Dental Tribune United Kingdom Edition

page 18DTà 17ClinicalApril 15-21, 2013United Kingdom Edition Celebrating 10 years of innovation smile-on healthcarelearning inspiring better care Friday 17th and Saturday 18th May 2013 Millennium Gloucester Hotel, London Kensington BOOK NOW for early booking discount cic@healthcare-learning.com 020 7400 8989 3 Speakers include: Nasser Barghi Irfan Ahmad Louis MacKenzie Ash Parmar Ian Buckle P laque control is the cor- nerstone for the pre- vention and control of periodontal disease and caries. However, although salivary flow has some limited potential in cleaning debris from interproxi- mal spaces and occlusal pits, it is less effective in removing and⁄ or washing out plaque, and nat- ural cleaning of the dentition by physiological forces – ie, move- ment of the tongue and cheeks – is virtually non-existent (Lindhe & Wicén, 1969). Therefore, to be controlled, plaque must be removed frequently by active methods, and evidence from large cohort studies has dem- onstrated that high standards of oral hygiene will ensure ef- fective plaque removal (Van der Weijden & Slot, 2011). There is substantial evidence showing that toothbrushing can control plaque, provided that clean- ing is sufficiently thorough and performed at appropriate in- tervals. The underlying factors influencing the effectiveness of toothbrushing include tooth- brush design, its mode of action, ease-of-use and patient compli- ance. Systematic reviews Evidence-based dentistry is an approach to oral health care that requires judicious integra- tion of systematic assessments of clinically relevant scientific evidence, with the dental pro- fessional’s clinical expertise and the patient’s treatment needs, preferences and the available tools. At present, systematic reviews are considered to pro- vide the highest level of evi- dence and to be the primary tool for summarising the existing evidence in a reproducible and systematic way. As such, they are crucial for evidence-based decision making. Systematic reviews differ from traditional reviews in that they are usually confined to a single focused question which serves as the basis for systemat- ic searches, selection and clini- cal evaluation of the relevant research. Systematic reviews minimise bias and provide a comprehensive and contempo- rary overview. Such analyses are objective in their appraisal of quality and transparent in their assessment of heterogene- ity, allowing others to appraise the methodology and quality of the review itself. By perform- ing a meta-analysis on suffi- ciently similar studies, a pooled average can be calculated, the range of results limited and the strength of the results increased. The Cochrane Handbook for Systematic Reviews (http:// www.cochrane.org/training/ cochrane-handbook) declares that reviews are needed to help ensure that healthcare deci- sions can be based on informed, high-quality, timely research evidence. In addition, the Amer- ican Dental Association (ADA) has launched a website called ‘Center for Evidence-Based Dentistry’ (http://ebd.ada.org/ SystematicReviews.aspx) that currently contains more than 1600 clinically relevant system- atic reviews. PICO(S)-question The protocol for a systematic review is developed beginning with a carefully formulated question using the ‘PICO(S)’ rule – patient, intervention, comparison, outcome and study design. The manner in which this question is formulated is The effectiveness of toothbrushing Fridus van der Weijden*, Dagmar Else Slot* *Academic Center for Dentistry Amsterdam, The Netherlands