title: A systematic review of oral health outcomes produced by dental teams incorporating midlevel providers.
abstract: BACKGROUND
  The authors conducted a systematic review on this research question: “In populations where nondentists conduct diagnostic, treatment planning, and/or irreversible/ surgical dental procedures, is there a change in disease increment, untreated dental disease, and/or cost-effectiveness of dental care?”
  
  
  METHODS
  The authors searched 12 electronic databases for articles published through February 2012 and hand searched relevant articles. They assessed the risk of bias of included studies and extracted data.
  
  
  RESULTS
  The authors screened 7,701 citations, resulting in 18 observational studies that met the inclusion criteria. They judged 13 of the studies to be at high risk of bias, five at moderate risk and one at low risk. The authors found no data regarding cost effectiveness, irreversible diagnostic procedures or diseases other than caries.
  
  
  CONCLUSIONS
  The authors concluded that the quality of the evidence was poor. They found that in select groups in which participants received irreversible dental treatment from teams that included midlevel providers, caries increment, caries severity or both decreased across time; however, there was no difference in caries increment, caries severity or both compared with those in populations in which dentists provided all irreversible treatment. In select groups in which participants had received irreversible dental treatment from teams that included midlevel providers, there was a decrease in untreated caries across time and a decrease in untreated caries compared with that in populations in which dentists provided all treatment.
  
  
  CONCLUSIONS
  Generalizability of results to populations other than those studied is limited owing to the age of some of the studies, as well as to clinical and methodological heterogeneity; consequently, the conclusions should be viewed with caution.
authors.affiliation: Department of Pediatric Dentistry, School of Dentistry, The University of North Carolina, Chapel Hill, NC, USA.
authors.forename: J Timothy
authors.initials: JT
authors.lastname: Wright
authors.forename: Frank
authors.initials: F
authors.lastname: Graham
authors.forename: Catherine
authors.initials: C
authors.lastname: Hayes
authors.forename: Amid I
authors.initials: AI
authors.lastname: Ismail
authors.forename: Kirk W
authors.initials: KW
authors.lastname: Noraian
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weyant
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Tracy
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: Hanson
authors.forename: Julie
authors.initials: J
authors.lastname: Frantsve-Hawley
mesh_terms: D003362:Cost-Benefit Analysis; D004245:DMF Index; D003727:Dental Auxiliaries; D003729:Dental Care / Q000191:economics; D003731:Dental Caries / Q000191:economics; D003815:Dentists; D006801:Humans; D009909:Oral Health; D010348:Patient Care Team; D063868:Patient Outcome Assessment