You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Caries-preventive effect of glass ionomer and resin-based fissure sealants on permanent teeth: An update of systematic review evidence
Abstract 1:
Background This article constitutes a partial up date of the original systematic review evidence by Yengopal et al. from 15 January 2008 ( published in the Journal of Oral Science in 2009 ) with primary focus on research quality in regard to bias risk in trials . Its aim is to up date the existing systematic review evidence from the English literature as to whether caries occurrence on pits and fissures of teeth sealed with either GIC or resin is the same . Methods In addition to the 12 trials included during the original systematic review , 5 new trials were identified during the data base search ( up to 26 August 2010 ) and 2 further trials were included from a h and search and reference check . Of these , 3 trials were excluded and 16 were accepted for data extraction and quality assessment . The quality of accepted trials was assessed , using up date d quality criteria , and the risk of bias was investigated in more depth than previously reported . In addition , the focus of quantitative synthesis was shifted to single data sets that were extracted from the accepted trials . Results Twenty-six dichotomous and 4 continuous data sets were extracted . Meta- analysis and cumulative meta- analysis were used in combining clinical ly homogenous data sets . The overall outcome of the computed data sets suggest no difference between the caries-preventive effects of GIC- and resin-based fissure sealants . Conclusions This overall outcome is in agreement with the conclusions of the original systematic review . Although the findings of the trials identified in this up date may be considered to be less affected by attrition- and publication bias , their risk of selection - and detection-/performance bias is high . Thus , verification of the currently available results requires further high quality r and omised control trials


Title 2:
Use of caries prevention services in the Northwest PRECEDENT dental network.
Abstract 2:
OBJECTIVE This cross-sectional study assessed the use of  caries preventive services  by Northwest PRECEDENT dental network practitioners and compared the caries experience of patients who received such services in the past 12 months with those who had not . METHODS An oral health survey was conducted on approximately 20 patients seen by each of 97 private practice dental practitioners in the network . Eligible patients ( total of 1877 aged 3 - 92 ) were r and omly assessed for the occurrence of one or more new caries lesions as well as having received the following preventive services within the past 12 months : fluoride varnish or gel , sealant in molar or premolar , and prophylaxis .  Patients were stratified by gender and age ( 1 - 17 years old , 18 - 64 years old , and 65 + years old ) .  Logistic regression was used to investigate the association between the practitioner characteristics and the use of preventive services , as well as the preventive services and the presence of a new caries lesion in the past 12 months . RESULTS The percent of patients in age category 1 - 17 years old/18 - 64 years old/65 + years old receiving each preventive treatment varied as follows : 95%/85%/81 % for prophylaxis , 87%/24%/22 % for fluoride , and 27%/2%/0 % for sealant . There was a very limited association between the use of a specific preventive service and practitioner gender , and no significant association between use of services and practice location ( rural , urban or suburban ) . There was a significant association between greater use of sealants  for dentists with 0 - 15 years of practice experience as compared with those having more than 25 years of experience . For the 1 - 17-year-old age group , boys had about 1.7 times the odds of having a new lesion than girls in the past 12 months , and patients receiving a sealant had 1.9 times the odds of having a new caries lesion . In the 18 - 64-year-old group , receiving a prophylaxis in the past 12 months was significantly associated with lower odds for having a new lesion ( odds ratio = 0.57 ) . CONCLUSIONS This study reports that aside from prophylaxis , which more than 85 % of the patients had received , about one-third of the patients overall received preventive services consisting of either sealants or some type of fluoride treatment in private dental practice s in the Northwest PRECEDENT network


Title 3:
Attitudes, knowledge and utilization of fissure sealants among Greek Dentists: a national survey
Abstract 3:
AIM : This was to evaluate the attitudes and knowledge of Greek Dentists concerning fissure sealants ( FS ) and other preventive measurements , together with the extent and the reasons for using or not using FS in their clinical practice . METHODS : 1,221 general dental practitioners ( GDPs ) including 50 Paediatric Dentists ( PD ) were r and omly selected from 35 local dental societies of Greece and asked to answer a telephone question naire regarding their attitudes to prevention , use of FS and variables influencing their placement . Non parametric Pearson ’s Chi square test and multifactorial logistic regression models were used for analysing the data . RESULTS : Although 87.6 % of all Greek dentists believe and apply prevention , only 35.8 % are using them routinely . Factors highly correlated with FS usage for all dentists were using fluoride regimens ( p<0.001 ) , being in practice for 5–14 years ( p=0.004 ) and practicing in urban areas ( p<0.001 ) . By contrast , all PD were using FS , regardless of any parameter ( p>0.01 ) . Concerning the type of surfaces sealed , 45.6 % of GDP used FS  on intact surfaces and 41.1 % on question able , while only 15 % of them sealed incipient caries . Overall , fewer GDPs compared with PD sealed premolars , primary teeth , question able surfaces , incipient enamel caries and molars in high risk patients ( p<0.001 ) , while fewer PD sealed intact surfaces ( p≤0.001 ) . The reasons mentioned for not using FS were : 76.3 % that parents were unwilling to pay , 61.9 % did not know how to use them , while 43.0 % believed that oral hygiene was sufficient in order to reduce caries . CONCLUSIONS : Insufficient knowledge and lack of clinical practice guidelines for the use of FS by GDPs in Greece , leads to low usage rates . Appropriate professional and scientific authorities should join efforts to improve knowledge of GDP and instil confidence in using FS


Title 4:
Sealants and dental caries: dentists' perspectives on evidence-based recommendations.
Abstract 4:
BACKGROUND The authors conducted a study to survey the perspectives of dentists regarding the 2010 American Dental Association ( ADA ) recommendation to seal non-cavitated carious lesions ( NCCLs ) in children and young adults . METHODS The authors mailed a question naire to a r and omly selected sample of 2,400 general dentists ( GDs ) and pediatric dentists ( PDs ) in the United States . The sample was chosen by the ADA 's Survey Center . The question naire included two photographs of NCCLs ( permanent first molar and premolar ) in a 12-year-old child . Respondents were provided with radiographic findings and asked to choose from several management options . RESULTS In the absence of radiographic evidence of caries , 37.4 percent and 42.3 percent of GDs and PDs , respectively , indicated that they would seal the NCCL in the molar . For the premolar , a significantly lower percentage of GDs than of PDs indicated that they would seal the NCCL . With radiographic evidence of caries in dentin , less than 4 percent of all dentists surveyed indicated that they would seal the NCCLs , and more than 90 percent indicated that they would remove the caries and place restorations . Less than 40 percent of dentists indicated that they sealed NCCLs in their practice . CONCLUSIONS The U.S. dentists surveyed have not adopted evidence -based clinical recommendations regarding the sealing of NCCLs . Practice Implication s. New educational and dissemination programs should be developed regarding these evidence -based caries management approaches


Title 5:
A 24-month study comparing sealant and fluoride varnish in caries reduction on different permanent first molar surfaces.
Abstract 5:
OBJECTIVE The aim of this study was to determine the separate effects of dental sealants and fluoride varnish on  dental  caries in fissured and nonfissured surfaces of permanent first molars . METHODS A clinical trial was conducted with three groups of 6- to 8-year-old schoolchildren : a sealant group ( n = 100 ) , in which  Delton was applied to first molars ; a varnish group ( n = 98 ) , in which  Duraphat was applied to first molars  ;  and a control group ( n = 116 ) , which  had no intervention as part of the study .  Absolute and percent caries reductions were compared at 24 months . RESULTS Compared to the controls , sealants result ed in a 68 percent and 87 percent reduction on fissured and nonfissured surfaces , respectively . The corresponding figures for varnish were 38 percent and 66 percent . CONCLUSION Sealant and fluoride varnish are effective in preventing caries in both fissured and nonfissured surface


Title 6:
Oral health survey of the child population in the Valencia Region of Spain (2004).
Abstract 6:
UNLABELLED INTRODUCTION ( BASIS AND OBJECTIVES ): The objectives of this study were to study the evolution of child oral health in the Valencia Region and establish a six-year interval for these surveys , at a time of major demographic changes associated with immigration into the region . MATERIAL S AND METHODS A cross sectional study was conducted in a r and om sample of 509 children aged 6 years , 478 aged 12 years and 401 aged 15 - 16 years . The clinical examinations  were performed by calibrated dentists ( Kappa > 0.85 ) . RESULTS Caries prevalence was 32 % at 6 years of age ( dft=1.08 ) in primary dentition and 42.5 % at 12 years ( DMFT=1.07 ) and 55.9 % at 15 - 16 years ( DMFT=1.84 ) in permanent dentition . Caries levels in immigrant children were significantly high . The mean numbers of sextants with bleeding were 0.16 , 1.58 and 1.10 while the scores for sextants with calculus were 0.15 , 0.76 and 0.88 , respectively . CONCLUSIONS Caries levels in both primary and permanent dentition have remained stable at 6 and 12 years of age and have continued to fall in the 15 - 16-year-old age group . Immigrant children have high caries levels and are a population group in serious need of treatment and prevention plans


Title 7:
Knowledge May Not Be the Best Target for Strategies to Influence Evidence-Based Practice: Using Psychological Models to Understand RCT Effects
Abstract 7:
Background Interventions to enhance the implementation of evidence -based practice have a varied success rate . This may be due to a lack of underst and ing of the mechanism by which interventions achieve results . Purpose Use psychological models to further an underst and ing of trial effects by piggy-backing on a r and omised controlled trial testing 2 interventions ( Audit & Feedback and Computer-aided Learning ) in relation to evidence -based third molar management . Method All participants of the parent trial ( 64 General Dental Practitioners across Scotl and ) , regardless of intervention group , were invited to complete a question naire assessing knowledge and predictive measures from Theory of Planned Behaviour and Social Cognitive Theory . The main outcome was evidence -based extracting behaviour derived from patient records . Results Neither intervention significantly influenced behaviour in the parent trial . This study revealed that the interventions did enhance knowledge , but knowledge did not predict extraction behaviour . However , the interventions did not influence variables that did predict extraction behaviour ( attitude , perceived behavioural control , self-efficacy ) . Results suggest both interventions failed because neither influenced possible mediating beliefs for the target behavior . Conclusion Using psychology models eluci date d intervention effects and allowed the identification of factors associated with evidence based practice , providing the basis for improving future intervention design


Title 8:
Clinicians' preventive strategies for children and adolescents identified as at high risk of developing caries.
Abstract 8:
BACKGROUND Clinicians h and le diagnosis and treatment planning of caries in different ways , and the underlying factors leading to management of risk and choice of treatment strategies are poorly understood . AIM The aim of this study was to investigate dentists ' and dental hygienists ' choices of preventive strategies for children and adolescents identified as at high risk of developing caries . DESIGN A sample of dental records from 432 of a total of 3372 children in a Swedish county identified as at high risk of developing caries , aged 3 - 19 years , was r and omly selected for analysis in the study . Information of importance for the therapists ' choice of caries management strategies were obtained from the dental records . RESULTS The results showed that therapists considered tooth brushing instruction and fluoride treatment at the clinic to be of primary importance as treatment given in 60 % of the cases , respectively . Fluoride treatment at home and diet counselling were both chosen in half of the cases .  Fissure sealant therapy  was used in 21 % of the cases , and 15 % of the patients did not receive any preventive treatment at all . The results also showed that girls more often received  fluoride treatment , tooth brushing instruction and oral hygiene information  than boys . CONCLUSIONS In the majority of the children and adolescents , several preventive measures were given . The more background factors included in the risk assessment , the more preventive measures were given . The differences between the treatments given to girls and the boys need to be further investigated
Conclusions The results suggest that , similar to other countries , And alusian dentists know that sealants are effective , have neutral to positive attitudes toward sealants ; though , based on epidemiological studies , underuse sealants .