Treating all teeth (full mouth) within 24 hours for gum disease in adults

Long‐lasting gum disease is common. It can cause damage to gums and bone around the teeth and can result in tooth loss. It is treated by scaling and root planing, which involves deep cleaning below the gum line. Usual treatment is carried out in two to four sessions over several weeks. The mouth is divided into quarters and a different quarter of the mouth is treated at each session.

An alternative approach is full-mouth scaling. The whole mouth is treated within 24 hours in one or two sessions. When an antiseptic is added to full-mouth scaling, the treatment is called full‐mouth disinfection. Full‐mouth treatments are thought to reduce the likelihood of re‐infection in already treated sites.

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Can giving antibiotics before dental treatment prevent infections to the inner lining of the heart in people at risk of developing serious complications?

Infections to the inner lining of the heart can occur in damaged areas of the heart. This is known as bacterial endocarditis. It is usually treated with antibiotics. Bacterial endocarditis is rare, but it can be life-threatening. Many dental procedures cause bacteraemia, which is the presence of bacteria in the blood. Although bacteraemia is usually dealt with quickly by the body’s immune system, some experts think it may lead to bacterial endocarditis in some at‐risk people. One way to prevent at-risk people from getting these infections might be to routinely give them antibiotics before dental treatment. But this has been questioned. The routine use of antibiotics has resulted in resistance to common antibiotics. This means that antibiotics are no longer effective to treat infections. Some people can also develop severe allergic reactions to antibiotic treatment.

In 2007, guidance from the American Heart Association changed to recommend that antibiotics be given only to people at high risk of developing bacterial endocarditis before dental treatment. Guidance from the National Institute for Health and Care Excellence (NICE) in England and Wales went further, advising against the routine prescription of preventive antibiotics before dental or surgical procedures.

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Does treatment for gum disease help people with diabetes control their blood sugar levels?

The level of sugar in the blood is too high in people with diabetes, so keeping blood sugar levels under control is a key issue. Glycemic control is a medical term referring to the typical levels of blood sugar (glucose) in a person with diabetes mellitus. Some research suggests a relationship exists between gum disease treatment and glycaemic control. Glycaemic control can be measured in different ways. For this review, we focused on HbA1c, which shows average blood glucose levels over the preceding 3 months. It can be reported as a percentage (of total haemoglobin) or as mmol/mol (millimoles per mole). Excellent glycaemic control in a diabetic person might be around 6.5% or 48 mmol/mol.

This review was carried out by authors working with the Cochrane Oral Health and is part one of an update of a review previously published in 2010 and 2015. This review evaluates gum disease treatment versus no active treatment or usual care for improving glycaemic control. The evidence is current up to 7 September 2021.

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Sealants for preventing tooth decay in baby teeth

Tooth decay is common and can affect the overall well‐being of children. The back teeth are the teeth that become decayed most often. Their biting surfaces are not flat and have grooves that can retain bits of food and bacteria, leading to tooth decay forming on the teeth. In addition, the opening of these grooves is so small that a toothbrush bristle cannot enter them completely, making them difficult to clean. Sealing the grooves is one of the ways to prevent decay in back teeth. Sealants act as a protective barrier against food and bacteria, and may prevent harm to the teeth.

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What is the best treatment for children with crowded teeth?

When teeth erupt (come through the gum into the mouth), they may twist, stick out, drop back, or overlap if there is not enough space in the mouth. Losing baby teeth early from tooth decay or trauma can lead to crowded permanent teeth. If crowded teeth affect a child’s self‐esteem or cause pain, damage or chewing problems, the child may be referred to a specialist dentist known as an orthodontist to correct them. Crowded teeth can be prevented or corrected using braces if crowding is mild (less than 4 mm). Removal of some teeth (extraction) may also be needed if crowding is moderate (4 to 8 mm) or severe (more than 8 mm). Fixed braces are used on permanent teeth. Removable braces can be used on baby or permanent teeth, or both. Baby or permanent teeth can be extracted.

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Interventions to encourage eruption of eye teeth buried under the gum or growing upwards, without the need for surgery, in children aged 9 to 14 years

Upper permanent canine teeth (commonly known as eye teeth or fang teeth) are positioned in the upper jaw, one on the right and one on the left. In around 1% to 3% of children, they may not erupt (appear from behind the gum and into the mouth) into their correct position. The permanent canine tooth or teeth may grow towards the palate (roof of the mouth) and remain unerupted (buried under the gum). This is known as a palatally displaced canine (PDC). If the permanent canine tooth remains displaced and unerupted, it can damage or change the position of neighbouring teeth, and occasionally it can lead to a cyst.

Management of a PDC can take a long time, involving surgery to uncover the tooth and prolonged orthodontic (brace) treatment to straighten it. Various quicker or easier alternatives have been suggested to encourage the tooth or teeth to erupt. These include extraction (taking out) of the primary (baby) canine, extraction of the primary canine and primary first molar (also called double primary tooth extraction), or using braces to create space in children’s mouths.

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Are braces effective for treating crossbite (top back teeth biting down inside the bottom back teeth)?

Posterior crossbite occurs when the top teeth or jaw are narrower than the bottom teeth. It can happen on one side or both sides of the dental arches. This condition may increase the likelihood of dental problems (e.g. tooth wear), abnormal development of the jaws, joint problems, and unbalanced facial appearance. Posterior crossbites affect around 4% and 17% of children and adolescents in Europe and America. 

Different treatment approaches have been proposed, resulting in many different braces being produced. The basic treatment to correct crossbite correction treatment involves using an orthodontic device on the palate (roof of the mouth) to expand the upper jaw by exerting pressure on both sides of the jaw. The devices can be fixed (e.g. quad‐helix, Haas, Hyrax expander) or removable (e.g. expansion plate). Fixed appliances are bonded to the teeth, while removable devices can be taken out of the mouth by patients.

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Chemotherapy for mouth and throat cancer

Oral cavity (mouth) and oropharynx (throat) cancers that are detected early are treated primarily with surgery or radiotherapy. These treatments are effective in curing cancer and improving survival. However, with surgery and radiotherapy alone there remains a chance that cancer will recur, which can shorten survival for patients. The addition of chemotherapy to surgery or radiotherapy may help improve survival. 

Chemotherapy treatments are drugs that work by killing rapidly dividing cells such as cancer cells. There are other rapidly dividing cells in our body, such as those on our skin or in our gut. Chemotherapy can affect these healthy cells as well, which is why these treatments can have unpleasant side effects.  

In the treatment of cancer, chemotherapy can be given before surgery or radiotherapy, during radiotherapy or after treatment with surgery or radiotherapy. There are also different types of chemotherapy that can be given either as pills or through the veins (intravenously). These differences in the ways of giving chemotherapy and types of chemotherapy are likely to have different effects on survival. At this time, we do not know which way is best.

This review updates one previously published in 2011.

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What are the most accurate tests for screening for cancer of the mouth (oral cancer) and conditions that may lead to oral cancer?

There is a lack of high-certainty evidence to support the use of screening tests for cancer of the mouth and conditions that may lead to mouth cancer in the general population. General dental practitioners and healthcare professionals should be watchful for signs of oral potentially malignant disorders (OPMD) and malignancies whilst performing routine oral examinations in practice for other common oral lesions/conditions.

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