Which type of attachment system is most effective for connecting implants to dentures?

For adults with complete tooth loss, the modern approach is to use implant dentures with attachment systems, these connect the implant to the undersurface of the dentures. The choice of the number of implants and the design of the attachments influences the success of the dentures, the amount of wear and tear, patient satisfaction, preference and cost. Continue reading

Receding gums: we evaluate the different surgical techniques for covering an exposed tooth root

Receding gums (also known as gingival recession) is the gradual loss of gum tissue, and if left untreated it can result in exposure of the tooth root, between the gum and the tooth. It can involve one tooth (single recession‐type defect) or many teeth (multiple recession‐type defects). It can affect the look of the teeth, and is also linked to tooth sensitivity. Exposure of the tooth root can be treated by cosmetic surgery; techniques include grafting and gum regeneration. Grafting involves taking tissue from another place in the mouth and stitching it over the area of the exposed root. With gum regeneration, biomaterials are used to regenerate gum tissue without the need for taking it from the roof of the mouth. Procedures used in gum grafting and gum regeneration include: free gingival grafts, coronally advanced flaps, acellular dermal matrix grafts, laterally positioned flaps and guided tissue regeneration. This review is an update of the original version that was published in 2009. Continue reading

Professional oral mouth care for nursing home residents: is it more effective than usual care?

Pneumonia is common among elderly people living in nursing homes. Nursing home‐acquired pneumonia (NHAP) is a bacterial infection of the lung that occurs in residents of long‐term care facilities and nursing homes. Poor oral hygiene is considered to contribute to the likelihood of contracting an infection. Professional mouth care is a combination of brushing teeth and mucosa, cleaning dentures, using mouthrinse, and check‐up visits to a dentist, while usual mouth care is generally less intensive, and is self‐administered, or provided by nursing home staff without special training in oral hygiene. Continue reading

Toothache caused by inflammation or infection at the root of the tooth: do antibiotics help?

Dental pain is a common problem and can arise when the nerve within a tooth dies due to progressing decay or injury. Without treatment, bacteria can infect the dead tooth and cause a dental abscess, which can lead to swelling and spreading infection, which can occasionally be life threatening.

The recommended treatment for these forms of toothache is removal of the dead nerve and associated bacteria. This is usually done by extraction of the tooth or root canal treatment (a procedure where the nerve and pulp are removed and the inside of the tooth cleaned and sealed). Antibiotics are only recommended when there is severe infection that has spread from the tooth into the surrounding tissues. However, some dentists still routinely prescribe oral antibiotics to patients with acute dental conditions who have no signs of spreading infection, or without dental treatment to remove the infected material.

Use of antibiotics contributes to the development of antibiotic‐resistant bacteria. It is therefore important that antibiotics are only used when they are likely to result in benefit for the patient. Dentists prescribe approximately 8% to 10% of all primary care antibiotics in high‐income countries, and therefore it is important to ensure that dentists have good information about when antibiotics are likely to be beneficial for patients. Continue reading

Treating communications between the oral cavity and maxillary sinus: insufficient evidence

dental examThe floor of the main sinus near the nose is thin and lies directly above the roots of the teeth at the back of the mouth. Sometimes following infection or dental treatment, this structure becomes damaged and openings or channels between the mouth and the sinus are formed. These are known as oro-antral communications (OAC). If the OAC is left open (then described as an oro-antral fistula (OAF), it may become permanent, leading to long-lasting sinus infections. This condition can be treated surgically by using flaps, grafts and other techniques; or non-surgically using a variety of methods and materials. There is little evidence for the most effective and safe treatments for closing OACs and OAFs and clinicians who treat these conditions have identified an urgent need for this. This is an update of a review first published in May 2016. Continue reading

Which material works best for the first arch wire in a fixed brace?

Orthodontic treatment is undertaken worldwide to correct crowded, twisted, buried or prominent front teeth. This treatment is normally given in adolescence or adulthood. Fixed orthodontic appliances, otherwise known as braces, consist of brackets bonded to the teeth. The brackets are connected by arch wires, which exert forces on the teeth to straighten them. The first, or initial, type of arch wire, inserted at the beginning of treatment, is for correcting crowded and twisted teeth. Over recent years, a number of new materials have been developed, which show a range of different properties in the laboratory and which manufacturers claim offer benefits in terms of tooth alignment. These include mixtures of nickel and titanium (NiTi). Continue reading