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CASE 1
a.
P – children, low socioeconomic status
I – glass ionomer cement
C – composite
O – caries development
T – therapy

Question: What is the effectiveness of using glass ionomer cement (GIC) as a filling material to prevent caries development in high- risk toddlers when compared to composite?

b.
P – children, low socioeconomic status
I – fluoride varnish
C – fluoride gel
O – caries
T – therapy

Question: What is the effectiveness of bi-annually applying fluoride varnish to prevent caries in children from communities with suboptimal water fluoridation when compared to fluoride gel?

c.
Question (a): Therapy

Studies: Randomised Control Trial (RCT) -> Cohort Study -> Case Control Study -> Case Series

Question (b): Therapy

Studies: Randomised Control Trial (RCT) -> Cohort Study -> Case Control Study -> Case Series

ABSTRACT 1
Type of Study: Case Control Study

Question: What is the effect of denture related sores, in conjunction with social factors, on the risk of oral cancer development in denture wearers?

P – denture wearers
E – denture-related sores

C – healthy denture wearers

O – development of oral cancer

ABSTRACT 2
Type of Study: Cohort Study

Question: Are people with periodontal disease at increased risk of developing non-communicable diseases?

P – patients with periodontal disease
E – periodontal disease
C – patients with healthy periodontal status
O – non-communicable disease

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A) Locate a systematic review to answer the therapy type question below:

In children (toddlers) with high caries risk, are glass ionomer fillings more effective than resin- based composite fillings in preventing secondary caries?

P- Children (toddlers)

I- glass ionomer fillings

C- resin-based composite fillings

O- secondary caries

Site Searched:
https://pubmed.ncbi.nlm.nih.gov

Search Technique Used:
BOOLEAN

Searched Questions:
1. (toddlers OR child*) AND caries AND ("glass ionomer filling" OR "composite") NOT sealant*

Filter(s): Systematic review

No Result

2. (Child* OR toddlers) AND ("Glass ionomer" OR Composite) AND ("Secondary caries") OR (“dental caries”)

Filter(s): Systematic review
Free Full Text

Article Found: Not Free
'Clinical preformance of glass ionomer cementnd composite resin in calss II restorations in primary teeth: A systematic review and meta-analysis'

https://pubmed.ncbi.nlm.nih.gov/29649506/

3. (toddler* OR child* OR pediatric) AND caries AND ("glass ionomer filling" OR "composite" OR "restorative material") NOT sealant*
Filter(s): Systematic Review
Free Full Text

Article Found: Free
'Is there a conventional material for restoring posterior primary teeth? A network meta-analysis'
https://pubmed.ncbi.nlm.nih.gov/29513886/

4. (toddler* OR child* OR pediatric) AND (caries OR "secondary caries" OR decay) AND ("glass ionomer" OR restoration OR filling) AND (composite OR restoration OR filling) NOT sealant*
Filter(s): Systematic Review
Free Full Text

Article Found: Free (Same as Above)
https://pubmed.ncbi.nlm.nih.gov/29513886/

Filter(s): Systematic Review
Free Full Text

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doi: 10.1590/1807-3107bor-2018.vol32.0010.

Affiliations

¹ Centro Universitário da Serra Gaúcha - FSG, School of Dentistry, Caxias do Sul, RS, Brazil.

² Universidade Federal de Santa Maria - UFSM, School of Dentistry, Graduate Program in Dental Science, Santa Maria, RS, Brazil.

³ Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Restorative Dentistry, Santa Maria, RS, Brazil.

⁴ Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Epidemiology Graduate Program, Porto Alegre, RS, Brazil.

⁵ Universidade Federal de Santa Maria - UFSM, School of Dentistry,, Santa Maria, RS, Brazil.

Free article

Free article

doi: 10.1590/1807-3107bor-2018.vol32.0010.

Affiliations

¹ Centro Universitário da Serra Gaúcha - FSG, School of Dentistry, Caxias do Sul, RS, Brazil.

² Universidade Federal de Santa Maria - UFSM, School of Dentistry, Graduate Program in Dental Science, Santa Maria, RS, Brazil.

³ Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Restorative Dentistry, Santa Maria, RS, Brazil.

⁴ Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Epidemiology Graduate Program, Porto Alegre, RS, Brazil.

⁵ Universidade Federal de Santa Maria - UFSM, School of Dentistry,, Santa Maria, RS, Brazil.

Abstract

This study aimed to compare the longevity of different conventional restorative materials placed in posterior primary teeth. This systematic review was conducted following the PRISMA statement and registered in PROSPERO (CRD42016035775). A comprehensive electronic search without date or language restrictions was performed in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, Turning Research Into Practice (TRIP) and Clinical Trials databases up to January 2017, selecting randomized clinical trials that assessed the longevity of at least two different conventional restorative materials performed in primary molars. Seventeen studies were included in this systematic review. Pairwise and network meta-analyses were performed and relative risks and 95% confidence intervals (CI) calculated. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Restorations of primary molars with conventional glass ionomer cement showed increased risk of failure than compomer, resin-modified glass ionomer cement, amalgam, and composite resin. Risk of bias was low in most studies (45.38% of all items across studies). Pediatric dentists should avoid conventional glass ionomer cement for restoring primary molars.

[Amalgam and alternatives-discussions on mercury reduction in the environment].

Frankenberger R, Winter J, Schmalz G. Frankenberger R, et al. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2021 Jul;64(7):847-855. doi: 10.1007/s00103-021-03355-4. Epub 2021 Jun 18. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2021. PMID: 34143251 Free PMC article. Review. German.

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national center for biotechnology information

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Is there a best conventional material for restoring posterior primary teeth? A network meta-analysis - PubMed

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This study aimed to compare the longevity of different conventional restorative materials placed in posterior primary teeth. This systematic review was conducted following the PRISMA statement and registered in PROSPERO (CRD42016035775). A comprehensive electronic search without date or language res ...

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B) Locate a randomized controlled trial to answer the therapy type question below:

What is the effectiveness of semi-annual fluoride varnish compared with semi-annual fluoride gel treatment in preventing dental caries in primary dentition among high risk children?

P- high risk children

I- fluoride varnish

C- fluoride gel

O- dental caries

Site(s) Searched:
https://pubmed.ncbi.nlm.nih.gov/
https://www.ncbi.nlm.nih.gov/

Search Technique(s):
BOOLEAN
MeSH

Search Questions:
1. (children* OR adolescent*) AND ("high caries risk" OR "caries risk") AND (cavities OR caries OR cavity) AND ("fluoride gel" OR "fluoride varnish") AND (“semi-annual” OR “biannual”) AND prevent*

Filter(s): Randomized Control Trial
Full Free Text

Article Found: Free
'Effect of 5%fluoride varnish application on caries among school children in rural Brazil: a randomized controlled trial'
https://pubmed.ncbi.nlm.nih.gov/22150341/

2. "caries risk"[All Fields] AND "fluoride varnish"[All Fields] AND "fluoride gel"[All Fields] AND ("child"[MeSH Terms] OR "child"[All Fields] OR "children"[All Fields])

Article Found: Free
'Fluoride gels for preventing dental caries in children and adolscents'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138249/

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By Dr Brown

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The article that is under the heading of 'Tutorial 2 (Part A)', was critically appraised utilizing the CEBM Tool.

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Critically Appraised - Systematic Review

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The article that is under the heading of 'RCT Study - B', was critically appraised utilizing the CEBM Tool.

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→ Based on the article, composite resists failure in posterior teeth better than conventional glass ionomer cement (GIC) but is on the same level as resin-modified glass ionomer cement (RMGIC). It can be inferred, however, that it may be different for anterior teeth as they would bear less load. Also, for caries prevention, GIC would be better because of its fluoride releasing property. RMGIC, specifically, would be best due to its increased strength compared to conventional GIC.

1. Our patient is a 2 year old boy (primary dentition) from low socioeconomic background, high caries risk, who needs anterior restorations.

Article refers to:

Primary dentition

Restorations for posterior teeth

Article does not refer to:

Socioeconomic background (high/low)

High caries risk

The difference is not that great therefore the results still can apply to our patient.

2. Yes, it (treatment - RMGIC/GIC) may be feasible if the patient can afford it or if offered for free at events such as outreaches. Otherwise, the patient may not be able to afford the treatment due to their socioeconomic background.

3. Potential benefits of GIC:

Fluoride release

Chemical bonding to enamel and dentin

Minimal removal of sound structure during tooth preparation

Biocompatible

Potential harms of GIC:

Low wear resistance

Low flexural strength,

High risk of failure; least effective in treating caries in posterior primary teeth

Potential benefits of resin-based composite:

Aesthetics

Better fracture and wear resistance

Chemical bonding to enamel and dentin

Tooth preparation with minimal removal of sound structure

Potential harms of resin-based composite:

No fluoride release [inferred]

Resin modified GIC: fluoride release, biocompatibility, physiochemical bonding to the tooth, favorable thermal expansion and contraction, better fracture and wear resistance than GIC

4. Despite the family’s socioeconomic background, it was evident that they wanted what’s best for their child as they followed through on referral in addressing the child’s current caries state. As parents seeking medical assistance, they expect that the dentist’s ability as a professional will offer applicable information regarding treatment and through informed decision, allow the parents to decide on the best treatment for their child based on the individuality of the case.

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1. Although our patient's age ( 2 years old) falls below the age range for the RCT study ( 4.8-7.6 years), primary dentition is a commonality between our patient and the children in the study. Therefore there is a 50/50 chance of our patient relating to the outcomes of the treatment.

2. The patient is from a low socioeconomic background and so may not be able to afford the treatment plans being tested in the study. However the patient may be able to receive these treatments if offered within his means or in certain situations such as an outreach.

3. The potential benefits of Fluoride and/or Chlorhexidine

Inhibits biofilm formation

Reduces the amount of Streptococcus mutans in the oral cavity

Prevention of caries

Remineralization of the enamel

The potential harms are:

Poisoning

Hypermineralization

Staining

Loss of Taste

Disease (Skeletal Fluorosis)

4.

Patient’s confidence, social and emotional intelligence may be adversely affected should treatment not be administered.

The patient should expect the prevention of new and recurring caries with the use of fluoride and/or Fluoride 1% CHX. The patient should not expect good overall results if good oral hygiene practices do not accompany this treatment.

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1. Yes
2. Yes
3. No
4. Yes
5. Yes
6. Not sure
7. N/A
8. N/A
9. No
10. N/A
11. N/A