Controversie
Meno carie per tutti?
Osservazioni sulle Linee Guida Nazionali per la promozione della salute orale e la prevenzione delle patologie orali in età evolutiva
LESS CARIES FOR EVERYBODY? A CRITICAL POINT OF VIEW OF THE ITALIAN GUIDELINES
Mattia Doria, Roberto Buzzetti
1Pediatra di famiglia, Chioggia (Venezia)
2Epidemiologo, Rimini
Marzo 2010 - pagg. 161 -164
Abstract
This paper analyzes the methodological quality of the National Guidelines of the Italian
Ministry of Health for the prevention of caries. Beside the formal evaluation through the
AGREE check-list, the composition of the panel producing the guideline, the method for retrieving
and assessing evidence, the grading of recommendations and the wording of
the individual statements were analyzed in detail. The link between studies and levels of
evidence, and between levels of evidence and strength of recommendations, is at times not
sufficiently robust. Comments on applicability were made. Although there is insufficient evidence
to support the systemic fluoride-prophylaxis for the prevention of caries, the guideline
recommends this praxis. There are numerous trials and systematic reviews in favour of
topical products containing fluoride but issue of acceptability and economic feasibility
should be considered.
Classificazione MeSH
Bibliografia
1. Ministero del Lavoro, della Salute e delle
Politiche Sociali. Linee Guida Nazionali per la
promozione della salute orale e la prevenzione
delle patologie orali in età evolutiva (http://
www.salute.gov.it/sorrisoSalute/archivioDoc
umentiSorrisoSalute.jsp?lingua=italiano&
id=867).
2. Programma Nazionale per le Linee Guida. Manuale Metodologico; http://www.snlg.it/ cms/files/Manuale_PNLG_0.pdf.
3. Scottish Intercollegiate Guidelines Network; http://www.sign.ac.uk/guidelines/fulltext/ 50/index.html.
4. AGREE (Appraisal of Guidelines REsearch & Evaluation in Europe): uno strumento per la valutazione della qualità delle linee guida cliniche; http://asr.regione.emilia-romagna.it/ wcm/asr/collana_dossier/doss060/link/doss 60.pdf.
5. Campus G, Solinas G, Cagetti MG, et al. The Italian Study Group on Children Oral Health. ECC (Early Childhood Caries) in Italy, pattern and severity. Caries Res 2007;41:299-300.
6. Campus G, Sacco G, Cagetti M, Abati S. Changing trend of caries from 1989 to 2004 among 12-year old Sardinian children. BMC Public Health 2007b;7:28doi:10.1186/1471- 2458-7-28.
7. Karjalainen S. Eating patterns, diet and dental caries. Dent Update 2007;34:295-300.
8. Law V, Seow WK, Townsend G. Factors influencing oral colonization of mutans streptococci in young children. Aust Dent J 2007; 52:93-100.
9. Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet 2007;369:51-9.
10. Kumar JV, Moss ME. Fluorides in Dental Public Health Programs. Dent Clin N Am 2008;52:387-401.
11. The GRADE working group. Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490-4.
12. Leverett DH, Adair SM, Vaughan BW, Proskin HM, Moss ME. Randomized clinical trial of the effect of prenatal fluoride supplements in preventing dental caries. Caries Res 1997; 31:174-9.
13. Sá Roriz Fonteles C, Zero DT, Moss ME, Fu J. Fluoride concentrations in enamel and dentin of primary teeth after pre- and postnatal fluoride exposure. Caries Res 2005;39:505-8.
14. http://www.sign.ac.uk/guidelines/fulltext/ 47/index.html.
15. http://www.sign.ac.uk/pdf/2005dentalreport. pdf.
16. Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. MMWR 2001;50:1-42.
17. Kumar JV, Moss ME. Fluorides in Dental Public Health Programs. Dent Clin North Am 2008;52:387-401.
18. Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2002;(3):CD002279. Review.
19. Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2002;(2):CD002280. Review.
20. Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003;(1):CD002278. Review.
21. Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003;(3):CD00-
2284. Review.
22. Marinho VC, Higgins JP, Logan S, Sheiham A. Topical fluoride (toothpastes, mouthrinses, gels, or varnishes) for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003;(4):CD00-
2782. Review.
23. Marinho VC, Higgins JP, Sheiham A, Logan S. Combinations of topical fluoride (toothpastes, mouthrinses, gels, or varnishes) versus single topical fluoride for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2004;(1):CD002781. Review.
24. Marinho VC, Higgins JP, Sheiham A, Logan S. One topical fluoride (toothpastes, or mouthrinses, or gels, or varnishes) versus another for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2004;(1):CD002780. Reviews.
25. Tubert-Jeannin S, Tramini P, Gerbaud L, et al. Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children. Cochrane Database Syst Rev 2009;(1):CD007592. Protocols.
26. Erickson PR, Mazhari E. Investigation of the role of human breast milk in caries developement. Pediatr Dent 1999;21:86-90.
2. Programma Nazionale per le Linee Guida. Manuale Metodologico; http://www.snlg.it/ cms/files/Manuale_PNLG_0.pdf.
3. Scottish Intercollegiate Guidelines Network; http://www.sign.ac.uk/guidelines/fulltext/ 50/index.html.
4. AGREE (Appraisal of Guidelines REsearch & Evaluation in Europe): uno strumento per la valutazione della qualità delle linee guida cliniche; http://asr.regione.emilia-romagna.it/ wcm/asr/collana_dossier/doss060/link/doss 60.pdf.
5. Campus G, Solinas G, Cagetti MG, et al. The Italian Study Group on Children Oral Health. ECC (Early Childhood Caries) in Italy, pattern and severity. Caries Res 2007;41:299-300.
6. Campus G, Sacco G, Cagetti M, Abati S. Changing trend of caries from 1989 to 2004 among 12-year old Sardinian children. BMC Public Health 2007b;7:28doi:10.1186/1471- 2458-7-28.
7. Karjalainen S. Eating patterns, diet and dental caries. Dent Update 2007;34:295-300.
8. Law V, Seow WK, Townsend G. Factors influencing oral colonization of mutans streptococci in young children. Aust Dent J 2007; 52:93-100.
9. Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet 2007;369:51-9.
10. Kumar JV, Moss ME. Fluorides in Dental Public Health Programs. Dent Clin N Am 2008;52:387-401.
11. The GRADE working group. Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490-4.
12. Leverett DH, Adair SM, Vaughan BW, Proskin HM, Moss ME. Randomized clinical trial of the effect of prenatal fluoride supplements in preventing dental caries. Caries Res 1997; 31:174-9.
13. Sá Roriz Fonteles C, Zero DT, Moss ME, Fu J. Fluoride concentrations in enamel and dentin of primary teeth after pre- and postnatal fluoride exposure. Caries Res 2005;39:505-8.
14. http://www.sign.ac.uk/guidelines/fulltext/ 47/index.html.
15. http://www.sign.ac.uk/pdf/2005dentalreport. pdf.
16. Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. MMWR 2001;50:1-42.
17. Kumar JV, Moss ME. Fluorides in Dental Public Health Programs. Dent Clin North Am 2008;52:387-401.
18. Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2002;(3):CD002279. Review.
19. Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2002;(2):CD002280. Review.
20. Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003;(1):CD002278. Review.
21. Marinho VC, Higgins JP, Logan S, Sheiham A. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003;(3):CD00-
2284. Review.
22. Marinho VC, Higgins JP, Logan S, Sheiham A. Topical fluoride (toothpastes, mouthrinses, gels, or varnishes) for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003;(4):CD00-
2782. Review.
23. Marinho VC, Higgins JP, Sheiham A, Logan S. Combinations of topical fluoride (toothpastes, mouthrinses, gels, or varnishes) versus single topical fluoride for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2004;(1):CD002781. Review.
24. Marinho VC, Higgins JP, Sheiham A, Logan S. One topical fluoride (toothpastes, or mouthrinses, or gels, or varnishes) versus another for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2004;(1):CD002780. Reviews.
25. Tubert-Jeannin S, Tramini P, Gerbaud L, et al. Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children. Cochrane Database Syst Rev 2009;(1):CD007592. Protocols.
26. Erickson PR, Mazhari E. Investigation of the role of human breast milk in caries developement. Pediatr Dent 1999;21:86-90.
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