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Song Y, Ren L, Liu J, Zeng X, Chen Q, Dan H. The research status and progress of core outcome set in oral health. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:249-256. [PMID: 36528484 DOI: 10.1016/j.oooo.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
The core outcome set (COS) refers to the minimum set of outcomes that should be reported by all clinical trials in a particular health field. The use of COS in clinical studies can reduce the heterogeneity caused by using different outcomes across different clinical studies, facilitate the systematic review of different clinical studies on the same topic, reduce selective reporting bias, and increase the utility of clinical studies. The importance of COS in oral health has recently been recognized. This review summarizes the history, necessity, and key methodological points of COS development, with emphasis on the research status and existing problems in COS development, in the field of oral health.
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Affiliation(s)
- Yansong Song
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Ling Ren
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Jiaxin Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China; Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, China.
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
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Dental Policy Lab 2 - towards paying for health in dentistry. Br Dent J 2021; 231:759-763. [PMID: 34921273 PMCID: PMC8683368 DOI: 10.1038/s41415-021-3725-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/20/2021] [Indexed: 11/08/2022]
Abstract
The first Alliance for a Cavity-Free Future (ACFF)/King's College London Dental Policy Lab, held in 2017, identified the need for a review of dental payment systems in order to see progress towards achieving improvements in caries and cavities. The lack of incentivisation for preventive intervention and care has long been a barrier to progress. The second Dental Policy Lab, held in July 2018, focused on this issue with the overarching question: 'How can we create and implement acceptable prevention-based dental payment systems to achieve and maintain health outcomes?' Using a design approach and participatory research, 29 participants from five stakeholder categories developed a blueprint report that aims to serve as a framework to adapt or create remuneration systems that are compatible with evidence-based dentistry with a focus on preventive care. Aimed at policymakers and policy entrepreneurs, this blueprint provides guidance and potential solutions using several international examples. The report and accompanying infographic explored in this paper have been well received and have helped to frame discussions in several country settings, with a direct implementation which is being trialled in France in 2021.
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Wang Y, Qin D, Guo F, Levey C, Huang G, Ngan P, Hua F, He H. Outcomes used in trials regarding the prevention and treatment of orthodontically induced white spot lesions: A scoping review. Am J Orthod Dentofacial Orthop 2021; 160:659-670.e7. [PMID: 34366187 DOI: 10.1016/j.ajodo.2021.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The objective was to identify and summarize the outcomes and evaluation methods used in clinical trials regarding the prevention and treatment of orthodontically induced white spot lesions (WSLs). METHODS Three electronic databases were searched to identify studies that were (1) clinical trials on prevention and/or treatment of orthodontically induced WSLs, (2) reported in English, and (3) published between January 2010 and October 2019. At least 2 authors assessed the eligibility and extracted the characteristics, outcomes, and evaluation methods from included studies. All disagreements were resolved through discussion. RESULTS Among 1328 studies identified, 51 were eligible and included. A total of 48 different outcomes and 11 different evaluation methods were used in these studies. The most frequently used outcomes were WSLs clinical visual examination scores (n = 22, 43.1%), DIAGNOdent values (n = 14; 27.5%), fluorescence loss measured with quantitative light-induced fluorescence (QLF) (n = 10; 19.6%), and lesion area measured with QLF (n = 10; 19.6%). The most frequently used evaluation methods were clinical examination (n = 25; 49.0%), visual inspection by photographs (n = 15; 29.4%), DIAGNOdent (n = 14; 27.5%), and QLF (n = 10; 19.6%). None of the included studies reported data on quality of life. CONCLUSIONS Substantial outcome heterogeneity exists among studies regarding the prevention and treatment of orthodontically induced WSLs. Most of the identified outcomes are aimed to assess morphologic changes of WSLs and may not reflect patient perspectives. REGISTRATION The Core Outcome Set for trials on the prevention and treatment of enamel White Spot Lesions (COS-WSL) project was registered in the COMET Initiative database (No. 1399).
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Affiliation(s)
- Yunlei Wang
- Department of Orthodontics, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China
| | - Danchen Qin
- Department of Orthodontics, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China
| | - Feiyang Guo
- Department of Orthodontics, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China
| | - Colin Levey
- School of Dentistry, University of Dundee, Dundee, United Kingdom
| | - Greg Huang
- Department of Orthodontics, School of Dentistry, University of Washington, Seattle, Wash
| | - Peter Ngan
- Department of Orthodontics, West Virginia University, Morgantown, WVa
| | - Fang Hua
- Department of Orthodontics and Center for Evidence-Based Stomatology, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China; Division of Dentistry, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
| | - Hong He
- Department of Orthodontics, School and Hospital of Stomatology, Hubei-MOST KLOS & KLOBM, Wuhan University, Wuhan, China.
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Qin D, Wang Y, Levey C, Ngan P, He H, Hua F. Protocol for the development of a Core Outcome Set for trials on the prevention and treatment of Orthodontically induced enamel White Spot Lesions (COS-OWSL). Trials 2021; 22:507. [PMID: 34332635 PMCID: PMC8325281 DOI: 10.1186/s13063-021-05371-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enamel white spot lesions (WSLs), characterized by an opaque, matt, and chalky white appearance of enamel, are a sign of incipient caries. WSLs are common in orthodontic practice and can affect both the oral health and dental aesthetics of patients. Extensive studies have been conducted to evaluate the effectiveness of prevention or treatment for orthodontically induced enamel WSLs. However, substantial heterogeneity has been found in the outcomes used for the prevention and treatment of WSLs in literature, which prevents researchers from comparing and combining the results of different studies to draw more decisive conclusions. Therefore, we aim to develop a Core Outcome Set for trials on the prevention and treatment of Orthodontically induced enamel White Spot Lesions (COS-OWSL). METHODS The development of COS-OWSL comprises four phases: (1) a scoping review to identify and summarize all existing outcomes that have been used in trials on the prevention or treatment of orthodontically induced WSLs; (2) qualitative interviews with orthodontic patients without (for prevention) and with WSL-affected teeth (for treatment) and relevant dental professionals to identify additional outcomes relevant to them; (3) Delphi surveys to collect opinions from key stakeholders including patients, dental professionals, and researchers and to reach a preliminary consensus; and (4) a consensus meeting to develop the final COS-OWSL. DISCUSSION The COS-OWSL will be developed to facilitate the synthesis of evidence regarding the prevention and treatment of orthodontically induced WSLs and to promote the consistent use of relevant patient-important outcomes among future studies in this field. TRIAL REGISTRATION Core Outcome Measures in Effectiveness Trials (COMET) initiative (the COS-WSL project) 1399.
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Affiliation(s)
- Danchen Qin
- Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Luoyu Rd. 237, Wuhan, 430079, China
| | - Yunlei Wang
- Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Luoyu Rd. 237, Wuhan, 430079, China
| | - Colin Levey
- School of Dentistry, University of Dundee, Dundee, UK
| | - Peter Ngan
- Department of Orthodontics, West Virginia University, Morgantown, USA
| | - Hong He
- Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China. .,Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Luoyu Rd. 237, Wuhan, 430079, China.
| | - Fang Hua
- Department of Orthodontics, School & Hospital of Stomatology, Wuhan University, Luoyu Rd. 237, Wuhan, 430079, China. .,Centre for Evidence-Based Stomatology, School & Hospital of Stomatology, Wuhan University, Luoyu Rd. 237, Wuhan, 430079, China. .,Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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Lamont TJ, Clarkson JE, Ricketts DNJ, Heasman PA, Ramsay CR, Gillies K. Developing a core outcome set for periodontal trials. PLoS One 2021; 16:e0254123. [PMID: 34292965 PMCID: PMC8297801 DOI: 10.1371/journal.pone.0254123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is no agreement which outcomes should be measured when investigating interventions for periodontal diseases. It is difficult to compare or combine studies with different outcomes; resulting in research wastage and uncertainty for patients and healthcare professionals. OBJECTIVE Develop a core outcome set (COS) relevant to key stakeholders for use in effectiveness trials investigating prevention and management of periodontal diseases. METHODS Mixed method study involving literature review; online Delphi Study; and face-to-face consensus meeting. PARTICIPANTS Key stakeholders: patients, dentists, hygienist/therapists, periodontists, researchers. RESULTS The literature review identified 37 unique outcomes. Delphi round 1: 20 patients and 51 dental professional and researchers prioritised 25 and suggested an additional 11 outcomes. Delphi round 2: from the resulting 36 outcomes, 13 patients and 39 dental professionals and researchers prioritised 22 outcomes. A face-to-face consensus meeting was hosted in Dundee, Scotland by an independent chair. Eight patients and six dental professional and researchers participated. The final COS contains: Probing depths, Quality of life, Quantified levels of gingivitis, Quantified levels of plaque, Tooth loss. CONCLUSIONS Implementation of this COS will ensure the results of future effectiveness trials for periodontal diseases are more relevant to patients and dental professionals, reducing research wastage. This could reduce uncertainty for patients and dental professionals by ensuring the evidence used to inform their choices is meaningful to them. It could also strengthen the quality and certainty of the evidence about the relative effectiveness of interventions. REGISTRATION COMET Database: http://www.comet-initiative.org/studies/details/265?result=true.
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Affiliation(s)
- Thomas J. Lamont
- Dundee Dental School & Hospital, University of Dundee, Dundee, United Kingdom
| | - Jan E. Clarkson
- Dundee Dental School & Hospital, University of Dundee, Dundee, United Kingdom
| | | | - Peter A. Heasman
- Newcastle University School of Dental Sciences, Newcastle upon Tyne, United Kingdom
| | - Craig R. Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
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Rogers HJ, Freitas RD, Beeson MJ, Vernazza CR. Economic evaluations in paediatric dentistry clinical trials. Int J Paediatr Dent 2020; 31 Suppl 1:56-65. [PMID: 33469952 DOI: 10.1111/ipd.12772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/22/2022]
Abstract
Economic evaluations play an important role in identifying the cost-effectiveness of alternative healthcare programmes, informing decisions surrounding funding and the allocation of resources. This paper outlines the basic principles of economic evaluation and how it can be conducted alongside a clinical trial. Furthermore, it considers the ways in which evidence from these studies can be used, and the challenges researchers are faced with when conducting economic evaluations in the field of children's oral health.
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Affiliation(s)
| | - Raiza Dias Freitas
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Rogers HJ, Rodd HD, Vermaire JH, Stevens K, Knapp R, El Yousfi S, Marshman Z. A systematic review of the quality and scope of economic evaluations in child oral health research. BMC Oral Health 2019; 19:132. [PMID: 31262293 PMCID: PMC6604207 DOI: 10.1186/s12903-019-0825-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/19/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Economic evaluations provide policy makers with information to facilitate efficient resource allocation. To date, the quality and scope of economic evaluations in the field of child oral health has not been evaluated. Furthermore, whilst the involvement of children in research has been actively encouraged in recent years, the success of this movement in dental health economics has not yet been explored. This review aimed to determine the quality and scope of published economic evaluations applied to children's oral health and to consider the extent of children's involvement. METHODS The following databases were searched: CINAHL, Cochrane Library, Econlit, EThOS, MEDLINE, NHS EED, OpenGrey, Scopus, Web of Science. Full economic evaluations, relating to any aspect of child oral health, published after 1997 were included and appraised against the Drummond checklist and the Consolidated Health Economic Evaluation Reporting Standards by a team of four calibrated reviewers. Data were also extracted regarding children's involvement and the outcome measures used. RESULTS Two thousand seven hundred fifteen studies were identified, of which 46 met the inclusion criteria. The majority (n = 38, 82%) were cost-effectiveness studies, with most focusing on the prevention or management of dental caries (n = 42, 91%). One study quantified outcomes in Quality Adjusted Life Years (QALYs), and one study utilised a child-reported outcome measure. The mean percentage of applicable Drummond checklist criteria met by the studies in this review was 48% (median = 50%, range = 0-100%) with key methodological weaknesses noted in relation to discounting of costs and outcomes. The mean percentage of applicable CHEERS criteria met by each study was 77% (median = 83%, range = 33-100%), with limited reporting of conflicts of interest. Children's engagement was largely overlooked. CONCLUSIONS There is a paucity of high-quality economic evaluations in the field of child oral health. This deficiency could be addressed through the endorsement of standardised economic evaluation guidelines by dental journals. The development of a child-centred utility measure for use in paediatric oral health would enable researchers to quantify outcomes in terms of quality adjusted life years (QALYs) whilst promoting child-centred research.
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Affiliation(s)
- H J Rogers
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
| | - H D Rodd
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - J H Vermaire
- Division of Child Health, TNO Institute for Applied Sciences, Leiden, The Netherlands
| | - K Stevens
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - R Knapp
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - S El Yousfi
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Z Marshman
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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Alshihri AA, Rogers HJ, Alqahtani MA, Aldossary MS. Association between Dental Caries and Obesity in Children and Young People: A Narrative Review. Int J Dent 2019; 2019:9105759. [PMID: 31191654 PMCID: PMC6525928 DOI: 10.1155/2019/9105759] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/21/2019] [Accepted: 04/14/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To explore the association between obesity and dental caries in children and adolescents. Furthermore, to consider the possible reasons behind this relationship. METHODS A database search for papers published between January 2015 and May 2018, inclusive, addressing the association between obesity and dental caries was conducted. A review and critical appraisal of all included studies was performed. RESULTS Twenty-six studies were included in this review from different populations worldwide. Eight studies assessed the primary dentition, nine studies were conducted on permanent dentition, and remaining nine studies on both dentitions. The results regarding the association between obesity and dental caries were conflicting and inconsistent. Nine studies concluded that there was no relationship between obesity and dental caries. A positive association was reported in five studies, while the inverse association was reported in eleven studies. Studies included in this review had significant variations in methodology and the investigated cofactors. Possible explanations of the controversial association between obesity and dental caries are discussed in this review. CONCLUSION Both obesity and dental caries are multifactorial diseases, and their association is far more complex that can be explained by a single common risk factor, presenting evidence for the complexity of this association.
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Affiliation(s)
- Abdulmonem A. Alshihri
- Department of Prosthodontics and Biomaterials, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Helen J. Rogers
- Division of Pediatric Dentistry, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Mohammed A. Alqahtani
- Department of Prosthodontics and Biomaterials, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed S. Aldossary
- Division of Pediatric Dentistry, Department of Dentistry, Ministry of Health, Riyadh, Saudi Arabia
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The use of FDI criteria in clinical trials on direct dental restorations: A scoping review. J Dent 2018; 68:1-9. [DOI: 10.1016/j.jdent.2017.10.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/14/2017] [Accepted: 10/18/2017] [Indexed: 12/17/2022] Open
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Opdam N, Collares K, Hickel R, Bayne S, Loomans B, Cenci M, Lynch C, Correa M, Demarco F, Schwendicke F, Wilson N. Clinical studies in restorative dentistry: New directions and new demands. Dent Mater 2018; 34:1-12. [DOI: 10.1016/j.dental.2017.08.187] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
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Levey C, Innes N, Schwendicke F, Lamont T, Göstemeyer G. Outcomes in randomised controlled trials in prevention and management of carious lesions: a systematic review. Trials 2017; 18:515. [PMID: 29096680 PMCID: PMC5669005 DOI: 10.1186/s13063-017-2256-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 10/12/2017] [Indexed: 01/07/2023] Open
Abstract
Background Inconsistent outcome reporting is one significant hurdle to combining results from trials into systematic reviews. Core outcome sets (COS) can reduce this barrier. The aim of this review was to map outcomes reported in caries prevention and management randomised controlled trials (RCT) as a first step to COS development. We also investigated RCT characteristics and reporting of primary outcomes and sample size calculations. Methods PubMed, Embase, Web of Knowledge and Cochrane CENTRAL were systematically searched (1 January 1968 to 25 August 2015). Inclusion criteria: RCTs comparing any technique for prevention or management of caries with another or placebo and RCTs comparing interventions to support patients undergoing treatment of caries (without setting, dentition or age restrictions). Categories were developed through piloting and group consensus and outcomes grouped accordingly. Results Of 4773 search results, 764 were potentially relevant, full text was available for 731 papers and 605 publications met the inclusion criteria and were included. For all outcomes across the time periods 1968–1980 and 2001–2010, reporting of outcome ‘caries experience’ reduced from 39% to 18%; ‘clinical performance of the restoration’ reporting increased from 33% to 42% although there was a reduction to 22% in 2011–2015. Emerging outcome domains include ‘lesion activity’ and ‘pulp health-related outcomes’, accounting for 1% and 0%, respectively, during 1968–1980 and 10% and 4% for 2011–2015. Reporting ‘resource efficiency’ and ‘quality of life measures’ have remained at a low level. No publications reported tooth survival independent of an index such as DMFT or equivalent. Primary outcomes were only identified as such in 414 (68%) of the reports. Conclusions Over the past 50 years, outcome reporting for trials on prevention and management of carious lesions have tended to focus on outcomes measuring caries experience and restoration material clinical performance with lesion activity and cost-effectiveness increasingly being reported. Patient-reported and patient-focused outcomes are becoming more common (although as secondary outcomes) but remain low in use. The challenge with developing a COS will be balancing commonly previously reported outcomes against those more relevant for the future. Trial registration PROSPERO, CRD42015025310. Registered on 14 August 2015, Trials (Schwendicke et al., Trials 16:397, 2015) and COMET initiative online (COMET, 2017). Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2256-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Colin Levey
- School of Dentistry, University of Dundee, Park Place, Dundee, UK.
| | - Nicola Innes
- School of Dentistry, University of Dundee, Park Place, Dundee, UK
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin, Berlin, Germany
| | - Thomas Lamont
- School of Dentistry, University of Dundee, Park Place, Dundee, UK
| | - Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin, Berlin, Germany
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Schwendicke F, Opdam N. Clinical studies in restorative dentistry: Design, conduct, analysis. Dent Mater 2017; 34:29-39. [PMID: 28988780 DOI: 10.1016/j.dental.2017.09.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/28/2017] [Accepted: 09/15/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Clinical studies should be one main aspect underlying dentists' decision-making towards dental materials. Study design, conduct, analysis and reporting impact on the usefulness of studies. We discuss problems with current studies and highlight areas where improvement might be possible. METHODS Based on systematically and non-systematically collected data, we demonstrate where and why current studies in clinical dentistry deliver less-than-optimal results. Lending from general medicine, we suggest ways forward for clinical dental material science. RESULTS Randomized controlled (efficacy) trials remain a major pillar in dental material science, as they reduce selection bias and, if well-designed and conducted, have high internal validity. Given their costs and limited external validity, alternatives like practice-based or pragmatic controlled trials or observational studies can complement the evidence-base. Prior to conduct, researchers should focus on study comparators and setting (answering questions with relevance to clinical dentistry), and pay attention to statistical power, considering the study aim (superiority or non-inferiority trial), the expected event rate, and attrition. Study outcomes should be chosen on the basis of a core outcome set or, if not available, involving patients and other stakeholders. Studies should be registered a priori, and reporting should adhere to standards. Possible clustering should be accounted for during statistical analysis. SIGNIFICANCE Many clinical studies in dental material science are underpowered, and of limited validity and usefulness for daily decision-making. Dental researchers should mirror existing efforts in other medical fields in making clinical studies more valid and applicable, thus contributing to better dental care.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14199 Berlin, Germany.
| | - Niek Opdam
- Radboud University Medical Centre, College of Dental Sciences, P.O. Box 9101, NL 6500 HB Nijmegen, The Netherlands.
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Lamont TJ, Clarkson JE, Ricketts DNJ, Heasman PA, Ramsay CR. Core outcomes in periodontal trials: study protocol for core outcome set development. Trials 2017; 18:436. [PMID: 28931440 PMCID: PMC5607503 DOI: 10.1186/s13063-017-2169-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 09/01/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There are a large number of clinical outcome measures used to assess the effectiveness of prevention and management strategies of periodontal diseases. This heterogeneity causes difficulties when trying to synthesise data for systematic reviews or clinical guidelines, reducing their impact. Core outcome sets are an agreed, standardised list of outcomes that should be measured and reported in all trials in specific clinical areas. We aim to develop a core outcome set for effectiveness trials investigating the prevention and management of periodontal disease in primary or secondary care. METHODS To identify existing outcomes we screened the Cochrane systematic reviews and their included studies on the prevention and management of periodontal diseases. The core outcome set will be defined by consensus of key stakeholders using an online e-Delphi process and face-to-face meeting. Key stakeholders involved in the development will include: patients, dentists, hygienists/therapists, specialists, clinical researchers and policy-makers. Stakeholders will be asked to prioritise outcomes and feedback will be provided in the next round(s). Stakeholders will have an opportunity to add outcomes found in the Cochrane review screening process at the end of the first round. If consensus is not reached after the second round we will provide feedback prior to a third round. Remaining outcomes will be discussed at a face-to-face meeting and agreement will be measured via defined consensus rules of outcome inclusion. DISCUSSION The inclusive consensus process should provide a core outcome set that is relevant to all key stakeholders. We will actively disseminate our findings to help improve clinical trials, systematic reviews and clinical guidelines with the ultimate aim of improving the prevention and management of periodontal diseases. TRIAL REGISTRATION COMET ( http://www.comet-initiative.org/studies/details/265?result=true ). Registered on August 2012.
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Affiliation(s)
- Thomas J Lamont
- Dundee Dental School, Park Place, University of Dundee, Dundee, UK.
| | - Jan E Clarkson
- Dundee Dental School, Park Place, University of Dundee, Dundee, UK
| | | | - Peter A Heasman
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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14
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Schwendicke F, Innes N, Levey C, Lamont T, Göstemeyer G. Comparator choice in cariology trials limits conclusions on the comparative effectiveness of caries interventions. J Clin Epidemiol 2017; 89:209-217. [DOI: 10.1016/j.jclinepi.2017.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/09/2017] [Accepted: 05/29/2017] [Indexed: 11/25/2022]
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15
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Why we need a core outcome set for trials of interventions for prevention and management of caries. Evid Based Dent 2016; 16:66-8. [PMID: 26492796 DOI: 10.1038/sj.ebd.6401109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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16
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Are dental researchers asking patient-important questions? A scoping review. J Dent 2016; 49:9-13. [DOI: 10.1016/j.jdent.2016.04.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 04/05/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022] Open
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17
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Probiotics for managing caries and periodontitis: Systematic review and meta-analysis. J Dent 2016; 48:16-25. [DOI: 10.1016/j.jdent.2016.03.002] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/09/2016] [Accepted: 03/05/2016] [Indexed: 12/15/2022] Open
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