Do the drugs work? Cochrane evidence on antibiotics in dentistry

799px-Medication_amoxycillin_capsule13-17 November is World Antibiotic Awareness Week. The World Health Organization (WHO) has said that antibiotic resistance is:  “one of the biggest threats to global health, food security, and development today”. Antibiotics are used to prevent and treat bacterial infections, but if over-used they can cause bacteria to change and become resistant. This makes infections more difficult to treat, and results in longer hospital stays, higher medical costs and increased mortality (World Health Organization, 2017).

Antibiotics are still commonly used in dentistry, Cope et al (2014) estimate that 8-10% of antibiotics used in primary care are prescribed by dentists in some parts of the world. Their effectiveness has been explored by several Cochrane Oral Health reviews over the years, looking at some of the scenarios where they might be prescribed. Today we have a look back over the evidence… Continue reading

Treating gum disease to prevent heart disease: the evidence is unclear

Heart diseaseGum disease is a common chronic or persisting condition that can get worse over time. It involves inflammation of the gums, which surround and support the teeth, causing swollen and painful gums and in severe cases loss of the bone (alveolar) that supports the teeth. Clinical investigations have shown that there might be a link or association between chronic, ongoing gum disease and heart and blood vessel disease (cardiovascular disease). Some investigators believe that the treatment for gum disease, which gets rid of bacteria and infection and controls inflammation, might prevent the occurrence or recurrence.

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No evidence that fluoride supplements taken by pregnant women prevent tooth decay in their babies

Tooth decay is one of the most common health problems among children. If fluoride supplements taken by pregnant women can prevent tooth decay in their children, pregnant women with no access to a fluoridated drinking water supply can obtain the benefits of systemic fluoridation. Fluoride tablets, drops, lozenges or chewing gums are sucked or chewed to provide topical fluoride and ingested to provide systemic fluoride. Continue reading

Treating and preventing medication-related osteonecrosis of the jaw

Medication-related osteonecrosis of the jaw (MRONJ) is severe bone damage in the jaw bone that occurs in some people as an adverse reaction to certain medicines commonly used in the treatment of cancer and osteoporosis (a disease that makes bones fragile). It is a painful condition that can be difficult to treat. MRONJ occurs rarely in people taking some medicines for osteoporosis. However, in people receiving these drugs at higher doses for cancer-related conditions, the risk of MRONJ may be higher and has been reported to occur in up to 5 in 100 individuals. It is essential to obtain better treatments for people who have MRONJ. It is also important to identify effective preventive measures to reduce the risk of MRONJ. Continue reading

Resorbable or titanium plates? Which is better for corrective jaw surgery?

Under- or overgrowth of one or both of the jaw bones can lead to reduced function and an unattractive facial appearance, either of which may have lasting and significant psychosocial effects. Treatment of severe cases may require a combination of orthodontic appliances and orthognathic (corrective jaw) surgery. After surgery the cut bone needs to be immobilised to ensure that optimal healing takes place. Titanium plates used for fixation are recognised to be the ‘gold standard’ but recent developments in biomaterials have led to an increased use of bioresorbable plates or screws for corrective jaw surgery. The use of bioresorbable plates for the fixation of facial bones might appear to reduce the need for a further operation for the removal of metal plates. However, whilst resorbable plates do appear to offer certain advantages over metal plates, concerns remain about the stability of fixation, the length of time required for their resorption (being reabsorbed), the possibility of foreign body reactions, and with some of the technical difficulties experienced with resorbable plates. Continue reading

No evidence from RCTs on effectiveness of orthodontic treatment for deep bite and retroclined teeth

Orthodontics is concerned with growth of the jaws and face, development of the teeth, and the way teeth and jaws bite together. Ideally, the lower front teeth bite in the middle of the back surface of the upper front teeth. When the lower front teeth bite further behind the upper front teeth than ideal, this is known as a Class II malocclusion. A Class II division 2 malocclusion is characterised by upper front teeth that are retroclined (tilted toward the roof of the mouth) and an increased overbite (vertical overlap of the front teeth), which can cause oral problems and may affect appearance. This problem can be corrected by the use of special dental braces (functional appliances) that move the upper front teeth forward and change the growth of the upper or lower jaws, or both. These braces can be removed from the mouth and this approach does not usually require removal of any permanent teeth. Additional treatment with fixed braces may be necessary to ensure the best result.

An alternative approach is to provide space for the correction of the front teeth by moving the molar teeth backwards. This is done by applying a force to the teeth from the back of the head using a head brace (headgear) and transmitting this force to part of a fixed or removable dental brace that is attached to the back teeth. The treatment may be carried out with or without extraction of permanent teeth. If headgear use is not feasible, the back teeth may be held in place by bands connected to a fixed arch placed across the roof of the mouth or in contact with the front of the roof of the mouth. This treatment usually requires two permanent teeth to be taken out from the middle of the upper arch (one on each side).

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No RCT evidence to determine best technique for exposing displaced eye teeth

Permanent canine teeth in the upper jaw usually erupt into the mouth between the ages of 11 to 12 years. In 2% to 3% of young people, the canine teeth fail to erupt (grow down) and become displaced in the roof of the mouth (palate).This can leave unsightly gaps, cause damage to the surrounding roots (which can be so severe that neighbouring teeth are lost or have to be removed) and, occasionally, result in the development of cysts.

Management of this problem is both time consuming and expensive. It usually involves surgical exposure (uncovering), followed by fixed orthodontic braces for two to three years, to move the canine into the correct position. Two surgical techniques are routinely used in the UK: the closed technique involves uncovering the buried tooth, gluing an attachment onto the exposed tooth and repositioning the palatal flap. Shortly after surgery, an orthodontic brace is used to apply gentle forces to bring the canine into its correct position within the dental arch. The canine moves into position beneath the gum. An alternative method is the open technique, which involves surgically uncovering the canine tooth as before, but instead of placing an attachment onto the exposed tooth, a window of gum from around the tooth is removed and a dressing (pack) placed to cover the exposed area. Approximately 10 days later, this pack is removed and the canine is allowed to erupt naturally. Once the tooth has erupted sufficiently for an orthodontic attachment to be glued onto its surface, orthodontic braces are used to bring the tooth in line with the other teeth. Continue reading