dissertations, conference proceedings, correspondence
Review articles, systematic reviews, meta-analysis, practice guidelines, monographs on a specific subject
Textbooks, encyclopedias, handbooks, newspapers
These examples and descriptions of publication types will give you an idea of how to use various works and why you would want to write a particular kind of paper.
Scholarly (aka empirical) article -- example
Empirical studies use data derived from observation or experiment. Original research papers (also called primary research articles) that describe empirical studies and their results are published in academic journals. Articles that report empirical research contain different sections which relate to the steps of the scientific method.
Abstract - The abstract provides a very brief summary of the research.
Introduction - The introduction sets the research in a context, which provides a review of related research and develops the hypotheses for the research.
Method - The method section describes how the research was conducted.
Results - The results section describes the outcomes of the study.
Discussion - The discussion section contains the interpretations and implications of the study.
References - A references section lists the articles, books, and other material cited in the report.
Review article -- example
A review article summarizes a particular field of study and places the recent research in context. It provides an overview and is an excellent introduction to a subject area. The references used in a review article are helpful as they lead to more in-depth research.
Many databases have limits or filters to search for review articles. You can also search by keywords like review article, survey, overview, summary, etc.
Conference proceedings, abstracts and reports -- example
Conference proceedings, abstracts and reports are not usually peer-reviewed. A conference article is similar to a scholarly article insofar as it is academic. Conference articles are published much more quickly than scholarly articles. You can find conference papers in many of the same places as scholarly articles.
To identify an article based on empirical research, look for the following characteristics:
The article is published in a peer-reviewed journal .
The article includes charts, graphs, or statistical analysis .
The article is substantial in size , likely to be more than 5 pages long.
The article contains the following parts (the exact terms may vary): abstract, introduction, method, results, discussion, references .
What constitutes a primary source varies by discipline.
In the social sciences the terms primary literature and primary data are preferred over primary source . The former imply the results of original research or experimentation, usually gathered in the field and later reported in the peer-reviewed journal literature. Disciplinary examples are too numerous to list but include anthropologists who undertake dirt archaeology and ethnographic fieldwork; education researchers who gather data in the classroom; linguists who record communication patterns in a particular language community; and political scientists who conduct voter polls and surveys. In many social sciences disciplines a fine-grained distinction is made between the primary literature (i.e., the scholarly articles and presentations that report on original research) and the primary data (i.e., the "raw" data collected by researchers through interviews, observations, and survey instruments).
In the arts and humanities primary sources are original, creative works. These include photographs, paintings, prints, sculptures, ceramics, textiles and other studio works; original literary creations such as novels, plays, short stories, and poems; musical compositions and performances; and in architecture buildings, complexes, and even whole cities. Art historians greatly prefer, when possible, to study original artworks yet often make do with re-productions. An art historian studying Olmec sculpture, for instance, might work with high-quality illustrations published in an exhibition catalog or found in library databases such as ARTstor. Preferred would be to study Olmec sculptures at the museum. Best of all might be the opportunity to study the sculptures in situ . The latter could be logistically difficult or even impossible if the original archaeological context has been lost.
In history primary sources are "original records created at the time historical events occurred or well after events in the form of memoirs and oral histories. Primary sources may include letters, manuscripts, diaries, journals, newspapers, speeches, interviews, memoirs, documents produced by government agencies such as Congress or the Office of the President, photographs, audio recordings, moving pictures or video recordings, research data [social scientists' primary data, described above], and objects or artifacts such as works of art or ancient roads, buildings, tools, and weapons. These sources serve as the raw material to interpret the past..." ( Primary Sources on the Web , a website of the History Section of RUSA, American Library Association). Primary sources are available in archives or as re-productions of originals published online or in books widely held by academic libraries.
What constitutes a secondary source is dependent on the discipline but the difference is largely semantic.
In the social sciences a secondary source is based on or written about the primary literature . A secondary source analyzes, editorializes, reports on, or summarizes the primary literature. While secondary sources in the social sciences are sometimes scholarly (e.g., a scholarly book that summarizes a body of primary literature or a review article published in an academic journal), more typically secondary sources in the social sciences appear in credible but popular publications. Examples include general-interest magazines such as Newsweek and Time , highbrow publications such as The Atlantic and New Yorker , newspapers such as The New York Times , and books and websites aimed at non-specialized audiences. The "conversation" social scientists have with one another occurs not in these popular publications but rather within the primary literature .
In the arts , humanities , and history a secondary source is also based on or written about primary sources . A secondary source in the humanities, however, is typically if not always scholarly (e.g., a book aimed at other scholars or an article published in a peer-reviewed journal). Historians, for instance, explore the significance of Thomas Jefferson's writings (i.e., the primary sources) in scholarly books and peer-reviewed journal articles written by and for other scholars .
Scholars in all disciplines work to address unresolved disciplinary problems and questions. At the same time, scholars strive to complicate what is already known. In all cases such "conversations" nearly always occur within the pages of scholarly books (i.e., monographs and edited volumes), and in peer-reviewed journal articles. Students will typically cite these sources in research papers.
You might encounter a tertiary source, more commonly called a reference work. Two layers removed from the primary evidence, tertiary sources are based on secondary sources. They contextualize or summarize secondary sources or list, index, or in some other way promote their efficient discovery. Reference works provide researchers with the information needed to conduct further research. Types of reference works include bibliographies, biographies, catalogs, chronologies, companions, dictionaries, directories, encyclopedias, handbooks, and indexes.
Scholars do more than present what is already known. Academics from undergraduates to senior scholars develop cogent arguments in support of their theses. The baseline information contained in encyclopedia articles cannot substitute for original scholarship. This is one reason why reference works are not generally cited in scholars' own bibliographies or reference lists. And yet each type or class of information—primary, secondary, and tertiary—fulfills a critical function in the research process.
Questions about what constitutes or how to find primary sources for your project? Please contact me for help!
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1 Centre for Functional and Evolutionary Ecology (CEFE), CNRS, Montpellier, France
2 Centre for Biodiversity Synthesis and Analysis (CESAB), FRB, Aix-en-Provence, France
Literature reviews are in great demand in most scientific fields. Their need stems from the ever-increasing output of scientific publications [1] . For example, compared to 1991, in 2008 three, eight, and forty times more papers were indexed in Web of Science on malaria, obesity, and biodiversity, respectively [2] . Given such mountains of papers, scientists cannot be expected to examine in detail every single new paper relevant to their interests [3] . Thus, it is both advantageous and necessary to rely on regular summaries of the recent literature. Although recognition for scientists mainly comes from primary research, timely literature reviews can lead to new synthetic insights and are often widely read [4] . For such summaries to be useful, however, they need to be compiled in a professional way [5] .
When starting from scratch, reviewing the literature can require a titanic amount of work. That is why researchers who have spent their career working on a certain research issue are in a perfect position to review that literature. Some graduate schools are now offering courses in reviewing the literature, given that most research students start their project by producing an overview of what has already been done on their research issue [6] . However, it is likely that most scientists have not thought in detail about how to approach and carry out a literature review.
Reviewing the literature requires the ability to juggle multiple tasks, from finding and evaluating relevant material to synthesising information from various sources, from critical thinking to paraphrasing, evaluating, and citation skills [7] . In this contribution, I share ten simple rules I learned working on about 25 literature reviews as a PhD and postdoctoral student. Ideas and insights also come from discussions with coauthors and colleagues, as well as feedback from reviewers and editors.
How to choose which topic to review? There are so many issues in contemporary science that you could spend a lifetime of attending conferences and reading the literature just pondering what to review. On the one hand, if you take several years to choose, several other people may have had the same idea in the meantime. On the other hand, only a well-considered topic is likely to lead to a brilliant literature review [8] . The topic must at least be:
Ideas for potential reviews may come from papers providing lists of key research questions to be answered [9] , but also from serendipitous moments during desultory reading and discussions. In addition to choosing your topic, you should also select a target audience. In many cases, the topic (e.g., web services in computational biology) will automatically define an audience (e.g., computational biologists), but that same topic may also be of interest to neighbouring fields (e.g., computer science, biology, etc.).
After having chosen your topic and audience, start by checking the literature and downloading relevant papers. Five pieces of advice here:
The chances are high that someone will already have published a literature review ( Figure 1 ), if not exactly on the issue you are planning to tackle, at least on a related topic. If there are already a few or several reviews of the literature on your issue, my advice is not to give up, but to carry on with your own literature review,
The bottom-right situation (many literature reviews but few research papers) is not just a theoretical situation; it applies, for example, to the study of the impacts of climate change on plant diseases, where there appear to be more literature reviews than research studies [33] .
When searching the literature for pertinent papers and reviews, the usual rules apply:
If you read the papers first, and only afterwards start writing the review, you will need a very good memory to remember who wrote what, and what your impressions and associations were while reading each single paper. My advice is, while reading, to start writing down interesting pieces of information, insights about how to organize the review, and thoughts on what to write. This way, by the time you have read the literature you selected, you will already have a rough draft of the review.
Of course, this draft will still need much rewriting, restructuring, and rethinking to obtain a text with a coherent argument [11] , but you will have avoided the danger posed by staring at a blank document. Be careful when taking notes to use quotation marks if you are provisionally copying verbatim from the literature. It is advisable then to reformulate such quotes with your own words in the final draft. It is important to be careful in noting the references already at this stage, so as to avoid misattributions. Using referencing software from the very beginning of your endeavour will save you time.
After having taken notes while reading the literature, you will have a rough idea of the amount of material available for the review. This is probably a good time to decide whether to go for a mini- or a full review. Some journals are now favouring the publication of rather short reviews focusing on the last few years, with a limit on the number of words and citations. A mini-review is not necessarily a minor review: it may well attract more attention from busy readers, although it will inevitably simplify some issues and leave out some relevant material due to space limitations. A full review will have the advantage of more freedom to cover in detail the complexities of a particular scientific development, but may then be left in the pile of the very important papers “to be read” by readers with little time to spare for major monographs.
There is probably a continuum between mini- and full reviews. The same point applies to the dichotomy of descriptive vs. integrative reviews. While descriptive reviews focus on the methodology, findings, and interpretation of each reviewed study, integrative reviews attempt to find common ideas and concepts from the reviewed material [12] . A similar distinction exists between narrative and systematic reviews: while narrative reviews are qualitative, systematic reviews attempt to test a hypothesis based on the published evidence, which is gathered using a predefined protocol to reduce bias [13] , [14] . When systematic reviews analyse quantitative results in a quantitative way, they become meta-analyses. The choice between different review types will have to be made on a case-by-case basis, depending not just on the nature of the material found and the preferences of the target journal(s), but also on the time available to write the review and the number of coauthors [15] .
Whether your plan is to write a mini- or a full review, it is good advice to keep it focused 16 , 17 . Including material just for the sake of it can easily lead to reviews that are trying to do too many things at once. The need to keep a review focused can be problematic for interdisciplinary reviews, where the aim is to bridge the gap between fields [18] . If you are writing a review on, for example, how epidemiological approaches are used in modelling the spread of ideas, you may be inclined to include material from both parent fields, epidemiology and the study of cultural diffusion. This may be necessary to some extent, but in this case a focused review would only deal in detail with those studies at the interface between epidemiology and the spread of ideas.
While focus is an important feature of a successful review, this requirement has to be balanced with the need to make the review relevant to a broad audience. This square may be circled by discussing the wider implications of the reviewed topic for other disciplines.
Reviewing the literature is not stamp collecting. A good review does not just summarize the literature, but discusses it critically, identifies methodological problems, and points out research gaps [19] . After having read a review of the literature, a reader should have a rough idea of:
It is challenging to achieve a successful review on all these fronts. A solution can be to involve a set of complementary coauthors: some people are excellent at mapping what has been achieved, some others are very good at identifying dark clouds on the horizon, and some have instead a knack at predicting where solutions are going to come from. If your journal club has exactly this sort of team, then you should definitely write a review of the literature! In addition to critical thinking, a literature review needs consistency, for example in the choice of passive vs. active voice and present vs. past tense.
Like a well-baked cake, a good review has a number of telling features: it is worth the reader's time, timely, systematic, well written, focused, and critical. It also needs a good structure. With reviews, the usual subdivision of research papers into introduction, methods, results, and discussion does not work or is rarely used. However, a general introduction of the context and, toward the end, a recapitulation of the main points covered and take-home messages make sense also in the case of reviews. For systematic reviews, there is a trend towards including information about how the literature was searched (database, keywords, time limits) [20] .
How can you organize the flow of the main body of the review so that the reader will be drawn into and guided through it? It is generally helpful to draw a conceptual scheme of the review, e.g., with mind-mapping techniques. Such diagrams can help recognize a logical way to order and link the various sections of a review [21] . This is the case not just at the writing stage, but also for readers if the diagram is included in the review as a figure. A careful selection of diagrams and figures relevant to the reviewed topic can be very helpful to structure the text too [22] .
Reviews of the literature are normally peer-reviewed in the same way as research papers, and rightly so [23] . As a rule, incorporating feedback from reviewers greatly helps improve a review draft. Having read the review with a fresh mind, reviewers may spot inaccuracies, inconsistencies, and ambiguities that had not been noticed by the writers due to rereading the typescript too many times. It is however advisable to reread the draft one more time before submission, as a last-minute correction of typos, leaps, and muddled sentences may enable the reviewers to focus on providing advice on the content rather than the form.
Feedback is vital to writing a good review, and should be sought from a variety of colleagues, so as to obtain a diversity of views on the draft. This may lead in some cases to conflicting views on the merits of the paper, and on how to improve it, but such a situation is better than the absence of feedback. A diversity of feedback perspectives on a literature review can help identify where the consensus view stands in the landscape of the current scientific understanding of an issue [24] .
In many cases, reviewers of the literature will have published studies relevant to the review they are writing. This could create a conflict of interest: how can reviewers report objectively on their own work [25] ? Some scientists may be overly enthusiastic about what they have published, and thus risk giving too much importance to their own findings in the review. However, bias could also occur in the other direction: some scientists may be unduly dismissive of their own achievements, so that they will tend to downplay their contribution (if any) to a field when reviewing it.
In general, a review of the literature should neither be a public relations brochure nor an exercise in competitive self-denial. If a reviewer is up to the job of producing a well-organized and methodical review, which flows well and provides a service to the readership, then it should be possible to be objective in reviewing one's own relevant findings. In reviews written by multiple authors, this may be achieved by assigning the review of the results of a coauthor to different coauthors.
Given the progressive acceleration in the publication of scientific papers, today's reviews of the literature need awareness not just of the overall direction and achievements of a field of inquiry, but also of the latest studies, so as not to become out-of-date before they have been published. Ideally, a literature review should not identify as a major research gap an issue that has just been addressed in a series of papers in press (the same applies, of course, to older, overlooked studies (“sleeping beauties” [26] )). This implies that literature reviewers would do well to keep an eye on electronic lists of papers in press, given that it can take months before these appear in scientific databases. Some reviews declare that they have scanned the literature up to a certain point in time, but given that peer review can be a rather lengthy process, a full search for newly appeared literature at the revision stage may be worthwhile. Assessing the contribution of papers that have just appeared is particularly challenging, because there is little perspective with which to gauge their significance and impact on further research and society.
Inevitably, new papers on the reviewed topic (including independently written literature reviews) will appear from all quarters after the review has been published, so that there may soon be the need for an updated review. But this is the nature of science [27] – [32] . I wish everybody good luck with writing a review of the literature.
Many thanks to M. Barbosa, K. Dehnen-Schmutz, T. Döring, D. Fontaneto, M. Garbelotto, O. Holdenrieder, M. Jeger, D. Lonsdale, A. MacLeod, P. Mills, M. Moslonka-Lefebvre, G. Stancanelli, P. Weisberg, and X. Xu for insights and discussions, and to P. Bourne, T. Matoni, and D. Smith for helpful comments on a previous draft.
This work was funded by the French Foundation for Research on Biodiversity (FRB) through its Centre for Synthesis and Analysis of Biodiversity data (CESAB), as part of the NETSEED research project. The funders had no role in the preparation of the manuscript.
Primary sources in literature are original, uninterpreted information (often, but not exclusively textual) relevant to a literary research topic. Examples include original works of fiction, art, or music; letters; diaries; interviews; or even works of criticism.
The key question to ask when trying to classify a source as primary versus secondary is how you intend to use it . If a work was written or created during the time period that you are researching, it can be used as a primary source.
For example:
A 1922 review of T. S. Eliot's The Waste Land would be considered a secondary source if your project is an analysis of Eliot's poem, but would be a primary source if your topic is the critical reception of Eliot's works, or the perception of modernism as a literary style in the 1920s.
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Image via avrenim_acceber at Flickr , used under Creative Commons license.
Different types of publications have different characteristics.
Primary Literature Primary sources means original studies, based on direct observation, use of statistical records, interviews, or experimental methods, of actual practices or the actual impact of practices or policies. They are authored by researchers, contains original research data, and are usually published in a peer-reviewed journal. Primary literature may also include conference papers, pre-prints, or preliminary reports. Also called empirical research .
Secondary Literature Secondary literature consists of interpretations and evaluations that are derived from or refer to the primary source literature. Examples include review articles (such as meta-analysis and systematic reviews) and reference works. Professionals within each discipline take the primary literature and synthesize, generalize, and integrate new research.
Tertiary Literature Tertiary literature consists of a distillation and collection of primary and secondary sources such as textbooks, encyclopedia articles, and guidebooks or handbooks. The purpose of tertiary literature is to provide an overview of key research findings and an introduction to principles and practices within the discipline.
Adapted from the Information Services Department of the Library of the Health Sciences-Chicago , University of Illinois at Chicago.
Original research results in journals, |
Review articles, systematic reviews, meta-analysis, practice guidelines, monographs on a specific subject |
Textbooks, encyclopedias, handbooks, newspapers |
Sources: NEJM, JAMA | Sources: PubMed, CINAHL, Cochrane Library, Web of Science, Williams Obstetrics, Hurst's The Heart | Sources: Gale Encyclopedia of Genetic Disorders, Oxford Handbook of Internal Medicine |
These examples and descriptions of publication types will give you an idea of how to use various works and why you would want to write a particular kind of paper.
Scholarly (aka empirical) article -- example
Empirical studies use data derived from observation or experiment. Original research papers (also called primary research articles) that describe empirical studies and their results are published in academic journals. Articles that report empirical research contain different sections which relate to the steps of the scientific method.
Abstract - The abstract provides a very brief summary of the research.
Introduction - The introduction sets the research in a context, which provides a review of related research and develops the hypotheses for the research.
Method - The method section describes how the research was conducted.
Results - The results section describes the outcomes of the study.
Discussion - The discussion section contains the interpretations and implications of the study.
References - A references section lists the articles, books, and other material cited in the report.
Review article -- example
A review article summarizes a particular field of study and places the recent research in context. It provides an overview and is an excellent introduction to a subject area. The references used in a review article are helpful as they lead to more in-depth research.
Many databases have limits or filters to search for review articles. You can also search by keywords like review article, survey, overview, summary, etc.
Conference proceedings, abstracts and reports -- example
Conference proceedings, abstracts and reports are not usually peer-reviewed. A conference article is similar to a scholarly article insofar as it is academic. Conference articles are published much more quickly than scholarly articles. You can find conference papers in many of the same places as scholarly articles.
To identify an article based on empirical research, look for the following characteristics:
The article is published in a peer-reviewed journal .
The article includes charts, graphs, or statistical analysis .
The article is substantial in size , likely to be more than 5 pages long.
The article contains the following parts (the exact terms may vary): abstract, introduction, method, results, discussion, references .
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A primary source is "first-hand" information, sources as close as possible to the origin of the information or idea under study.
Primary sources are contrasted with secondary sources, works that provide analysis, commentary, or criticism on the primary source.
In literary studies, primary sources are often creative works, including poems, stories, novels, and so on.
In historical studies, primary sources include written works, recordings, or other source of information from people who were participants or direct witnesses to the events in question.
Examples of commonly used primary sources include government documents, memoirs, personal correspondence, oral histories, and contemporary newspaper accounts.
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Primary sources of a literary work can include the following:
Explore millions of high-quality primary sources and images from around the world, including artworks, maps, photographs, and more.
Explore migration issues through a variety of media types
Harness the power of visual materials—explore more than 3 million images now on JSTOR.
Enhance your scholarly research with underground newspapers, magazines, and journals.
Explore collections in the arts, sciences, and literature from the world’s leading museums, archives, and scholars.
Knowing a primary source when you see one, kinds of primary sources, find primary sources in hollis, using digital libraries and collections online, using bibliographies.
Primary sources provide first-hand testimony or direct evidence concerning a topic under investigation. They are created by witnesses or recorders who experienced the events or conditions being documented.
Often these sources are created at the time when the events or conditions are occurring, but primary sources can also include autobiographies, memoirs, and oral histories recorded later.
Primary sources are characterized by their content, regardless of the format available. (Handwritten notes could be published; the published book might be digitized or put on microfilm, but those notes are still primary sources in any format).
Some types of primary sources:
Examples of primary sources include:
Outline of Primary Sources for History
Archives and Manuscripts
Archives and manuscripts are the unpublished records of persons (letters, notes, diaries, etc.) and organizations. What are Archives? Usually each archival collection has a (short) catalog record and a detailed finding aid (which is often available online).
To find Archives and manuscripts at Harvard, go to HOLLIS Advanced search . Search your keywords or Subject terms (see the HOLLIS page of this guide ) in the Library Catalog, limiting to Resource Type: Archives/Manuscripts. You can choose the library at the right (Search Scope). Countway Medicine has abundant medical archives, and Schlesinger has many archives of women activists, many in health and reproductive rights fields. Sample search on Subject: Women health .
Library Research Guide for Finding Manuscripts and Archival Collections explains
For digitized archival material together with other kinds of primary sources:
Methods for finding books are described under the HOLLIS page of this guide and in the Finding Primary Sources in HOLLIS box on this page.
Periodicals
Scientific articles :
Web of Science Citation Indexes (Harvard Login) (1900- ) articles in all areas of science. Includes medical articles not in PubMed. You can use the Cited Reference search in the Web of Science to find primary source articles that cite a specified article, thus getting an idea of its reception. More information on the Web of Science .
PubMed (1946- ) covers, usually with abstracts, periodical articles on all areas of medicine. - --Be sure to look at the MeSH (Medical Subject Headings) at the bottom of pertinent records. Very recent articles may not as yet received their MeSH terms. So look at older records to find the MeSH terms, and use a variety of keywords as well as MeSH terms to find the new records. --The MeSH terms are the same as the Medical Subject terms found in HOLLIS. --Hit Free article or Try Harvard Library, not the publisher's name to see full text
JSTOR (Harvard Login) offers full-text of complete runs (up to about 5 years ago) of over 400 journals. JSTOR allows simultaneous or individual searching, full-text searching optional, numerous journals in a variety of fields of science and medicine. See the list at the bottom of the Advanced search screen. JSTOR searches the "Notes and News" sections of journals ( Science is especially rich in this material). In Advanced Search choose Item Type: Miscellaneous to limit largely to "Notes and News".
PsycINFO) (Harvard Login) (1872- ) indexes the professional and academic literature in psychology and related disciplines
Many more scientific periodical indexes are listed in the Library Research Guide for the History of Science .
General interest magazines and periodicals see:
American Periodicals Series Online (Harvard Login) (1740-1900) offers full text of about 1100 American periodicals. Includes several scientific and medical journals including the American Journal of Science and the Medical Repository. In cases where a periodical started before 1900, coverage is included until 1940.
British Periodicals (Harvard Login) (1681-1920) offers full text for several hundred British periodicals.
Ethnic NewsWatch (Harvard Login) (1959- ) is a full text database of the newspapers, magazines, and journals of the ethnic, minority and native press.
Periodicals Index Online (Harvard Login) indexes contents of thousands of US and European journals in the humanities and social sciences, from their first issues to 1995.
Reader's Guide Retrospective (WilsonWeb) (Harvard Login) (1890-1982) indexes many American popular periodicals.
Many more general periodical indexes are listed in Finding Articles in General and Popular Periodicals (North America and Western Europe) .
Articles in non-science fields (religion, public policy): see the list in the Library Research Guide for History .
Professional/Trade : Aimed at particular trades or professions. See the Library Research Guide for History
Newspaper articles : see the Guide to Newspapers and Newspaper Indexes .
Personal accounts . These are first person narratives recalling or describing a person’s life and opinions. These include Diaries, memoirs, autobiographies, and when delivered orally and recorded: Oral histories and Interviews.
National Library of Medicine Oral Histories
Regulatory Oral History Hub (Kenan Institute for Ethics, Duke University) offers links to digital collections containing interviews with regulators, lawyers, and judges. Mainly U.S.
Visual sources :
Records for many, but by no means all, individual Harvard University Library images are available in HOLLIS Images , an online catalog of images. Records include subjects and a thumbnail image. HOLLIS Images is included in HOLLIS searches.
Science & Society Picture Library offers over 50,000 images from the Science Museum (London), the National Museum of Photography, Film & Television and the National Railway Museum.
Database of Scientific Illustrators (DSI) includes over 12500 illustrators in natural history, medicine, technology and various sciences worldwide, c.1450-1950. Living illustrators excluded.
NYPL Digital Gallery Pictures of Science: 700 Years of Scientific and Medical Illustration
Images from the History of Medicine (IHM) includes prints and photographs from the U.S. National Library of Medicine. (The IHM is contained within a larger NLM image database, so this link goes to a specialized search).
Images From the History of the Public Health Service: a Photographic Exhibit .
Wellcome Images
Films/Videos
To find films in HOLLIS , search your topic keywords, then on the right side of the results screen, look at Resource Type and choose video/film.
To find books about films about your topic, search your topic keywords AND "in motion pictures" (in "")
Film Platform offers numerous documentary films on a wide variety of subjects. There are collections on several topics. Searches can be filtered by topic, country of production, and language.
A list of general sources for images and film is available in the Library Research Guide for History and additional sources for the history of science in Library Research Guide for the History of Science .
Government documents often concern matters of science and health policy. For Congressional documents, especially committee reports, see ProQuest Congressional (Harvard Login ).
HathiTrust Digital Library . Each full text item is linked to a standard library catalog record, thus providing good metadata and subject terms. The catalog can be searched separately. Many government documents are full text viewable. Search US government department as Author.
More sources are listed in the Library Research Guide for History
For artifacts and other objects , the Historic Scientific Instruments Collection in the Science Center includes over 15,000 instruments, often with contemporary documentation, from 1450 through the 20th century worldwide.
Waywiser, online database of the Collection of Historical Scientific Instruments .
Warren Anatomical Museum of the Center for the History of Medicine in the Countway Library of Medicine has a rich collection of medical artifacts and specimens.
Peabody Museum of Archaeology and Ethnology
Fall 2020: these collections are closed during the pandemic. Check out their links above to see what they have available online.
Primary Source Terms :
You can limit HOLLIS searches to your time period, but sources may be published later, such as a person's diary published posthumously. Find these with these special Subject terms.
You can use the following terms to search HOLLIS for primary sources:
Include these terms with your topical words in HOLLIS searches. For example: tuberculosis personal narratives
Online Primary Source Collections for the History of Science lists digital collections at Harvard and beyond by topic
Google Book Search, HathiTrust Digital Library and Internet Archives offer books and periodicals digitized from numerous libraries. Only out-of-copyright, generally post-1923, books are fully viewable. Each of these three digital libraries allows searching full text over their entire collections.
Google Book Search
HathiTrust Digital Library is a vast digital library of books an dperiodicals. Full text searchs can be limited by standard Subjetc term (as usd in HOOLIS) or by aiuthor or til=tle (useful for periodicals). Many post-1925 out-of-copyright books, especially government documents, are full text viewable. You can search within copyright books to see what page your search term is on.
Internet Archive also offers a full text search which also can be limited by author, title, subject. For instructions see: Details on searching HathiTrust and Internet Archive.
The Internet: Archive includes the Medical Heritage Library . Information about the Medical Heritage Library. Searchable full text. Includes:
Biodiversity Heritage Library
The Online Books Page arranges electronic texts by Library of Congress call numbers and is searchable (but not full text searchable). Includes books not in Google Books, HathiTrust, or Internet Archive. Has many other useful features.
Contagion: Historical Views of Diseases and Epidemics (1493-1922) provides digitized historical, manuscript, and image resources selected from Harvard University libraries and archives.
Expeditions and Discoveries (1626-1953) features nine expeditions in anthropology and archaeology, astronomy, botany, and oceanography in which Harvard University played a significant role. Includes manuscripts and records, published materials, visual works, and maps from 14 Harvard repositories.
Defining Gender Online: Five Centuries of Advice Literature for Men and Women (1450-1910).
Twentieth Century Advice Literature: North American Guides on Race, Sex, Gender, and the Family.
Finding Primary Sources Online offers methods for finding digital libraries and digital collections on the open Web and for finding Digital Libraries/Collections by Region or Language .
Many more general History digital libraries and collections: Library Research Guide for History
More History of Science digital libraries: Library Research Guide for the History of Science .
There may already be a detailed list of sources (a bibliography) for your topic.
For instance:
A bibliography of eugenics , by Samuel J. Holmes ... Berkeley, Calif., University of California press, 1924, 514 p. ( University of California publications in zoology . vol. XXV) Full text online .
Look for specialized subject bibliographies in HOLLIS Catalog . Example . WorldCat can do similar searches in the Subject Keyword field for non-Harvard holdings.
Harvard University Digital Accessibility Policy
Databases for finding articles.
In the sciences, a primary source describes original research, while a secondary source analyzes or comments on a primary source or sources. For example, a research article is primary literature because it describes an original experiment and its results, while a review article is secondary literature because it collates multiple research articles to describe the current state of the field.
Examples of primary sources:
Examples of secondary sources:
The databases below can help you find primary literature in the sciences. While searching, you can narrow your results to primary literature by using filters on the left of the page.
A primary source is an original object or document created during the time under study. Primary sources vary by discipline and can include historical and legal documents, diaries, letters, family records, speeches, interviews, autobiographies, film, government documents, eye witness accounts, results of an experiment, statistical data, pieces of creative writing, and art objects. In the natural and social sciences, the results of an experiment or study are typically found in scholarly articles or papers delivered at conferences, so those articles and papers that present the original results are considered primary sources.
A secondary source is something written about a primary source. Secondary sources include comments on, interpretations of, or discussions about the original material. You can think of secondary sources as second-hand information. If I tell you something, I am the primary source. If you tell someone else what I told you, you are the secondard source. Secondary source materials can be articles in newspapers or popular magazines, book or movie reviews, or articles found in scholarly journals that evaluate or criticize someone else's original research.
Examples | ||
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| Slave narratives preserved on microfilm. is an example of a mircofilm colletion, housed at the Library of Congress, that has been digatized and is freely available. | The book by DoVeanna Fulton |
| American photographer Man Ray's photograph of a flat-iron called ” (The Gift) | Peggy Schrock's article called Ray Le cadeau: the unnatural woman and the de-sexing of modern man published in . |
| published in the
| A review of the literature on college student drinking intervention which uses the article in an analysis entitled: drinking: A meta-analytic review, published in the journal |
| U.S. Government | An article which used samples of census data entitled: " published in the journal |
Research versus Review
Scientific and other peer reviewed journals are excellent sources for primary research sources. However, not every article in those journals will be an article with original research. Some will include book reviews and other materials that are more obviously secondary sources . More difficult to differentiate from original research articles are review articles . Both types of articles will end with a list of References (or Works Cited). Review articles are often as lengthy or even longer that original research articles. What the authors of review articles are doing is analysing and evaluating current research or investigations related to a specific topic, field, or problem. They are not primary sources since they review previously published material. They can be helpful for identifying potentially good primary sources, but they aren't primary themselves. Primary research articles can be identified by a commonly used format. If an article contains the following elements, you can count on it being a primary research article. Look for sections entitled Methods (sometimes with variations, such as Materials and Methods), Results (usually followed with charts and statistical tables), and Discussion . You can also read the abstract to get a good sense of the kind of article that is being presented. If it is a review article instead of a research article, the abstract should make that clear. If there is no abstract at all, that in itself may be a sign that it is not a primary resource. Short research articles, such as those found in Science and similar scientific publications that mix news, editorials, and forums with research reports, may not include any of those elements. In those cases look at the words the authors use, phrases such as "we tested," "we used," and "in our study, we measured" will tell you that the article is reporting on original research.
Primary or Secondary: You Decide
The distinction between types of sources can get tricky, because a secondary source may also be a primary source. DoVeanna Fulton's book on slave narratives, for example, can be looked at as both a secondary and a primary source. The distinction may depend on how you are using the source and the nature of your research. If you are researching slave narratives, the book would be a secondary source because Fulton is commenting on the narratives. If your assignment is to write a book review of Speaking Power , the book becomes a primary source, because you are commenting, evaluating, and discussing DoVeanna Fulton's ideas.
You can't always determine if something is primary or secondary just because of the source it is found in. Articles in newspapers and magazines are usually considered secondary sources. However, if a story in a newspaper about the Iraq war is an eyewitness account, that would be a primary source. If the reporter, however, includes additional materials he or she has gathered through interviews or other investigations, the article would be a secondary source. An interview in the Rolling Stone with Chris Robinson of the Black Crowes would be a primary source, but a review of the latest Black Crowes album would be a secondary source. In contrast, scholarly journals include research articles with primary materials, but they also have review articles that are not, or in some disciplines include articles where scholars are looking at primary source materials and coming to new conclusions.
For your thinking and not just to confuse you even further, some experts include tertiary sources as an additional distinction to make. These are sources that compile or, especially, digest other sources. Some reference materials and textbooks are considered tertiary sources when their chief purpose is to list or briefly summarize or, from an even further removed distance, repackage ideas. This is the reason that you may be advised not to include an encyclopedia article in a final bibliography.
The above material was adapted from the excellent explanation written by John Henderson found on Ithaca College's library website http://www.ithacalibrary.com/sp/subjects/primary and is used with permission.
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BDJ Open volume 10 , Article number: 74 ( 2024 ) Cite this article
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Managing dental caries in primary teeth with pulp involvement is a significant challenge. Clinical guidelines offer recommendations for effective management.
To identify and analyze policies, guidelines, and recommendations for treating primary teeth with pulp-involved carious lesions, highlighting existing research gaps and setting the foundation for future research.
A comprehensive search was conducted across databases (PubMed, Scopus, Embase, GIN, and LILACS) and grey literature sources (Trip and ProQuest) to identify guidelines, consensus, policy, and position statements on primary teeth pulp therapy and extraction thresholds. Two independent reviewers screened the abstracts and titles, followed by full-text screening.
After removing duplication, of the 1098 records, 14 were selected for analysis. This review examined various treatments for deep caries lesions in primary teeth, including indirect/direct pulp capping, pulpotomy, pulpectomy, lesion sterilization/tissue restoration, and extraction. Time search was restricted to documents published from 30th January 2008 to 30th January 2024, offering insights into evolving clinical practices.
Treatment for carious lesions in primary teeth involving the pulp depends on clinical indications and may involve minimally invasive techniques. Recommended options are indirect pulp capping, pulpotomy, and pulpectomy, while direct capping and tooth removal are discouraged. Further research is needed to address gaps, improve guideline development, and enhance consistency of recommendations.
Introduction.
Dental caries remains a significant oral health issue affecting approximately half of the global child population, with little change in prevalence over the past few decades (Uribe, Innes, & Maldupa, 2021). Despite efforts to address the problem, complications arising from carries, including pulp damage, continue to impact a considerable number of children (Lin et al., 2019). Pulp damage resulting from caries lesions accounts for nearly 90% of cases and requires effective management strategies [ 1 ].
Primary teeth present unique challenges in the treatment of pulp pathology due to their distinct anatomical and physiological characteristics, as well as the psycho-emotional development of young children [ 2 ]. While the preservation of pulp for as long as possible is advocated as the primary approach, minimally intervention dental (MID) techniques have emerged as successful preventive measures for pulp pathologies [ 3 ]. However, there are clinical scenarios where MID cannot be applied, and immediate treatment becomes necessary for pulp-related complications.
Management of carious lesion with pulp involvement in primary teeth include pulpotomy, pulpectomy, or extraction. The choice of treatment and medications is influenced by various factors. However, pulp therapy treatments often require a child’s cooperation and may involve multiple sessions or general anaesthesia. These factors can heighten anxiety for the child and increase the time and resource burden for their family and dental staff [ 4 ]. Besides, the success rate of endodontic treatment for primary teeth remains a contentious issue [ 5 ]. Consequently, extractions are increasingly favoured as the preferred treatment for pulpal pathology [ 4 ]. Nevertheless, concerns arise regarding space loss, potential orthodontic needs, and the overall impact on the child’s quality of life following premature loss of primary teeth [ 4 ].
To guide healthcare providers in making well-informed decisions regarding the management of caries lesions involving the pulp in primary teeth, various authoritative sources have developed clinical practice guidelines (CPGs), consensus statements, policy documents, and position statements. These resources aim to provide evidence-based recommendations and standardised clinical practices. However, there is considerable variability in the recommendations due to differences in available evidence, contextual factors, and variations in healthcare systems across different countries.
Numerous systematic reviews have synthesized the efficacy of pulp therapy for primary teeth, including Cochrane reviews and other comprehensive analyses [ 6 , 7 ]. These reviews have significantly contributed to our understanding of the outcomes associated with different treatment approaches. Moreover, research has explored the factors influencing clinicians’ decision-making process when choosing between endodontic treatment and extraction for primary teeth with pulp involvement [ 8 ].
Despite these existing systematic reviews and research efforts, the optimal course of action for the preservation or extraction of primary teeth with pulp involvement remains a subject of ongoing debate. CPGs and recommendations have been developed to offer clear and evidence-based guidance. However, the variability in recommendations, based on the best available evidence and contextual factors, underscores the need for further exploration and examination of the existing documents related to the management of caries lesions reaching the pulp in primary teeth.
Hence, this scoping review aims to identify and describe documents (current CPGs, consensus, policies, clinical recommendations and position statements) for managing caries lesions that reached the pulp in primary teeth.
The research protocol for this scoping review was registered on the Open Science Framework (OSF) platform to ensure transparency and adherence to the planned methodology (OSF registration: ( https://doi.org/10.17605/OSF.IO/APCKG )). The review followed the established methodology for scoping reviews outlined by the Joanna Briggs Institute (JBI) and the report followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines for Scoping Reviews [ 9 ].
A comprehensive search strategy was developed in collaboration with experienced researchers and information specialists to identify relevant studies and sources of evidence. Electronic databases, including MEDLINE, Scopus, Embase, GIN, and LILACS, were systematically searched up to 30 th January 2024. Grey literature sources, such as Trip and ProQuest, were also consulted to capture unpublished documents, reports, and guidelines. The search terms and keywords were carefully selected to cover the key concepts of paediatric dentistry, dental caries, clinical practice guidelines, extraction, and pulp therapy (See Appendix 1 ).
This study included recent clinical practice guidelines (CPGs), consensus statements, policy documents, and position statements addressing the threshold for pulp therapy and extraction in primary teeth with pulp involvement. Eligible documents had to be officially endorsed or produced by reputable organisations like government agencies, professional associations, or expert panels, using a systematic consensus approach. In the case of multiple versions, only the latest one was considered. Time search was restricted to the last 20 years (30th January 2004) as older guidelines are likely to be updated or irrelevant. No language restrictions were applied in the search strategy.
Primary and secondary research articles, expert opinions, editorials, and letters to editors, as well as studies involving adult participants or special needs children.
A two-step screening process was conducted by two independent reviewers. In the initial step, titles and abstracts of the identified records were screened to assess their eligibility based on the predefined inclusion and exclusion criteria. Full-text articles were obtained for potentially relevant sources, and two reviewers independently evaluated them for final inclusion in the review. Discrepancies or disagreements between the reviewers were resolved through discussion or consultation with a third reviewer to ensure consensus.
Data extraction was performed using an ad hoc standardised form developed specifically for this scoping review. Two reviewers independently extracted relevant information from the included studies and documents, including publication year, authorship, study design, participant characteristics, methodology, key recommendations, and additional findings deemed relevant. Consistency and accuracy of the extracted data were ensured through cross-checking, and any disagreements were resolved through discussion or involvement of a third reviewer.
Data analysis aimed to capture the range of recommendations and approaches related to the threshold for pulp therapy and extraction in primary teeth with pulp involvement. A narrative synthesis approach was employed to analyse and present the extracted data. Key themes, concepts, and recommendations from the included studies and documents were systematically organised and summarised. The extracted data were presented using table and graphs to enhance clarity and facilitate understanding. Patterns and variations among the recommendations were identified to provide a comprehensive overview of the existing literature.
The initial search process yielded a total of 1098 records from multiple databases and organisations [American Academy of Paediatric Dentistry (AAPD), European Academy of Paediatric Dentistry (EAPD), Scottish Dental Clinical Effectiveness Programme (SDCEP), Qatari, Saudi, Health Ministry of Chile, Brazilian and Iraqi Dental Association] (See Appendix 3 ). After removing duplicates, the titles and abstracts of 417 unique records were screened for eligibility. From this initial screening, 30 papers were selected for a more detailed evaluation. Finally, 14 papers met the inclusion criteria and were included in the in-depth analysis. Figure 1 provides a visual representation of the study selection process following PRISMA-ScR guidelines (See Appendix 2 ) [ 10 ].
The process consists of four stages: Identification, Screening, Eligibility, and Inclusion. Identification: a total of 1098 records were identified from various databases, including PubMed/Medline ( n = 120), Embase ( n = 135), Scopus ( n = 176), Lilacs ( n = 84), Trip ( n = 170), ProQuest ( n = 26), and other sources ( n = 387). After removing 681 duplicate records, 417 records were screened. Screening: out of the 417 records screened, 387 were excluded based on title and abstract screening, and 30 reports were sought for retrieval. Eligibility: among the 30 reports, 8 were not retrieved. The remaining 22 reports were assessed for eligibility, with 8 reports being excluded due to updated versions being available. Inclusion: ultimately, 14 studies were included in the final review.
The included studies were primarily sourced from reputable databases, with the highest number of records obtained from the American Academy of Paediatric Dentistry (AAPD) (345), Scopus (176), Trip (170), Embase (135), and PubMed/MEDLINE (120). Additional sources, such as Lilacs (84), ProQuest (26), Scottish Dental Clinical Effectiveness Programme (SDCEP) (16), European Academy of Paediatric Dentistry (EAPD) (14), and GIN (6), also contributed to the final selection of papers. The selected papers focused on the treatment of primary teeth with deep caries lesions and provided insights into extraction, pulpectomy, pulpotomy, and variations within these treatment options.
Most CPGs discussed both Direct Pulp Capping (DPC) ( n = 6) and Indirect Pulp Capping (IPC) ( n = 8), pulpotomy ( n = 10) and pulpectomy ( n = 9) as potential treatment options for specific cases involving deep caries lesions in primary teeth. IPC and DPC techniques were outlined concerning their indications, recommended protocols, and supporting evidence. Additionally, some papers explored the concept of lesion sterilisation/tissue repair (LSTR), albeit being mentioned in only two documents. The use of LSTR for managing carious lesions reaching the pulp in primary teeth was discussed in terms of its effectiveness, limitations, and potential application.
While the included studies and documents shared commonalities in their recommendations, some variations were observed. These variations were often influenced by contextual factors, such as the healthcare system, resources, and available treatment options in different countries or regions. Additionally, certain aspects of the management of caries lesions in primary teeth with pulp involvement lacked clear consensus or had limited evidence, indicating gaps in the existing literature.
The reviewed literature explored various treatment options for primary teeth with deep caries lesions, including extraction, pulpectomy, pulpotomy, and their subdivisions.
Indirect Pulp Capping was recommended as a successful treatment for vital deciduous teeth affected by deep caries, as it is a MID approach that does not interfere with the natural exfoliation process [ 11 , 12 ]. This treatment is indicated when there is no pulp involvement [ 13 ] and is considered a standard treatment option [ 14 ]. To ensure successful IPC, it is crucial to achieve an excellent seal of the coronal part of the tooth [ 12 ]. The procedure involves selective removal of soft caries tissue, particularly from the dentin-enamel junction, using hand instruments [ 11 , 15 , 16 ]. Subsequently, materials such as zinc oxide eugenol (ZOE), hard-setting calcium hydroxide (Ca(OH)₂), or resin-modified glass ionomer cement (RMGIC) are placed and covered with a preformed crown or adhesive restoration. These procedures have received a grade B recommendation, and level III evidence, and have shown success rates of over 90% after three years [ 16 ]. Alternative approaches, including the use of slow rotary instruments and other biocompatible materials like mineral trioxide aggregate (MTA), were also mentioned (See Fig. 2 ). Compared to pulpotomy treatments, IPC has demonstrated higher long-term success rates [ 11 , 15 ]. Meta-analyses did not find significant differences between bonding agent liners and Ca(OH)₂, with moderate and low evidence after 24–48 months [ 17 ]. In contrast, recommendations from 2005 suggested complete removal of caries and direct pulp capping (DPC) or pulpotomy in cases of iatrogenic pulp exposure due to higher symptom occurrence and uncertain outcomes. Before filling the cavity, Ca(OH)₂ is placed to promote secondary dentin formation (See Fig. 2 ) [ 18 ].
This timeline summarises the evolution of IPC guidelines across various countries and regions from 2005 to 2022. It outlines the indications, recommendations, and levels of evidence in countries such as the UK, Chile, USA, New Zealand, and others. Specific recommendations range from total caries removal to selective caries removal with materials like calcium hydroxide and glass ionomer cement. Evidence levels vary from low to high across different years and regions.
The use of DPC as a treatment option is restricted to spot-like pulpal exposure areas due to trauma or mechanical opening during caries removal in cases of non-symptomatic and non-infectious circumstances (See Fig. 3 ), to facilitate dentine structure development [ 16 , 18 , 19 ].
The figure displays DPC guidelines across regions from 2005 to 2022, including the UK, USA, and international recommendations. Indications include traumatic pulp exposures and materials recommended include calcium hydroxide and MTA. Evidence levels range from low to not stated, reflecting the evolving clinical recommendations over the years.
For the purpose of teeth protection from microleakage, Ca(OH)₂ and mineral trioxide aggregate (MTA) have been suggested [ 11 ]. Meta-analyses show no significant difference in success between Ca(OH)₂ and MTA, formocresol (FC) and dentin bonding agents after 24 months. Due to the missing discrepancy of included studies, the quality of evidence was rated as very low [ 17 ]. Prior haemorrhage control by a piece of cotton damped with saline or water has been recommended with grade C and evidence quality level IV [ 16 ].
In general, DPC is not recommended as a regular treatment option for primary teeth [ 15 ]. This might be connected to the elevated cellular density in the pulp tissue of deciduous teeth and poor prognosis [ 20 , 21 ] However, close to the physiological exfoliation time, DPC can be indicated due to less severe consequences (See Fig. 3 ) [ 16 ].
Pulpotomy is a recommended treatment option for primary teeth with profound carious lesions, boasting a 24-month success rate of 82.6% [ 22 ]. However, due to limited direct comparisons, no definitive evidence-supported recommendation can be made regarding the choice between pulpotomy, DPC, and IPC (See Fig. 4 ) [ 14 , 22 ].
This figure highlights pulpotomy guidelines in the UK, Chile, Italy, and other regions from 2005 to 2022. Indications include symptoms of irreversible pulpitis, and materials recommended include formocresol (FC), MTA, and ferric sulfate. Evidence is rated from low to high depending on the year and location. The timeline also covers regional variations in managing pulpotomy procedures.
Pulpotomy is generally indicated for primary teeth with exposed vital pulp or irreversible pulpitis of the coronal pulp, if the underlying tissue is healthy or shows reversible inflammation [ 16 , 17 ]. It can be performed on deciduous teeth at any developmental stage [ 13 ]. Contraindications include severe root resorption, facial cellulitis, abscess history, or specific patient conditions necessitating general anaesthesia [ 23 ]. Pulpotomy for vital pulp in primary molars is a recommended treatment, while non-vital pulpotomy, which differs in procedure and indication, is considered obsolete in most current guidelines.
Some guidelines discourage the use of Ca(OH)₂ during pulpotomy due to compromised results and lower success rates compared to ferric sulphate (FS), mineral trioxide aggregate (MTA), and formocresol [ 12 , 16 , 17 , 19 ].
MTA (87.8%) and formocresol (85%) have shown the highest success rates among recommended treatment choices, leading to a strong recommendation for their use [ 17 ]. Other options are conditionally recommended, and the use of formocresol may raise concerns among parents [ 15 , 16 , 17 ].
MTA, despite higher initial costs, proves to be more cost-effective in the long run due to its greater success rates and reduced need for secondary treatments compared to Ca(OH)₂ [ 17 ]. MTA preserves pulp integrity, reduces inflammation, and promotes tissue formation, while Portland cement is considered a low-cost alternative [ 24 ].
Additional research is needed to determine specific recommendations for lining materials, caution is advised regarding the combination of FS and eugenol, and control of haemorrhage is essential during treatment [ 16 , 18 , 24 ].
Stainless steel crowns are recommended as a permanent restoration after pulpotomy, while composite resin and amalgam can be used for deciduous teeth with minor structural damage [ 11 ].
Pulpectomy is a recommended treatment for restorable primary teeth with necrosis, irreversible pulpitis, root resorption, and other pathologies [ 11 ]. It is preferred over LSTR in the absence of root resorption. Pulpectomy is generally not recommended as a first-line treatment for deep caries in vital primary molars due to the effectiveness of more conservative alternatives like indirect pulp capping or pulpotomy. However, it may be used instead of extraction when tooth loss could harm dental health and long-term occlusion, or if there is no permanent successor [ 12 ].
Prior to treatment, a periapical radiograph is taken for diagnosis, and anaesthesia is administered [ 4 ]. Root canal shaping can be done with rotary or hand files, followed by irrigation using sodium hypochlorite or alternative solutions [ 11 , 15 ]. Canals are dried before using zinc oxide eugenol (ZOE) cement or calcium hydroxide (Ca(OH)₂) with iodoform paste for obturation [ 11 , 15 ].
Different approaches exist for pulpectomy depending on the condition, such as two-stage or one-stage procedures [ 18 ]. The Italian Ministry of Health recommends pulpectomy for non-vital primary teeth in specific developmental stages and with clinical signs like abscesses, fistula, and pain [ 2 ]. The use of Ca(OH)₂ combined with iodoform paste is advantageous, although ZOE is also suggested [ 2 ]. Irrigation should be performed using hypochlorite, saline, or chlorhexidine [ 16 ].
The Federal University of Rio de Janeiro (UFRJ) recommends specific irrigation techniques and materials for obturation, such as ZOE, glass ionomer cement (GIC), or heated gutta-percha. The heated gutta-percha is used specifically to seal the canal orifice, not to fill the canals [ 25 ]. Preformed crowns are suggested for excellent coronal seal [ 16 ]. Pulpectomy success rates range from 59% to 69% for teeth with root resorption and 84% to 90% for those without [ 25 ]. Extraction may be necessary if fistula or abscess persists after Ca(OH)₂ [ 25 ]. The Dubai Health Authority limits pulpectomy to primary teeth with less than one-third root resorption and without facial cellulitis or abscess [ 23 ]. Considerations for pulpectomy include long-term retention of second deciduous molars and stable occlusion, with conservative treatments preferred for profound carious lesions (See Fig. 5 ).
The pulpectomy timeline from 2005 to 2022 illustrates recommendations from the UK, Chile, USA, and other countries. It covers the management of irreversible pulpitis and related pathology, with recommendations including the use of zinc oxideeugenol, MTA, and root canal instrumentation. Evidence levels range from low to moderate across different regions.
LSTR is a possible treatment option for primary teeth experiencing clinical symptoms of irreversible pulpitis, fistula formation, and other pathologies (see Fig. 6 ) [ 11 , 15 ]. It is considered preferable over pulpectomy in cases of root resorption and teeth expected to exfoliate within one year. The treatment involves establishing access to the pulp chamber and augmenting the orifices. Phosphoric acid is used to cleanse the chamber, followed by rinsing and drying. Subsequently, a paste containing ciprofloxacin, metronidazole, and clindamycin, along with macrogol and polyethylene, is placed in the affected areas. It is important to avoid the incorporation of tetracycline into the antibiotic mix. Finally, glass ionomer cement (GIC) and a stainless-steel crown are placed [ 11 , 15 ].
This figure outlines LSTR treatment guidelines between 2005 and 2022 in regions like the USA and international contexts. The timeline reflects recommendations for disinfecting root canals using antibiotics like ciprofloxacin and metronidazole for cases of irreversible pulpitis and root resorption. Evidence is generally not stated.
Extraction is indicated for primary teeth in the following situations: teeth approaching exfoliation, teeth that are non-restorable due to extensive caries or uncontrolled pulp haemorrhage [ 16 , 18 , 20 , 26 ]. In addition, pulpectomy with repeated medication application without symptom relief or continuous exudation is also a reason for extraction [ 25 ]. (See Fig. 7 ).
From 2005 to 2022, this figure tracks extraction guidelines in the UK, Chile, USA, and other regions. Indications include nonrestorable teeth with extensive decay or advanced root resorption. Recommendations include balanced extractions and use of chlorhexidine (CHX) irrigation. Evidence levels vary from low to not stated.
Balanced bilateral extractions may be considered for primary canines, and in cases where there is absence of the contralateral tooth, extraction may be indicated for the first deciduous molars, provided that the jaw space is not excessively crowded [ 16 , 18 ]. However, primary incisors are less frequently subjected to extraction [ 18 ]. It is important to consider the need for space maintainers when the development of permanent root formation does not exceed one-third of its completion [ 25 ].
In addition to clinical factors, such as tooth condition and stage of eruption, other factors including patient cooperation, social factors, and medical conditions should be considered when deciding on extraction [ 20 ]. Furthermore, the attitude of the patient and parents, as well as the number and complexity of required treatments, should be also considered [ 16 , 18 ]. It is generally recommended to avoid extractions during initial dental visits [ 13 , 20 ]. Whenever possible, extraction should be avoided in cases of crowding, absence of underlying permanent teeth, and situations that may cause increased stress for the patient [ 18 ].
The management of caries lesions that reach the pulp in primary teeth presents a complex challenge for dental professionals. CPGs play a crucial role in providing evidence-based recommendations for the treatment of such cases. This scoping review aimed to identify and describe documents, including CPGs, consensus statements, policies, and clinical recommendations, pertaining to the management of caries lesions that reached the pulp in primary teeth. Hence, this review provides valuable insights into the variations in thresholds and recommendations for different treatment procedures. Although our focus was on published documents, it is important to note that we could not verify whether these documents utilised the best available evidence to formulate their recommendations or if they had low risk of bias.
The analysis of the included documents revealed variations in thresholds and recommendations for different treatment procedures. These variations stem from differences in the interpretation of the available evidence, clinical judgement, and priorities of different dental organizations and professional societies.
The comparison of indications for each procedure among different CPGs provides valuable insights into the diverse perspectives and considerations when managing caries lesions that reach the pulp in primary teeth. These variations in recommendations reflect the complexities of clinical decision-making and the diverse approaches taken by different guidelines.
For instance, the AAPD guidelines recommend Indirect Pulp Capping as a standard treatment option for vital primary teeth with deep caries lesions but without pulp involvement [ 16 ]. IPC is widely practiced in the United States and has shown favourable outcomes. In contrast, the EAPD guidelines also support IPC but provide more specific indications, such as minimal pulp involvement and limited symptoms [ 12 ].
When considering direct pulp capping and pulpotomy, guidelines offer varying recommendations. The AAPD guidelines suggest DPC for spot-like pulpal exposures resulting from trauma or mechanical opening during caries removal [ 19 ]. On the other hand, the SDCEP guidelines discourage the routine use of DPC and instead recommend pulpotomy as a treatment option [ 13 ].
The indications for pulpotomy also show variations among guidelines. The IAPD guidelines recommend pulpotomy for primary teeth with exposed vital pulp or irreversible pulpitis of the coronal pulp [ 15 ]. However, specific indications provided by different guidelines may vary, taking into account factors such as clinical signs, developmental stages, and the prevalence of dental conditions.
Similarly, the indications for pulpectomy vary among guidelines. The AAPD guidelines recommend pulpectomy for restorable primary teeth with necrosis, irreversible pulpitis, root resorption, or other pathologies [ 11 ]. In contrast, guidelines from other sources may provide more specific indications based on their own research and clinical experience.
These variations in recommendations highlights the influence of context on treatment recommendations. Guidelines developed in different regions may reflect the specific needs and resources available in those areas. Furthermore, the availability of materials and resources can significantly impact the treatment options recommended in the guidelines. Different regions may have varying access to materials such as Ca(OH)₂, MTA, or formocresol. These variations in material availability can lead to differences in the recommended treatment modalities. Cost-effectiveness of materials play a key role in the treatment choices outlined in the guidelines. The review evidence highlights the departure from historical practices, with the more recent CPGs no longer endorsing complete caries removal [ 21 ]. Similarly, the reconsideration of calcium hydroxide (Ca(OH)₂) usage, previously employed for secondary dentin formation before cavity filling, reflects this evolving perspective. This shift aligns with our growing understanding of cariology, emphasising minimally invasive procedures to preserve teeth tissue whenever possible [ 27 ]. Despite these advancements, the adoption of these guideline points among clinicians remains limited [ 28 ]. Addressing this gap may necessitate broader dissemination of updated guidelines, targeted educational initiatives, and ongoing efforts to bridge the translation gap between evidence-based recommendations and clinical implementation.
Another important consideration is the publication and development process of the guidelines. While guidelines aim to provide evidence-based recommendations, the level of detail and transparency in their development can vary. Some guidelines may provide extensive information on the underlying evidence, the grading of recommendations, and the consensus process followed. An example of such comprehensive guidelines is the Guidelines for the Management of Dental Emergencies by the SDCEP, which provide clear explanations of the evidence base, and the consensus process used [ 13 ]. On the other hand, some guidelines may lack sufficient information on the level of evidence, or the specific studies considered during their development.The lack of transparency and detail in guideline development makes it challenging to understand the rationale behind certain recommendations and hampers the ability to compare and reconcile differences between guidelines. To enhance the transparency and quality of guidelines, future efforts should prioritize the adherence to established guideline development methodologies, such as those recommended by Guidelines International Network. This includes clearly outlining the process for evidence synthesis, the grading of recommendations, and the involvement of multidisciplinary experts. The reporting quality of clinical practice guidelines exhibits significant variability. A previous study assessing the reporting quality of CPGs in paediatric dentistry has indicated suboptimal adherence to quality standards, underscoring the need for future improvement in their applicability. Implementation of standardised checklists such as the Appraisal of Guidelines for Research and Evaluation (AGREE) is imperative during CPG development processes to ensure methodological rigour and transparency in newly developed guidelines, before their adoption into clinical practice.
Among the myriad recommended treatments for various pulp conditions, a fundamental principle must remain unequivocal—treating patients based on the minimum intervention approach. In navigating the therapeutic choices, the essence of the Hippocratic principle, “primum non nocere” (first, do no harm). Thus, as practitioners, we are reminded to balance the intricacies of diverse treatment modalities with a commitment to the overarching goal of delivering care that is both effective and minimally invasive.
There are significant variations in guidelines for diagnosing and managing caries lesions that reach the pulp in primary teeth, reflecting differences in evidence interpretation, clinical judgement, and organisational priorities.
For caries with pulp involvement, guidelines differ: the AAPD advocates treating small pulpal exposures due to trauma or mechanical opening with direct pulp capping, while the SDCEP recommends more conservative approaches. The IAPD focuses on specific clinical signs and developmental stages to guide treatment, such as the extent of pulp involvement and the child’s age.
Regional needs and resources influence treatment recommendations, including the availability of materials like calcium hydroxide, mineral trioxide aggregate (MTA), or formocresol, and cost-effectiveness considerations. Recent guidelines favour minimally invasive procedures and reconsider the use of traditional materials like calcium hydroxide.
Transparency and methodological rigour in guideline development vary. Comprehensive guidelines, such as those from the SDCEP, provide clear evidence bases and consensus processes. Future guidelines should adhere to established methodologies to ensure transparency and methodological rigour.
Why this paper is important to paediatric dentists:
There is significant variation in guidelines for managing caries in primary teeth, influenced by regional contexts, material availability, and opaque guideline development processes. Understanding this variation is crucial for paediatric dentists to interpret and apply guidelines appropriately.
Adhering to clear guideline development methodologies and transparency about the rationale and evidence behind recommendations is needed to promote consistency and confidence in guidelines. This allows paediatric dentists to make properly evidence-based decisions.
Enhancing the quality and usability of guidelines on managing dental caries will facilitate decision-making for paediatric dentists seeking to provide optimal patient care. Reducing ambiguity supports the provision of appropriate care tailored to specific contexts.
The data that support the findings of this study are available in the Appendix 3 .
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The study was funded by Fundamental & Applied Research Projects (FLPP), Latvian Council of Science wide no. lzp-2022/1-0047, IEVA—Implementation of the Evidence-Based Paediatric CAries Management Strategies in Latvian Clinical Practice—an Evidence Transfer Study. The Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES; Coordination for the Improvement of Higher Education Personnel)—finance code 001 granting scholarships to RAE. The funders had no role in the conduct of the study, the analysis of the data or the decision to submit the manuscript for publication.
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Department of Conservative Dentistry and Oral Health, Riga Stradiņš University Faculty of Dentistry, Riga Stradiņš University, Rīga, Latvia
Ilze Maldupa & Julius Giese
School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, UK
Waraf Al-Yaseen & Daniela Prócida Raggio
Department of Orthodontics and Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
Rokaia Ahmed Elagami & Daniela Prócida Raggio
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IM, DPR, and WA conception and design of the study; IM, JG, RAE, and WA data acquisition; JG, IM and DPR. data analysis and interpretation; WA, IM, RAE AND DPR drafted the manuscript; IM, WA, RAE, DPR revised and gave final approval of the manuscript.
Correspondence to Waraf Al-Yaseen .
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The authors declare no competing interests.
Ethics approval was not required for this study as it is a scoping review based on secondary data, all of which are publicly available. The review did not involve any interaction with human subjects, and no personal or sensitive information was obtained.
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Maldupa, I., Al-Yaseen, W., Giese, J. et al. Recommended procedures for managing carious lesions in primary teeth with pulp involvement—a scoping review. BDJ Open 10 , 74 (2024). https://doi.org/10.1038/s41405-024-00259-8
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Received : 19 June 2024
Revised : 04 August 2024
Accepted : 07 August 2024
Published : 18 September 2024
DOI : https://doi.org/10.1038/s41405-024-00259-8
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Research for your literature review can be categorised as either primary or secondary in nature. The simplest definition of primary sources is either original information (such as survey data) or a first person account of an event (such as an interview transcript). Whereas secondary sources are any publshed or unpublished works that describe ...
The term primary source is used broadly to embody all sources that are original. Primary sources provide first-hand information that is closest to the object of study. Primary sources vary by discipline. In the natural and social sciences, original reports of research found in academic journals detailing the methodology used in the research, in ...
Primary sources provide raw information and first-hand evidence. Examples include interview transcripts, statistical data, and works of art. Primary research gives you direct access to the subject of your research. Secondary sources provide second-hand information and commentary from other researchers. Examples include journal articles, reviews ...
Scholarly, professional literature falls under 3 categories, primary, secondary, and tertiary. Published works (also known as a publication) may fall into one or more of these categories, depending on the discipline. See definitions and linked examples of primary, secondary, and tertiary sources. Differences in Publishing Norms by Broader ...
Writing a Literature Review. A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and ...
Examples of literature reviews. Step 1 - Search for relevant literature. Step 2 - Evaluate and select sources. Step 3 - Identify themes, debates, and gaps. Step 4 - Outline your literature review's structure. Step 5 - Write your literature review.
Primary literature may also include conference papers, pre-prints, or preliminary reports. Secondary Literature/Source Secondary literature consists of interpretations and evaluations that are derived from or refer to the primary source literature. Examples include review articles (e.g., meta-analysis and systematic reviews) and reference works.
Review articles are based on analysis of the published 'literature' (books, articles and dissertations about the topic). Secondary sources can include books, book chapters, articles, especially literature reviews, and some book reviews. A tertiary source is commonly a resource or tool that helps people find primary or secondary sources ...
A literature review may consist of simply a summary of key sources, but in the social sciences, a literature review usually has an organizational pattern and combines both summary and synthesis, often within specific conceptual categories.A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information in a way that ...
Primary source: Usually a report by the original researchers of a study (unfiltered sources) Secondary source: Description or summary by somebody other than the original researcher, e.g. a review article (filtered sources) Conceptual/theoretical: Papers concerned with description or analysis of theories or concepts associated with the topic.
Primary sources are first-hand, authoritative accounts of an event, topic, or historical time period. They are typically produced at the time of the event by a person who experienced it, but can also be made later on in the form of personal memoirs or oral histories. Anything that contains original information on a topic is considered a primary ...
Sources for literature review and examples. Generally, your literature review should integrate a wide range of sources such as: Books. Textbooks remain as the most important source to find models and theories related to the research area. Research the most respected authorities in your selected research area and find the latest editions of ...
Tertiary Literature. Tertiary literature consists of a distillation and collection of primary and secondary sources such as textbooks, encyclopedia articles, and guidebooks or handbooks. The purpose of tertiary literature is to provide an overview of key research findings and an introduction to principles and practices within the discipline.
A secondary source analyzes, editorializes, reports on, or summarizes the primary literature. While secondary sources in the social sciences are sometimes scholarly (e.g., a scholarly book that summarizes a body of primary literature or a review article published in an academic journal), more typically secondary sources in the social sciences ...
When searching the literature for pertinent papers and reviews, the usual rules apply: be thorough, use different keywords and database sources (e.g., DBLP, Google Scholar, ISI Proceedings, JSTOR Search, Medline, Scopus, Web of Science), and. look at who has cited past relevant papers and book chapters.
Primary sources in literature are original, uninterpreted information (often, but not exclusively textual) relevant to a literary research topic. Examples include original works of fiction, art, or music; letters; diaries; interviews; or even works of criticism. The key question to ask when trying to classify a source as primary versus secondary is how you intend to use it.
Secondary literature consists of interpretations and evaluations that are derived from or refer to the primary source literature. Examples include review articles (such as meta-analysis and systematic reviews) and reference works. Professionals within each discipline take the primary literature and synthesize, generalize, and integrate new ...
A primary source is "first-hand" information, sources as close as possible to the origin of the information or idea under study. Primary sources are contrasted with secondary sources, works that provide analysis, commentary, or criticism on the primary source. In literary studies, primary sources are often creative works, including poems ...
Primary Source Material in Literature. Primary sources of a literary work can include the following: Autograph/Holograph ( the author's original manuscript) Copies (handwritten by another person: student, professional copyist, monastic scribes) First edition. Early editions ( could be edited by someone close the the author)
Broaden your research with images and primary sources. Harness the power of visual materials—explore more than 3 million images now on JSTOR. Enhance your scholarly research with underground newspapers, magazines, and journals. Take your research further with Artstor's 3+ million images. Explore collections in the arts, sciences, and ...
Primary Source Terms:. You can limit HOLLIS searches to your time period, but sources may be published later, such as a person's diary published posthumously. Find these with these special Subject terms. You can use the following terms to search HOLLIS for primary sources:. Archives; Correspondence
In the sciences, a primary source describes original research, while a secondary source analyzes or comments on a primary source or sources. For example, a research article is primary literature because it describes an original experiment and its results, while a review article is secondary literature because it collates multiple research articles to describe the current state of the field.
A primary source of literature, provides first-hand evi dence about an event, object, person, or work of art. Primary sources include historical and legal documents, eyewitness accounts, and ...
A primary source is an original object or document created during the time under study. Primary sources vary by discipline and can include historical and legal documents, diaries, letters, family records, speeches, interviews, autobiographies, film, government documents, eye witness accounts, results of an experiment, statistical data, pieces of creative writing, and art objects.
Managing dental caries in primary teeth with pulp involvement is a significant challenge. Clinical guidelines offer recommendations for effective management. To identify and analyze policies ...