Non-Cochrane · intervention · PM24377091
Reducing Alaska Native paediatric oral health disparities: a systematic review of oral health interventions and a case study on multilevel strategies to reduce sugar-sweetened beverage intake.
Chi Donald L · International journal of circumpolar health · 2013 · PubMed · doi:10.3402/ijch.v72i0.21066
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
34
current version
GRADE rated
0
No studies
0
Included studies
11
linked below
No studies 0 · 0%Ungraded 34 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Alaska Native children below age 18 | Alaska Native (and American Indian) Head Start preschoolers; pregnant Alaska Native women/infants; DHAT dental patients (n=9 publications) |
| Intervention | Population-based oral health interventions | Three intervention types: caregiver/community education (n=2 publications); dental chemotherapeutics/xylitol gum (n=2 publications); mid-level dental providers - DHATs and PDHAs (n=5 studies) |
| Comparison | Comparison groups (per PICO screening); comparator not otherwise pre-specified | Pre-intervention baseline / discontinued program; placebo gum; dentists; baseline simulation scenario |
| Outcomes | Oral health outcomes / intervention effectiveness (e.g. tooth decay prevention); challenges encountered | BBTD prevalence reduction; child dental caries (not assessed, trial discontinued); DHAT technical performance/satisfaction/record keeping; simulated DMFT, SiC index, caries-free %, dental utilisation |
| Study designs | Clinical trials, evaluation studies, systematic reviews, conference abstracts and reports (English, 1970-2012) | Non-randomized community-based trials (n=2); discontinued RCT (n=2 reports); observational DHAT evaluations (n=4); simulation/modeling study (n=1) |
| Timing | Follow-up period abstracted per study; publication years 1970-2012 | Education 3-8 years; chemotherapeutics none (discontinued); DHAT evaluations cross-sectional; PDHA simulation 20-year projection |
Search date: October 5, 2012. Databases: Medline (PubMed); Embase; Web of Science; GoogleScholar; health foundation websites (e.g. Kellogg Foundation, Robert Wood Johnson Foundation)
Questions and results
Community and caregiver oral health education plus media campaign vs Pre-intervention BBTD rate
Population: Alaska Native and American Indian Head Start children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Baby bottle tooth decay prevalence 3 years · Medium-intensity training Medium-intensity community education was associated with an 18% reduction in BBTD prevalence, without a GRADE rating. Source: Results · same question in other reviews | Percent reduction in BBTD prevalence 18 | 1 study | Ungraded |
Reduction in prevalence of baby bottle tooth decay (BBTD) 3 to 8 years Population: Alaska Native and American Indian Head Start (preschool) children Community and caregiver oral health education was associated with a significant ~25% overall reduction in baby bottle tooth decay among Head Start children (certainty not graded). Source: Results (Study results); Table I; References [17][18] · same question in other reviews | Percent reduction in BBTD prevalence 25 | 1 study | Ungraded |
Baby bottle tooth decay prevalence 3 years · High-intensity training High-intensity community education was associated with a 33% reduction in BBTD prevalence, without a GRADE rating. Source: Results · same question in other reviews | Percent reduction in BBTD prevalence 33 | 1 study | Ungraded |
Baby bottle tooth decay prevalence 3 years · Alaska Native site Population: Alaska Native Head Start children The Alaska Native site had a 20% increase in BBTD prevalence, without a GRADE rating. Source: Results · same question in other reviews | Percent increase in BBTD prevalence 20 | 1 study | Ungraded |
Baby bottle tooth decay prevalence 3 years · Low-intensity training Low-intensity community education was associated with a 27% reduction in BBTD prevalence, without a GRADE rating. Source: Results · same question in other reviews | Percent reduction in BBTD prevalence 27 | 1 study | Ungraded |
Ongoing BBTD Prevention Program vs BBTD Prevention Program discontinued in 1989
Population: Alaska Native and American Indian Head Start children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Baby bottle tooth decay prevalence 1986 to 1994 · Program maintained Sites maintaining the prevention program had a 28% reduction in tooth decay rate, without a GRADE rating. Source: Results · same question in other reviews | Percent reduction in tooth decay rate 28 | 1 study | Ungraded |
Baby bottle tooth decay prevalence 1986 to 1994 · Program discontinued Sites discontinuing the prevention program had a non-significant 15% reduction in tooth decay rate, without a GRADE rating. Source: Results · same question in other reviews | Percent reduction in tooth decay rate 15 | 1 study | Ungraded |
Dental care provided by dental health aide therapists (DHATs, mid-level providers) vs Dental care provided by dentists (or no comparison group)
Population: Alaska Native dental patients (children aged 6-17 and adults) and their caregivers
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Technical performance / deficient restorations (DHATs vs dentists) Cross-sectional (DHATs practising ~9 months to several years) · Amalgam restorations DHATs had a lower amalgam restoration deficiency rate than dentists (12% vs 22%; certainty not graded). Source: Results (Study results); References [23][24] · same question in other reviews | Deficient restorations (%), DHAT vs dentist 12 vs 22 (DHAT vs dentist) | 2 studies | Ungraded |
Quality of dental record keeping by DHATs Cross-sectional (DHATs practising ~9 months to several years) Dental record keeping by DHATs was high quality and met Indian Health Service guidelines (certainty not graded). Source: Results (Study results); Table I; References [21][23] · same question in other reviews | Record keeping by DHATs was consistent with evaluation criteria; the 4 practising DHATs met Indian Health Service guidelines on record keeping. | 2 studies | Ungraded |
Technical performance / deficient restorations (DHATs vs dentists) Cross-sectional (DHATs practising ~9 months to several years) · Composite restorations DHATs and dentists had similar composite restoration deficiency rates (15% vs 12%; certainty not graded). Source: Results (Study results); References [23][24] · same question in other reviews | Deficient restorations (%), DHAT vs dentist 15 vs 12 (DHAT vs dentist) | 2 studies | Ungraded |
Infant dental caries Trial discontinued Population: Pregnant Alaska Native women and their infants No infant caries outcomes were assessed because the proposed randomized trial was discontinued. Source: Results; Table I · same question in other reviews | no estimate extracted | 1 study | Ungraded |
Technical performance / deficient restorations (DHATs vs dentists) Cross-sectional (DHATs practising ~9 months to several years) · Stainless steel crowns DHATs had a lower stainless steel crown deficiency rate than dentists (3% vs 9%; certainty not graded). Source: Results (Study results); References [23][24] · same question in other reviews | Deficient placements (%), DHAT vs dentist 3 vs 9 (DHAT vs dentist) | 2 studies | Ungraded |
Primary dental health aide (PDHA) service-delivery models (PDHA program; PDHA + intensive staffing; PDHA + robust prevention) vs Baseline pre-intervention service-delivery scenario
Population: Alaska Native children (below age 18)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Projected Significant Caries (SiC) index 20-year projection · Children overall A simulation projected a 50% drop in the Significant Caries index for children (12.3 to 6.1) under the PDHA model (certainty not graded). Source: Results (Study results); Table I; References [25] · same question in other reviews | Significant Caries (SiC) index, children 6.1 | 1 study | Ungraded |
Projected proportion of caries-free children (5-18 years) 20-year projection · Baseline (pre-intervention) model A simulation projected 0% of children aged 5-18 would be caries-free under the baseline scenario (certainty not graded). Source: Results (Study results); Table I; References [25] · same question in other reviews | Caries-free children 5-18 y (%) 0 | 1 study | Ungraded |
Projected receipt of school-based prevention services 20-year projection A simulation projected that over 90% of children would receive school-based prevention services under the PDHA model, up from 53% (certainty not graded). Source: Results (Study results); Table I; References [25] · same question in other reviews | Children receiving school-based prevention services (%) >90 | 1 study | Ungraded |
Clinical care quality 9 months Population: Alaska dental health aide therapists Four newly trained DHATs met stated clinical care standards in a qualitative evaluation, without a GRADE rating. Source: Results; Table I · same question in other reviews | Four practising DHATs met Indian Health Service guidelines for record keeping and standards of care for cavity preparation and restoration, patient management, and patient safety. | 1 study | Ungraded |
Projected dental care utilisation 20-year projection A simulation projected that the PDHA program would raise dental care utilisation from 75% to 90% (certainty not graded). Source: Results (Study results); Table I; References [25] · same question in other reviews | Projected dental care utilisation (%) 90 | 1 study | Ungraded |
Projected Significant Caries (SiC) index 20-year projection · 12-year-olds A simulation projected a 70% drop in the Significant Caries index for 12-year-olds (10.5 to 3.3) under the PDHA model (certainty not graded). Source: Results (Study results); Table I; References [25] · same question in other reviews | Significant Caries (SiC) index, 12-year-olds 3.3 | 1 study | Ungraded |
Projected proportion of caries-free children (5-18 years) 20-year projection · PDHA + robust prevention model A simulation projected that the PDHA + robust prevention model would leave over 50% of children aged 5-18 caries-free (certainty not graded). Source: Results (Study results); Table I; References [25] · same question in other reviews | Caries-free children 5-18 y (%) >50 | 1 study | Ungraded |
Projected proportion of caries-free children (5-18 years) 20-year projection · PDHA or PDHA + intensive staffing model A simulation projected only 8% of children aged 5-18 would be caries-free under the PDHA or PDHA + intensive staffing models (certainty not graded). Source: Results (Study results); Table I; References [25] · same question in other reviews | Caries-free children 5-18 y (%) 8 | 1 study | Ungraded |
Projected mean DMFT (children below 5 years) 20-year projection A simulation projected mean DMFT in children under 5 would fall from 7.4 to 4.9 under the PDHA model (certainty not graded). Source: Results (Study results); Table I; References [25] · same question in other reviews | Mean DMFT, children <5 y 4.9 | 1 study | Ungraded |
DHAT-delivered dental care vs Dentist-delivered dental care
Population: Alaska dental health aide therapists
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Stainless steel crown preparation and placement deficiency No stainless steel crown preparation deficiencies were reported; placement deficiency was 3% for DHATs versus 9% for dentists, without a GRADE rating. Source: Results · same question in other reviews | Proportion deficient 0% for preparations; 3% vs 9% for placements | 2 studies | Ungraded |
Composite restoration deficiency Composite restoration deficiency was 15% for DHATs versus 12% for dentists, without a GRADE rating. Source: Results · same question in other reviews | Proportion of deficient composite restorations 15% vs 12% | 2 studies | Ungraded |
Consistency of diagnosis and postoperative complications No significant difference was reported between DHATs and dentists in diagnosis consistency or postoperative complications, without a GRADE rating. Source: Results · same question in other reviews | There was no significant difference between DHATs and dentists in consistency of diagnosis or postoperative complications. | 1 study | Ungraded |
Caregiver satisfaction Population: Caregivers of Alaska Native children aged 6 to 17 years More than 90% of caregivers reported being usually or always satisfied with DHAT care, without a GRADE rating. Source: Results · same question in other reviews | Proportion usually or always satisfied >90% | 1 study | Ungraded |
Amalgam restoration deficiency Amalgam restoration deficiency was 12% for DHATs versus 22% for dentists, without a GRADE rating. Source: Results · same question in other reviews | Proportion of deficient amalgam restorations 12% vs 22% | 2 studies | Ungraded |
Amalgam preparation deficiency Two of 13 DHAT amalgam preparations were deficient, without a GRADE rating. Source: Results · same question in other reviews | Number of deficient DHAT amalgam preparations 2 | 2 studies | Ungraded |
PDHA program vs Baseline pre-intervention scenario
Population: Alaska children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Clinic-based dental care utilization 20 years The PDHA program was projected to increase clinic-based dental care utilization from 75% to 90%, without a GRADE rating. Source: Results; Table I · same question in other reviews | Percentage-point increase 15 | 1 study | Ungraded |
Mean decayed missing and filled teeth 20 years Population: Alaska children below age 5 years The PDHA program was projected to reduce mean DMFT in children below age 5 from 7.4 to 4.9, without a GRADE rating. Source: Results · same question in other reviews | Mean DMFT 7.4 to 4.9 | 1 study | Ungraded |
School-based oral health promotion services 20 years The PDHA program was projected to raise school-based oral health promotion service receipt from 53% to more than 90%, without a GRADE rating. Source: Results · same question in other reviews | Percentage receiving services >90% | 1 study | Ungraded |
Significant caries index 20 years · Children The PDHA program was projected to reduce the SiC index 50% from 12.3 to 6.1 for children, without a GRADE rating. Source: Results · same question in other reviews | Percent reduction in SiC index 50 | 1 study | Ungraded |
Significant caries index 20 years · Age 12 years Population: Alaska children aged 12 years The PDHA program was projected to reduce the SiC index 70% from 10.5 to 3.3 for 12-year-olds, without a GRADE rating. Source: Results · same question in other reviews | Percent reduction in SiC index 70 | 1 study | Ungraded |
PDHA program with robust prevention vs PDHA program or PDHA program with intensive staffing
Population: Alaska children aged 5 to 18 years
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Tooth decay-free children 20 years The robust prevention PDHA model was projected to yield more than 50% tooth decay-free children versus 8% with other PDHA models, without a GRADE rating. Source: Results · same question in other reviews | Percentage tooth decay-free >50% vs 8% | 1 study | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Technical performance / deficient preparations (DHATs) Composite preparations | Deficient preparations (%) 0 | 2 studies | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Partial Yes | Yes | no |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | No | No | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: N/A · NRSI: No | NRSI: No · RCT: No | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: N/A | NRSI: N/A · RCT: N/A | no |
| 12Impact of risk of bias on the pooled results | N/A | N/A | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | N/A | no |
| 15Publication bias investigatedcritical | N/A | N/A | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 11
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Bader et al. 2011 Clinical technical performance of dental therapists in Alaska DOI:10.14219/jada.archive.2011.0171 | this review only | Technical performance / deficient restorations (DHATs vs dentists); Composite restoration deficiency | not extracted yet | not extracted yet |
| Bolin 2008 Assessment of Treatment Provided by Dental Health Aide Therapists in Alaska DOI:10.14219/jada.archive.2008.0080 | this review only | PM24377091-P3-O3; Consistency of diagnosis and postoperative complications | not extracted yet | not extracted yet |
| Bruerd & Jones 1996 matched by author and year (probable) | this review only | Baby bottle tooth decay prevalence | not extracted yet | not extracted yet |
| Bruerd et al. 1989 matched by author and year (probable) | this review only | Baby bottle tooth decay prevalence | not extracted yet | not extracted yet |
| Bruerd, 1996 matched by author and year (probable) | this review only | Baby bottle tooth decay prevalence | not extracted yet | not extracted yet |
| Fiset 2005 matched by author and year (probable) | this review only | Technical performance / deficient restorations (DHATs vs dentists); Projected dental care utilisation | not extracted yet | not extracted yet |
| Jolles et al. 2008 matched by author and year (probable) | this review only | Baby bottle tooth decay prevalence; Infant dental caries | not extracted yet | not extracted yet |
| Kiley et al. 2008 Lossless synthesis of graphene nanosheets decorated with tiny cadmium sulfide quantum dots with excellent nonlinear optical properties. PMID:20081286 | this review only | Projected mean DMFT (children below 5 years) | not extracted yet | not extracted yet |
| Kiley, 2008 matched by author and year (probable) | this review only | Clinic-based dental care utilization | not extracted yet | not extracted yet |
| Riedy 2010 matched by author and year (probable) | this review only | Baby bottle tooth decay prevalence; Infant dental caries | not extracted yet | not extracted yet |
| RTI International 2010 matched by author and year (probable) | this review only | PM24377091-P3-O1 | not extracted yet | not extracted yet |