Qualidade de relato e síntese de evidências sobre o tratamento da hipersensibilidade dentinária: adesão ao CONSORT em ensaios clínicos com enxaguatórios bucais e overview de revisões sistemáticas sobre dentifrícios dessensibilizantes

Abstract

Dentin hypersensitivity (DH) is a prevalent clinical condition for which different desensitizing agents have been widely investigated. However, the reliability of the available evidence depends directly on the methodological quality of primary studies and the transparency of their reporting, as well as on the quality of the systematic reviews that synthesize these data. Thus, this thesis aimed to critically evaluate the quality of the scientific evidence regarding the treatment of DH through two complementary studies: (1) an assessment of adherence of randomized clinical trials (RCTs) to the CONSORT Statement and the risk of bias of these studies, and (2) an evaluation of the methodological quality of systematic reviews on desensitizing dentifrices using the AMSTAR 2 tool. In Study 1, the Cochrane Library, MEDLINE, Embase, BBO, LILACS, Scopus, and Web of Science databases were systematically searched between August and October 2024 to identify RCTs evaluating the effectiveness of desensitizing mouthwashes. Adherence to the CONSORT Statement was assessed using a specific tool, while the Cochrane Risk of Bias tool, version 2 (RoB 2), was used to evaluate the individual quality of the included studies. Of the 2,883 records retrieved, 36 studies were included in the qualitative analysis. The mean overall CONSORT score was 23.3 ± 1.4 out of a maximum of 32 points. Items related to interventions, outcomes, hypothesis testing, and effect size were the most comprehensively reported, whereas the “settings” and “protocol” items were described in only 12.5% of the articles. Significant differences in CONSORT scores were identified according to journal and year of publication. Low risk of bias was identified in 14 studies, two studies were judged as having unclear risk, and no studies were classified as having high risk of bias. Although full adherence to CONSORT recommendations was not achieved in any of the included studies, most trials demonstrated a low risk of bias. In Study 2, searches were conducted in PubMed, Cochrane Library, Web of Science, Scopus, Embase, and LILACS, without language or date restrictions. Two reviewers independently selected studies, extracted data, and assessed methodological quality using the AMSTAR 2 tool. Eligible studies were systematic reviews of RCTs evaluating the clinical effectiveness of desensitizing dentifrices in adults with DH. From 1,256 identified records, 14 systematic reviews published between 2006 and 2021 were included, encompassing 114 RCTs and 11,213 participants. The reviews evaluated dentifrices containing arginine, potassium salts, bioactive glass, strontium, stannous fluoride, nano-hydroxyapatite, oxalates, herbal agents, and polymers. Methodological quality was classified as critically low in 10 reviews and low in four. The main weaknesses included lack of protocol registration, incomplete search strategies, and limited assessment of publication bias. Strengths included clearly formulated PICO research questions and duplicate data extraction. Overall, the included reviews reported that desensitizing agents provide clinically meaningful reductions in DH; however, systematic reviews on desensitizing dentifrices generally showed low methodological quality. Taken together, the findings indicate that although evidence suggests clinical efficacy of desensitizing agents in the management of DH, shortcomings in the reporting of RCTs and in the conduct of systematic reviews reduce the reliability of the conclusions. Strengthening methodological rigor and reporting practices is essential to produce more robust evidence and to provide reliable support for clinical decision-making.