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1581. Comparison of endodontic sealers with or without bactericidal effect

in the study-designs. It would be desirable to standardize aspects of study-design, data recording and presentation format of outcome data in the much needed future outcome studies. Evidence Search antimicrobial"[All Fields] AND "Root Canal Therapy"[Mesh] AND "sealer"[All Fields]("root canal therapy"[MeSH Terms] OR ("root"[All Fields] AND "canal"[All Fields] AND "therapy"[All Fields]) OR "root canal therapy"[All Fields]) AND ("humans"[MeSH Terms] AND Meta-Analysis[ptyp] Comments on The Evidence

2010 UTHSCSA Dental School CAT Library

1582. Adjunctive use of minocycline with traditional non-surgical periodontal therapy in patients with chronic periodontitis produces increased attachment

, the minocycline gel was applied to the bottom of the pocket and withdrawn in a zigzag motion until the gel flowed over the gingival margin. The study authors concluded that “gingival crevicular fluid is relatively isolated from saliva,” and thus the antibiotic effect was not carried over from the minocycline treated half of the mouth to the untreated part of the mouth. Applicability Adult patients with chronic periodontitis and pocket depths of at least 5 mm. Minocycline is not currently available in the U.S

2010 UTHSCSA Dental School CAT Library

1583. Diabetes and The Dental Patient

Diabetes and The Dental Patient UTCAT580, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Preoperative Antibiotics To Prevent Infection In Diabetics: An Expert Opinion Clinical Question In diabetic dental patients, does routine use of antibiotics better prevent infection as opposed to no antibiotic use? Clinical Bottom Line There appears to be no difference in susceptibility to infection between diabetic patients who (...) received antibiotics prior to routine dental procedures and those who did not. (See Comments on the CAT below) Best Evidence (you may view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type (level of evidence) #1) Alexander/1999 Diabetic dental patients Expert opinion Key results There is no evidence to suggest that well-controlled diabetic patients are more prone to infection than other dental patients. For this reason, antibiotics should only be administered

2010 UTHSCSA Dental School CAT Library

1584. From The Archives: Is Prescribing Placebos An Ethical Practice?

a research article entitled “Prescribing placebo treatments: results of a national survey of US internists and rheumatologists.” Of 679 physicians who responded to a cross sectional mailed survey, over 50% reported having prescribed placebos on a regular basis. Placebos included varied from saline (3%), sugar pills (2%), OTC analgesics (41%), vitamins (38%), antibiotics (13%) and sedatives (13%). According to the authors’ definition, the placebo effect refers to positive clinical outcomes caused (...) by a treatment that is not attributable to its known physical properties or mechanism of action, but rather to positive expectations or hopes in patients, derived from the clinical encounter. Placebo treatments, however, are quite different from each other, as saline injections or sugar pills are considered inert substances, while prescribing antibiotics or sedatives may carry adverse consequences for individual patients as well as for public health. In the survey, physicians prescribing placebo treatments

2010 Clinical Correlations

1585. From the Archives: Should All Patients with Cellulitis Be Treated for Community-Acquired Methicillin-Resistant Staphylococcus Aureus?

: Should All Patients with Cellulitis Be Treated for Community-Acquired Methicillin-Resistant Staphylococcus Aureus? ” Given the most serious nature of the USA 300 clone CA MRSA, it is imperative that we now require, on an emergency basis, 24/7, 365 day pharmaceutical reserch aimed at developing effective medicinal treatment, including the development of multiple new antibiotics which can be used with a minimum of testing. Currently, with respect to this particilar strain of MRSA, we are at the same

2010 Clinical Correlations

1586. Give us the trial data

-gain are listed separately. (P.S. I am aware of the link between obesity/diabetes and why. I was curious on another point). skyesteve said, August 20, 2010 at Sorry eponymous85 but have to agree with Mike – when you say things like “schizophrenia is not a disease like diabetes” and “you can’t die from it” your aren’t just talking nonsense but your actually contributing to the ongoing prejudice that surrounds mental illness. With the exception of antimicrobials there are very few medicines

2010 Bad Science

1587. Can throat examination distinguish between bacterial and viral infective agents?

in inappropriate antibiotic prescription in 4.8% (discussed in another BET). Therefore a compromise is to rapid test all and treat positive reults without culture confirmation of negative results. For children the best option was to rapid test all and treat those with positive results and culture negative results. References Ebell MH, Smith MA, Henry BC et al. Does This Patient Have Strep Throat? JAMA 2000;284:2912–18. Schwartz RH, Gerber MA, McKay K. Pharyngeal findings of Group A Streptococcal Pharyngitis

2010 BestBETS

1588. Clindamycin phosphate 2% vaginal cream (Clindesse) for the treatment of bacterial vaginosis

alkali. For diagnosis in asymptomatic women and for clinical trials the FDA also requires use of the Nugent score which requires the use of a gram stained vaginal smear where the vaginal flora are examined and graded as: 0–3 normal (lactobacillus predominant), 4–6 intermediate, 7+ indicative of BV. Once diagnosis is confirmed the mainstay of treatment is antibiotic therapy. Antimicrobials, which include the 5-nitroimidazoles (metronidazole, tinidazole, secnidazole), and the lincosamide clindamycin (...) with bacterial vaginosis. Drug Clindesse is a semi-solid white cream containing 2% clindamycin phosphate, which is a water-soluble ester of the semi-synthetic antibiotic produced by a 7 (S)-chloro-substitution of the 7(R)-hydroxyl group of the parent antibiotic, lincomycea. The recommended dose is a single intravaginal administration on one day. Disease Bacterial vaginosis is a common vaginal infection caused by an imbalance in the vaginal flora. In bacterial vaginosis there is suppression of lactobacilli

2010 Therapeutics Letter

1589. The Polymyxins: Why am I using them all the time, and what are they?

cultures return ESBL Klebsiella with susceptibility only to polymyxin. I sat on the venerable call-room couch staring mindlessly at the cluttered, nauseating walls repeating the word ‘ polymyxin’ like an endless antimicrobial mantra. What strange dosing it has, and an even more peculiar name. [1]. In the long evolutionary struggle between gram positives and gram negatives, Bacillus Polymyxa (a gram positive) began secreting cyclic peptides with long hydrophobic chains that selectively bind to gram (...) , recent pharmacodynamic studies with Pseudomonas suggest that the bacteriocidal activity of Polymyxin B is related to the ratio of the area under the concentration-time curve to MIC [6]. This suggests that it may be the total daily dose, and not the frequency of administration that is important (1). As the mechanism of action detailed above alluded, synergism between the polymyxins and other antibiotics [5]. The overuse of broad-spectrum antibiotics has led to increasing antibiotic resistance

2010 Clinical Correlations

1590. Off Label

medicines and found that 31 were for indications not approved by the FDA [5]. A more recent analysis of prescribing practices in 2001 showed that 21% of all prescriptions filled for 160 common drugs were for off-label indications. The proportions were even higher for anticonvulsants (74%), antipsychotics (60%), and antibiotics (41%) [6]. The problem with wide spread off-label use is that there is often little or no evidence to support it. In fact, in a study of office based physician practices, Radley

2010 Clinical Correlations

1591. The year in nonsense

companies are to say that cigarettes prevent Alzheimer’s, and we saw the first describing how academics routinely mislead readers about their negative results in academic papers, by spinning them as positive. Dodgy facts aren’t the only reason clever people believe stupid things, as demonstrated by a gale of research on irrationality. Superstitious rituals . What affects listeners’ assessment of their skill. Antibiotics don’t work for a sore throat, but if you’re prescribed them, you come away . You can

2010 Bad Science

1592. Some evidence shows that certain mouthrinses can reduce halitosis

Kumar DDS, MDSc . Overview Systematic Review Conclusion Mouthrinses containing antibacterial agents (chlorhexidine and cetylpyridinium chloride) or those containing chlorine dioxide and zinc can reduce halitosis to some extent. Critical Summary Assessment Although antibacterial mouthrinses can reduce halitosis, the extent of effectiveness is uncertain owing to incomplete reporting, possible study and variation in patients’ characteristics and assessment methods. Evidence Quality Rating Limited

2010 ADA Center for Evidence-Based Dentistry

1593. Helping former smokers stay on the wagon: insufficient evidence regarding relapse prevention interventions for smoking cessation

are the strongest resources to aid dental professionals in clinical decision making and help incorporate evidence gained through scientific investigation into patient care. Guidelines include recommendation statements intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Antibiotics for Dental Pain and Swelling Guideline A panel of experts convened by the ADA Council on Scientific Affairs presents clinical (...) recommendations concerning the use of antibiotics for the urgent management of pulpal- and periapical-related dental pain and intra-oral swelling. This guideline updates the 1997 recommendations by the American Heart Association for the prevention of infective endocarditis (IE). The committee concluded that IE prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcomes from IE. A panel of experts convened

2010 ADA Center for Evidence-Based Dentistry

1594. Glycemic control of diabetics may improve slightly with periodontal treatment

levels. Main Results: The review included three RCTs and two CCTs, both of which totaled 199 treated patients and 183 control patients. All patients had type 2 diabetes and periodontitis. Periodontal treatment was scaling and root planning, with or without antibiotic therapy. All studies reported absolute change in A1C. A1C levels of 8 percent and less are considered good and 10 percent and above are considered poor. All studies showed an improved (decreased) A1C level in treated patients ranging (...) a lack of precision in the estimate of effect. The lacked robustness due to significant among the studies. The CCTs introduced by placing treatment avoiders in the control groups. Baseline A1C levels generally reflected poor glycemic control. However, some subjects in two of the RCTs had good control, which may have affected their treatment results. The studies used different or unstated definitions of periodontitis. When antibiotics were used, the protocols changed. Only two studies reported

2010 ADA Center for Evidence-Based Dentistry

1595. Limited evidence suggests no difference in denture cleaning methods

information. The inclusion criteria were limited to randomized clinical trials (RCTs) comparing any mechanical method or chemical in adults over age 18 wearing removable partial or complete dentures. Studies were excluded if participants had implant-retained prostheses or a history of corticosteroid or antimicrobial use within 3 months. Primary outcomes considered included health of denture bearing areas and patient satisfaction and preference. Secondary outcomes included denture plaque coverage area

2010 ADA Center for Evidence-Based Dentistry

1596. Effectiveness of different treatment regimens for peri-implantitis

complex and expensive therapies for peri-implantitis Candice G. McMullan-Vogel DDS . Overview Systematic Review Conclusion Local antibiotics, bone augmentation and subgingival débridement all may be effective in treating peri-implantitis. Critical Summary Assessment There is a need for properly designed studies to identify which treatments are most effective for peri-implantitis. Evidence Quality Rating Limited Evidence This summary is published in the Journal of the American Dental Association

2010 ADA Center for Evidence-Based Dentistry

1597. Patients may not need to stop oral anticoagulant therapy for simple oral surgical procedures

focused on clinically relevant outcomes of the studies, principally differences in postoperative bleeding rates and the control of any bleeding that did occur. Although the title implies that the dealt with the influence of OAT on oral implant therapy, all data provided relate only to simple oral surgical procedures. The authors recommended that drugs that may increase bleeding tendencies, aspirin and other NSAIDs, and antibiotics that can potentiate the anticoagulant effect of OAT be avoided prior

2010 ADA Center for Evidence-Based Dentistry

1598. Patients may not need to stop oral anticoagulant therapy for simple oral surgical procedures

focused on clinically relevant outcomes of the studies, principally differences in postoperative bleeding rates and the control of any bleeding that did occur. Although the title implies that the dealt with the influence of OAT on oral implant therapy, all data provided relate only to simple oral surgical procedures. The authors recommended that drugs that may increase bleeding tendencies, aspirin and other NSAIDs, and antibiotics that can potentiate the anticoagulant effect of OAT be avoided prior

2010 ADA Center for Evidence-Based Dentistry

1599. Some evidence shows that certain mouthrinses can reduce halitosis

Kumar DDS, MDSc . Overview Systematic Review Conclusion Mouthrinses containing antibacterial agents (chlorhexidine and cetylpyridinium chloride) or those containing chlorine dioxide and zinc can reduce halitosis to some extent. Critical Summary Assessment Although antibacterial mouthrinses can reduce halitosis, the extent of effectiveness is uncertain owing to incomplete reporting, possible study and variation in patients’ characteristics and assessment methods. Evidence Quality Rating Limited

2010 ADA Center for Evidence-Based Dentistry

1600. Helping former smokers stay on the wagon: insufficient evidence regarding relapse prevention interventions for smoking cessation

are the strongest resources to aid dental professionals in clinical decision making and help incorporate evidence gained through scientific investigation into patient care. Guidelines include recommendation statements intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Antibiotics for Dental Pain and Swelling Guideline A panel of experts convened by the ADA Council on Scientific Affairs presents clinical (...) recommendations concerning the use of antibiotics for the urgent management of pulpal- and periapical-related dental pain and intra-oral swelling. This guideline updates the 1997 recommendations by the American Heart Association for the prevention of infective endocarditis (IE). The committee concluded that IE prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcomes from IE. A panel of experts convened

2010 ADA Center for Evidence-Based Dentistry

Evidence-based Synopses

Synopses are typically easily digested, critical commentaries of articles e.g. critically appraised topics.