Objective To investigate problems in applying clinical epidemiology and evidence-based medicine in the field of dentistry in China. Method In early April of 2001, about 200 copies of a questionnaire were sent to chief editors of dental journals, directors and famous experts of the university dental schools and/or dental departments of the provincial/metropolitan hospitals located in the mainland of China. The sent back questionnaires were summarized and analysized. Results At the end of June, 2001, 40 replies from the experts of 12 universities and one metropolitan dental hospital were received. The main points are summarized as following: EBM in China is at starting stage of "anti-illiteracy" campaign. There are 6 out of 12 universities having delivered clinical epidemiology courses to postgraduates (2 to undergraduates), only 3 added lectures on evidence-based medicine to dental students and/or professionals, only one university held intensive training courses on EBM to clinicians. In dental practice there are still scram dentists making decisions simply by experiences. In the research practice some dentists are eager for quick success, and instant benefits, ignoring, scientific design aid quality control of the studies. Randomized controlled clinical trials are seldom appeared in Chinese dental journals. To popularize EBM in all dental clinicians is important for them to use and produce the best evidences. Conclusions EBM in dental field of China is at starling stage. Collection and dissemination of best dental evidences in dental professionals is a key to raise the dental care levels in China.
Objective To hand search all formally published articles on randomized controlled clinical trials (RCT) and controlled clinical trials (CCT) for inputting into the database of Chinese Cochrane Center (CCC) and the Central Database of Cochrane Collaboration. Method All Chinese dental journals of the mainland of China that started publication before the end of 1996 were hand searched page by page. Criteria of RCT and CCT were based on the guideline of Cochrane Oral Health Group. All included articles were copied and the titles of the articles and names of the journals were translated into English and input to Procite for submission. A senior professional monitored the process and checked the translation item by item. Results Fifteen dental journals were included. One started from 1953, six from 80s, and the rest from 90s. Ten of them were listed by Ministry of Science and Technology as part of the government database for scientific articles. From 1953 to 1990, 42 RCTs and 97 CCTs were found in 291 journal issues, from 1991-1995, 157 RCTs and 154 CCTs in 241 issues, from 1996-2000 358 RCTs and 264 CCTs in 316 issues. In the three periods, the average RCTs per journal issue were 0.14, 0.65, 1.13 respectively, the averages of CCTs per issue were 0.33, 0.64, 0.84 respectively. The ratios of RCT to CCT are 0.43, 1.02, 1.36 respectively which showed greatly increasing along with time. There are 113 articles accounting 10.54% of the total specially for testing the effect of various Chinese traditional medicines and therapies. The common problems for the searched RCTs and CCTs is small sample size, insufficient descriptions on randomization and concealment, compliance and drop outs. Some titles were improperly written such as using trade name of drugs etc. In translation into English, some words indicating category or main components of the drugs were added. Conclusions In comparison of one fourth of the world population and more than 30 thousands dental professionals of China, 557 RCTs and 515 CCTs in dental literature are quite small number but the increasing speed is encouraging. More effort should be offered to spread knowledge of evidence-based medicine (EBM) to the dental care workers of China to produce more evidences. RCTs and/or CCTs should be good tools to determining real effects of traditional Chinese medicines in dental fields to make them applicable to all.
Objective A systematic review was conducted based on the domestically published literature for improving the quality of oral nursing care.Methods The terms "oral nursing care", "oral hygiene care", "mouth care" were used to search related studies in Chinese databases (up to April 30, 2004) along with handsearching additional studies. Four authors screened and selected the studies, appraised the methodological quality and extracted data from these selected studies. The results were presented by description or Meta-analysis. Results A total of 28 studies were identified, of which 6 were excluded. The methodological quality varied among the studies, 7 scored as B, 15 as C (11 randomized controlled trials, 4 quasi-randomized trials). A total of 2 372 patients were observed including some were critically ill, or intubated, or receiving radiotherapy or chemotherapy or undergoing surgical operations.Six authors of RCT replied and four of them provided more information on methods of randomization. Data analysis revealed that traditional oral nursing procedure was suitable for the severely sick patients who could not take self-care. Brushing and gargling were suitable for conscious patients who could use their hands. Tea and toothpaste were safe, economical and convenient oral nursing agents. Oral pH was a useful index for the selection of oral nursing agents and mouthwashes. A gargle containing sodium bicarbonate was used in the acidic oral environment and reduced fungal infection. The mouthwash with tea polyphenols had good effect for oral health, and might be as the first choice for prophylaxis of stomatitis induced by radiotherapy and/or chemotherapy. Some mouthwashes developed by Chinese herbs improved oral health efficiently. Some disinfectants with good safety and low toxicity might be used as supplementary agents in oral nursing care. Conclusions Oral nursing care procedures have improved the efficiency of oral care. But the conclusion should be verified by more, well designed randomized controlled trials involving a collaborative multidiscipliary health care professionals. Oral nursing care practice needs to be evidence based.
Objective To assess efficacy of mepivacaine on local anesthesia in dentistry and oral surgery and its safety. Methods Parallel group, stratified randomization, double blinded, muti-center clinical trial was designed. Two percent lidocaine with adrenaline in same cartridge was as control. Healthy patients with deep decay, pulpitis needed operative dentistry, or indication for extraction of the teeth, which located in the maxilla or front part of the mandible were included. Results Except 17 cases, 127 patients fulfilled inclusion criteria: 66 in treatment group and 61 in control group, dental filling for 60 and extraction for 67 cases, male 55 and female 72, average at 38.84 + 12.06 years. Submucous infiltration of 1.5 ml mepivacaine at labial or buccal side of the alveolar process produced onset of anesthesia in the median of 60 seconds which was same as that of lidocaine, anesthesia duration for 146.7 minutes with the median of 125 minutes, permitting painless filling or extractions. In the treatment group 81.82% freed of pain, while 15.15% had slight pain but received no extra local anesthetic for implementation of the treatment procedures, making the successful rate of 96.97%. In the mepivacaine group, 13.64% of the cases had transient elevation of the systolic pressure to the level of 145-162 mmHg, 8.33% diastolic pressure to the level of 91-93 mmHg. Only one case had transient palpitation in half minute after one minute injection of the drug with no medical care needed. All the cardiovascular reactions might result from adrenaline containing in the injections. Conclusion Mepivacaine is an effective, safe and reliable anesthetic agent for dentistry and oral surgery.