Case Study-Xylitol

Result

Book• Nelson Textbook of Pediatrics, 2007 18e.

– possible sources of evidences 2004-2006

Review• Dental caries. Lancet 369:51-9 2007• Infect Dis Clin North Am 2007; 21(2): 471-502

– possible sources of evidences 2006-2007

Patient Education• Early childhood caries,• Dental cavities, Radiography, Dental

Rampant caries (early childhood caries) in 3 yr old child

Basic Dental Anatomy

Diagnosis (iceberg metaphor)

Caries Process

Clinical Presentations

Clinical Implications

Clinical Implications

Patient Education

Case - Clinician

• 張小妹，六歲，喜歡吃糖但卻滿口蛀口。

Ask• P: children/adults (with dental caries)• I: chewing gum with xylitol• C: chewing gum without xylitol• O: incidence of dental decay

• Type of Question: therapy• Keyword:

– Dental caries– xylitol

Acquire / Search2007

Search - xylitol dental caries2009

Acquire / Search

2009

xylitol dental caries

xylitol

2007

2009

Advanced Search - Article Type

• Cochrane — thoes found in The Cochrane Database of Systematic Reviews (CDSR)

• Trials — Narrows you search to articles containing information about Clinical Trials, Randomized Control Trials, and similar articles.

2005

2005

2004

2007

2008

等級 治療 診斷 預後 病因

I 第 II 級證據的系統回顧 (systematic review)

II隨機對照

試驗由連續或隨機取樣組成的橫斷面研究

前瞻性起始世代研究

前瞻性世代研究

LOE: Level of Evidence (Oxford)

LOE (GRADE)

• 評分方式：結合研究方法，研究品質，一致性，相關性• 高（ high ） = further research is very unlikely to change

our confidence in the estimate of effect • 中（moderate ） = further research is likely to have an

important impact on our confidence in the estimate of effect and may change the estimate

• 低（ low ） = further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate

• 極低（ very low ） = any estimate of effect is very uncertain

The GRADE Working Group - http://www.gradeworkinggroup.org/

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