Does isolating the site of a dental restoration during treatment improve the performance of the restoration?

dentist at work with patient, installation of rubber dam or kofferdam

Restorative dental treatments are used to repair damage to teeth caused by tooth decay or accidents. Creating a physical barrier around a treatment site to reduce contamination of the site with saliva is a common practice. Reducing the amount of saliva in the area may enable the materials used for repair to bond together more effectively, improving the performance and reliability of the restoration. It may also reduce exposure to bacteria in the mouth.

Two methods of creating a barrier are commonly used; either a rubber dam around the tooth or cotton rolls together with suction to remove excess saliva. The rubber dam method involves using a sheet of latex in a frame. A small hole is made in the sheet and it is placed over the tooth to be treated creating a barrier around it. Using a rubber dam can isolate the tooth from the rest of the person’s mouth, which allows the tooth to be repaired dry and with relatively less exposure to bacteria in the mouth. A common alternative method of isolation of the tooth is the use of cotton rolls combined with the removal of excess saliva by suction. The evidence on the effects of rubber dam usage versus cotton roll usage is conflicting. Continue reading

Should asymptomatic disease-free impacted wisdom teeth be removed? Insufficient evidence!

Tooth extraction concept with an array of stainless steel dental tools and a mask with the extracted tooth clasped in the pincers and reflected in the mirrorWisdom teeth, or third molars, generally erupt between the ages of 17 and 26 years. These are the last teeth to erupt, and they normally erupt into a position closely behind the last standing teeth (second molars). Space for these teeth to erupt can be limited. Wisdom teeth often fail to erupt or erupt only partially, which is often due to impaction of the wisdom teeth against the second molars (teeth directly in front of the wisdom teeth). In most cases, this occurs when second molars are blocking the path of eruption of third molar teeth and act as a physical barrier, preventing complete eruption. An impacted wisdom tooth is called asymptomatic and disease-free in the absence of signs and symptoms of disease affecting the wisdom tooth or nearby structures.

Impacted wisdom teeth can cause swelling and ulceration of the gums around the wisdom teeth, damage to the roots of second molars, decay in second molars, gum and bone disease around second molars and development of cysts or tumours. General agreement exists that removal of wisdom teeth is appropriate if signs or symptoms of disease related to the wisdom teeth are present. Less agreement exists about the appropriate management of asymptomatic disease-free impacted wisdom teeth. Continue reading

Evidence inconclusive on giving painkillers to children before dental treatment

Child_dentist 3Dental pain is common after dental procedures and can lead to increased fear of dental treatment, avoidance of dental treatment and other associated problems. Reduction of pain is important, particularly in children and adolescents. One way of managing this might be to give painkillers before treatment so that the painkillers can start to work right away. This updated review looked at evidence for using painkillers in children, aged up to 17 years, undergoing treatment without sedation or general anaesthetic, but who may have had a local anaesthetic. The treatments included extracting teeth, restoring teeth and fitting braces. Continue reading

Supervised use of fluoride mouthrinse results in large reductions in decay in children’s permanent teeth

Tooth decay is a health problem worldwide, affecting the vast majority of adults and children. Levels of tooth decay vary between and within countries, but children in lower socioeconomic groups (measured by income, education and employment) tend to have more tooth decay. Untreated tooth decay can cause progressive destruction of the tops of teeth (crowns), often accompanied by severe pain. Repair and replacement of decayed teeth is costly in terms of time and money and is a major drain on the resources of healthcare systems.

Preventing tooth decay in children and adolescents is regarded as a priority for dental services and is considered more cost-effective than treatment. Use of fluoride, a mineral that prevents tooth decay, is widespread. As well as occurring naturally, fluoride is added to the water supply in some areas, and is used in most toothpastes and in other products that are available to varying degrees worldwide. As an extra preventive measure, fluoride can be applied directly to teeth as mouthrinses, lozenges, varnishes and gels.

Fluoride mouthrinse has frequently been used under supervision in school-based programmes to prevent tooth decay. Supervised (depending on the age of the child) or unsupervised fluoride mouthrinse needs to be used regularly to have an effect. Recommended procedure involves rinsing the mouth one to two minutes per day with a less concentrated solution containing fluoride, or once a week or once every two weeks with a more concentrated solution. Because of the risk of swallowing too much fluoride, fluoride mouthrinses are not recommended for children younger than six years of age.

This review updates the Cochrane review of fluoride mouthrinses for preventing tooth decay in children and adolescents that was first published in 2003. Continue reading

Preventing oral cancer by treating oral leukoplakia: limited evidence

shutterstock_163829423Oral leukoplakia is a white patch formed in the mouth lining that cannot be rubbed off. It often does not hurt and may go unnoticed for years. People with leukoplakia develop oral cancer more often than people without it. Preventing this is critical; rates of oral cancer survival longer than five years after diagnosis are low. Drugs, surgery and other therapies have been tried for treatment of oral leukoplakia. Medical and complementary treatments can be locally applied (i.e. directly onto the white patch) or systemic (affecting the whole body, e.g. taken as a pill). Continue reading