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April 2015

Dental evidence

As part of a wider piece of work I’ve been looking through the search logs and clickstream data associated with the dental specialty.  It’s interesting, and the following information is based on the 1,100+ registered users on Trip who have ticked the clinical specialty of dentistry. 

Top twenty search terms, most frequently used at the top

  • caries
  • gingivitis
  • periodontitis
  • dentistry
  • orthodontics
  • dental caries
  • dental implants
  • restorative dentistry
  • periodontal disease
  • oral cancer
  • Caries Risk Assessment
  • Medical errors
  • dental public health
  • fluoride
  • hypnosis
  • dental materials
  • endodontic outcome
  • pit and fissure sealants
  • pediatric dentistry
  • Patient Safety

And the top twenty articles are as follows:

  1. Pregnancy and gingival inflammation – Dental Elf
  2. Patients with Amalgam Restorations Are Not at a Significantly Greater Risk for Developing Health Complications Than Those With Composite Restorations – UTHSCSA Dental CATs
  3. The Use of Dental Crowns for Vital and Endodontically Treated Teeth: A Review of the Clinical and Cost-Effectiveness and Guidelines – CADTH
  4. Dental interventions to prevent caries in children – SIGN
  5. Dental Implants and Conventional Prosthetics: Comparative Clinical Effectiveness and Safety – CADTH
  6. Composite Resin and Amalgam Dental Filling Materials: A Review of Safety, Clinical Effectiveness and Cost-effectiveness – CADTH
  7. Conscious (Moderate) Sedation Can Be Used Safely On Patients With Obstructive Sleep Apnea – UTHSCSA Dental CATs
  8. Diagnosis and Treatment of Obstructive Sleep Apnea in Adults – AHRQ
  9. 12-Year Survival of Composite vs. Amalgam Restorations – J Dent Res.
  10. Methods of Diagnosis and Treatment in Endodontics – SBU
  11. A Randomized Clinical Trial Comparing At-Home and In-Office Tooth Whitening Techniques: A Nine-Month Follow-up – J Am Dent Assoc.
  12. Composite resin and amalgam dental filling materials: a review of safety, clinical effectiveness and cost-effectiveness – NHS CRD (HTA record of number 6 above!)
  13. Fluoride varnishes for preventing dental caries in children and adolescents – Cochrane
  14. Community Water Fluoridation in Canada ? Trends, Benefits, and Risks – National Collaborating Centre for Environmental Health
  15. Flossing for the management of periodontal diseases and dental caries in adults – Cochrane
  16. Interventions for replacing missing teeth: antibiotics at dental implant placement to prevent complications – Cochrane
  17. Oral Appliance Therapy and Continuous Positive Airway Pressure Demonstrate Similar Improvements in the Treatment of Mild/ Moderate Obstructive Sleep Apnea – UTHSCSA Dental CATs
  18. Cost-effectiveness of a long-term dental health education program for the prevention of early childhood caries – NHS EED
  19. Prosthetic rehabilitation of partially dentate or edentulous patients – SBU
  20. Primary clinical care manual (7th edition, 2011) – The State of Queensland (Queensland Health) and the Royal Flying Doctor Service (Queensland Section)

     

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Evidence Live, systematic reviews and the US Air Force

I’m just back from the wonderful Evidence Live.  While I was away I saw this news story Is the West losing its edge on defence? and I was particularly drawn to the following passage:

The military have also contributed to their own misfortunes by conspiring with defence contractors to build ever more expensive weapons that can only be afforded in much smaller numbers than those they are supposed to replace.

Pierre Sprey, chief designer on the F-16 fighter noted the ruinous consequences of buying stealth aircraft at hundreds of millions of dollars a copy.

“It’s a triumph of the black arts of selling an airplane that doesn’t work,” he said.

This fits in very nicely with my perspective on systematic review methods, and was one of the main threads in my presentation on the future of evidence synthesis.  The current methods of systematic review production are costing way too much for what they deliver.  If you consider that the majority of systematic reviews rely on published trials they are inherently unreliable.

In the EBM world we’re buying F-16s…!

More to follow on this theme.

UPDATE: The wonderful Anne Marie Cunningham has pointed out (see comments) has pointed out that the consequence is of buying the really expensive stealth fighters (not F16s).  That’s a consequence of rushing a blog post so soon after a vigorous conference!  The point remains – purchasing too expensive planes has caused massive problems. 

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