Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Cochrane and the COMET initiative: developing the evidence base in oral medicine

Key Points

  • Discusses the importance of evidence-based practice and suggests ways to improve the evidence base in oral medicine.

  • Describes the history and development of the Cochrane Collaboration and Cochrane Oral Health.

  • Introduces the concept of core outcome sets and demonstrates an approach used to develop a core outcome set in oral medicine.

Abstract

All clinicians in medicine and dentistry aim to deliver evidence-based practice; however, it is widely recognised that the current evidence base for interventions in oral medicine, as with many other specialties, is of a low quality. The highest level of evidence is considered to be the systematic review and meta-analysis. The Cochrane Collaboration and the Cochrane Oral Health group produce high quality systematic reviews, however, despite the large number of trials carried out for treatments in oral medicine, the results are often not able to be utilised to guide clinical care due to the various methodological limitations of the trials including the heterogeneity of outcome measures used. To improve the strength of the evidence base this will need to change. The Comet initiative aims to support the development of core outcome sets which are used to allow homogeneity of outcome measures in trials and therefore will allow pooling of data for meta-analysis in future systematic reviews. This paper explores the complexities involved in producing evidence for oral medicine interventions and introduces an approach for developing core outcome sets in oral medicine.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1

    Lind J . A treatise of scurvy. In three parts. Edinburgh: Sands, Murray and Cochran for A Kincaid and A Donaldson, 1753.

    Google Scholar 

  2. 2

    Woolf S H, Grol R, Hutchinson A, Eccles M, Grimshaw J . Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ 1999; 318: 527–530.

    Article  Google Scholar 

  3. 3

    Sackett D L . Evidence-based medicine. Semin Perinatol 1997; 21: 3–5.

    Article  Google Scholar 

  4. 4

    Miller M, Kearney N . Guidelines for clinical practice: development, dissemination and implementation. Int J Nurs Stud 2004; 41: 813–821.

    Article  Google Scholar 

  5. 5

    Craig J C, Irwig L M, Stockler M R . Evidence-based medicine: useful tools for decision making. Med J Aust 2001; 174: 248–253.

    Google Scholar 

  6. 6

    Raine R, Fitzpatrick R, Barratt H et al. Challenges, solutions and future directions in the evaluation of service innovations in health care and public health. Health Services and Delivery Research. Southampton, 2016.

  7. 7

    Worthington H V, Glenny A M, Mauleffinch L F, Daly F, Clarkson J . Using Cochrane reviews for oral diseases. Oral Dis 2010; 16: 592–596.

    Article  Google Scholar 

  8. 8

    Brocklehurst P, Tickle M, Glenny A M et al. Systemic interventions for recurrent aphthous stomatitis (mouth ulcers). Cochrane Database Syst Rev; CD005411.

  9. 9

    Higgins J P T, Altman D G, Sterne J A C . Chapter 8: Assessing risk of bias in included studies. In Higgins J P T, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011.

    Google Scholar 

  10. 10

    Lalla R V, Choquette L E, Feinn R S et al. Multivitamin therapy for recurrent aphthous stomatitis: a randomized, double-masked, placebo-controlled trial. J Am Dent Assoc 2012; 143: 370–376.

    Article  Google Scholar 

  11. 11

    Ni Riordain R, McCreary C . Further reliability and responsiveness of the Chronic Oral Mucosal Diseases Questionnaire. Oral Dis 2012; 18: 60–66.

    Article  Google Scholar 

  12. 12

    Baccaglini L, Lalla R V, Bruce A J et al. Urban legends: recurrent aphthous stomatitis. Oral Dis 2011; 17: 755–770.

    Article  Google Scholar 

  13. 13

    Baccaglini L, Shuster J J, Cheng J et al. Design and statistical analysis of oral medicine studies: common pitfalls. Oral Dis 2010; 16: 233–241.

    Article  Google Scholar 

  14. 14

    Taylor J, McMillan R, Shephard M et al. World Workshop on Oral Medicine VI: a systematic review of the treatment of mucous membrane pemphigoid. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120: 161–171.

    Article  Google Scholar 

  15. 15

    McMillan R, Taylor J, Shephard M et al. World Workshop on Oral Medicine VI: a systematic review of the treatment of mucocutaneous pemphigus vulgaris. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120: 132–142.

    Article  Google Scholar 

  16. 16

    Innes N P, Schwendicke F, Lamont T . How do we create, and improve the evidence base? BDJ 2016; 220: 651–655.

    Article  Google Scholar 

  17. 17

    Shemilt I, Mugford M, Byford S et al. Chapter 15: Incorporating economics evidence. In Higgins J P T, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011.

    Google Scholar 

  18. 18

    Taylor J . Core outcome set for recurrent aphthous stomatitis: a collaborative approach. Oral Dis 2016; 22: 14–41.

    Article  Google Scholar 

  19. 19

    Williamson P R, Altman D G, Blazeby J M et al. Developing core outcome sets for clinical trials: issues to consider. Trials 2012; 13: 132.

    Article  Google Scholar 

Download references

Acknowledgements

Thanks to Sasha Louise Worthington for her assistance in formatting the paper.

Author information

Affiliations

Authors

Corresponding author

Correspondence to J. Taylor.

Additional information

Refereed Paper

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Taylor, J., Walsh, T., Worthington, H. et al. Cochrane and the COMET initiative: developing the evidence base in oral medicine. Br Dent J 223, 729–732 (2017). https://doi.org/10.1038/sj.bdj.2017.893

Download citation

Further reading

Search

Quick links