Abstract This study aimed to assess whether dentists correctly understand the benefit of a dental treatment when it is presented using absolute numbers or relative risk reduction (RRR). This parallel-group randomized controlled trial recruited dentists from 3 postgraduate courses in Rio de Janeiro, Brazil. Participants received, in sequentially numbered sealed opaque envelopes, the description of a hypothetical scenario of the benefit (avoidance of multiple tooth loss) of nonsurgical periodontal treatment without or with antibiotics. Treatment benefit was presented in 2 different formats: absolute numbers or RRR. Dentists were given 10 minutes to read the treatment scenario and answer 5 questions. The final sample for analysis included 101 dentists. When asked to estimate the number of patients out of 100 who would avoid multiple tooth loss without antibiotics, 17 dentists (33%) in the absolute numbers group and 12 (25%) in the RRR group provided the correct response (p = 0.39). Regarding treatment with antibiotics, 26 dentists (50%) in the absolute numbers group and 14 (29%) in the RRR group provided the correct response (p = 0.04). Only 16 dentists (31%) in the absolute numbers group and 12 (25%) in the RRR group gave correct answers for both questions (p = 0.51). Most dentists did not correctly understand the benefit of the treatment, irrespective of the format it was presented. Slightly more dentists correctly understood the benefit of the treatment when it was presented as absolute numbers than as RRR. . (RRR) parallelgroup parallel Janeiro Brazil received envelopes avoidance antibiotics formats 1 33% 33 (33% 25% 25 (25% p 0.39. 039 0.39 0 39 0.39) 50% 50 (50% 29% 29 (29% 0.04. 004 0.04 04 0.04) 31% 31 (31% 0.51. 051 0.51 51 0.51) (RRR (33 (25 03 0.3 (50 (29 00 0.0 (31 05 0.5 (3 (2 0. (5 (

Abstract The aim of this review was to map the practice of spin in scientific publications in the dental field. After registering the review protocol (osf.io/kw5qv/), a search was conducted in MEDLINE via PubMed, CENTRAL, Embase, Scopus, LILACS, ClinicalTrials.gov, and OpenGrey databases in June 2023. Any study that evaluated the presence of spin in dentistry was eligible. Data were independently extracted in duplicate by two reviewers. After removing duplicates, 4888 records were screened and 38 were selected for full-text review. Thirteen studies met the eligibility criteria, all of which detected the presence of spin in the primary studies, with the prevalence of spin ranging from 30% to 86%. The most common types of spin assessed in systematic reviews were failure to mention adverse effects of interventions and to report the number of studies/patients contributing to the meta-analysis of main outcomes. In randomized controlled trials, there was a focus on statistically significant within-group and between-group comparisons for primary or secondary outcomes (in abstract results) and claiming equivalence/noninferiority/similarity for statistically nonsignificant results (in abstract conclusions). The practice of spin is widespread in dental scientific literature among different specialties, journals, and countries. Its impact, however, remains poorly investigated. field osf.io/kw5qv/, osfiokw5qv osfiokwqv osf.io/kw5qv/ , osf io kw5qv kw qv (osf.io/kw5qv/) PubMed CENTRAL Embase Scopus LILACS ClinicalTrialsgov ClinicalTrials gov ClinicalTrials.gov 2023 eligible reviewers duplicates 488 3 fulltext full text criteria 30 86 86% studiespatients patients metaanalysis meta analysis trials withingroup within group betweengroup between equivalencenoninferioritysimilarity equivalence noninferiority similarity conclusions. conclusions . conclusions) specialties journals countries impact however investigated osfiokw osf.io/kw5qv kwqv (osf.io/kw5qv/ 202 48 8 (osf.io/kw5qv 20 4 2

Abstract Physicians and dentists usually make clinical decisions and recommendations without a clear understanding of the meaning of the numbers regarding the accuracy of diagnostic tests and the efficacy of treatments. This critical review aimed to identify problems in the communication of diagnostic test accuracy and treatment benefits and to suggest strategies to improve risk communication in these contexts. Most clinical decisions are taken under uncertainty. Health professionals cannot predict the outcome in one individual patient. This uncertainty invites these professionals to make decisions based on heuristics, which gives rise to several cognitive biases. Cognitive biases are automatic and unconscious, so how is it possible to mitigate their undesirable effects on risk interpretation in the context of clinical practice? Some forms of risk communication reinforce cognitive bias, while others weaken them. Maybe one of the most difficult obstacles to overcome is the difficulty to think with numbers. This difficulty probably arises from a mismatch of ancestral adaptations of the brain having to deal with modern environments, which are quite different from the ancestral ones. There are two quite common, but bad, forms of risk communication: the conditional probability and the relative risk reduction or efficacy. People, including physicians and dentists, are confused with this kind of information. The main methods discovered so far to facilitate a clearer understanding are to emphasize the base rates of the events and to use absolute numbers, that is to use natural frequencies, instead of percentages and conditional probabilities.

Abstract The World Health Organization declared a COVID-19 pandemic on March 11, 2020, when there were 4,293 confirmed cumulative deaths. By May 17, 2020 this number increased to 315,005. The risk of death is higher above the age of 60, but there are many deaths below 60 (for example, in Sao Paulo, 25%). Due to the lack of a vaccine or specific treatment, there are at least three types of interventions used in the first wave of this pandemic: increased alertness and hygiene (e.g. Sweden); identification and isolation of infected people and their contacts (e.g. South Korea); lockdown (e.g. Italy). These interventions are complementary. Choices of the right mix of interventions will vary from society to society and in the same society at different times. The search for a miracle drug is dangerous because it is based on the mistaken belief that any treatment option is better than “nothing”. Brazilian society will not be able to maintain lockdown for a long period. Naturally, in the near future, regardless of the advice from scientists, doctors and authorities, commerce, services and schools will reopen. In order to implement any strategy aimed to control the pandemic and preserve the economy, the country needs leadership that centralizes and coordinates actions. Unfortunately, the Brazilian government is not fulfilling this role; on the contrary, it is a hindrance. This negative leadership and lack of coordination are causing many deaths and are severely damaging the lives of survivors by delaying the resuming of economic and social activities.

RESUMO O objetivo deste artigo foi apresentar uma estratégia de busca sistemática e eficiente, apropriada para cirurgiões-dentistas, professores e alunos de Odontologia, para ser utilizada quando eles tiverem dúvidas sobre a efetividade de uma intervenção clínica. O sistema proposto para a Medicina, chamado de “Sistema 6-S”, foi adaptado para que uma estratégia de busca com foco na Odontologia fosse construída. Essa estratégia é fácil e rápida de usar e alcança a melhor evidência científica disponível. A sequência de busca proposta, com foco na validade da evidência e eficiência da busca, consiste em: resumos críticos de revisões sistemáticas (RS) de ensaios controlados randomizados (ECR), RS de ECR, resumos críticos de ECR e, por último, ECR. A busca por esses artigos pode ser feita na biblioteca Cochrane; em revistas de odontologia baseada em evidência; sites da Internet e blogs; e no Pubmed através da ferramenta "Clinical Queries”. Essa estratégia pode aprimorar a habilidade de obter rapidamente evidência importante para informar a prática clínica, a educação em Odontologia e o cuidado em saúde bucal. A adoção de estratégias como a proposta neste artigo pode aumentar a prática da Odontologia Baseada em Evidência.

ABSTRACT The aim of this article was to offer an efficient systematic search strategy appropriate for clinicians, professors and dental students, for when they have a question regarding the effectiveness of clinical intervention. We adapted the “6-S System” proposed for Medicine in order to build a search strategy focused on oral health, which is speedy, easy to use and arrives at the appropriate evidence. With a focus on validity and search efficiency, the following searching sequence is proposed: critical abstracts of systematic reviews (SR) of randomized controlled trials (RCTs), SR of RCTs, critical abstracts of RCTs, and RCTs. These can be searched in the Cochrane library; evidence-based journals; websites and blogs; and in Pubmed using the tool Clinical Queries. This strategy can enhance the ability to quickly retrieve evidence that is important to dental education, clinical practice and delivery of oral health care. The adoption of strategies such as the one proposed in this paper is likely to increase evidence based dental practice.

RESUMO Objetivo: Mostrar como um cirurgião-dentista clínico geral procurou responder, com base em evidência científica, à pergunta: "O escurecimento das lesões de cárie em dentes decíduos tratados com diaminofluoreto de prata contribui para a redução da aceitação desse tipo de tratamento pelos pais?". Métodos: O dentista seguiu o seguinte roteiro: formulação de uma pergunta específica; realização da busca bibliográfica utilizando descritores e termos livres; seleção dos artigos científicos completos para leitura; leitura e avaliação crítica dos artigos selecionados; resumo da evidência disponível e aplicação da evidência à sua prática clínica. O dentista localizou 45 trabalhos e selecionou 20 para leitura na íntegra, mas apenas três puderam ser utilizados, sendo dois ensaios controlados realizados na China e um no Brasil. Resultados: Os resultados mostraram que a estética não foi uma questão importante nem um fator decisivo para a indicação do tratamento proposto. No entanto, embora haja evidência científica robusta sobre a efetividade do diaminofluoreto de prata em paralisar e prevenir lesões de cárie, há pouca informação sobre seu efeito estético. Assim, a falta de estudos que avaliam o impacto do escurecimento das lesões de cárie e o efeito estético do tratamento sobre a qualidade de vida das crianças e seus familiares deve ser ressaltada. Conclusão: O dentista concluiu que não existe evidência suficiente sobre o efeito estético das aplicações de diaminofluoreto de prata em dentes decíduos e optou por informar os responsáveis por seus pacientes a respeito e compartilhar com eles a decisão sobre a indicação do mesmo para cada caso específico.

ABSTRACT Objective: The aim of this paper was to demonstrate how a general dental practitioner tried to answer, based on scientific evidence, to the question: "Does the darkening of caries lesions caused by silver diamine fluoride treatment contribute to reducing parents' acceptance of such treatment?". Methods: The dentist adopted the following approach: formulation of a specific question; bibliographic search using controlled vocabulary and free terms; selection of full-text articles for reading; reading and critical appraisal of selected articles; summary of the available evidence; translation of the evidence into clinical practice. The dentist identified 45 studies and selected 20 to be read in full, but only three could be used; two controlled trials from China and one from Brazil. Results: Results showed that the esthetic effect was neither a major issue nor a decisive factor for the indication of the proposed treatment. However, although there is robust scientific evidence on the effectiveness of silver diamine fluoride in arresting and preventing caries lesions, there is scarce information about its esthetic effect. Thus, the lack of studies assessing the impact of the darkening of caries lesions and the esthetic effect of the treatment on the quality of life of children and their parents must be emphasized. Conclusion: The dentist concluded that there is insufficient evidence about the esthetic effect of silver diamine fluoride applications on primary teeth and opted to inform it to his/her patients' caregivers and to share with them the decision whether to use it or not in each specific case.

Os objetivos deste estudo foram verificar se as recomendações fornecidas por órgãos governamentais brasileiros sobre higiene bucal em crianças são consistentes e se possíveis inconsistências nessas recomendações estão associadas a uma aparente falta de evidência científica. Cinqüenta e quatro órgãos governamentais brasileiros foram contatados por endereço eletrônico ou postal. Foi solicitado que enviassem materiais contendo recomendações sobre práticas de higiene bucal para crianças. Em seguida, realizou-se uma busca nos sites Cochrane Oral Health Review Group e PubMed-Clinical Queries para avaliar a evidência científica disponível sobre o assunto. Quarenta (74%) órgãos governamentais responderam e 21 materiais contendo recomendações sobre higiene bucal foram obtidos. Foram identificadas 11 revisões sistemáticas pertinentes. Este estudo preliminar detectou algumas recomendações divergentes e não baseadas em evidência científica, ressaltando a necessidade de se realizar revisões sistemáticas da literatura sobre esses tópicos para aproximar a pesquisa científica da prática clínica.

The aims of this study were to detect whether recommendations concerning oral hygiene practices for children among Brazilian health agencies are consistent and to verify whether possible inconsistencies in these recommendations might be associated with an apparent gap in the scientific evidence. Fifty-four Brazilian health agencies were contacted by mail or electronic mail and were asked to send any material containing recommendations on oral hygiene practices aimed at children. A search was subsequently carried out on the Cochrane Oral Health Review Group and PubMed-Clinical Queries websites in order to assess the scientific evidence available on this subject. Forty (74%) agencies answered and 21 materials containing oral hygiene recommendations were obtained. Eleven pertinent systematic reviews were identified. This preliminary study detected some conflicting and not evidence-based oral hygiene messages, which emphasizes the need to carry out and disseminate systematic reviews on these controversial issues in order to bridge the gap between knowledge and practice.

Os objetivos deste estudo foram verificar se as recomendações fornecidas por órgãos governamentais brasileiros sobre higiene bucal em crianças são consistentes e se possíveis inconsistências nessas recomendações estão associadas a uma aparente falta de evidência científica. Cinqüenta e quatro órgãos governamentais brasileiros foram contatados por endereço eletrônico ou postal. Foi solicitado que enviassem materiais contendo recomendações sobre práticas de higiene bucal para crianças. Em seguida, realizou-se uma busca nos sites Cochrane Oral Health Review Group e PubMed-Clinical Queries para avaliar a evidência científica disponível sobre o assunto. Quarenta (74%) órgãos governamentais responderam e 21 materiais contendo recomendações sobre higiene bucal foram obtidos. Foram identificadas 11 revisões sistemáticas pertinentes. Este estudo preliminar detectou algumas recomendações divergentes e não baseadas em evidência científica, ressaltando a necessidade de se realizar revisões sistemáticas da literatura sobre esses tópicos para aproximar a pesquisa científica da prática clínica.

The aims of this study were to detect whether recommendations concerning oral hygiene practices for children among Brazilian health agencies are consistent and to verify whether possible inconsistencies in these recommendations might be associated with an apparent gap in the scientific evidence. Fifty-four Brazilian health agencies were contacted by mail or electronic mail and were asked to send any material containing recommendations on oral hygiene practices aimed at children. A search was subsequently carried out on the Cochrane Oral Health Review Group and PubMed-Clinical Queries websites in order to assess the scientific evidence available on this subject. Forty (74%) agencies answered and 21 materials containing oral hygiene recommendations were obtained. Eleven pertinent systematic reviews were identified. This preliminary study detected some conflicting and not evidence-based oral hygiene messages, which emphasizes the need to carry out and disseminate systematic reviews on these controversial issues in order to bridge the gap between knowledge and practice.

O objetivo deste estudo foi associar freqüência de higiene bucal e presença de biofilme visível na dentição decídua. A amostra constou de 90 crianças com idade até 4 anos, cadastradas no Hospital Universitário da Universidade do Estado do Rio de Janeiro. Os exames foram realizados em consultório odontológico por um único examinador treinado, auxiliado por um anotador. Os pais responderam a um questionário estruturado sobre métodos e freqüência de higiene bucal. Foram utilizados dois índices de biofilme: um simplificado (BF1) e um convencional (BF2). O BF1 classifica o biofilme como ausente, fino ou espesso, em dentes anteriores e/ou posteriores, gerando um escore para o paciente, enquanto o BF2 classifica o biofilme como ausente ou presente, fornece escores a três superfícies de cada dente e o escore final corresponde ao percentual de superfícies com biofilme. Mais da metade dos pais (51 - 56,7%) relataram limpar os dentes dos filhos pelo menos duas vezes ao dia ao passo que 7 (7,8%) nunca tinham limpado os dentes dos filhos. O BF1 demonstrou que 12,2% (11) das crianças não apresentavam biofilme visível, 37,8% (34) apresentavam biofilme fino em dentes anteriores e/ou posteriores, 27,8% (25), biofilme espesso em dentes anteriores ou posteriores, e 22,2% (20), biofilme espesso em dentes anteriores e posteriores. O BF2 revelou uma média de 21,8% (d.p. 16,5). Não foram encontradas correlações estatisticamente significativas entre a freqüência de higiene bucal e os índices de biofilme (p > 0,05), demonstrando que a freqüência de higiene bucal não esteve associada à qualidade da mesma na amostra estudada.

The purpose of this study was to associate oral hygiene frequency and presence of visible biofilm in the primary dentition. The sample consisted of 90 children, aged up to 4 years old, outpatients of the University Hospital of the Rio de Janeiro State University. The examinations were carried out in a dental office by a single trained examiner who was aided by an assistant. The parents answered a structured questionnaire about oral hygiene methods and frequency. Two biofilm indices, one simplified (BF1) and the other conventional (BF2), were used. BF1 classifies biofilm as absent, thin or thick, in anterior and/or posterior teeth, and provides a score for the patient, whereas BF2 classifies biofilm as absent or present, provides scores for three surfaces of each tooth and the final score is the percentage of tooth surfaces with biofilm. More than half of the parents (51 - 56.7%) reported they cleaned their child's teeth at least twice a day, while 7 (7.8%) had never cleaned their child's teeth. BF1 revealed that 12.2% (11) of the children had no visible biofilm, 37.8% (34) had thin biofilm in anterior and/or posterior teeth, 27.8% (25) had thick biofilm in anterior or posterior teeth and 22.2% (20) had thick biofilm in both anterior and posterior teeth. BF2 revealed a mean value of 21.8% (s.d. 16.5). No statistically significant correlations were found between oral hygiene frequency and the two biofilm indices (p > 0.05), indicating that oral hygiene frequency was not associated to oral hygiene quality in the evaluated sample.

O objetivo deste trabalho foi avaliar a prevalência de cárie e de fatores de risco em crianças com idade até 36 meses cadastradas no Ambulatório de Pediatria do Hospital Universitário Pedro Ernesto (HUPE-UERJ). Após a obtenção de consentimento livre e informado, foi realizada uma entrevista com os responsáveis por meio da qual foram avaliados os fatores de risco à cárie, incluindo condições sócio-econômico-culturais, hábitos de higiene oral e de dieta. Um único examinador realizou o exame bucal das crianças para a avaliação de cárie, de biofilme dental e de sangramento gengival. Os dados obtidos foram analisados através do programa Epi Info, utilizando-se o teste qui-quadrado. As crianças tinham em média 22,9 meses de idade. A prevalência de cárie encontrada, incluindo lesões não cavitadas, foi de 41,6% e o índice ceo-s foi de 1,7 (± 2,5). Os dentes mais afetados foram os anteriores superiores e o tipo de lesão mais comum foi a mancha branca ativa. Não houve associação significativa estatisticamente entre a prevalência de cárie e os fatores sócio-econômico-culturais, freqüência de higiene, hábito de amamentação noturna e dieta cariogênica durante o dia. Entretanto, a associação entre cárie e presença de biofilme dental foi considerada altamente significativa (p < 0,001). Os resultados sugerem que o acúmulo de biofilme dental espesso foi o fator preponderante para a ocorrência da cárie de estabelecimento precoce na amostra avaliada.

The aim of this study was to assess the prevalence of caries and risk factors in outpatients of the Pediatric Ambulatory of the Pedro Ernesto University Hospital aging up to 36 months. After signing informed consent forms, the parents answered a structured questionnaire in order to evaluate risk factors for dental caries, including socioeconomic status, oral hygiene and dietary habits. A single investigator carried out the dental examination which assessed the presence of caries, biofilm and gingival bleeding. The data were analyzed by means of the Epi Info program, utilizing the chi-squared test. The children’s mean age was 22.9 months. The prevalence of caries, including white spot lesions, was 41.6%, and the mean def-s was 1.7 (± 2.5). The most affected teeth were the maxillary incisors, and the most common lesion was the white spot. No significant associations were found between the prevalence of caries and socioeconomic status, frequency of oral hygiene, nocturnal bottle- and breast-feeding or cariogenic food and beverage intake during the day. However, the association between caries and oral hygiene quality (dental biofilm) was statistically significant (p < 0.001). The results suggest that the presence of a thick biofilm was the most important factor for the occurrence of early childhood caries in the evaluated sample.