Does using a mouth rinse before dental treatment reduce the spread of infection from the patient to the dental professional?

High‐speed instruments, such as drills, are often used in dental clinics. These instruments remove small pieces from tooth surfaces or from the teeth themselves, which become mixed with water and saliva. This can create an aerosol in the room where the dental treatment is taking place. Aerosols are tiny droplets that remain in the air. Aerosols can be inhaled and can also settle further away on surfaces. Aerosols contain bacteria which may spread infection and disease. Reducing the amount of bacteria in the aerosol may help to reduce the spread of infection. Chlorhexidine, povidone-iodine and cetylpyridinium chloride (CPC) are some commonly used mouth rinses. They act by killing bacteria in the mouth. The use of mouth rinses before dental treatment has been suggested as a possible way to reduce the bacteria in the aerosol.

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What are the benefits and risks of psychological therapies for adults and young people over 12 years old with painful temporomandibular disorders (TMDs)?

Temporomandibular disorders (TMDs) are conditions that affect the jaw joint and the muscles that move it. They are often associated with pain that lasts more than 3 months. Other symptoms include limited mouth opening, and jaw clicking and locking. All symptoms can interfere with quality of life and mood. This review explores whether psychological therapies can help to treat TMDs. Psychological therapies are sometimes known as “talking therapies”. They can be delivered one-to-one or in group sessions. An important aim of psychological therapies for TMD is to support self‐management. Self‐management refers to a person’s use of a range of strategies to enable them to live well with pain. Although it is considered to be an important aspect of living with pain, successful self‐management can be difficult to achieve. An instinctive response to pain is to try to fight or avoid it. Psychological therapies support self‐management by encouraging behaviours that are helpful and reducing responses that are potentially harmful.

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Uncertain evidence on the value of school dental screening programmes

Cochrane Oral Health

Oral diseases, especially tooth decay, affect children worldwide. Poor oral health can have an impact on children’s well-being. Treating oral health can be expensive, and it can come at a cost to both families and the community. School dental screening involves a dental professional examining children’s mouths and teeth at school. The dental professional will then let parents or caregivers know about their child’s oral condition and treatment needs. It aims to identify oral health concerns at an early stage. A further aim is to prompt parents or caregivers to seek treatment for the child.

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Interventions to prevent and treat severe damage to the jaws caused by medication

Severe damage to the jaw can happen in some people as a reaction to some medicines used in the treatment of cancer and osteoporosis. Osteoporosis is a disease that makes bones fragile. Damage to the jaws caused by this reaction is known as medication-related osteonecrosis of the jaws (MRONJ). MRONJ is a painful condition that can be difficult to treat. MRONJ occurs rarely in people taking medicines for osteoporosis. However, some of these medicines are also used at higher doses for cancer‐related conditions. The risk of MRONJ may be higher in cancer patients. It has been reported to occur in up to five in 100 individuals. It is important to identify effective preventive measures to reduce the risk of MRONJ, and to test better treatments for those who have it.

This is an update of our review first published in 2017. It is based on a search for articles that was conducted most recently in June 2021.

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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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