key: cord-0021205-jui9n4pj authors: Shamsoddin, E.; Sofi-Mahmudi, A.; Natoli, V.; Franchi, T.; Tovani-Palone, M. R. title: Halting 'research waste' date: 2021-09-24 journal: Br Dent J DOI: 10.1038/s41415-021-3488-8 sha: f42acdc5c6193dae9c9888c6951a5797d1ae0abe doc_id: 21205 cord_uid: jui9n4pj nan https://doi.org/10.1038/s41415-021-3486-x use as a mouthwash' and 'do not swallow' . 1, 6 Directions on the prescription will always be replicated on the dispensing label. The British and Irish Society for Oral Medicine (BISOM) has a detailed and comprehensive PIL on the use of betamethasone mouthwash and this can be accessed and downloaded from the society website. 6 The authors advise that the patient receives the BISOM PIL -in addition to the manufacturers' PIL supplied with the medicine. A. Field, C. Randall, Liverpool, UK https://doi.org/10.1038/s41415-021-3487-9 Sir, the use of betamethasone 500 microgram soluble tablets as a mouthwash is referenced in national guidance sources as a treatment for oral ulceration, including aphthous ulcers. 1,2 However, the topical use of this medication is unlicensed. The Summary of Product Characteristics for betamethasone 500 microgram soluble tablets advises that: 'Betnesol Tablets/ Betamethasone Tablets are best taken dissolved in water, but they can be swallowed whole without difficulty' . 3 The advice in the Patient Information Leaflet (PIL) which is provided with the product states: 'Your tablets can be swallowed whole, but they are best taken as a drink after allowing them to dissolve in a glass of water' . The PIL also advises to 'always take this medicine exactly as your doctor or pharmacist has told you' . 4 The National Patient Safety team at NHS England and NHS Improvement has received a number of incident reports related to betamethasone soluble tablets prescribed as a mouthwash but mistakenly taken orally. One report described hospital admission for adrenal crisis, a potentially life-threatening condition, particularly if not recognised early. 5 To reduce the risk of inappropriate use, dental and medical practitioners prescribing betamethasone 500 microgram soluble tablets for use as a mouthwash need to include detailed instructions on the prescription and also provide information to the patient. The authors would recommend that prescriptions are endorsed, with full dose instructions -ie '500 micrograms four times a day, to be dissolved in 10-20 ml water and rinsed around the mouth' but include 'for Evidence-based dentistry Sir, the main goal of evidence-based dentistry (EBD) is to integrate the most up-to-date and reliable scientific evidence with dentists' clinical expertise, to drive up standards of care. 1 Recently, numerous studies have published questionable findings, 2,3,4 including an overwhelming number of COVID-19 clinical trials without adequate methodological rigour and design. This is contrary to the principles of EBD. 1, 5 Such occurrences raise the notion of a well-known phenomenon in medical sciences: 'research waste' . 4 Dentistry is no exception, where it has been recognised by many. 5 Despite previous attempts to enhance the quality of dental evidence, several questions with significant Clip-on questions Available at: https:// bnf.nice.org.uk/treatment-summary/oral-ulcerationand-inflammation.html Betamethasone 500 microgram Soluble Tablets Betamethasone 500 microgram Soluble Tablets Understanding safety risks with betamethasone soluble tablets used as mouthwash The British and Irish Society for Oral Medicine. Patient information leaflet -Betamethasone 500 microgram soluble tablets used as a mouthwash Evidence based dentistry Retraction: Cardiovascular disease, drug therapy, and mortality in Covid-19 Expression of concern: Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis Avoidable waste in the production and reporting of research evidence The quality of the evidence according to GRADE is predominantly low or very low in oral health systematic reviews Dental research waste in design, analysis, and reporting: A scoping review clinical relevance remain unanswered. 5, 6 Encouraging dental researchers to work on COVID-19 ultimately reduces the availability of resources, infrastructure and time to conduct 'normal' research on non-COVID-19-related topics. This distraction from finding answers for key dental questions may prove critically detrimental to the progression of dental sciences.In the current COVID-19-focused research climate, we recommend that the following criteria be considered by funding bodies and publishers when reviewing papers in the dental sciences to prevent further research waste: • Any COVID-19 paper should aim to assess or measure an outcome directly or indirectly altered by the COVID-19 pandemic or its ramifications • Random and unsubstantiated citations or stating difficulties levied upon the research team by the pandemic that do not directly or indirectly change the outcomes of interest, should not warrant the paper to be classified as COVID-19-related