This systematic review evaluates evidence describing histologically validated performance of methods for identifying carious lesions. A search identified 1,407 articles, of which 39 were included that described 126 assessment of visual, visual/tactile, radiographic (film and digital), fiber optic transillumination, electrical conductance, and laser fluorescence methods. A subsequent update added four studies contributing 10 assessments. The strength of the evidence was judged to be poor for all applications, signifying that the available information is insufficient to support generalizable estimates of the sensitivity and specificity of any given application of a diagnostic method. The literature is problematic with respect to complete reporting of methods, variations in histological validation methods, the small number of in vivo studies, selection of teeth, small numbers of examiners, and other factors threatening both internal and external validity. Future research must address these problems as well as expand the range of assessments to include primary teeth and root surfaces.
We found significant deficiencies in the practice of warfarin management and suggestive evidence that anticoagulation services can partially ameliorate these deficiencies. More research is needed to describe the quality of anticoagulation management in typical practice and how this management can be improved.
Whether such improvements, even if statistically significant, are clinically meaningful remains a question. A substantial agenda of future research to address this and other issues (e.g., costs, patient-oriented outcomes) is suggested.
A systematic review of the periodic scientific literature was undertaken to determine the strength of the evidence for the efficacy of professional caries preventive methods applied to high risk individuals, and the efficacy of professionally applied methods to arrest or reverse non-cavitated carious lesions. An initial search identified 1435 articles, of which 27 were eventually included in the review. Among the 22 studies addressing the prevention of carious lesions in caries-active or high risk individuals, the strength of the evidence was judged to be fair for fluoride varnishes and insufficient for all other methods. Among the seven studies addressing the management of non-cavitated carious lesions, the strength of the evidence for efficacy was judged to be insufficient for all methods. The results do not indicate that the preventive and management methods reviewed are not efficacious; rather, they demonstrate that not enough is known to determine the efficacy of the methods. Suggestions for strengthening the limited evidence base involve the following: i) increasing the number of studies that examine prevention among high risk individuals and non-surgical management of non-cavitated lesions, ii) including a wider variety of subject ages, iii) targeting aspects of the efficacy questions not yet addressed, iv) strengthening research methods employed in the studies, and v) reporting methods and outcomes more completely.
The consequences of even mild stroke affect all dimensions of health except pain. Standardized assessment of persons with stroke must evaluate across the entire continuum of health-related functions.
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