What are the benefits and risks of using antibiotics as well as cleaning by a dental care professional to treat gum disease?

Gum disease is a common condition in which the gums become swollen, sore, or infected. It is caused by bacteria that accumulate on gums and teeth. Diseased gums may bleed when people brush their teeth and may cause bad breath. If gum disease is not treated, teeth can become loose and eventually fall out. This can affect a person’s ability to chew and speak. It can also make people feel self‐conscious about their appearance. Dental‐care professionals can clean teeth and gums to remove excess bacteria from the mouth. They use special instruments – typically, an ultrasound scraper followed by specialised hand‐held instruments – to scrape bacteria from the teeth and stop these from affecting the gums.

Antibiotics (medicines that kill bacteria) taken by mouth (orally) can be used alongside professional cleaning, to remove bacteria from the area between the teeth and gums. However, there are potential risks associated with antibiotics, such as allergic reactions and antibiotic resistance (changes in bacteria after exposure to antibiotics, that allow the bacteria to survive future antibiotic treatment).

Sealants or fluoride varnishes: which treatment is better for preventing decay in the permanent back teeth of children and adolescents?

Tooth decay is when a small hole develops in a tooth. This happens because bacteria that live in the mouth feed on sugar in the food we eat. As they feed, the bacteria produce acid that attacks teeth. If teeth are not cleaned regularly after eating, or if someone consumes a lot of sugary foods and drinks, the repeated acid attacks can create holes in the hard outer surface of the teeth. If untreated, these holes can deepen and damage the layer of tooth underneath the surface (dentine). Many people around the world develop tooth decay at some point in their life. In most adolescents and children over the age of six years, decay damages the biting surfaces of the permanent teeth at the back of the mouth.

To prevent decay, dentists can apply a dental sealant, or fluoride varnish, directly onto the back teeth. A dental sealant is a coating made from an adhesive material such as resin or glass ionomer, which the dentists applies once to teeth. It seals off the grooves in teeth that tend to collect food, and protects them from the acid. By comparison, a fluoride varnish is a sticky paste that contains high levels of fluoride; fluoride is a mineral naturally present in teeth that protects them from damage. Fluoride varnishes need to be applied to teeth by the dentist two to four times a year.

How often should you see your dentist for a check‐up?

A dental check‐up helps to keep your mouth healthy and lets your dentist see if you have any dental problems. It allows your dentist to deal with any problems early, or even better, to prevent problems from developing. Leaving problems untreated may make them harder to treat in the future.

Do measures that aim to reduce aerosol production during dental procedures prevent the transmission of infectious diseases?

Most dental care procedures create tiny drops of liquid that float in the air, called aerosols. For example, to remove the plaque that builds up on teeth, dentists use scalers. Scalers vibrate at high speed and use a flow of water to wash away the plaque. This produces aerosols that are made of air, water, and the patient’s saliva, which may also contain micro‐organisms such as bacteria, fungi and viruses. Aerosols that contain bacteria, fungi or viruses can spread infectious diseases. Limiting the production of these aerosols could help to prevent disease transmission in a dental setting, which is especially important at the moment because of the COVID-19 pandemic.

Methods of reducing aerosols include:

• ways to prevent aerosols from leaving the mouth (for example, placing a rubber sheet – known as a ‘dam’ – around the tooth that is to be treated, to isolate the treatment zone from saliva; or using a straw‐like suction tube known as a saliva ejector);
• local ventilation using a suction device (known as a high‐volume evacuator) that draws up a large volume of air and evacuates aerosols from the treatment zone;
• general ventilation, to reduce the concentration of aerosols in the air, for example by keeping windows open;
• decontamination of air‐borne aerosols, for example using ultraviolet light to sterilize the air.

These can be used alone, or in combination.

Antimicrobial mouthrinses and nasal sprays to protect healthcare workers and patients at risk of COVID-19

Cochrane Oral Health and Cochrane ENT have co-published three new reviews looking at antimicrobial mouthrinses and nasal sprays to protect healthcare workers and patients from COVID-19 infection.

COVID‐19 is an infectious disease caused by the SARS‐CoV‐2 virus. Most people infected with COVID‐19 develop a mild to moderate respiratory illness, and some may have no symptoms (asymptomatic infection). Others experience severe symptoms and need specialist treatment and intensive care.

Training available: September to December 2020

Some training courses in systematic reviews or related topics have been announced for the next few months. However, due to ongoing uncertainty because of the COVID-19 pandemic, we recommend that you check that the course is still available and accepting registrations from your country of residence and that you have adequate insurance cover in place in case of cancellation. Follow the links for more information!

Methods of removing wisdom teeth from the lower jaw

The removal of wisdom teeth is a common operation, but it can cause short-and long‐term side effects. People may have their wisdom teeth removed if they are causing pain or infection, or if they are damaging other teeth or not breaking through the gum properly. Surgery has a risk of complications. One of the most common is dry socket. This is when a blood clot fails to form in the socket that the tooth has come out of, or the clot is disturbed before the socket has properly healed. The bones and nerves underlying the socket may be exposed, and it can be a very painful condition.

Cochrane Oral Health: our response to the COVID19 pandemic

The Cochrane Oral Health team have been busy during the lockdown, and we thought we would take this opportunity to let our readers know what we’ve been doing.

These are unprecedented times, and a global pandemic of an infectious disease poses particular challenges for dentistry and oral care. Which treatments can dentists and other members of the oral care team safely provide to clients? Should dental clinics be investing in new equipment? What measures need to be in place before resuming aerosol-generating procedures? What personal protective equipment (PPE) is needed to protect staff, clientele, and members of the public?

Cochrane Oral Health are responding in the following ways, to help the dental community find a path through the evidence:

Should disease-free wisdom teeth be extracted to stop them causing issues in the future?

Wisdom teeth generally grow and appear between the ages of 17 and 26 years. They are the last teeth to come through and normally grow into a position close to other teeth. Space for wisdom teeth can be limited and so they often fail to come through, or only partly come through. In most cases, this occurs when other teeth are blocking the growth of wisdom teeth, and act as a barrier. A wisdom tooth like this is known as an “impacted tooth”. An impacted wisdom tooth is called ‘asymptomatic’ and ‘disease‐free’ if there are no signs of disease affecting the wisdom tooth or the gum which supports it.

Impacted wisdom teeth can cause swelling and soreness of the gums around the wisdom teeth and decay and damage to nearby teeth. They can also cause gum and bone disease around other teeth and the development of cysts or tumours. It is generally agreed that wisdom teeth should be removed if there are signs of disease, but there is less agreement about how to manage wisdom teeth if there are no signs of disease.

Corticosteroids for treating oral lichen planus

Oral lichen planus is a non-infectious rash that can cause white patches on your gums, tongue or the insides of your cheeks. It is a common condition that can cause long‐term, painful areas on the lining of the mouth. The usual treatment is with drugs known as corticosteroids applied directly to the painful areas, or taken as a pill or a medicine. Treatment aims to reduce pain and improve healing of the mouth, but there is no cure for the disease.