Comparative efficacy of an antiseptic mouthrinse and an antiplaque/antigingivitis dentifrice. A six-month clinical trial. Clinical effect of a new liquid dentifrice containing triclosan/copolymer on existing plaque and gingivitis. Comparative study of four over-the-counter mouthrinses claiming antiplaque and/or antigingivitis benefits. Comparative clinical trial of two antigingivitis mouthrinses. Comparison of the short-term antiplaque/antibacterial efficacy of two commercial dentifrices. Comparative antiplaque and antigingivitis effectiveness of a chlorhexidine and an essential oil mouthrinse: 6-month clinical trial. Efficacy of vitamin D supplementation in depression in adults: a systematic review protocol Comparative antiplaque and antigingivitis efficacy of a multipurpose essential oil-containing mouthrinse and a cetylpyridinium chloride-containing mouthrinse: A 6-month randomized clinical trial. Methodological quality of systematic reviews in subfertility: a comparison of Cochrane and non-Cochrane systematic reviews in assisted reproductive technologies. Antiplaque and antigingivitis effectiveness of a hexetidine mouthwash. A modification to the experimental gingivitis protocol to compare the antiplaque properties of two toothpastes. The antiplaque effect of herbal mouthwash in comparison to chlorhexidine in human gingival disease: a randomized placebo controlled clinical trial Essential oils in an antiplaque and antigingivitis dentifrice: a 6-month study. Superiority of essential oils versus 0.075% CPC-containing mouthrinse: a two-week randomized clinical trial. Biofeedback for treatment of awake and sleep bruxism in adults: systematic review protocol ANTIPLAQUE AND ANTIGINGIVITIS EFFECT OF LIPPIA SIDOIDES. A DOUBLE-BLIND CLINICAL STUDY IN HUMANS Financial Conflicts of Interest and Conclusions About Neuraminidase Inhibitors for Influenza ANTIPLAQUE AND ANTIGINGIVITIS EFFECTS OF A GEL CONTAINING PUNICA GRANATUM LINN EXTRACT. A DOUBLE-BLIND CLINICAL STUDY IN HUMANS Antiplaque and antigingivitis efficacy of toothpastes containing Triclosan and fluoride. Engaging medical librarians to improve the quality of review articles. Cluster Randomised Trials in Cochrane Reviews: Evaluation of Methodological and Reporting Practice Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. The efficacy of 0.12% chlorhexidine versus 0.12% chlorhexidine plus hyaluronic acid mouthwash on healing of submerged single implant insertion areas: a short‐term randomized controlled clinical trial Resting blood pressure reductions following isometric handgrip exercise training and the impact of age and sex: protocol for a systematic review Controversies around Xylitol Evidence-based clinical practice guideline for the evaluation of potentially malignant disorders in the oral cavity: A report of the American Dental Association. Part 3: Evidence evaluation process: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Title and Abstract Screening and Evaluation in Systematic Reviews (TASER): a pilot randomised controlled trial of title and abstract screening by medical students Interventions for domestic violence among pregnant women in low- and middle-income countries: a systematic review protocol Systematic review automation technologies Protocol for a systematic review of psychological interventions for cancer-related fatigue in post-treatment cancer survivors Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. Evaluation of a new method for librarian‐mediated literature searches for systematic reviews Key Steps in Conducting Systematic Reviews for Underpinning Clinical Practice Guidelines: Methodology of the European Association of Urology. Development and evaluation of an instrument for the critical appraisal of randomized controlled trials of natural products Implementing PRISMA-P: recommendations for prospective authors Clinical effect of a gel containing Lippia sidoides on plaque and gingivitis control Spine surgery research: on and beyond current strategies.
BACKGROUND The efficacy of an essential oil-containing antiseptic mouthrinse ( Listerine Antiseptic , Pfizer ) and an antiplaque/antigingivitis dentifrice ( Colgate Total , Colgate-Palmolive ) has been demonstrated in numerous double-blind clinical studies . This study was conducted to determine their comparative efficacy . METHODS Three hundred sixteen subjects with mild-to-moderate gingival inflammation and plaque received a dental prophylaxis and began their r and omly assigned brushing and rinsing regimen in an unsupervised setting . Subjects brushed for one minute and rinsed with 20 milliliters for 30 seconds twice daily for six months . The three groups were L ( control toothpaste/Listerine rinse ) , T ( Colgate Total toothpaste/control rinse ) and P ( control toothpaste/control rinse ) . RESULTS Subjects in the L and T groups demonstrated statistically significantly lower ( P < .001 ) Modified Gingival Index , or MGI ; Bleeding Index , or BI ; and Plaque Index , or PI , at both three and six months than subjects in the P group . The magnitude of reduction for the L group was 22.9 percent , 70 percent and 56.1 percent , respectively , and for the T group , 20.8 percent , 58 percent and 22.1 percent , respectively . Subjects in the L group were not different from subjects in the T group in regard to visual signs of gingivitis ( MGI ) , but were more effective ( P < .001 ) than subjects in the T group in experiencing reduced BI and PI . No product-related adverse events were reported . CONCLUSION Although the Listerine Antiseptic and Colgate Total antiplaque/antigingivitis products produced similar , clinical ly significant reductions in gingivitis ( as measured by MGI and BI ) , Listerine , when used in conjunction with a fluoride dentifrice and usual oral hygiene , provided a greater benefit in reducing plaque . CLINICAL IMPLICATION S When considering an antiplaque/antigingivitis product to recommend to patients , clinicians should consider Listerine Antiseptic , in conjunction with usual oral hygiene , if more rigorous plaque control is desired BACKGROUND Dentifrices traditionally have been formulated as pastes or gels . However , liquid varieties recently have become available The authors conducted a study to determine whether a fluori date d liquid product with added triclosan and a polyvinyl methyl ether/maleic acid , or PVM/MA , copolymer delivery system is efficacious for the control of supragingival plaque and gingivitis . METHODS The authors conducted a six-month , double-blind , parallel , stratified clinical study in accordance with American Dental Association guidelines for the clinical evaluation of antiplaque/antigingivitis products . Subjects who qualified with a suitable amount of existing plaque and gingivitis were given one of two dentifrices : an " experimental " liquid dentifrice containing 0.3 percent triclosan , 2.0 percent PVM/MA copolymer and 0.243 percent sodium fluoride , or NaF , in a silica base ; or a " placebo " dentifrice containing 0.243 percent NaF in a silica base . The authors collected subjects ' plaque and gingival index scores at baseline , three months and six months . RESULTS The results of the study indicate that the use of the experimental liquid dentifrice provided a significant reduction in existing levels of plaque and gingivitis as compared with the placebo st and ard dentifrice . At six months , the experimental group demonstrated a 34.9 percent reduction in plaque formation and a 25.7 percent reduction in gingivitis as compared with the placebo group ( P < .001 ) . CONCLUSIONS When compared with the placebo , the experimental dentifrice had a significantly better ability to reduce plaque and gingivitis . When compared with results reported in the literature , this new form of dentifrice achieved results comparable in efficacy to those of traditional dentifrice pastes with matching active ingredients . CLINICAL IMPLICATION S This study confirms that a liquid dentifrice containing a triclosan/copolymer/NaF delivery system is efficacious in its ability to reduce existing plaque and gingivitis The efficacy of over-the-counter mouthrinses cl aim ing to have antiplaque/antigingivitis benefits was compared using the modified Löe-Silness Gingival Index and the Quigley-Hein Plaque Index . The double-blind in vivo study involved 122 subjects . Each subject was r and omly assigned to one of five groups . Gingival inflammation and plaque were evaluated at 0 , 2 , 4 and 6 weeks of product use . Results revealed that plaque scores for some of the products were statistically significant from the control at the 4-week and 6-week visits . Changes in the gingival scores were negligible PURPOSE To compare the safety and the antiplaque and antigingivitis efficacy of two oral rinses . METHODS A r and omized , double-blind , parallel groups , single-center study was conducted to evaluate the safety and efficacy of a high bioavailable , alcohol-free 0.07 % cetylpyridinium chloride ( CPC ) rinse ( Crest Pro-Health Rinse ) and a positive control rinse containing essential oils ( EO ) and 21.6 % ethyl alcohol ( Cool Mint Listerine ) .  Seventy-eight healthy adults were enrolled in a modified experimental gingivitis clinical trial . Four weeks before the baseline visit , subjects received a prophylaxis and were instructed to brush twice daily in a manner to approach optimum gingival health . At the end of the 4-week period , subjects were r and omly assigned to treatment and instructed to use 20 ml of their assigned product for 30 seconds after brushing twice daily during a 21-day treatment phase . Plaque removal by brushing was prevented during the treatment phase for one m and ibular quadrant ( experimental gingivitis region ) by means of a specially-manufactured tooth shield . Safety and efficacy measurements were obtained at baseline and at the end-of-treatment using the Modified Gingival Index ( MGI ) , Gingival Bleeding Index ( GBI ) , and Modified Quigley-Hein Plaque Index ( MQH ) . At all visits , an oral soft tissue examination was performed for each subject . The efficacy data obtained in the experimental gingivitis region were analyzed with analysis of covariance .  RESULTS Seventy-five subjects completed the study and were included in the data analyses . No statistically significant differences were detected between the two treatment groups for MGI , GBI or MQH measures . Results were similar for shielded interproximal sites . Both treatments were well-tolerated . CLINICAL SIGNIFICANCE This r and omized , controlled comparative clinical trial demonstrated that rinsing twice daily with the experimental alcohol-free 0.07 % CPC rinse provides antiplaque and antigingivitis efficacy similar to that of the positive control EO rinse , a recognized antiplaque and antigingivitis mouthrinse that contains alcohol OBJECTIVE The objective of these three clinical trials was to compare the impact of two commercial products , Colgate Total and Crest Pro-Health , on the formation of dental plaque over a 24-hour period of time . The studies utilized the Modified Gingival Margin Plaque Index ( MGMPI ) , a vali date d and reliable clinical method for assessing the efficacy of products in reducing plaque build-up . METHODS Colgate Total and Crest Pro-Health were the test products for all three clinical trials . Colgate Great Regular Flavor ( CR ) was used as the universal washout product . Colgate Total , as the only toothpaste approved by the FDA under an NDA for antiplaque , antigingivitis , and anticaries benefits , contains 0.3 % triclosan/2.0 % PVM/MA copolymer for antigingivitis and antiplaque , as well as 0.243 % sodium fluoride ( NaF ) for anticaries . Crest Pro-Health contains 0.454 % stannous fluoride ( SnF2 ) as both a monographed anticaries agent and a monographed antigingivitis agent , along with sodium hexametaphosphate and zinc lactate .  Twenty-five healthy subjects meeting all study criteria were included into each of the double-blind studies . Product assignment was r and omized and a crossover design was implemented . Informed consent was obtained from all subjects prior to commencement of each of the studies . The studies followed published MGMPI procedures , which require subjects to receive a dental scaling/prophylaxis followed by a one-week washout period prior to use of test products . A baseline MGMPI score was calculated following use of the test products in the dental clinic . Subjects refrained from all oral hygiene for 24 hours following use of each test product , and returned to the clinic for a 24-hour MGMPI score . Following a washout period , subjects repeated the procedure with the other test product as per the crossover design . The differences ( delta ) between baseline plaque scores and 24-hour plaque scores were independently calculated for each study , and the delta values were compared for the two test products in each of the studies . RESULTS In all three clinical trials , Colgate Total significantly reduced plaque regrowth over a 24-hour time period ( p < or = 0.05 ) compared to Crest Pro-Health . Existing differences were determined via a paired t-test , which confirmed that Colgate Total was statistically significantly different from Crest Pro-Health . CONCLUSION These in vivo data support the antiplaque benefit of the 0.3 % triclosan/2.0 % PVM/MA copolymer/0.243 % sodium fluoride dentifrice . Additionally , the results support that Colgate Total provides superior efficacy in inhibiting the formation of dental plaque compared to Crest Pro-Health OBJECTIVES The objective of this study was to compare the antiplaque and antigingivitis effectiveness and the side-effect profiles of an essential oil-containing mouthrinse and a chlorhexidine-containing mouthrinse . MATERIAL AND METHODS One hundred and eight qualifying subjects , aged 20 - 57 years , were r and omized into three groups : essential oil mouthrinse ( ListerineAntiseptic ) ; 0.12 % chlorhexidine mouthrinse ( Peridex ) ; or 5 % hydroalcohol negative control . At baseline , subjects received a complete oral soft tissue examination and scoring of the Loe-Silness gingival index ( GI ) , Quigley-Hein plaque index ( PI ) , Volpe-Manhold calculus index ( CI ) , and Lobene extrinsic tooth stain index ( SI ) . Following a complete dental prophylaxis , subjects started rinsing twice daily with their respective mouthrinse as an adjunct to their usual mechanical oral hygiene procedures . One of the rinses on each weekday was supervised . Subjects were reexamined at 3 and 6 months . The treatment groups were compared with respect to baseline demographic and clinical variables . The primary efficacy variables were GI and PI . Intergroup differences for all clinical variables were tested at 3 and 6 months using appropriate statistical procedures . RESULTS All of the 108 r and omized subjects were evaluable at 3 months , and 107 subjects were evaluable at 6 months . There were no statistically significant differences among the three groups at baseline , with the exception that the control group PI was significantly lower than that of the essential oil group ( p<0.05 ) and the chlorhexidine group ( p<0.001 ) , and the essential oil mouthrinse group had a significantly greater number of subjects than the control group with body region SI scores > or = 1.0 ( p=0.021 ) . At 6 months , the essential oil and chlorhexidine mouthrinses produced statistically significant ( p<0.001 ) GI reductions of 14.0 % and 18.2 % , respectively , and statistically significant ( p<0.001 ) PI reductions of 18.8 % and 21.6 % , respectively , compared with the control and were not statistically significantly different from each other with respect to plaque and gingivitis reduction . The chlorhexidine mouthrinse group had significantly more calculus and extrinsic tooth stain than either the essential oil mouthrinse group or the control group . CONCLUSION This 6-month controlled clinical study demonstrated that the essential oil mouthrinse and the chlorhexidine mouthrinse had comparable antiplaque and antigingivitis activity . Insofar as side effects associated with the chlorhexidine mouthrinse may limit patient compliance , it is suggested that each product can have a distinct role in the management of patients with periodontal diseases Background The role of vitamin D in management of depression is unclear . Results from observational and emerging r and omized controlled trials ( RCTs ) investigating the efficacy of vitamin D in depression lack consistency - with some suggesting a positive association while others show a negative or inconclusive association . Methods / Design The primary aim of this study is to conduct a systematic review of RCTs to assess the effect of oral vitamin D supplementation versus placebo on depression symptoms measured by scales and the proportion of patients with symptomatic improvement according to the authors ’ original definition . Secondary aims include assessing the change in quality of life , adverse events and treatment discontinuation . We will conduct the systematic review and meta- analysis according to the recommendations of the Cochrane H and book for Systematic Review s of Interventions . We will search the Cochrane Central Register of Controlled Trials ( CENTRAL ) , MEDLINE ( 1966 to present ) , EMBASE ( 1980 to present ) , CINAHL ( 1982 to present ) , PsychINFO ( 1967 to present ) and Clinical Trials.gov . Unpublished work will be identified by search ing two major conferences : the International Vitamin Conference , the Anxiety Disorders and Depression Conference , while grey literature will be acquired by contacting authors of included studies . We will use the r and om-effects meta- analysis to synthesize the data by pooling the results of included studies . Discussion The results of this systematic review will be helpful in clarifying the efficacy of vitamin D supplementation and providing evidence to establish guidelines for implementation of vitamin D for depression in general practice and other relevant setting s. Study registration Unique identifier : CRD42013003849 OBJECTIVE This 6-month , examiner-blind , single-center , r and omized , parallel group clinical trial compared the antiplaque and antigingivitis effects of an essential oil-containing mouthrinse with zinc chloride and sodium fluoride ( EO ) to a 0.05 % cetylpyridinium chloride-containing mouthrinse ( CPC ) also with fluoride . METHOD AND MATERIAL S Four hundred and eight gingivitis subjects were monitored for the primary outcomes of modified Gingival Index ( MGI ) and Plaque Index ( PI ) at baseline and 3 and 6 months . Subjects were r and omly assigned to 6-month twice a day unsupervised use of EO , CPC , or negative control rinse in conjunction with normal brushing and flossing . RESULTS EO was always better than CPC at 3 and 6 months considering all parameters . All benefits allowed by EO increased from 3 to 6 months . CPC was better than the negative control at 3 and 6 months with respect to whole mouth plaque , and the proportion of more severe sites ( baseline scores ≥ 3 ) in PI and MGI . At 6 months , CPC did not differ from negative control in relation to whole mouth MGI reduction , proximal MGI reduction , and percentages of sites improved over baseline in PI and MGI . CONCLUSION This new EO mouthrinse provided superior clinical benefits to CPC and demonstrated increasing plaque and gingivitis reductions over 6 months . Our findings support the regular long-term use of the EO mouthrinse and selection over a 0.05 % CPC rinse for better efficacy STUDY QUESTION Are there differences in the method ological quality of Cochrane systematic review s ( CRs ) and non-Cochrane systematic review s ( NCRs ) of assisted reproductive technologies ? SUMMARY ANSWER CRs on assisted reproduction are of higher method ological quality than similar review s published in other journals . WHAT IS KNOWN ALREADY The quality of systematic review s varies . STUDY DESIGN , SIZE AND DURATION This was a cross-sectional study of 30 CR and 30 NCR systematic review s that were r and omly selected from the eligible review s identified from a literature search for the years 2007 - 2011 . MATERIAL S , SETTING AND METHODS We extracted data on the reporting and method ological characteristics of the included systematic review s. We assessed the method ological quality of the review s using the 11-domain Measurement Tool to Assess the Method ological Quality of Systematic Review s ( AMSTAR ) tool and subsequently compared CR and NCR systematic review s. MAIN RESULTS AND THE ROLE OF CHANCE The AMSTAR quality assessment found that CRs were superior to NCRs . For 10 of 11 AMSTAR domains , the requirements were met in > 50 % of CRs , but only 4 of 11 domains showed requirements being met in > 50 % of NCRs . The strengths of CRs are the a priori study design , comprehensive literature search , explicit lists of included and excluded studies and assessment s of internal validity . Significant failings in the CRs were found in duplicate study selection and data extraction ( 67 % meeting requirements ) , assessment for publication bias ( 53 % meeting requirements ) and reporting of conflicts of interest ( 47 % meeting requirements ) . NCRs were more likely to contain method ological weaknesses as the majority of the domains showed < 40 % of review s meeting requirements , e.g. a priori study design ( 17 % ) , duplicate study selection and data extraction ( 17 % ) , assessment of study quality ( 27 % ) , study quality in the formulation of conclusions ( 23 % ) and reporting of conflict of interests ( 10 % ) . LIMITATIONS , REASONS FOR CAUTION The AMSTAR assessment can only judge what is reported by authors . Although two of the five authors are involved in the production of CRs , the risk of bias was reduced by not involving these authors in the assessment of the systematic review quality . WIDER IMPLICATION S OF THE FINDINGS Not all systematic review s are equal . The reader needs to consider the quality of the systematic review when they consider the results and the conclusions of a systematic review . STUDY FUNDING /COMPETING INTEREST(S ) There are no conflicts with any commercial organization . Funding was provided for the students by the summer studentship programme of the Faculty of Medical and Health Sciences of the University of Auckl and OBJECTIVE To assess the  antiplaque/antigingivitis efficacy of a hexetidine-containing mouthwash . METHODS This examiner-blind , parallel group , controlled clinical study examined the effectiveness of a hexetidine ( 0.1 % ) mouthwash both in inhibiting the development of supragingival plaque and in reducing gingivitis . One hundred and thirty-four adult subjects completed the 2-week experimental gingivitis model study . Following baseline examinations , which included plaque index , modified gingival index and gingival bleeding index , subjects received a full dental prophylaxis . Subjects were r and omly assigned to one of three mouthwashes ( hexetidine 0.1 % , chlorhexidine 0.12 % ( positive control ) or a 5 % hydroalcohol negative control ) and commenced three times daily supervised rinsing as their sole method of oral hygiene . All indices were rescored after 2 weeks . RESULTS Compared to the negative control group , the hexetidine group demonstrated a statistically significant inhibition and reduction of supragingival plaque and gingival inflammation with reductions of 6.3 % , 33.5 % and 56 % for gingivitis , plaque and gingival bleeding , respectively . The results of the chlorhexidine group were used to vali date the study . CONCLUSION The study confirms the efficacy of a hexetidine rinse in reducing supragingival plaque and gingival inflammation BACKGROUND AND AIMS R and omised , blind , controlled experimental gingivitis and home-use study protocol s are used to evaluate the efficacy of oral hygiene products . The present method ological study combined the two clinical trial design s to compare the preventive and therapeutic potentials of two toothpastes . MATERIAL AND METHODS The study was a parallel group , r and omised , double-blind design , initially involving 73 healthy dentate subjects . A 21-day experimental gingivitis protocol was combined with a 6-week ( 42 days ) home-use protocol . At baseline , modified gingival index ( MGI ) , gingival index ( GI ) and gingival bleeding ( GB ) were recorded . A dental prophylaxis was then performed . Subjects were allocated to either control fluoride or stannous fluoride toothpaste based on gender and GI . During the first 21-day period , subjects applied the allocated toothpaste , for 1 min twice a day , to a group of teeth in a plastic shield and brushed the remaining teeth with the same paste . From day 21 the shield was not placed , and subjects brushed all teeth with the toothpaste for 1 min twice per day up to day 42 . MGI , GB and a plaque index ( PI ) were recorded on days 21 and 42 . RESULTS Sixty-nine and 67 subjects completed to days 21 and 42 , respectively . For shielded teeth , PI , MGI and GB increased to day 21 and then after ceasing the use of the shield decreased to day 42 . At day 21 , PI favoured the stannous fluoride toothpaste , but differences did not achieve statistical significance for any parameter at days 21 or 42 . For unshielded teeth , there were no significant differences between the toothpastes for any parameter at either time point . CONCLUSION : The feasibility of combining two gingivitis clinical trial method ologies appears proven , and data on both the preventive and therapeutic chemical and mechanical efficacy of toothpastes can be obtained through such protocol s. Specifically from the present study and consistent with some other reports , the plaque inhibitory properties of the stannous fluoride product are limited and do not always translate into an antiplaque/antigingivitis effect Abstract Background : The aim of this study was to compare the efficacy , safety , antiplaque and antigingivitis properties of a herbal mouthwash with chlorhexidine mouthwash . Methods : A double-blinded r and omized clinical trial was conducted among 72 undergraduate students with age group 18–24 years . They were r and omly divided into three mouthwash group with 24 participants in each group . Group A ( herbal ) , Group B ( chlorhexidine ) and Group C ( normal saline).The  Turesky et al. 1970 plaque index and Loe and Silness 1963 gingival index was recorded . Student ’s t-test and one-way ANOVA were used to test the significance . Results : A statistically highly significant difference was obtained between mouthwash B and C ( p=0.00 ) and a significant difference between mouthwash A and C ( p=0.004 ) , showing that chlorhexidine was superior to herbal mouthwash and saline . However , there was a nonsignificant difference between mouthwash A and B ( p=0.435 ) showing that herbal and chlorhexidine mouthwash was equally effective in reducing plaque and gingivitis . Conclusions : The efficacy of herbal mouthwash was equally effective in reducing plaque and gingivitis as compared to chlorhexidine mouthwash and may be considered as a good alternative . The chlorhexidine mouthwash was reported with many side effects which limits its acceptability and long-term use , whereas the presently tested herbal mouthwash had no side effects apart from mild burning sensation PURPOSE To determine if a dentifrice formulated with the fixed combination of essential oils possessed antiplaque and antigingivitis properties . MATERIAL S AND METHODS This study was a blinded , r and omized , controlled clinical trial . The 6-month study had clinical examinations at baseline , 3 and 6 months . The examinations consisted of three indices ; a plaque index , the Modified Gingival Index and a bleeding index . RESULTS At 6 months , the essential oil-containing dentifrice group had statistically significantly ( P < 0.001 ) lower whole-mouth and interproximal mean plaque index scores exhibiting mean reductions of 18.3 % and 18.1 % relative to the vehicle control . At 6 months , the essential oil-containing dentifrice group had statistically significantly ( P < 0.001 ) lower whole-mouth and interproximal mean gingival index scores compared to the vehicle control with reductions of 16.2 % and 15.5 % , respectively . Finally , for the gingival bleeding index , the essential oil-containing dentifrice group had statistically significantly ( P < 0.001 ) lower whole-mouth and interproximal mean bleeding index scores and reductions of 40.5 % and 46.9 % at 6 months compared to the vehicle control OBJECTIVE The objective of this r and omized , examiner-blind , parallel , controlled clinical study was to compare the antiplaque/antigingivitis efficacy of an essential oil-containing mouthrinse ( EO ) to a new 0.075 % cetylpyridinium chloride mouthrinse ( CPC ) using a two-week experimental gingivitis model with a 5 % hydroalcohol rinse serving as the negative control . METHODS After signing informed consents and completing baseline examinations , 185 subjects were r and omized into three groups . Subjects began supervised/recorded rinsing with 20 ml of their assigned rinse for 30 seconds twice daily for two weeks , with no mechanical oral hygiene permitted . Baseline and two-week assessment s were conducted as follows : Turesky Modification of the Quigley-Hein Plaque Index ( PI ) , Modified Gingival Index ( MGI ) , and the Gingival Bleeding Index ( BI ) . Analysis of efficacy variables ( i.e. , mean PI , mean MGI , mean BI , and proportion of bleeding sites derived from the BI ) was performed using a one-way analysis of covariance ( ANCOVA ) . RESULTS Among the 182 subjects who completed the study , the EO rinse showed statistically significant reductions compared to the negative control within the range previously reported in this model ; PI = 36.5 % ( p < 0.001 ) and MGI = 17.5 % ( p < 0.001 ) . A 43.2 % reduction in proportion of bleeding sites ( p < 0.001 ) was demonstrated . Mean PI , MGI , and proportion of bleeding sites at two weeks were statistically significantly lower for the EO rinse compared to the CPC rinse ( p < 0.001 ) , showing 27.7 % , 11.9 % , and 30.0 % reductions , respectively . CONCLUSION An EO rinse provided superior antigingivitis/antiplaque efficacy compared to a 0.075 % CPC rinse in this short-term clinical trial , and demonstrated efficacy within the range shown in previous studies using this model Background Bruxism is a disorder of jaw-muscle activity characterised by repetitive clenching or grinding of the teeth which results in discomfort and damage to dentition . The two clinical manifestations of the condition ( sleep and awake bruxism ) are thought to have unrelated aetiologies but are palliated using similar techniques . The lack of a definitive treatment has prompted renewed interest in biofeedback , a behaviour change method that uses electronic detection to provide a stimulus whenever bruxism occurs . This systematic review aims to provide a comprehensive overview of the state of research into biofeedback for bruxism ; to assess the efficacy and acceptability of  biofeedback therapy in management of awake bruxism and , separately , sleep bruxism in adults ; and to compare findings between the two variants . Methods A systematic review of published literature examining biofeedback as an intervention directed at controlling primary bruxism in adults . We will search electronic data bases and the grey literature using a predefined search strategy to identify r and omised and non-r and omised studies , technical reports and patents . Search es will not be restricted by language or date and will be exp and ed through contact with authors and experts , and by following up reference lists and citations . Two authors , working independently , will conduct screening of search results , study selection , data extraction and quality assessment and a third will resolve any disagreements . The primary outcomes of acceptability and effectiveness will be assessed using only r and omised studies , segregated by bruxism subtype . A meta- analysis of these data will be conducted only if pre-defined conditions for quality and heterogeneity are met , otherwise the data will be summarized in narrative form . Data from non-r and omised studies will be used to augment a narrative synthesis of the state of technical developments and any safety-related issues . PROSPERO registration number : CRD42013006880 . Discussion Biofeedback is not new , but its place in the clinical management of bruxism remains unclear . New research , and the availability of miniaturized consumer- grade devices , makes a systematic review timely to guide treatment decisions and inform future research Objectives : The antiplaque and antigingivitis effect of Lippia Sidoides ( LS ) was evaluated in this in vivo investigation . Material and Methods : Twenty-three subjects participated in a cross-over , double-blind clinical study , using 21-day partial-mouth experimental model of gingivitis . A toothshield was constructed for each volunteer , avoiding the brushing of the 4 experimental posterior teeth in the lower left quadrant . The subjects were r and omly assigned initially to use either the placebo gel ( control group ) or the test gel , containing 10 % LS ( test group ) . Results : The clinical results showed statistically significant differences for plaque index ( PLI ) ( p<0.01 ) between days 0 and 21 in both groups , however only the control group showed statistically significant difference ( p<0.01 ) for the bleeding ( IB ) and gingival ( GI ) index within the experimental period of 21 days . On day 21 , the test group presented significantly better results than the control group with regard to the GI ( p<0.05 ) . Conclusions : The test gel containing 10 % LS was effective in the control of gingivitis Industry funding and author financial conflicts of interest may influence the production and synthesis of scientific evidence ( 1 ) . Associations with the pharmaceutical company developing and marketing a drug have been found to influence the design of trials ( 2 ) , the conduct of trials ( 3 ) , and the reporting of trial results ( 47 ) . Furthermore , financial ties and industry funding seem to result in greater rates of favorable conclusions in clinical trials examining new drugs ( 812 ) . Fewer studies have considered the potential influence of financial conflicts of interest on the synthesis of clinical evidence in systematic review s ( 13 , 14 ) . Neuraminidase inhibitors , which are used in the prophylaxis and treatment of seasonal and p and emic influenza , have been the subject of ongoing uncertainty about their specific clinical benefits ( 15 , 16 ) . This is the result of not only the continuing emergence of strains with unknown drug responses but also the increasing awareness in the medical community that , until recently , its knowledge of the safety and efficacy of these drugs has been incomplete ( 17 ) . Despite the abundance of clinical trials and publications on neuraminidase inhibitors , the details of many key trials had not been disclosed ( 18 , 19 ) . As a result , systematic review ers analyzing and synthesizing evidence on the effectiveness of these agents have faced incomplete information , unresolved discrepancies in the data , and a high risk of publication and reporting biases among the primary clinical trials ( 20 , 21 ) . This prompted extensive efforts to access complete records of all published and unpublished clinical trials from manufacturers , culminating in the publication of several review s on the basis of comprehensive clinical study reports and potentially changing the way systematic review s will be undertaken in the future ( 2227 ) . Review s of neuraminidase inhibitors exhibit wide variation in their conclusions , ranging from strong endorsements of the use of these agents in the prophylaxis and treatment of influenza ( 28 , 29 ) to more conservative assessment s question ing the evidence on the drugs ' safety and efficacy ( 15 , 30 ) . The reasons for this discordance in review conclusions are likely multifactorial and may be related in part to the manner in which evidence is accessed , synthesized , and presented ( 23 , 27 ) , both in terms of the numerical results and the authors ' emphasis and interpretation ( 31 , 32 ) . Our aim was to determine whether there is an association between financial conflicts of interest and the favorable presentation of evidence in systematic review s on the use of neuraminidase inhibitors for the prophylaxis and treatment of influenza . Methods Data Sources Systematic review s were identified in PubMed , PubMed In Process , EMBASE , and the Cochrane Data base of Systematic Review s. Search es were done using the keywords influenza , neuraminidase inhibitors , oseltamivir , zanamivir , peramivir , and laninamivir . Articles were retrieved if the search terms appeared in the title or abstract or were included as data base-specific keywords . In PubMed and EMBASE , search es were also constrained to review publication types . We limited our search to English- language articles published since 1 January 2005 . These articles were manually review ed to identify those that focused on the use of neuraminidase inhibitors for influenza prophylaxis or treatment ( such as excluded articles primarily about drug development or other manufacturing processes ) . We selected all review s that used a systematic search protocol , which we defined as the inclusion and reporting of an explicit search strategy , including reasons for subsequent exclusion of articles . The final search es were done on 26 May 2014 . Cochrane review s are periodically up date d to incorporate new evidence , and the results and conclusions are resynthesized as indicated . The authors of these review s are typically different , and there may be differences in the methods as well as the results and language of the review . These up date d review s were included separately . Other Cochrane review s are occasionally rewritten by a subset of the authors for publication in medical journals as abridged versions to increase dissemination . These reports have separate peer review s and are prepared on the basis of a selection of the complete results . We considered these review s separately as well but also did a sensitivity analysis in which they were combined with the original Cochrane review s. Data Extraction Financial conflicts of interest were identified for all authors of the review s and included affiliations with or funding from the pharmaceutical company manufacturing any of the neuraminidase inhibitors under review . We defined financial conflicts of interest as employment , the funding of grants paid to an author or an author 's research group , and the funding of medical writers for the systematic review . These financial conflicts of interest were identified using information about affiliations or funding listed in the systematic review s , as well as in any other articles published by one of the authors during the 3 years before the publication of the index systematic review . In addition , we search ed authors ' personal and institutional Web sites ; lists of disclosures from GlaxoSmithKline ( Research Triangle Park , North Carolina ) and Roche Pharmaceuticals ( Basel , Switzerl and ) ; and performed Web search es combining the names of the authors , drugs , and pharmaceutical companies to identify any additional information about financial relationships . Details of the specific financial conflicts of interest identified for each author are listed in Appendix Table 1 . Appendix Table 1 . Financial Conflicts of Interest Among Authors of the Systematic Review s For each systematic review , we recorded whether prophylaxis or treatment was assessed , the forms of evidence to be included ( such as r and omized , controlled trials and observational studies ) , the specific clinical outcomes assessed , the population s examined , and whether meta-analyses were done . We also examined whether the review s included information about the validity or quality of the primary literature . In particular , we recorded whether there were statements addressing nonpublication of primary studies or publication bias , including tests done by the review ers to assess for bias in meta-analyses ( such as the Egger or Begg test [ 33 , 34 ] ) , difficulty in accessing comprehensive study data , and the prevalence or role of industry in conducting and funding the primary studies . Data Analysis Two investigators were provided with redacted copies of each review that did not include the review s ' authors , their affiliations , or information on financial conflicts of interest . These versions also did not contain the journal name , journal formatting , or the article 's acknowledgments or references . The investigators independently evaluated the review s and classified the prophylaxis and treatment assessment s as favorable or not favorable toward the use of neuraminidase inhibitors . They were instructed to do this grading on the basis of the entirety of the review text without restriction to conclusions or recommendations made in any specific section of the review , thus allowing them to take into account the emphasis and interpretation of the authors throughout the review . The agreement between the investigators was strong at 86 % ( Cohen , 0.72 ; P < 0.001 ) . Disagreements were resolved by a third investigator using the same redacted copies . Descriptive analyses were done to examine the associations between financial conflicts of interest and the grading of the systematic review s. A sensitivity analysis excluding the summary review s was done to further examine this association . We also assessed the association between financial conflicts of interest and the inclusion of statements addressing the validity or quality of the primary evidence . Role of the Funding Source This study was funded by the Australian National Health and Medical Research Council . The funding source had no role in the design and conduct of the study , analysis of the results , or the decision to su bmi t the manuscript for publication . Results We identified 827 published articles across the 4 data bases using the specified search criteria , with 26 systematic review s included in the final cohort ( Figure ) . Thirteen review s examined prophylaxis and 24 examined treatment of influenza , accounting for 37 distinct assessment s ( Appendix Table 2 ) . In terms of review methods , 7 were Cochrane systematic review s and 19 conducted and reported a meta- analysis ( 73 % ) . The evidence inclusion criteria were limited to r and omized , controlled trials for 14 of the systematic review s ( 54 % ) , and 5 included evidence from clinical study reports or patient-level data . The main population s examined were healthy adults ( 18 of 26 systematic review s ) , children ( 13 of 26 ) , and hospitalized patients ( 6 of 24 ) . The outcome measures for prophylaxis assessment s included influenza-like illness and laboratory-confirmed influenza . For the treatment assessment s , the outcomes were illness duration , influenza-related complications , hospitalization , and mortality , mostly in combination . Five review s were up date s of previous Cochrane review s , and 3 were summary review s based on Cochrane review s. Figure . Summary of evidence search and selection . Eligible systematic review s included those with outcomes related to the prophylaxis or treatment of influenza . Appendix Table 2 . Characteristics of Systematic Review s Examining Prophylaxis and Treatment Outcomes for Neuraminidase Inhibitors Association Between Financial Conflicts of Interest and Favorable Assessment s Seven of the 26 systematic review s ( 27 % ) , corresponding to 8 of the 37 assessment s ( 22 % ) , were associated with a financial conflict of interest ( Appendix Table 1 ) . We identified financial conflicts of interest in publications other than the index systematic review in 2 cases , and no additional Objectives : The antiplaque and antigingivitis effects of a gel containing 10 % Punica granatum Linn extract were evaluated using a 21-day partial-mouth experimental model of gingivitis . Methods : 23 volunteers participated in this cross-over , doubleblind study , carried out in 2 phases of 21 days each . For each period of the experiment , an acrylic toothshield was made for each volunteer to carry the test or placebo gel as well as to avoid brushing of the 4 experimental teeth ( posterior teeth in the lower left quadrant ) . The subjects were r and omly assigned to use either the placebo gel ( control group ) or the test gel ( experimental group ) and were instructed to brush the remaining teeth normally 3 times a day . On days 0 and 21 , the visible plaque index ( VPI ) and gingival bleeding index ( GBI ) were recorded . Results : The results did not show statistically significant difference between control and experimental groups for either of the indices ( VPI and GBI ) . Conclusion : The gel containing 10 % Punica granatum Linn extract was not efficient in preventing supragingival dental plaque formation and gingivitis OBJECTIVE To compare the reduction of plaque and gingivitis from the following three toothpaste formulations containing : 0.3 % Triclosan , 1,000ppm fluoride and 0.13 % calcium glycerophosphate in a natural calcium carbonate base ( a new paste ) ; 0.2 % Triclosan and 1,000ppm fluoride in a precipitated calcium carbonate base ; 0.3 % Triclosan , 1,000ppm fluoride and Gantrez in a silica base . A control group was maintained , which used commercially available toothpastes without the above actives . METHODS A double-blind , four-cell , stratified , parallel group design study . Subjects brushed twice daily with their allocated toothpaste for 12 weeks . Plaque , MGI and gingival bleeding assessment s were carried out at baseline , after 6 and 12 weeks of product use . RESULTS AND CONCLUSION An analysis of covariance of the 12-week results showed significant differences between products [ p<0.0001 ] for plaque , MGI and gingival bleeding . The new toothpaste formulation containing 0.3 % Triclosan , 1,000ppm fluoride and 0.13 % calcium glycerophosphate in a natural calcium carbonate base was shown to be significantly more effective in reducing plaque and gingivitis than the other toothpaste formulations in the study Review articles published in JAMA summarize various aspects of medical practice and are written by known authorities . An expert ’s opinion about a topic has value , but often more can be learned by that expert ’s assessment of all the pertinent literature . When reading individual research articles , readers could miss subtle features of the studies that are more apparent to an expert clinician research er . Readers benefit from the expert ’s explanation of the validity and applicability of individual studies . When authors summarize the literature , a natural tendency is to select articles supporting their views . To minimize this potential for bias , JAMA editors ask authors to systematic ally review the literature and comment on as much of it as is practical . Extensive literature search es can be difficult to perform , given the complexity of the search process and authors ’ time constraints . It is also unlikely that a content expert will be familiar with the intricacies of more than one data base . Empirical evidence provides a strong rationale for search ing multiple data bases . 1,2 For this reason , collaborating with medical librarians is recommended when writing review articles . A general approach for this collaboration is presented in the Box . Preliminary search es conducted by a librarian can help refine the question and determine its feasibility and scope . These initial screening search es can also inform the development of the review ’s prospect i ve inclusion and exclusion criteria . The choice of data base depends on several factors . Most important is the content ( topic ) Objective Systematic review s can include cluster-r and omised controlled trials ( C- RCTs ) , which require different analysis compared with st and ard individual-r and omised controlled trials . However , it is not known whether review authors follow the method ological and reporting guidance when including these trials . The aim of this study was to assess the method ological and reporting practice of Cochrane review s that included C- RCTs against criteria developed from existing guidance . Methods Criteria were developed , based on method ological literature and personal experience supervising review production and quality . Criteria were grouped into four themes : identifying , reporting , assessing risk of bias , and analysing C- RCTs . The Cochrane Data base of Systematic Review s was search ed ( 2nd December 2013 ) , and the 50 most recent review s that included C- RCTs were retrieved . Each review was then assessed using the criteria . Results The 50 review s we identified were published by 26 Cochrane Review Groups between June 2013 and November 2013 . For identifying C- RCTs , only 56 % identified that C- RCTs were eligible for inclusion in the review in the eligibility criteria . For reporting C- RCTs , only eight ( 24 % ) of the 33 review s reported the method of cluster adjustment for their included C- RCTs . For assessing risk of bias , only one review assessed all five C- RCT -specific risk-of-bias criteria . For analysing C- RCTs , of the 27 review s that presented unadjusted data , only nine ( 33 % ) provided a warning that confidence intervals may be artificially narrow . Of the 34 review s that reported data from unadjusted C- RCTs , only 13 ( 38 % ) excluded the unadjusted results from the meta-analyses . Conclusions The method ological and reporting practice s in Cochrane review s incorporating C- RCTs could be greatly improved , particularly with regard to analyses . Criteria developed as part of the current study could be used by review authors or editors to identify errors and improve the quality of published systematic review s incorporating C- RCTs BACKGROUND An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence -Based Dentistry conducted a systematic review and formulated evidence -based clinical recommendations for the arrest or reversal of  noncavitated and cavitated dental caries  using nonrestorative treatments  in children and adults . TYPES OF STUDIES REVIEW ED The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid , Cochrane CENTRAL , and Cochrane data base of systematic review s to identify r and omized controlled trials reporting on nonrestorative treatments  for noncavitated and cavitated carious lesions . The authors used the Grading of Recommendations Assessment , Development and Evaluation approach to assess the certainty in the evidence and move from the evidence to the decisions . RESULTS The expert panel formulated 11 clinical recommendations , each specific to lesion type , tooth surface , and dentition . Of the most effective interventions , the panel provided recommendations for the use of 38 % silver diamine fluoride , sealants , 5 % sodium fluoride varnish , 1.23 % acidulated phosphate fluoride gel , and 5,000 parts per million fluoride ( 1.1 % sodium fluoride ) toothpaste or gel , among others . The panel also provided a recommendation against the use of 10 % casein phosphopeptide-amorphous calcium phosphate . CONCLUSIONS AND PRACTICAL IMPLICATION S Although the recommended interventions are often used for caries prevention , or in conjunction with restorative treatment options , these approaches have shown to be effective in arresting or reversing carious lesions . Clinicians are encouraged to prioritize use of these interventions based on effectiveness , safety , and feasibility Objectives : The study was performed to evaluate the incidence of post‐surgical adverse events at submerged implant sites as well as the antiplaque , antigingivitis and antistaining effects in the entire dentition of patients treated with two mouthwashes . Methods : The present r and omized controlled clinical study considered 40 patients subjected to dental implant treatment .  Two 0.12 % chlorhexidine mouthwashes were compared for 15 days : one with 0.1 % hyaluronic acid ( CHX⊗HYL group ) and one without it ( CHX group ) . Surgical outcome variables , and plaque , gingival , and staining indexes were recorded . Results : Significant differences were found between the two rinses regarding the presence of oedema within 2 days after surgery ( 20 % for the CHX⊗HYL group and 78 % for the CHX group ) . No other significant differences were recorded between the two mouthwashes . No intergroup differences in plaque , staining and gingivitis indexes were registered . The intragroup analysis revealed that for the plaque and gingival indexes , the differences between the baseline values ( before surgery ) and those at 15 days were all found to be significant just for CHX⊗HYL rinse , with final values ranging from 0.18 to 0.23 for the plaque index and from 0.06 to 0.07 for the gingival index . The staining index increased for both mouthwash types with significant results ( with final value of 0.19 and 0.31 for CHX⊗HYL and CHX groups , respectively ) . Conclusions : In the sites of patients subjected to dental implant placement , an additional anti‐oedematigenous effect in early healing seemed to be disclosed for 0.12 % CHX⊗HYL mouthwash . Regarding antiplaque and antigingivitis activities , HYL seemed to be ineffective Background The risk of developing cardiovascular disease is directly correlated to one ’s resting blood pressure ( BP ) , age , and biological sex . Resting BP can be reduced using h and grip exercise training , but the impact of age and sex on the effectiveness of training is not well documented . Methods / design A systematic search of the literature will be conducted for all experimental studies ( including r and omized controlled trials and prospect i ve experiments ) that report the influence of isometric h and grip exercise training on resting systolic blood pressure . The data bases Medline , Embase , Cochrane Review s , Cumulative Index to Nursing and Allied Health Literature ( CINAHL ) , SPORTD iscus , Web of Science , Allied and Complementary Medicine ( AMED ) , PubMed , and Scopus will be search ed until 1 December 2015 . Screening of potential articles , data abstract ion , and quality appraisal will be completed in duplicate independently . When necessary , corresponding authors will be contacted in order to facilitate the separation of pooled data into age and sex categories . Method ological quality will be determined using the Quality Assessment Framework developed by the Cochrane Collaboration and the Newcastle-Ottawa Quality Assessment Scale as appropriate . Any discrepancies will be resolved by a third author . Findings will be presented in accordance with the preferred reporting items for systematic review s and meta- analysis ( PRISMA ) guidelines . Discussion This systematic review will determine the overall effectiveness  of h and grip exercise training in improving resting blood pressure . A novel , focused assessment will contrast  effectiveness of h and grip training  based on the age ( younger 18–54 years , older > 55 years ) and the sex ( men , women ) of study participants . This information is essential to consoli date before moving forward with the development and implementation of h and grip exercise training programmes which are design ed to best meet the needs of particular cohorts . Systematic review registration PROSPERO Xylitol research has been conducted since the early 70 ’s ; at the beginning of 2009 there were almost 500 PubMed - indexed papers on “ xylitol and dental ” . Xylitol research was initiated in Finl and , but nowadays the majority of papers are published by non-Finnish authors . Xylitol studies have been criticized mainly by European research ers . This criticism is reflected for example in the most recent textbook of cariology , Dental Caries – The Disease and its Clinical Management ( 2008 ) , used by students in all Nordic countries . It shows a figure with reduction in caries occurrence in the Turku Sugar Studies as an example , not of the effect of total substitution of dietary sugars with xylitol , but rather “ indicating the importance of removal of sugar from the diet , rather than starch , in caries control “ . Moreover , a frequently cited review in Caries Research in 2004 came to the conclusion that “ there is no evidence for a caries-therapeutic effect of xylitol”.1 Xylitol studies are easy to criticize especially by authors who have never been involved in field trials . For example , to avoid exchange of test products between children of the same class r and omisation has to be done by schools or school classes . This is rarely recognized by the critics of xylitol studies . In addition , it is hard to find volunteers to comply with 2–3 years chewing of a hard and tasteless gum base , which is the control often suggested for chewing gum trials . Polyols like maltitol and sorbitol are by no means inert and are thus not valid controls for xylitol . Fortunately , US dental experts have critically , but positively , conducted research and review ed the literature on xylitol.2–5 One consequence of practical problems associated with field trials is that in systematic review s of methods for caries control and prevention the strict exclusion criteria leave only few xylitol studies for evaluation . For example , the inclusion criteria for a Swedish systematic review on methods of caries prevention ( SBU ; www.sbu.se ) were so strict that hardly any recommendations concerning caries prevention could be made . This also applied to xylitol : according to the report , the evidence on the clinical efficacy for xylitol was inconclusive . In a critical evaluation of the SBU report , the following question was asked “ where does this leave the confused dental practitioner , who has to offer chairside advice to patients , but can not wait of further ( good- quality ) research to be conducted and published , providing a more solid evidence -base ? ” ( Stillman-Lowe , 2005 ) . On the other h and , xylitol has been recommended for use in caries control and prevention by several dental associations . Also the European Food Safety Authority evaluated the literature on xylitol in 2008 and came to the conclusion that “ xylitol chewing gum reduces the risk of caries in children ” . The cl aim had to be reformulated since chewing gum is not a medicine and can thus not be cl aim ed to reduce the risk of a disease , caries . In Europe , there is a strong interest not to give xylitol a better status than for other polyol sweeteners . Xylitol differs from other polyols as is obvious to all experts familiar with microbiology . Xylitol has beneficial effects on the oral flora not shared by other polyols . The evidence so far supports specific xylitol-effects on oral bacteria , but not on saliva .  Xylitol can not be metabolized by plaque bacteria , contrary to sorbitol and other 6-carbon polyols , and may thus favour mineralization . The accumulated evidence suggests that 1 ) mutans streptococci are the target organisms of xylitol in vivo , 2 ) mutans streptococci are reduced and stay on a lower level even during long-term xylitol consumption as long as the consumption lasts , 3 ) xylitol consumption reduces the accumulation of plaque , 4 ) xylitol consumed by mothers reduces the mother-child transmission of mutans streptococci and consequently , caries occurrence in their children,6,7 and 5 ) xylitol consumption reduces the risk of caries in children.4 In clinical trials on xylitol mostly chewing gum with high xylitol concentrations has been used . Studies with low daily doses of xylitol are known as a rule to fail to show any caries-preventive effects . To obtain beneficial xylitol-effects on mutans streptococci , on plaque and caries occurrence xylitol must be consumed three times or more per day , with a daily dose of 5–6 grams.4,7 When using chewing gums or pastilles , saliva stimulation always occurs due to chewing or sucking . Some authors have cl aim ed that the beneficial effects of xylitol are solely based on saliva stimulation and that all sugar-free gums are similar in this respect . In fact , in conditions where caries occurrence is high , even sorbitol gum can prevent caries.8 A recent study elegantly shows caries prevention with xylitol without any saliva stimulation . In this study fifteen-month-old children were given xylitol or sorbitol syrup with a syringe for 12 months.9 The xylitol syrup prevented  early childhood caries  effectively , while sorbitol had no effect . In spite of the abundant literature still more studies are needed on the action of xylitol . Biofilm models could be very useful in xylitol research . There is a clear need for properly design ed , r and omized , controlled , clinical trials to demonstrate 1 ) the feasibility of  xylitol prevention in different population s with different dietary and oral hygiene habits , 2 ) suitable vehicles to deliver xylitol , 3 ) the extent to which xylitol can be “ diluted ” with other polyols without losing the caries preventive effects , and 4 ) the minimum daily xylitol dose and frequency of xylitol are needed to obtain the expected xylitol-effects on mutans streptococci , plaque and most importantly , on caries occurrence . Clinical trials often aim to improve treatment methods . When several clinical trials give similar results , clinicians can be given treatment guidelines based on findings verified by research . In this way research serves the clinicians in treating patients according to evidence -based solid information . Systematic review s are currently required to up date guidelines for caries prevention . As such , critical evaluation of the existing literature is a positive goal , but if it leads to a situation where no treatment guidelines can be given , something is wrong . This also applies to xylitol studies . Though strict inclusion criteria prevent conclusions based on systematic review s of the literature , evidence -based treatment guidelines can still be given for the use of xylitol . Xylitol is a useful adjunct to traditional methods for caries control and prevention . Caries prevention with xylitol has been cl aim ed to be expensive , but if true primary prevention is obtained , as demonstrated in the mother-child study , 6,7 it may be worth it BACKGROUND An expert panel convened by the American Dental Association ( ADA ) Council on Scientific Affairs and the Center for Evidence -Based Dentistry conducted a systematic review and formulated clinical recommendations to inform primary care clinicians about the potential use of adjuncts as triage tools for the evaluation of lesions , including potentially malignant disorders ( PMDs ) , in the oral cavity . TYPES OF STUDIES REVIEW ED This is an up date of the ADA 's 2010 recommendations on the early diagnosis of PMDs and oral squamous cell carcinoma . The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid and the Cochrane Central Register of Controlled Trials to identify r and omized controlled trials and diagnostic test accuracy studies . The authors used the Grading of Recommendations Assessment , Development and Evaluation approach to assess the certainty in the evidence and to move from the evidence to the decisions . RESULTS The panel formulated 1 good practice statement and 6 clinical recommendations that concluded that no available adjuncts demonstrated sufficient diagnostic test accuracy to support their routine use as triage tools during the evaluation of lesions in the oral cavity . For patients seeking care for suspicious lesions , immediate performance of a biopsy or referral to a specialist remains the single most important recommendation for clinical practice . In exceptional cases , when patients decline a biopsy or live in rural areas with limited access to care , the panel suggested that cytologic testing may be used to initiate the diagnostic process until a biopsy can be performed ( conditional recommendation , low- quality evidence ) . CONCLUSIONS AND PRACTICAL IMPLICATION S The authors urge clinicians to remain alert and take diligent action when they identify a PMD . The authors emphasize the need for counseling because patients may delay diagnosis because of anxiety and denial > “ There are known knowns . These are things we know that we know . There are known unknowns . That is to say , there are things that we now know we do n't know . But there are also unknown unknowns . These are things we do not know we do n't know . ” > > —United States Secretary of Defense Donald Rumsfeld ( February 2002 ) > “ Thought is the wind , knowledge the sail , and mankind the vessel . ” > > August Hare ( 1792–1834 ) The international resuscitation community , under the auspices of the International Liaison Committee on Resuscitation ( ILCOR ) , has performed an exhaustive review of the published literature related to resuscitation and emergency cardiovascular care ( ECC ) . We had the opportunity to build on the detailed process developed over the past decade that facilitated the publication of the international consensus statement on therapeutic hypothermia1 and the Consensus on Cardiopulmonary Resuscitation ( CPR ) and ECC Science With Treatment Recommendations in 2005 (C2005).2 The overall process has been informed by the increasing evidence base behind good , systematic literature review s.3,4 There are , however , many questions that have never been addressed in a r and omized controlled trial , and much of the supporting scientific literature is at lower levels of evidence ( LOEs ) . In total , 356 worksheet authors from 29 countries throughout the world completed 411 worksheets on 277 topics . The information from these worksheets , with additional iterations from the writing groups and editorial board , makes up the evidence base from which the 2010 International Consensus on CPR and ECC Science with Treatment Recommendations ( CoSTR ) document is derived . As has been the process since the evidence evaluation for Guidelines 2000,5 volunteers from around the world were asked to perform systematic review s of the literature . These review s were conducted according to st and ardized instructions in completing the evidence worksheet template , and these worksheets were subsequently review ed in a detailed iterative process ( see www . ILCOR.org).6 A revised worksheet template ( based on that Background The production of high quality systematic review s requires rigorous methods that are time-consuming and re source intensive . Citation screening is a key step in the systematic review process . An opportunity to improve the efficiency of systematic review production involves the use of non-expert groups and new technologies for citation screening . We performed a pilot study of citation screening by medical students using four screening methods and compared students ’ performance to experienced review authors . Methods The aims of this pilot r and omised controlled trial were to provide preliminary data on the accuracy of title and abstract screening by medical students , and on the effect of screening modality on screening accuracy and efficiency . Medical students were r and omly allocated to title and abstract screening using one of the four modalities and required to screen 650 citations from a single systematic review up date . The four screening modalities were a reference management software program ( EndNote ) , Paper , a web-based systematic review workflow platform ( ReGroup ) and a mobile screening application ( Screen2Go ) .  Screening sensitivity and specificity were analysed in a complete case analysis using a chi-squared test and Kruskal-Wallis rank sum test according to screening modality and compared to a final set of included citations selected by expert review authors . Results Sensitivity of medical students ’ screening decisions ranged from 46.7 % to 66.7 % , with students using the web-based platform performing significantly better than the paper-based group . Specificity ranged from 93.2 % to 97.4 % with the lowest specificity seen with the web-based platform . There was no significant difference in performance between the other three modalities . Conclusions Medical students are a feasible population to engage in citation screening . Future studies should investigate the effect of incentive systems , training and support and analytical methods on screening performance . Systematic review registration Cochrane Data base Background Violence during pregnancy is a global problem , associated with serious health risks for both the mother and baby . Evaluation of interventions targeted for reducing or controlling domestic violence ( DV ) is still in its infancy , and the majority of findings are primarily from high-income countries ( HICs ) . Therefore , there is an urgent need for generating evidence of DV interventions among pregnant women in low- and middle-income countries ( LMICs ) . Methods Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRISMA ) guidelines will be employed to structure the review . A comprehensive search will be carried out via electronic data bases including MEDLINE , CINAHL , Scopus , Embase , Web of Science , PsycINFO , and The Cochrane library . Gray literature will also be scrutinized for potential articles . An optimal search strategy has been developed following consultations with subject-matter experts and librarians . This search strategy will be adapted to the different data bases . Experimental studies evaluating DV interventions among pregnant women from LMICs will be included in the review . The review will only include literature written in English . Two review ers will independently screen and assess studies for inclusion in the review . A third author will resolve any discrepancies between the review ers . Risk of bias will be assessed based on the Cochrane risk of bias assessment tool , and overall quality of the evidence will be judged using Grading of Recommendations , Assessment , Development , and Evaluation ( GRADE ) criteria . Findings will be presented with the narrative synthesis , and if applicable , they will be further quantified using r and om-effects meta- analysis . Effect size , risk ratio for dichotomous variables , and st and ardized mean differences for continuous variables will be calculated for each outcome using Review Manager 5.3 . Discussion Systematic review s to evaluate the efficacy of interventions to address DV within the perinatal context have been limited . Hence , no one intervention has emerged as substantially effective towards addressing perinatal DV and associated health consequences . The evidence generated from this systematic review will inform research ers and policy makers about the effectiveness of existing DV interventions among pregnant women in LMICs and provide recommendations for future research in this area . This in turn will contribute towards violence prevention in LMICs . Systematic review registration PROSPERO Systematic review s , a cornerstone of evidence -based medicine , are not produced quickly enough to support clinical practice . The cost of production , availability of the requisite expertise and timeliness are often quoted as major contributors for the delay . This detailed survey of the state of the art of information systems design ed to support or automate individual tasks in the systematic review , and in particular systematic review s of r and omized controlled clinical trials , reveals trends that see the convergence of several parallel research projects . We surveyed literature describing informatics systems that support or automate the processes of systematic review or each of the tasks of the systematic review . Several projects focus on automating , simplifying and /or streamlining specific tasks of the systematic review . Some tasks are already fully automated while others are still largely manual . In this review , we describe each task and the effect that its automation would have on the entire systematic review process , summarize the existing information system support for each task , and highlight where further research is needed for realizing automation for the task . Integration of the systems that automate systematic review tasks may lead to a revised systematic review workflow . We envisage the optimized workflow will lead to system in which each systematic review is described as a computer program that automatically retrieves relevant trials , appraises them , extracts and synthesizes data , evaluates the risk of bias , performs meta- analysis calculations , and produces a report in real time Background Fatigue is a common symptom in cancer patients that can persist beyond the curative treatment phase . Some evidence has been reported for interventions for fatigue during active treatment . However , to date , there is no systematic review on psychological interventions for fatigue after the completion of curative treatment for cancer . This is a protocol for a systematic review that aims to evaluate the effectiveness of psychological interventions for cancer-related fatigue in post-treatment cancer survivors . This systematic review protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) data base . Methods / design We will search the Cochrane Central Register of Controlled Trials ( CENTRAL ; The Cochrane Library ) , PubMed , MEDLINE , EMBASE , CINAHL , PsycINFO , and relevant sources of grey literature . R and omised controlled trials ( RCTs ) which have evaluated psychological interventions in adult cancer patients after the completion of treatment , with fatigue as an outcome measure , will be included . Two review authors will independently extract data from the selected studies and assess the method ological quality using the Cochrane Collaboration Risk of Bias Tool . Discussion Most existing evidence on cancer-related fatigue is from those in active cancer treatment . This systematic review and meta- analysis will build upon previous evaluations of psychological interventions in people during and after cancer treatment . With the growing need for stage-specific research in cancer , this review seeks to highlight a gap in current practice and to strengthen the evidence base of r and omised controlled trials in the area . Systematic review registration PROSPERO CRD42014015219 BACKGROUND CONTEXT Low back pain ( LBP ) is a prevalent disorder in society that has been associated with increased loss of work time and medical expenses . A common intervention for LBP is spinal manipulation , a technique that is not specific to one scope of practice or profession . PURPOSE The purpose of this systematic review was to examine the effectiveness of physical therapy spinal manipulations for the treatment of patients with low back pain . METHODS A search of the current literature was conducted using PubMed , CINAHL , SPORTD iscus , Pro Quest Nursing and Allied Health Source , Scopus , and Cochrane Controlled Trials Register . Studies were included if each involved : 1 ) individuals with LBP ; 2 ) spinal manipulations performed by physical therapists compared to any control group that did not receive manipulations ; 3 ) measurable clinical outcomes or efficiency of treatment measures , and 4 ) r and omized control trials . The quality of included articles was determined by two independent authors using the criteria developed and used by the Physiotherapy Evidence Data base ( PEDro ) . RESULTS Six r and omized control trials met the inclusion criteria of this systematic review . The most commonly used outcomes in these studies were some variation of pain rating scales and disability indexes . Notable results included varying degrees of effect sizes favoring physical therapy spinal manipulations and minimal adverse events result ing from this intervention . Additionally , the manipulation group in one study reported statistically significantly less medication use , health care utilization , and lost work time . CONCLUSION Based on the findings of this systematic review there is evidence to support the use of spinal manipulation by physical therapists in clinical practice . Physical therapy spinal manipulation appears to be a safe intervention that improves clinical outcomes for patients with low back pain Objective To evaluate and vali date the time of completion and results of a new method of search ing for systematic review s , the exhaustive search method ( ESM ) , using a pragmatic comparison . Methods Single‐line search strategies were prepared in a text document . Term completeness was ensured with a novel optimization technique . Macros in MS Word converted the syntaxes between data bases and interfaces almost automatically . We compared search characteristics , such as number of search terms and data bases , and outcomes , such as number of included and retrieved references and precision , from ESM search es and other Dutch academic hospitals identified by search ing PubMed for systematic review s published between 2014 and 2016 . We compared time to perform the ESM with a secondary comparator of recorded search times from published literature and contact with authors to acquire unpublished data . Results We identified 73 published Erasmus MC systematic review s and 258 published by other Dutch academic hospitals meeting our criteria . We pooled search time data from 204 other systematic review s. The ESM search es differed by using 2 times more data bases , retrieving 44 % more references , including 20 % more studies in the final systematic review , but the time needed for the search was 8 % of that of the control group . Similarities between methods include precision and the number of search terms . Conclusions The evaluated similarities and differences suggest that the ESM is a highly efficient way to locate more references meeting the specified selection criteria in systematic review s than traditional search methods . Further prospect i ve research is required CONTEXT The findings of systematic review s ( SRs ) and meta-analyses ( MAs ) are used for clinical decision making . The European Association of Urology has committed increasing re sources into the development of high quality clinical guidelines based on such SRs and MAs . OBJECTIVE In this paper , we have summarised the process of conducting SRs for underpinning clinical practice guidelines under the auspices of the European Association of Urology Guidelines Office . EVIDENCE ACQUISITION The process involves explicit methods and the findings should be reproducible . When conducting a SR , the essential first step is to formulate a clear and answerable research question . An extensive literature search lays the foundation for evidence synthesis . Data are extracted independently by two review ers and any disagreements are resolved by discussion or arbitration by a third review er . EVIDENCE SYNTHESIS In SRs , data for particular outcomes in individual r and omised controlled trials may be combined statistically in a meta- analysis to increase power when the studies are similar enough . Biases in studies included in a SR/MA can lead to either an over estimation or an under estimation of true intervention effect size , result ing in heterogeneity in outcome between studies . A number of different tools are available such as Cochrane Risk of Bias assessment tool for r and omised controlled trials . In circumstances where there is too much heterogeneity , or when a review has included nonr and omised comparative studies , it is more appropriate to conduct a narrative synthesis . The GRADE tool for assessing quality of evidence strives to be a structured and transparent system , which can be applied to all evidence , regardless of quality . A SR not only identifies , evaluates , and summarises the best available evidence , but also the gaps to be targeted by future studies . CONCLUSIONS SRs and MAs are integral in developing sound clinical practice guidelines and recommendations . PATIENT SUMMARY Clinical practice guidelines should be evidence based , and systematic review s and meta-analyses are essential in their production . We have discussed the key steps of conducting systematic review s and meta-analyses in this paper Background The efficacy of natural products ( NPs ) is being evaluated using r and omized controlled trials ( RCTs ) with increasing frequency , yet a search of the literature did not identify a widely accepted critical appraisal instrument developed specifically for use with NPs . The purpose of this project was to develop and evaluate a critical appraisal instrument that is sufficiently rigorous to be used in evaluating RCTs of conventional medicines , and also has a section specific for use with single entity NPs , including herbs and natural source d chemicals . Methods Three phases of the project included : 1 ) using experts and a Delphi process to reach consensus on a list of items essential in describing the identity of an NP ; 2 ) compiling a list of non-NP items important for evaluating the quality of an RCT using systematic review methodology to identify published instruments and then compiling item categories that were part of a vali date d instrument and /or had empirical evidence to support their inclusion and 3 ) conducting a field test to compare the new instrument to a published instrument for usefulness in evaluating the quality of 3 RCTs of a NP and in applying results to practice . Results Two Delphi rounds result ed in a list of 15 items essential in describing NPs . Seventeen item categories fitting inclusion criteria were identified from published instruments for conventional medicines . The new assessment instrument was assembled based on content of the two lists and the addition of a Review er 's Conclusion section . The field test of the new instrument showed good criterion validity . Participants found it useful in translating evidence from RCTs to practice . Conclusion A new instrument for the critical appraisal of RCTs of NPs was developed and tested . The instrument is distinct from other available assessment instruments for RCTs of NPs in its systematic development and validation . The instrument is ready to be used by pharmacy students , health care practitioners and academics and will continue to be refined as required Systematic review s have become very popular . A recent estimate suggests that 22 new systematic review s are published daily [ 1 ] . One reason for this interest is that they serve many purpose s. For example , the influential Institute of Medicine has indicated that a systematic review is an essential component when developing clinical practice guidelines within the USA [ 2 ] . Some granting agencies are now advocating for the use of systematic review s as an evidence -based rationale for the conduct of a proposed r and omized trial [ 3 ] . And journals are now dem and ing the use of systematic review s to provide readers with context of the results of a clinical trial [ 4 ] . For systematic review s to be useful , they need to be reported in the highest possible quality thus facilitating their accurate use across a wide spectrum of stakeholders , including patients . Unfortunately , surveys of the published literature indicate that the quality of reporting is not optimal . For example , there is evidence indicating that reporting biases , particularly selective outcome reporting , is prevalent . An early example of differences between outcomes reported in protocol s and the paired completed review was an examination of 47 Cochrane review s in which 43 ( 91 % ) contained a major change , such as the addition or deletion of outcomes  , between the protocol and the full publication [ 5 ] . More recently , in an examination of 485 Cochrane protocol - review pairs , 38 % ( 95 % CI 23 to 54 % ) were found to have discrepant outcomes ( i.e. , added , omitted , or changed the priority ) between the protocol and completed review [ 6 ] . The vast majority of these discrepancies were without attribution with more significant outcomes being up grade d or added . Whether or not , and to what extent , these examples reflect reporting biases is not clear . However , they represent inconsistencies that should be avoided by authors . The gold st and ard for identifying reporting biases is a comparison of the completed review with its paired protocol . Such an examination is difficult with systematic review s as too few of them report working from a protocol , although a growing number of funders are now requiring them . Perhaps , systematic review ers do not report or use protocol s because there has been little guidance on how to report them until recently . To help facilitate the use of reporting systematic review protocol s , the three of us and several colleagues developed Preferred Reporting Items for Systematic Review and Meta- Analysis Protocol s ( PRISMA -P ) [ 7 ] . This is a reporting guideline consisting of a 17-item checklist , to help prospect i ve authors in the preparation and reporting of a scientifically rigorous systematic review protocol . We also prepared a pedagogical explanation and elaboration document to facilitate its use [ 8 ] . Readers appear interested in the guidance . Since its publication a little more than a year ago , it has been downloaded about 45,000 times and cited ( Google scholar ) nearly 100 times . This journal and others have endorsed PRISMA -P. Here , we describe how the journal intends to implement it . All protocol su bmi ssions to the journal should use continuous line numbering in their manuscript . Authors should also include a completed PRISMA -P checklist indicating whether or not the requested item information is reported ( by completing the check mark ) . If the item is checked , authors should then specify the line number ( or range of line numbers ) where this information is described . Manuscripts accepted for publication will have the completed PRIMSA-P checklist ( on su bmi ssion ) included as an Appendix to their publication , which must be referenced within the main text ( Additional file 1 ) . Prospect i ve authors can download a Word version of the PRISMA -P checklist , which includes the two added columns , from the journal ’s website ( URL to be added)or the PRISMA website ( ttp://www . prisma -statement.org/Extensions/ Protocol s.aspx ) . If PRISMA -P was used to help report the protocol , it should be cited or the PRISMA -P URL ( http://www . prisma -statement.org/Extensions/ Protocol s.aspx ) on the PRISMA website should be reported . About half of what the journal publishes are protocol s of systematic review s. We want to ensure they are published to the highest possible quality . Endorsement and implementation of reporting guidelines appears to improve the completeness of reporting . For example , a systematic review examining the completeness of reporting in more than 16,000 r and omized trials in journals that endorsed the CONSORT statement , compared to journals that did not , found more complete reporting [ 9 ] . Similarly , examining 300 systematic review s published in February 2014 found that mention of PRISMA was associated with better reporting [ 1 ] . There is always a tension between an optimal implementation strategy and ensuring minimal barriers to su bmi ssion for prospect i ve authors . We believe the journal has achieved a good balance with this strategy . Protocol s su bmi tted for publication consideration from now on that do not include a completed checklist , including the two aforementioned columns , will be returned to the authors with instructions about the journal ’s systematic review protocol implementation strategy and invited to resu bmi t their continuously line numbered manuscript and appropriately completed checklist Objective : This parallel controlled clinical trial evaluated the effect of a gel containing Lippia sidoides essential oil on plaque and gingivitis control . Methods : Thirty patients ( n=30 ) were r and omly selected and allocated into three groups : Lippia sidoides ( LS , n=10 ) , chlorhexidine ( CLX , n=10 ) or placebo ( control , n=10 ) . Plaque and bleeding index were recorded at baseline and after three months . All volunteers were instructed to brush with the gel three times a day throughout the experiment period . Results : There was a significant reduction on plaque and gingivitis in the test groups ( P<.05 ) , but no statistically significant difference was observed between them ( P>.05 ) . Conclusion : A gel preparation containing 10 % Lippia sidoides essential oil was an efficient herbal antiplaque and antigingivitis agent BACKGROUND CONTEXT Systematic review s of the literature are powerful tools in evidence -based medicine . However , the design and report of systematic review s in spinal surgery contain many aspects amenable to improvement . PURPOSE To discuss the issues especially relevant for systematic review s in spinal surgery . METHODS From our experience of systematic review s and meta-analyses of clinical trials in  spinal surgery  , we infer guidance for the design and execution of systematic literature review s. RESULTS There are many difficulties associated with the design as well as conduct of clinical trials and consequently appraising evidence in spinal surgery . New treatments should be compared with the gold st and ard before other comparisons are investigated . Studies should present data as thoroughly as possible regarding all subgroups and follow-up moments , possibly in supplementary material . To provide the highest level of evidence , systematic review s should be as rigorously design ed as possible . CONCLUSIONS Gathering information on clinical effectiveness in spinal surgery can be improved both at the clinical study level and at the systematic review level . Alternatives to r and omized controlled trials such as comparative studies can be valuable tools on the clinical effectiveness of treatments in spinal surgery . The experience reflected in this article can support the scientific efforts in this field
The studies in this systematic review provide strong evidence of the antiplaque , antigingivitis effects of multiple agents .
BACKGROUND AND METHODS The author conducted a systematic review of the literature to evaluate the efficacy of  antigingivitis and antiplaque products  in six-month trials .