The evidence on flossing and other methods of cleaning between the teeth

Tooth decay and gum diseases affect most people. They can cause pain, difficulties with eating and speaking, low self-esteem, and, in extreme cases, may lead to tooth loss and the need for surgery. The cost to health services of treating these diseases is very high.

As dental plaque is the root cause, it is important to remove plaque from teeth on a regular basis. While many people routinely brush their teeth to remove plaque up to the gum line, it is difficult for toothbrushes to reach into areas between teeth (‘interdental’), so interdental cleaning is often recommended as an extra step in personal oral hygiene routines. Different tools can be used for interdental cleaning, such as dental floss, interdental brushes, tooth cleaning sticks, and water pressure devices known as oral irrigators.

Which strength of fluoride in toothpaste is most effective?

Tooth decay (caries) is a widespread disease, affecting billions of people worldwide. Fluoride has long been used to prevent decay, through a variety of different methods including toothpaste, water, milk, mouthrinses, tooth gels and varnish. Regular toothbrushing is recommended to prevent decay and other oral diseases, and toothbrushing for 2 minutes twice daily with a fluoride toothpaste is generally recommended. The typical strength of regular or family toothpaste is around 1000 to 1500 parts per million (ppm) fluoride, but many other strengths are available worldwide. There is no minimum fluoride concentration, but the maximum permissible fluoride concentration for a toothpaste varies according to age and country. Higher concentrations are rarely available over the counter, and are classed as a prescription‐only medicine. Stronger fluoride toothpaste may offer greater protection against decay but also increases the risk of fluorosis (enamel defects) in developing teeth. This is an update of the Cochrane Review first published in 2010.

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Treatments for managing knocked out and replanted permanent front teeth

Injuring your front teeth is common. One of the most severe injuries occurs when the tooth is knocked totally out of the mouth (avulsed). Often the best option is to replant the tooth as quickly as possible. This is true only for permanent teeth. Once replanted the tooth can heal in one of two ways if managed correctly. Ideally the ligaments around the root repair and the tooth can be expected to last as long as any other tooth, this is known as ‘periodontal healing’. When there is too much damage to the ligaments, healing occurs by bony replacement. Over a number of years, the adjacent bony socket will remodel the tooth (replace the root with bone) leaving the tooth with no root. Once the root is replaced the visible part of the tooth, the crown, will eventually give way and be lost. This is called ‘bony healing’. Bony healing causes significant problems in the medium term for children and treatments for this are the subject of a different Cochrane Review. A missing front tooth or teeth, as a result of not replanting an avulsed tooth, or as a result of bony healing over the medium to long term, can have a major effect on dental and facial ‘good looks’. This can affect the individual’s self-esteem and general social interaction, as well as how others think and see them.

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Routine scale and polish has little or no effect on gingivitis

Scaling and polishing removes deposits such as plaque and calculus (tartar) from tooth surfaces. Over time, the regular removal of these deposits may reduce gingivitis (a mild form of gum disease) and prevent progression to periodontitis (severe gum disease). Routine scale and polish treatment is sometimes referred to as “prophylaxis”, “professional mechanical plaque removal” or “periodontal instrumentation”. Many dentists or hygienists provide scaling and polishing for most patients at regular intervals even if the patients are considered to be at low risk of developing gum disease. There is debate about whether scaling and polishing is effective and the best interval between treatments. Scaling is an invasive procedure and has been associated with a number of negative side effects including damage to tooth surfaces and tooth sensitivity.

For the purposes of this review, a ‘routine scale and polish’ was scaling and polishing of both the tooth and the root of the tooth to remove plaque deposits (mainly bacteria), and calculus. Calculus is so hard it cannot be removed by toothbrushing alone and this along with plaque, other debris and staining on the teeth is removed by the scale and polish treatment. Scaling or removal of hardened deposits is done with specially designed dental instruments or ultrasonic scalers, and polishing is done mechanically with special pastes. In this review, we included scaling above and below the gum level; however, we excluded any surgical procedure on the gums, any chemical washing of the space between gum and tooth (pocket) and root planing, which is more intense scraping of the root than simple scaling.

Surgical treatments for mouth and throat cancer: uncertainty in the evidence

Oral cancer is among the most common cancers worldwide, with more than 400,000 new cases diagnosed in 2012. This review looks at oral cavity cancer (mouth cancer) and oropharyngeal cancer (throat cancer). The treatment of these cancers can involve surgery, chemotherapy, radiotherapy or a combination of two or all three therapies. This topic area was identified as a priority by the an expert working group for oral and maxillofacial surgery in 2014.