insurance coverage for women can be found in the fact sheet from the Kaiser Family Foundation, "Women's Health Insurance Coverage."
Lipsticks May Contain Alternative Vasodilators
New lip glosses contain products that are designed to increase lip fullness. They may also produce burning or swelling of the lips. Two products, Lip Venom from DuWop and City Lips from Sephora, plump lips from 1.17 ml to 3.17 ml. These contain a variety of ingredients including cinnamon, wintergreen, ginger, and jojoba. The manufacturer of one of these claims that the ingredients cause "blood to rush to the surface of the lips, flushing and swelling them." However, there is no word on how these products could interact with dental medicaments.
HEALTH AND YOUR PRACTICE
Lowering Cholesterol Levels for Needed Therapy
New recommendations for therapy for cholesterol levels were released in mid-July 2004. Endorsed by the American Heart Association and the American College of Cardiology, they set guidelines to provide statins to moderately high-risk patients when patients' low-density lipoproteins (L.D.L.) are more than 100. A risk calculator for heart disease is available at the National Heart, Lung and Blood Institute at http:hin.nhlbi.nih.gov/atpiii/calculator.asp? usertype=prof. For the article, go to the journal Circulation, Scott M. et al. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines 2004; 110:227-239, or online at http://circ.ahajournals.org/cgi/content/abstract/110/2/227.
KUDOS!
- to Dr. June Lee, who is outgoing general chairman of the Yankee Dental Congress.
- to the Web site http://www.ihs.ox.ac.uk/cebd/dentjournals.htm for an online repository of dental journals, including the British Dental Journal, Canadian Dental Journal, the Journal of Periodontology and Oral Surgery, Oral Medicine, Oral Pathology, and Oral Radiology.
— UPCOMING CONFERENCES —
AOS (American Orthodontic Society) — Oct. 21-24, 2004; Westin Riverwalk; San Antonio, Texas; www.orthodontics.com; (813) 264-6677
GNYDM (Greater New York Dental Meeting) — Nov. 26-Dec. 1, 2004; Jacob K. Javitz Center; New York, N.Y.; www.gnydm.com; (212) 398-6922
Yankee Dental Congress — Jan. 27-30, 2005; Hynes Convention Center; Boston, Mass.; www.yankeedental.com; (508) 480-9797
Chicago Midwinter Dental Meeting — Feb. 24-27, 2005; McCormick Plaza Lakeside Center; Chicago, Ill.; www.cds.org; (312) 836-7327
