{Reference Type}: Journal Article
{Title}: The certainty of the evidence in oral health has not improved according to GRADE: a meta-epidemiological study.
{Author}: Seehra J;Bertl K;Faggion CM;Pandis N;
{Journal}: J Clin Epidemiol
{Volume}: 142
{Issue}: 0
{Year}: 10 2021 27
{Factor}: 7.407
{DOI}: 10.1016/j.jclinepi.2021.10.016
{Abstract}: The aim of this meta-epidemiological study was to provide an update of the certainty of the evidence in oral health by using the GRADE rating reported in oral health Cochrane systematic reviews (CSR).<BR>All interventional oral health CSR published between 2003-2021 were sourced. Study characteristics were extracted at the level of the CSR and the outcome/meta-analysis. One-hundred-five CSR were eligible and analysed.<BR>Almost a third of CSR (n=67) were excluded as a GRADE rating was not available. The most prevalent type of primary studies included in the CSR were randomized studies (93.4%) and the most used measure of effect was the risk ratio (67.3%). Overall, the certainty of the evidence according to the GRADE rating for all examined outcomes was very low/low (88%). The two most common reasons for downgrading the confidence in the evidence were study limitations (Risk of bias) and imprecision. The odds of moderate/high vs. low/very low-GRADE rating are higher for the primary compared to the secondary outcomes after adjusting for year and number of trials (OR 2.49; 95% CI: 1.09, 5.65; P=0.02). Per year (2010-2021 period) the odds of moderate/high vs. low/very low-GRADE rating decrease (OR 0.73; 95% CI: 0.60, 0.90; P=0.01), and as the number of trials per comparison increase the odds of moderate/high vs. low/very low GRADE rating increase (OR 1.13; 95% CI: 1.01, 1.25; P=0.001).<BR>The certainty of the evidence in oral health when assessed with the GRADE rating remains predominantly low or very low.