Use of Standards in Papers Published in Dental Journals

International standards give state of the art specifications for products, services and good practice, helping making industry more efficient and effective. Developed through global consensus, they help to break down barriers to international trade (1). Standards serve a variety of market-perfecting purposes. They provide the basis for comparison of products and establish consistent terminologies through standard definitions, measures, and test procedures. They also promote compatibility of products used in systems, thereby reducing the ranges of variety of products. Not only standards assure desired qualities and performance levels, but they also reduce low quality by providing consumers with an easy check on individual producer quality claims, thereby increasing consumer welfare. As a result, standards can enhance the overall image of industry. The use of standards increases buyer Use of Standards in Papers Published in Dental Journals


INTRODUCTION
International standards give state of the art specifications for products, services and good practice, helping making industry more efficient and effective.Developed through global consensus, they help to break down barriers to international trade (1).
Standards serve a variety of market-perfecting purposes.They provide the basis for comparison of products and establish consistent terminologies through standard definitions, measures, and test procedures.They also promote compatibility of products used in systems, thereby reducing the ranges of variety of products.Not only standards assure desired qualities and performance levels, but they also reduce low quality by providing consumers with an easy check on individual producer quality claims, thereby increasing consumer welfare.As a result, standards can enhance the overall image of industry.The use of standards increases buyer confidence about product quality and in turn may very well increase overall demand for the product, reflecting buyer preference regarding quality.Standards provide for transfer of technologies throughout industry and facilitate introduction of innovation by reducing market and technical risks.They provide the industry with an important marketing tool (2).
The leading current standards are from the International Standards Organization (ISO) and ASTM International, known prior to 2001 as the American Society for Testing and Materials (ASTM).The ASTM was formed in 1898 by chemists and engineers from the Pennsylvania Railroad.At the time of its establishment, the organization was known as the American Section of the International Association for Testing and Materials.Today, the ASTM has more than 30,000 members from 135 Countries (3,4).
The ISO is the world largest standards developing organization.It was born from the union of two Aiming "to facilitate the international coordination and unification of industrial standards", the new organization, ISO, officially began operations on 23 February 1947.Since then, ISO has published more than 19,000 International Standards, ranging from standards for activities such as agriculture and construction, through mechanical engineering, to medical and dental devices, to the newest information technology developments.Today ISO has members from more than 160 countries and more than 150 people work full time for ISO's Central Secretariat in Geneva, Switzerland (3,4).
In addition to ISO and ASTM standards, the American Dental Association (ADA), the accredited dental standards body of the American National Standards Institute (ANSI), also publishes dental standards (3,4).
The ISO dental standards are overseeing by the ISO Technical Committee (TC), namely ISO/TC106, which has published more than 150 dental standards.This is administered by a Secretariat through its standards organization (SCC).TC106 is currently divided into seven Sub-Committees (SC), each with their own Secretariat, that are further divided into convenorled Working Groups (WG), which produce drafts of one or more standard documents.When these drafts reach a definitive status they are released for voting and comments by the national bodies represented in the seven SC of the TC106 (3,4): SC 1: Filling and restorative materials; SC 2: Prosthodontic materials; SC 3: Terminology; SC 4: Dental instruments; SC 6: Dental equipment; SC 7: Oral care products; SC 8: Dental implants.
With the globalization of knowledge, it is essential to use standards to perform scientific studies, standardizing technical-scientific methodologies and terminology and, therefore, the criteria to allow for comparison between study results.Thus, the objective of the present study was to evaluate the use of standards in papers published in Brazilian and international dental journals during the last 5 years, testing the hypothesis that standards are underused in published dental papers.

MATERIAL AND METHODS
Two trained examiners evaluated papers published from January 2006 to December 2010 (5 years) in the following journals: Brazilian Dental Journal (Braz Dent J); Brazilian Oral Research (Braz Oral Res); Journal of Applied Oral Sciences (J Appl Oral Sci), Journal of Dental Research (J Dent Res) and Dental Materials -Journal for Oral and Craniofacial Biomaterials Sciences (Dent Mater).In addition to the title and the type of study, the issue, the volume and the year of publication, the following information were recorded from each paper: identification of any standard reported in the study; in case of no reported standard, indication if a standard could be used in the study (Table 1).
The ISO and ASTM standards related to the published papers were recorded.The percentage of each examined parameter was calculated.

RESULTS
A total of 3,046 papers were examined: 937 from the Dent Mater, 936 from the J Dent Res, 489 from the J Appl Oral Sci, 348 from the Braz Dent J, and 336 from the Braz Oral Res (Table 2).Considering the papers that could use some standard, Dent Mater showed the highest percentage (24.9%) of papers that actually used them, followed by J Appl Oral Sci (10.3%),Braz Oral Res (10.1%),Braz Dent J (6.3%) and J Dent Res (2.4%), which means for example that, from 936 papers examined (n) from the J Dent Res, 623 (np) could use some standard, but only 15 (nN) papers reported the use of at least one standard (Table 2).
From the 3,046 papers examined, 309 (10.1%) reported the use of some standard.The ISO standards were most frequently reported (57.8%), followed by 95 ASTM standards (23.7%) and 74 standards (18.5%) from other international organizations such as ADA and CIE (International Commission on Illumination).Yet, all of these 74 standards have equivalent standards from ISO or ASTM that could be reported as an alternative.
The most commonly reported standards are summarized in Table 3.Other relevant dental standards are presented in Table 4.

DISCUSSION
Standards are important tools to scientific research, including dental studies because they describe relevant parameters that substantiate reliable scientific work.
According to the study inclusion criteria, from the 2,393 published papers that could use scientific standards, only 309 papers used at least one of them.This implies that 87% (n=2,084) of the published papers did not use these valuable documents.Despite the relevance of this finding, it seems to be unrelated to the journal's impact factor, considering that J Dent Res, the highest impact factor in the dental literature, presented the worst standard/paper ratio (4.8%).Dent Mater reported the largest number of standards (n=290) that were used for 212 published papers.Yet, it accounts for only 24% (n=212) of the 850 published papers that could use some standard (np) during the evaluated period (Table 2).
From the three Brazilian journals evaluated, the J Appl Oral Sci showed the highest (12.2%) standard/ paper ratio, followed by the Braz Oral Res (8%) and the Braz Dent J (6.1%).
Considering the study design (type of study), the great majority of the papers were original research, irrespective of the journal evaluated, meaning, from the 3,046 papers, 72.2% (n=2,200) were original research, 18.4% (n=560) were clinical trials, 7.1% (n=217) were literature reviews and 2.3% (n=69) were case reports.This data is closely related to the use of standards since the papers (nN) that report at least one standard (n=309), 96.8% (n=299) were original research, 2.9% (n=9) were literature reviews and only one (0.3%) clinical trial (Table 2).Standards were absolutely not reported in case reports, irrespective of the evaluated journal.
The most commonly reported standards refer to ceramics and polymers, such as: the ISO 4049 (Dentistry -Polymer-based restorative materials) reported in 44 papers and the ISO 6872 (Dentistry -Ceramic materials) reported in 19 papers (Table 3).This finding may represent the researchers' concern to establish standardization criteria for the work within these biomaterials areas.Yet, the majority of papers that had a chance to report at least one standard (np=2,393) did not (2,084).Some of the ISO standards that could be reported in these studies are listed in Table 4.
Possible explanations for the low standard/paper ratio are the need of ordering such documents, which may influence researchers and authors to use other published papers as reference for the research methods, and the assumption that standards are not a consensus among authors and reviewers as a standardization parameter.
It is important to mention that the standards used to substantiate papers are sources of information and serve as scientific references for the work.Therefore, they should be properly listed in the references, which was not the case in many of the published papers.Table 2. Quantitative information on the number of papers examined (n), type of study*, number of papers that could use some standard (np), number of papers that reported the use of at least one standard (nN), total number of standards used in the examined papers (nNt) and the international organization from where they were published (ISO, ASTM or other).Despite of the high impact factors of the selected Brazilian and international dental journals, the published papers should use standards more often, which confirms the study hypothesis.As the standards substantiate scientific studies and facilitate data comparison among reports, the results of the present systematic review should assist journal editors and reviewers to encourage authors to consult and refer to available standards to support scientific studies and papers.

Table 1 .
Form to collect information from each scientific paper evaluated.Journal name, issue, volume and year of publication: Paper title: Type of study*: Did the paper use any standard?( ) Yes Standard number and title?( ) No Could it use any standard?If yes, what standard number and title?*1: original research; 2: clinical trial; 3: literature review; and 4: case report.
organizations -the ISA (International Federation of the National Standardizing Associations), established in New York in 1926, and the UNSCC (United Nations Standards Coordinating Committee), established in 1944.

Table 3 .
The most commonly reported standards presented by the identification number (ID) and describing title, the number of papers that cited the standard (nS), and the number of papers that could cite the standard, including the ones that actually cited it (ncS).

Table 4 .
Other relevant reported ISO standards presented by the identification number (ID) and describing title, the number of papers that cited the standard (nS) and the number of papers that could cite the standard, including the ones that actually cited it (ncS).