How effective are oral hygiene measures for preventing pneumonia in critically ill people on ventilators?

Ventilator‐associated pneumonia (VAP) is a lung infection. It develops in patients who are on artificial breathing machines (ventilators) in hospitals for more than 48 hours. Often, these patients are very ill – they may have had a heart attack or stroke, a serious accident, or major surgery. They may be unable to breathe on their own because they are unconscious or sedated while they receive treatment. Ventilators supply patients with oxygen through a tube placed in the mouth or nose, or through a hole in the front of the neck. If germs enter through the tube and get into the patient’s lungs, this can lead to VAP. VAP is a potentially very serious complication in patients who are already very ill. It can cause worsening health and increases patients’ risk of dying.

Keeping a patient’s mouth clean and free of disease could help to prevent VAP. Oral hygiene care includes mouthwash, antiseptics, using swabs to clean the mouth, toothbrushing and tools like suction devices, which suck away fluid from the mouth. These measures can be used on their own or combined.

How accurate are fluorescence devices for detecting and diagnosing early tooth decay?

Dentist holding caries detector with fluorescent light for checking the teeth.

Dentists often aim to identify tooth decay that has already advanced to a level which needs a filling. If dentists were able to find tooth decay when it has only affected the outer layer of the tooth then it is possible to stop the decay from spreading any further and prevent the need for fillings. It is also important to avoid a false-positive result, when treatment may be provided when caries is absent.

Diagnostic tools for detecting root caries: uncertain evidence

Root caries (tooth decay on the root of a tooth) is a well-recognised disease, that is on the increase as populations grow older and keep more of their natural teeth into later life. Like coronal caries (tooth decay on the crown of the tooth), root caries can be associated with pain, discomfort, and tooth loss, which can contribute to poorer oral health-related quality of life in the elderly. Detecting caries earlier can mean invasive treatment is needed, where more tooth tissue can be preserved. It could also mean less cost to the patient and to healthcare services.

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.