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Dental hygiene and dental associations create policies for their memberships to follow. The Federation Dentaire Internationale, or FDI World Dental Federation, has adopted new policies that impact the practice of dental hygiene internationally. Five of the nine newest policies from September 2015 will be discussed in this special feature. The policies discussed address oral health for healthy aging, oral health and quality of life, dietary free sugars and dental caries, oral cancer, and supervision of allied dental personnel. The five policy statements are reviewed and compared to current actions and practices of the American Dental Hygienists' Association and International Federation of Dental Hygienists. Calling attention to the need for all oral health care professions to work collaboratively will serve the public and bring the best evidence forward for providing care. The goal of this article is to convey the urgency for true interprofessional efforts that involve all related organizations to direct policy for the public's optimal health and well-being.

Schlagwörter: allied dental, dental hygiene, dental supervision, policy

There has been an increase worldwide in microorganisms such as bacteria, viruses, fungi, and parasites changing in ways that make the medications we use ineffective in curing the diseases they cause. This increasing antimicrobial resistance (AMR) means that diseases once well controlled with medications can now spread more easily to others at alarming cost to individuals and society. Dentistry is responsible for approximately 10% of the antibiotics prescribed worldwide. The limited surveillance information available about dental prescribing practices gives considerable cause for concern that far too many prescriptions are written that are not consistent with current clinical practice guidelines. It is essential that members of the dental team act as antimicrobial stewards to help combat the rise of AMR. Guidelines are available to inform dental clinicians on how to provide high-quality care without contributing unnecessarily to AMR.

Schlagwörter: antibiotic resistance, antibiotic stewardship, antimicrobial resistance, antimicrobial stewardship, chlorhexidine, triclosan

The Trip Database (www.tripdatabase.com) is a leading evidence-based search engine used by a worldwide audience. The aim of this website is to help health professionals find answers to their clinical questions. This paper highlights the site's breadth of content and ease of use before sharing future developments.

Schlagwörter: question answering, search, Trip database

Quickly finding high-quality scientific studies is an important part of the evidence-based process. PubMed, which is a free gateway to journal literature for the health sciences, is a common platform used by dentists and dental hygienists for this purpose. This article highlights lesser-known features of PubMed that can greatly improve a clinician's ability to find high-quality evidence.

Schlagwörter: clinical queries introduction, literature searching, medical subject headings, PubMed, search filters

Background: This article critically appraises a systematic review that was commissioned by the National Institute of Health and Care Excellence (NICE) to evaluate the effectiveness of different approaches within dental practices for promoting oral health.
Clinical question: Is the promotion of oral health within a dental practice effective and how can its effects be optimized?
Summary of methods: A search of 20 online resources was conducted. Additionally, a call for evidence was issued and the researchers hand searched the references of three relevant systematic reviews. A total of 44 studies pulled from 52 papers were included.
Critical appraisal: Based on current research standards, this was a well-conducted systematic review. The AMSTAR measurement tool was used to assess the systematic review and indicated that all necessary qualities of a credible review were present.
Practical implications: There is strong evidence for the use of psychologic and behavioral models for effectively providing oral health messages for improvement of gingival and oral health. There is also strong evidence that patients' knowledge levels can be improved by receiving oral health education verbally, from a leaflet, and from written oral health education materials; however, of all these educational methods, there is no evidence that leaflets are effective in changing people's behavior. Moderate evidence was found that patients' motivation and satisfaction are dependent on the oral health professional's communication skills and ability to build relationships with their patients. There is also moderate evidence that a message sender or receiver's attitude and beliefs about oral health promotion can act as either a barrier to or a facilitator for the effectiveness of oral health education.

Background: Silver diamine fluoride (SDF) was cleared for use by the Food and Drug Administration (FDA) in August 2014 and became commercially available in April 2015. SDF can be used for treatment of dental caries and dentin hypersensitivity, similar to fluoride varnish. Just as fluoride varnish is used off-label to treat and prevent dental caries, the authors present evidence and guidelines for using SDF off-label for caries arrest and prevention.
Clinical question: What is the evidence for SDF as an agent for caries arrest and prevention? If the evidence is sufficient to recommend SDF use for caries arrest, what are appropriate clinical guidelines for that application?
Summary of methods: A subcommittee of the University of California, San Francisco School of Dentistry paradigm shift committee examined the evidence from the literature for various clinical indications for SDF and developed a protocol for its use.
Critical appraisal: The evidence presented is useful for understanding the mechanism of action of SDF, indications for its use, the clinical situations and populations for which it provides beneficial and costeffective treatment, and the proper technique for its application. Though the authors indicate that a systematic review of the literature was conducted, the article does not provide a grading of the evidence for the nine randomized clinical trials that were retrieved.
Practical implications: There appears to be good evidence for the use of SDF for caries arrest and prevention. SDF will be especially useful for difficult-to-treat carious lesions and vulnerable populations who cannot tolerate treatment or who lack access to care.

Background: This article is a critical appraisal of a study done in 2016 that examined whether exposure to dental amalgam during pregnancy affected birth outcomes.
Clinical question: Does exposure to amalgam restorations during pregnancy affect birth outcomes?
Methods and results: This study is a prospective cohort study of 69,474 pregnancies and subsequent birth outcomes. Two questionnaires were sent out to pregnant Norwegian women at 17 and 30 weeks of pregnancy in order to determine exposure to dental amalgam. The data was then linked to the Medical Birth Registry of Norway, which records all pregnancy outcomes in the country. Logistic regression was performed to determine whether a mother's exposure to amalgam during pregnancy affected birth outcomes. The logistic regression revealed that the pregnancy outcomes early preterm delivery, late preterm delivery, low birth weight, malformation, and stillbirth were unrelated to the number of teeth with amalgam restorations during pregnancy. The authors found no evidence that exposure to dental amalgam during pregnancy is associated with serious perinatal outcomes after adjusting for confounding variables. This study was well planned and well implemented, and the findings are consistent with the findings of other large-scale studies done by independent groups.
Clinical implications: There is no evidence to suggest that the presence or placement of dental amalgam restorations during pregnancy will adversely affect birth outcomes. Practitioners should present this evidence to those patients who are thinking of delaying dental treatment until after pregnancy out of concerns regarding prenatal effects of amalgam.

Background: Oral squamous cell carcinoma (OSCC) is the most common form of oral cancer. The gold standard for diagnosing OSCC is the use of scalpel biopsy with histologic assessment, but there are many adjunctive tests for diagnosing OSCC that are less invasive. So, the authors conducted a systematic review to determine whether adjunctive oral cancer tests have a diagnostic accuracy comparable to scalpel biopsy and histologic assessment.
Clinical question: What is the diagnostic accuracy of oral cancer screening tests for the detection of oral cancer and potentially malignant disorders of the lip and oral cavity in individuals with clinically evident lesions?
Summary of methods and results: A systematic literature search was conducted of the following adjunctive oral cancer tests: vital staining, oral cytology, light-based detection, and blood and saliva analysis. A total of 37 studies were included in the meta-analysis; separate analyses were conducted to calculate the sensitivity and specificity of each diagnostic test. For vital staining, sensitivity was 0.84 (95% confidence interval [CI] = 0.74 to 0.90) and specificity was 0.70 (95% CI = 0.59 to 0.79); for cytology, sensitivity was 0.91 (95% CI = 0.81 to 0.96) and specificity was 0.91 (95% CI = 0.81 to 0.95); for light-based detection, sensitivity was 0.91 (95% CI = 0.77 to 0.97) and specificity was 0.58 (95% CI = 0.22 to 0.87). No studies were found evaluating blood and saliva analysis.
Critical appraisal: This systematic review met most of the AMSTAR criteria for assessing systematic reviews. However, the body of evidence was judged to be at high risk of bias and potentially suffered from selection bias. Because of this, the results should be interpreted with caution.
Practical applications: Scalpel biopsy with histologic assessment remains the gold standard for diagnosing lesions suspected to be OSCC or potentially malignant disorders (PMD). Patients with lesions should be referred to clinicians that have specialty training in oral and maxillofacial pathology/surgery for further evaluation and scalpel biopsy, if needed.

Background: This umbrella review evaluated the effect of nonsurgical periodontal treatment on glycemic control in patients with diabetes and periodontitis.
Clinical question: In patients with type 1 or type 2 diabetes diagnosed with chronic periodontitis, does nonsurgical periodontal treatment affect glycemic control?
Summary of methods: The authors conducted a search of PubMed, EMBASE, Cochrane Database of Systematic Reviews, Science Direct, Google Scholar, SCOPUS, and Scielo for published systematic reviews written in English, Spanish, and Portuguese that addressed the clinical question. Quality assessment was done using two assessment tools, AMSTAR and the Cochrane Risk of Bias tool. No meta-analysis was conducted.
Critical appraisal: This umbrella review included 13 systematic reviews. Generally, acceptable methods to conduct a systematic review were followed. A qualitative synthesis of the systematic reviews was provided in lieu of conducting a meta-regression of the available meta-analyses. A simple metaanalysis was possible but not completed, as previous attempts were considered adequate by the authors and repetition of the process would not have added new information.
Practical implications: Although there was a reported decrease in glycemic control after the first 3 months following periodontal treatment, the effects were relatively minor and disappeared after 6 months. The impact of nonsurgical treatment of chronic periodontitis on glycemic control in diabetic patients is inconclusive and based on a questionable level of evidence.

Background: This article critically appraises a randomized controlled trial that was conducted in 2016 to evaluate the efficacy of air polishing in peri-implant tissue maintenance compared with manual treatment.
Clinical question: In patients with implant prostheses, what is the efficacy of air polishing in maintaining periimplant tissue health when compared with a manual technique?
Summary of methods and results: The study population consisted of 46 patients, 24 in the air polishing group and 22 in the manual treatment group. At the beginning of treatment (baseline) and on a monthly basis for the duration of the study (6 months), all patients were subjected to oral hygiene sessions with either air-abrasive debridement with amino acid (glycine) powder or manual debridement and chlorhexidine treatment. The clinical measurements were performed with a plastic periodontal probe with a standardized probing force of 0.2 N. At baseline and after 3 and 6 months, the following periodontal indices were evaluated and recorded: plaque index (PI), bleeding index (BOP), probing depth (PD), clinical attachment level (CAL), and bleeding score (BS). No signs of inflammation were observed in eight patients (16 implants) in the air polishing group and no inflammation was observed in one patient (4 implants) in the manual treatment group. All subjects completed the study and no implants were lost.
Critical appraisal: This randomized controlled trial met most requirements of the Critical Appraisal Skills Program (CASP).
Practical implications: Air-abrasive debridement with glycine powder provides adequate and more effective removal of peri-implant biofilm and has lower risk of adverse effects, such as the formation of emphysema or site infection, when compared with manual treatment.

Background: This article critically appraises a systematic review that was conducted in 2015 to assess the effectiveness of peri-implant maintenance therapy (PIMT) in the prevention of biologic complications such as peri-implant diseases.
Clinical question: What is the effect of PIMT on the incidence of biologic complications (ie, mucositis and periimplantitis)?
Summary of methods: An electronic search, in addition to a manual search, was conducted in several databases for articles up to June 2015 without language restriction. Three authors independently performed the search and independently extracted data. In case of disagreement, consensus was reached by discussion with a fourth reviewer. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS), and the Cohen kappa coefficient was used to assess interrater agreement.
Critical appraisal: Although this study fulfilled most of the AMSTAR criteria for assessing systematic reviews, findings from the results of the present study must be cautiously interpreted because of the many study limitations and confounding factors.
Practical implications: For patients with implants, strict adherence to PIMT is imperative for prevention of biologic implant complications.

Background: Placing pit and fissure sealants, an effective measure to prevent caries, is a technique-sensitive procedure that is impacted by moisture control. In vitro and in vivo evidence suggests that use of an adhesive may improve sealant retention.
Clinical question: (1) Does placing resin-based sealants on permanent first molars with an ethanol-based etch-andrinse primer and adhesive system compared with placing sealants without an adhesive improve the 1-year retention rate? (2) Does patient behavior impact sealant retention rates?
Summary of methods and results: A split-mouth randomized controlled trial (RCT) was conducted with first permanent molars of 112 healthy children aged from 5 to 16 years. Molars in matching arches were randomized to receive either a bonded sealant (study group) or a conventional sealant (control group). Behavior was evaluated at the end of treatment for both groups, and complete retention was assessed 12 months posttreatment by blinded examiners. The authors concluded that the addition of an ethanol-based bonding agent significantly increased complete retention of sealants at 12 months, particularly on palatal fissures of permanent maxillary first molar teeth.
Critical appraisal: Overall, this RCT is of moderate quality. Strengths include: a clearly focused question was addressed, arches were randomly allocated, and a clinically relevant outcome was measured. Weaknesses include: a lack of clarity regarding statistician blinding, demographics of the study and control groups, and whether both groups were treated similarly. Intention-to-treat analysis was not performed.
Practical implications: Based on the evidence available through this study, the use of an adhesive may be considered for palatal surfaces, especially in the maxilla. Use on other surfaces remains questionable and may be considered on a case-by-case basis.

The University of Texas Health Science Center at San Antonio (UTHSCSA) Oral Health CATs Library was established in 2011, with the aid of an NIH grant, as a component of the Dental School's Evidence-Based Practice Program. Each CAT provides a concise answer to a focused clinical question based on the most recent and highest level of evidence. This online searchable library contains over 950 CATs written by student/faculty teams, and about 150 new CATs are added annually. The CATs are indexed by the British Trip Database, which allows users to search over a large number of evidence-based sites. The journal is grateful to UTHSCSA for sharing these CATs with our readers.

Background: Historically, the oral health care system has been separated both administratively and clinically from the larger health care delivery system. Despite this historical separation, providing oral health care services lies within the scope of all health care professionals' practices. Current efforts to shift the compartmentalized American health care system to a total patient care model provide an opportunity to integrate oral health care with primary care in order to improve the population's oral health. This article seeks to acquaint dental hygienists, the oral health care professionals focused on disease prevention, with new and emerging models of oral health care delivery and interprofessional collaborative practice in the hope that they soon will participate in and expand the implementation of these practice models.
Methods: This study focused on five health centers, all of which have been identified as organizational leaders in the development and implementation of models designed to support the integration of oral health care with primary care. Quantitative information on each health center was derived from annual reports submitted to the Uniform Data System (UDS) and information on the integration models was obtained through structured key informant interviews.
Results: Each organization has incorporated oral health risk assessment, clinical assessments, education, preventive interventions, and dental care coordination into primary care services. One organization provides oral health care as part of its outreach services and programs. The health care team members involved in integration vary. Some of the health centers primarily call on doctors to implement integration of oral health care while others employ dental hygienists, nurses, medical assistants, and outreach team members. Interprofessional collaboration was observed in each organization but took on different forms.
Conclusions: Although their methods of integrating oral health care with primary care differed, the five health centers described in this study successfully used integration to improve the delivery of oral health care services to their patients. All of these organizations placed a high value on interprofessional collaboration regardless of the particular collaborative model employed and identified a champion tasked with overseeing the improvement of oral health care delivery.

Schlagwörter: dental hygiene, interprofessional, oral health, primary care, workforce