Methodological quality and implications for practice of systematic Cochrane reviews in pediatric oral health: a critical assessment.
BACKGROUND
To ensure evidence-based decision-making in pediatric oral health, Cochrane systematic reviews that address topics pertinent to this field are necessary. We aimed to identify all systematic reviews of paediatric dentistry and oral health by the Cochrane Oral Health Group (COHG), summarize their characteristics and assess their methodological quality. Our second objective was to assess implications for practice in the review conclusions and provide an overview of clinical implications about the usefulness of paediatric oral health interventions in practice.


METHODS
We conducted a methodological survey including all paediatric dentistry reviews from the COHG. We extracted data on characteristics of included reviews, then assessed the methodological quality using a validated 11-item quality assessment tool (AMSTAR). Finally, we coded each review to indicate whether its authors concluded that an intervention should be implemented in practice, was not supported or was refuted by the evidence, or should be used only in research (inconclusive evidence).


RESULTS
We selected 37 reviews; most concerned the prevention of caries. The methodological quality was high, except for the assessment of reporting bias. In 7 reviews (19%), the research showed that benefits outweighed harms; in 1, the experimental intervention was found ineffective; and in 29 (78%), evidence was insufficient to assess benefits and harms. In the 7 reviews, topical fluoride treatments (with toothpaste, gel or varnish) were found effective for permanent and deciduous teeth in children and adolescents, and sealants for occlusal tooth surfaces of permanent molars.


CONCLUSIONS
Cochrane reviews of paediatric dentistry were of high quality. They provided strong evidence that topical fluoride treatments and sealants are effective for children and adolescents and thus should be implemented in practice. However, a substantial number of reviews yielded inconclusive evidence.
Institut National de la Santé et de la Recherche Médicale, UMR S 872, Equipe 22, Centre de Recherche des Cordeliers, Paris, France. violaine.smail-faugeron@parisdescartes.fr.
Violaine
V
Smaïl-Faugeron
Hélène
H
Fron-Chabouis
Frédéric
F
Courson
D002327:Cariostatic Agents / Q000627:therapeutic use; D003731:Dental Caries / Q000517:prevention & control; D055094:Evidence-Based Dentistry / Q000592:standards*; D005460:Fluorides, Topical / Q000627:therapeutic use; D006801:Humans; D009909:Oral Health / Q000592:standards*; D010377:Pediatric Dentistry / Q000592:standards*; D010895:Pit and Fissure Sealants / Q000627:therapeutic use; D011786:Quality Control; D018570:Risk Assessment
D002327:Cariostatic Agents; D005460:Fluorides, Topical; D010895:Pit and Fissure Sealants