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

The 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.

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).

Upcoming Cochrane and related training

If you’re looking for some training in systematic review methodology or health services research over the summer, here are some dates for your diary. Click on the links to find out more!

Early economic modelling to inform clinical trial design and other decisions
Where: York, UK
When: 3 July

Economic evaluations are increasingly used as tools to inform decision-makers about the cost-effectiveness of health technologies. Such evaluations are often undertaken during the late stages of the technology development (i.e. around the time of product launch or, in some cases, post-launch). However, there is an increasing need for the manufacturers of the technology to appraise the likely cost-effectiveness of the intervention before making decisions on price and indication, as well as to inform the development of clinical trials. The purposes of early economic modelling is to allow the user to determine the relative importance of different parameter inputs, in order to inform decisions on pricing, target populations and prioritisation of further research.

Writing a systematic review following Cochrane methods
Where: Sydney, Australia
When: 4-6 July 2018

This three-day workshop, organised by Cochrane Australia, is designed for authors of intervention reviews who wish to follow Cochrane methods. The workshop provides authors with a comprehensive overview of the methods required to write a protocol and get started on a review. The workshop is suitable for people with little or no experience in systematic reviews who have identified a topic and are either already working on or are about to start working on a review.

Health utilities for economic models
Where: York, UK
When: 4 July

Cost-utility analysis is a requirement for NICE health technology appraisals and is being increasingly used in other contexts and countries. Health utilities, a crucial component of cost-utility analysis, capture the relative change in health-related quality of life resulting from a treatment. As such, health utility can be a key driver of the cost-effectiveness ratio. Obtaining health utility values that are suitable for your economic evaluation, however, may not always be straight forward. This one-day training course, organised by YHEC, complements the early economic modelling course, discussing issues around different approaches to obtaining utility values. It introduces each approach in turn, giving an overview of the implementation, strengths, and limitations of each, across different contexts.

Developing a protocol for a Cochrane systematic review
Where: Penang, Malaysia
When: 6-8 August 2018

The three-day workshop begins with an introduction to the Cochrane Collaboration and a brief overview of the format of a protocol for a systematic review. A mixture of presentations and small group activities gives participants the opportunity to develop and refine their own protocols. At the end of the workshop participants should be able to complete the writing the of methods section of a protocol for a Cochrane systematic review.

Writing a systematic review following Cochrane methods
Where: Brisbane, Australia
When: 8-10 August 2018

This three-day workshop, organised by Cochrane Australia, is designed for authors of intervention reviews who wish to follow Cochrane methods. The workshop provides authors with a comprehensive overview of the methods required to write a protocol and get started on a review. The workshop is suitable for people with little or no experience in systematic reviews who have identified a topic and are either already working on or are about to start working on a review.

Identifying evidence for NICE economic submissions
Where: York, UK
When: 5 September 2018

Health economics evidence is a key element in much health services research and particularly in health technology assessments. Identifying economic evidence to inform such research can involve searches in a range of databases and using a variety of strategies. This study day, organised by YHEC, will include a ‘jargon buster’ session on the basics of health economics and economic models. It will also feature presentations about key economics information resources including the CEA Registry, and explorations of options for searching to identify data for economic models. With the closure of key economic evaluation databases (NHS EED and HEED) we will be focusing on how to identify economic evaluations from major bibliographic databases. There will be opportunities for hands-on practice.

Understanding and critiquing health economics models
Where: York, UK
When: 13 September 2018

This training day, organised by YHEC, aims to provide the participant with a sufficient grounding to effectively critique and validate models. The training day will be particularly useful to those people who commission health economic models, or use models to help make decisions. As well as discussing the strengths and uses of economic modelling, the training day will also explore the limitations and constraints of different approaches and will explore a number of commonly-observed errors in models. Please note that this training day has not been designed to teach delegates how to build models; instead, the course is aimed at those who will review or depend on models built by other researchers.

How to prepare a Cochrane systematic review: practical and methodological issues
Where: Umea, Sweden
When: 20 September 2018

The aim of this workshop, organised by Cochrane Sweden, is to facilitate participants in understanding how Cochrane reviews are structured and to show how to get involved in their preparation. The rationale behind and the main characteristics of a Cochrane protocol will be discussed briefly at the workshop. Cochrane relevant resources such Revman and Covidence will be presented. Deadline for registration is September 1st. The workshop is free of charge, open to everyone and held in English.

Pain in children’s milk teeth caused by extensive decay: we examine the best ways to treat the dental pulp

Tooth decay is one of the most common diseases in children. Tooth decay in the primary or milk teeth tends to progress rapidly, and it often reaches the pulp. Dental pulp consists of nerves, tiny blood vessels and connective tissue that make up the centre of a tooth. Symptoms of this extensive tooth decay include pain, swelling and abnormal tooth movement.

Dentists often have to perform one of three pulp treatment techniques to resolve the problem:

1. Direct pulp capping: where a healing agent is placed directly over the exposed pulp. The most common materials used for direct pulp capping are calcium hydroxide, mineral trioxide aggregate, formocresol or an adhesive resin, placed directly over the tooth’s nerve.
2. Pulpotomy: removal of a portion of the pulp. After a pulpotomy, one of four materials is generally used to fill the cavity: ferric sulphate, formocresol, calcium hydroxide or mineral trioxide aggregate.
3. Pulpectomy: removal of all of the pulp in the pulp chamber and root canal of a tooth. After a pulpectomy, a material is put into the space created by pulp removal.

This review looks at the three techniques, and the effectiveness of different materials (known as medicaments) for pulp capping, pulpotomy and pulpectomy.

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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