TOOLBOX
Questions and answers in Evidence-based Dentistry
volume 11
Derek Richards
Editor, Evidence-based Dentistry
As in previous years, we highlight here the guidelines, questions and answers
addressed by summaries in Evidence-based Dentistry.1–8
Evidence levels9 are only given for those papers that achieved level 3A and above.
Evidence-Based Dentistry (2010) 11, 119-122. doi:10.1038/sj.ebd.6400762
Clinical Recommendations
Topic Area Page
Oral Cancer Evidence-based clinical recommendations regarding screening for oral squamous cell carcinomas 101
Dental Evidence-based topics (DEBTs)
Topic area Question Answer Page
Restorative In adult patients requiring a two surface or There is no high quality evidence that supports or rejects 116
dentistry larger restoration on a posterior tooth, is a the practice of placing a crown or onlay on a vital posterior
crown or onlay a better option than a composite tooth rather than a composite or amalgam restoration to
or amalgam restoration for tooth survival? ensure longer tooth survival.
Commentaries
Topic Question Answer Evidence Page
level
Caries What is the relative effectiveness This review confirms the benefits of using fluoride toothpaste 1A 6-7
of fluoride toothpastes of different in preventing caries in children and adolescents compared with
concentrations in preventing dental placebo. However this is only statistically significant at fluoride
caries in children and adolescents? concentrations of 1000 ppm and use for children aged under 6
years should be balanced with the risk of fluorosis. The relative caries
preventive effects of fluoride toothpastes of different concentrations
increase with higher fluoride concentration.
In children using topical fluorides There should be a balanced consideration of the benefits of topical 1A 8-9
what is the risk of developing fluorides in caries prevention and the risk of the development of
fluorosis? fluorosis. There is weak unreliable evidence that starting the use of
fluoride toothpaste in children aged <12 months may be associated
with an increased risk of fluorosis. The evidence if use begins
between the age of 12 and 24 months is equivocal. If the risk of
fluorosis is of concern, the fluoride level of toothpaste for young
children (under 6 years of age) is recommended to be lower than
1000 parts per million (ppm).
Is sealant retention as good The results indicate that retention of sealants after a supervised 1a 79-80
following tooth surface cleaning toothbrush cleaning by the patient was at least as high as those
with a toothbrush compared with associated with a traditional handpiece prophylaxis. These findings may
handpiece prophylaxis? translate into lower costs for materials, equipment and personnel.
In children and adolescents is Chlorhexidine varnish does not appear to be effective for caries 1b 108
chlorhexidine varnish effective in prevention in children.
preventing caries?
Is daily high dose xylitol chewing This randomised clinical trial suggests that the use of high-dose 1b 109
gum more effective than non-xylitol xylitol chewing gum has beneficial effects on plaque pH and mutans
chewing gum at reducing plaque streptoccoci in children at high risk of caries.
acidogenicity and salivary mutans
streptoccoci?
Is enamel matrix derivative as Direct pulp capping has been shown to be a successful technique 1b 45-6
effective as calcium hydroxide where there is not carious exposure. Given the high treatment
for direct pulp capping of success rates of other techniques which are less invasive (indirect
primary molars? pulp cap, stepwise caries removal, partial caries removal or the Hall
Technique), the clinician may wish to consider these options for
asymptomatic primary molars with deep caries.
Which filling material should be used There was insufficient evidence from trials to make any 2b 4-5
for the treatment of caries in the recommendations about which filling material to use.
primary dentition?
www.nature.com/ebd 119
© 2010 Macmillan Publishers Limited. All rights reserved
Questions and answers in Evidence-based Dentistry
volume 11
Derek Richards
Editor, Evidence-based Dentistry
As in previous years, we highlight here the guidelines, questions and answers
addressed by summaries in Evidence-based Dentistry.1–8
Evidence levels9 are only given for those papers that achieved level 3A and above.
Evidence-Based Dentistry (2010) 11, 119-122. doi:10.1038/sj.ebd.6400762
Clinical Recommendations
Topic Area Page
Oral Cancer Evidence-based clinical recommendations regarding screening for oral squamous cell carcinomas 101
Dental Evidence-based topics (DEBTs)
Topic area Question Answer Page
Restorative In adult patients requiring a two surface or There is no high quality evidence that supports or rejects 116
dentistry larger restoration on a posterior tooth, is a the practice of placing a crown or onlay on a vital posterior
crown or onlay a better option than a composite tooth rather than a composite or amalgam restoration to
or amalgam restoration for tooth survival? ensure longer tooth survival.
Commentaries
Topic Question Answer Evidence Page
level
Caries What is the relative effectiveness This review confirms the benefits of using fluoride toothpaste 1A 6-7
of fluoride toothpastes of different in preventing caries in children and adolescents compared with
concentrations in preventing dental placebo. However this is only statistically significant at fluoride
caries in children and adolescents? concentrations of 1000 ppm and use for children aged under 6
years should be balanced with the risk of fluorosis. The relative caries
preventive effects of fluoride toothpastes of different concentrations
increase with higher fluoride concentration.
In children using topical fluorides There should be a balanced consideration of the benefits of topical 1A 8-9
what is the risk of developing fluorides in caries prevention and the risk of the development of
fluorosis? fluorosis. There is weak unreliable evidence that starting the use of
fluoride toothpaste in children aged <12 months may be associated
with an increased risk of fluorosis. The evidence if use begins
between the age of 12 and 24 months is equivocal. If the risk of
fluorosis is of concern, the fluoride level of toothpaste for young
children (under 6 years of age) is recommended to be lower than
1000 parts per million (ppm).
Is sealant retention as good The results indicate that retention of sealants after a supervised 1a 79-80
following tooth surface cleaning toothbrush cleaning by the patient was at least as high as those
with a toothbrush compared with associated with a traditional handpiece prophylaxis. These findings may
handpiece prophylaxis? translate into lower costs for materials, equipment and personnel.
In children and adolescents is Chlorhexidine varnish does not appear to be effective for caries 1b 108
chlorhexidine varnish effective in prevention in children.
preventing caries?
Is daily high dose xylitol chewing This randomised clinical trial suggests that the use of high-dose 1b 109
gum more effective than non-xylitol xylitol chewing gum has beneficial effects on plaque pH and mutans
chewing gum at reducing plaque streptoccoci in children at high risk of caries.
acidogenicity and salivary mutans
streptoccoci?
Is enamel matrix derivative as Direct pulp capping has been shown to be a successful technique 1b 45-6
effective as calcium hydroxide where there is not carious exposure. Given the high treatment
for direct pulp capping of success rates of other techniques which are less invasive (indirect
primary molars? pulp cap, stepwise caries removal, partial caries removal or the Hall
Technique), the clinician may wish to consider these options for
asymptomatic primary molars with deep caries.
Which filling material should be used There was insufficient evidence from trials to make any 2b 4-5
for the treatment of caries in the recommendations about which filling material to use.
primary dentition?
www.nature.com/ebd 119
© 2010 Macmillan Publishers Limited. All rights reserved
