More research is needed on the best techniques and materials for making dentures

It is common for elderly people to have lost some, or all of their teeth (edentulism). This has a significant impact on their quality of life. There are several steps to making complete and removable partial dentures. The final impression is a very important step for ensuring the quality of the denture in terms of satisfaction, comfort, stability of the denture, and chewing ability. There are a number of different techniques and materials used for making the final impression for complete dentures or removable partial dentures. There is no consensus on which are the best.

Early-phase treatment of prominent upper front teeth in children may have benefits

Prominent (or sticking out) upper front teeth are a common problem in children around the world. For example, this condition affects about a quarter of 12-year-old children in the UK. The correction of this condition is one of the most common treatments performed by orthodontists (dentists who specialise in the growth, function and position of teeth and jaws). This condition develops when the child’s permanent teeth erupt. Children are often referred to an orthodontist, for treatment with dental braces, to reduce the prominence of the teeth. Prominent upper front teeth are more likely to be injured and their appearance can cause significant distress. If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait until the child is older and provide treatment in adolescence.

In ‘early treatment’, treatment is given in two phases: first at an early age (seven to 11 years old) and again in adolescence (around 12 to 16 years old). In ‘late treatment’ (one phase), there is only one course of treatment in adolescence.

As well as the timing of treatment, this review also looked at the different types of braces used: removable, fixed, functional, or head-braces.

No evidence from randomized controlled trials on how to treat bleeding after tooth extraction

Our review on the treatment of post-extraction bleeding has been updated, but there is still no evidence on the topic from randomized controlled trials…

Cochrane Oral Health

After tooth extraction, it is normal for the area to bleed and then clot, generally within a few minutes. It is abnormal if bleeding continues without clot formation, or lasts beyond 8 to 12 hours; this is known as post-extraction bleeding (PEB). Such bleeding incidents can cause distress for patients, who might need emergency dental consultations and interventions. The causes of PEB can be local, a systemic disease, or a medication. To control this bleeding, many local and systemic methods have been practised, based on the clinician’s expertise. To inform clinicians about the best treatment, evidence is needed from studies where people have been randomly allocated to one of at least two different groups, which receive different treatments, or no treatment (i.e. ‘randomised controlled trials’ or RCTs).

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Slowly does it: no evidence that slow-release fluoride devices are effective

Tooth decay is not distributed evenly among the population, with certain groups being at greater risk of developing tooth decay than others. For example, research in Scotland has shown that 50% of tooth decay occurs in 11% of 5-year-old children and only 6% of 14-year-old children. In light of this uneven distribution, it is often suggested that these small percentages of children may be offered targeted-caries preventive measures to great potential effect, in a cost effective manner. One such preventive measure is the use of slow-release fluoride devices (e.g. slow-dissolving fluoride-releasing glass beads).

Cochrane and related training in 2018

Are you looking for some training in systematic review methodology, or a related topic? Here’s our collection of available workshops through to July in 2018. Follow the links to find out more!

What’s the evidence on the best approach to supportive periodontal therapy?

Periodontitis (gum disease) is a chronic condition caused by bacteria, which stimulate inflammation and destruction of the bone and gum tissue supporting teeth. People treated for periodontitis can reduce the probability of re-infection and disease progression through regular supportive periodontal therapy (SPT). SPT starts once periodontitis has been treated satisfactorily, meaning that inflammation has been controlled and destruction of tissues supporting the tooth (bone and gums) has been arrested. SPT aims to maintain teeth in function, without pain, excessive mobility or persistent infection over the long term. SPT treatment typically includes ensuring excellent oral hygiene, frequent monitoring for progression or recurrence of disease, and removal of microbial deposits by dental professionals. Although success of SPT has been suggested through a number of long-term, retrospective studies, it is important to consider evidence available from randomised controlled trials (RCTs).

Teeth restored using atraumatic restorative treatment may be more likely to fail, but evidence is low quality

Dental caries (tooth decay) has been considered the most common global disease. Conventional methods (drill and fill) involve the use of electric drills to clear away decayed areas of tooth before filling. Local anaesthetic (painkiller) is normally injected to prevent pain during the procedure. Conventional treatments require highly trained dental health personnel, access to electricity, appropriate tools and are more expensive. These factors may limit access especially in underdeveloped regions of service provision. Atraumatic Restorative Treatment (ART) is an alternative approach for managing dental decay, which involves removal of decayed tissue using hand instruments alone, usually without the use of anaesthesia (injected painkiller) and electrical equipment.