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.

Helping children to accept local anesthetic in dental treatment – can any interventions help children cope with the injection?

It is important that children and adolescents receive dental treatment without pain so they have less anxiety and fear. It will also help them accept treatment in the future. Giving local anaesthetic, medication that temporarily stops the sense of pain in one small area of the body while the child stays awake and alert, will help to achieve this. However, it is not always easy to give children local anaesthetic. Some children do not cope well with the injection. There are a number of interventions that may help children accept dental local anaesthetic, however, there is no agreement over which is the best method.

Training in systematic reviews and evidence synthesis this summer…

Do you want some training in the conduct of systematic reviews, or a related topic? Here’s our quarterly round-up of training opportunities. Follow the links to find out more!

Treating chronic gum disease to prevent heart disease

Chronic gum disease is also known as periodontitis. It causes swollen and painful gums and loss of the bone that supports the teeth. ‘Chronic’ is a label that means the disease has continued for some time without treatment.

There may be a link between periodontitis and heart disease. The treatment for chronic periodontitis gets rid of bacteria and infection and controls inflammation. It is thought that this may help prevent the diseases of the heart and blood vessels. We wanted to find out whether treating chronic gum disease could help prevent death or reduce the likelihood of heart attacks or strokes.

What is the best way prevent and control bad breath?

Bad breath or halitosis is caused by too much bacteria or small food parts left inside the mouth, most commonly at the back of the tongue. It can be a sign of disease within the mouth or other body diseases. People with bad breath can have low self-esteem and feel embarrassed. It can affect their personal relationships and work. In this review, we looked at treatments for bad breath due to a disease within the mouth and at treatments that aim to control not just mask bad breath.

Dental treatments for preventing damage to the jawbones in people with cancer receiving radiotherapy to the head and neck

Osteoradionecrosis (ORN) of the jaws is a serious problem that can happen after people have radiotherapy as part of their treatment for head and neck cancer. ORN refers to the death and exposure of bone that result from damage to the tissues due to being exposed to radiation. ORN is very difficult to treat and it is important that steps are taken to prevent it. In this review, we looked at any treatments that have been used to prevent ORN.

How can we prevent tooth decay in the first year of life?

Tooth decay in young children, especially poor children, is very common. It affects billions of children worldwide. Tooth decay can have long‐lasting effects on health and it can cost a lot to treat it. Dental plaque is bacteria in the mouth, and it is well known that it causes tooth decay, along with sugar. The attitudes, beliefs, and habits of pregnant women, mothers and other people looking after children can influence the dental health of their children.

Fluorides for preventing early tooth decay during fixed brace treatment

Wearing a fixed brace makes it harder for people to keep their teeth clean and may also cause pain. Pain can make it more difficult for people to brush their teeth. This can lead to a build-up of dental plaque around the brackets that attach the fixed brace to the teeth. If the plaque stays on the tooth for long enough, it will cause early tooth decay, which looks like white or brown marks (demineralised lesions, also known as white spot lesions). People often wear braces for 18 months or longer and if the decay is left to progress, it can cause holes, which are sometimes bad enough to need fillings to be done in the teeth.

Fluoride helps the tooth to heal, reducing tooth decay in people who are at risk of developing it. People receiving fixed brace treatment may be given different forms of fluoride treatment. It is important to think about how the fluoride gets to the teeth. Does the fluoride need to be placed by a dentist or dental nurse, or can people having treatment with braces apply the fluoride to their own teeth?