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.

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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. Continue reading

Uncertain evidence on which method of home-based tooth whitening is most effective

There has been an increasing demand for whiter teeth. Home-based whitening products with a bleaching action have become popular and are prescribed to people by the dentist or purchased over-the-counter. A variety of whitening products are available which include hydrogen peroxide, carbamide peroxide, sodium percarbonate, sodium hexametaphosphate, sodium tripolyphosphate, and calcium peroxide. These agents are supplied in different concentrations and are used with different methods of application (gel in tray, strips, paint-on gel, chewing gum, and mouthwash), which have varying application times and duration of treatment. Continue reading

Dealing with dental anxiety in children – the evidence on type of sedation

Fear of the dentist may be expressed as unco-operative behaviour in children requiring dental treatment. Behaviour management problems can result in a child’s tooth decay going untreated. While behavioural techniques play an important role in managing children, some children still find it difficult to co-operate with dental treatment and may require sedation. This review examined the effects of drugs to sedate a child whilst keeping them conscious. Continue reading

Only very low quality evidence available on the use of platelets for jawbone defects

Teeth are maintained in their position by soft and hard tissues (gums and surrounding bone). Gum disease or periodontitis, is an inflammatory condition of all these tissues caused by the bacteria present in the dental plaque. If left untreated, gum disease can cause teeth to loosen and eventually lead to tooth loss. The destruction of jaw bone around teeth (called the alveolar bone) during gum disease, can be horizontal (where the whole level of bone around the root is reduced) or vertical, forming a bone defect within the bone (infrabony defect). There are several available surgical treatments for infrabony defects, including: 1. open flap debridement in which the gum is lifted back surgically in order to clean the deep tartar; 2. bone graft in which a portion of natural or synthetic bone is placed in the area of bone loss; 3. guided tissue regeneration in which a small piece of membrane-like material is placed between the bone and gum tissue in order to keep the gum tissue from growing into the area where the bone should be; and 4. the use of enamel matrix derivative, a gel-like material which is placed in the area where bone loss has occurred and promotes its regeneration. In order to accelerate the healing process, autologous platelet concentrates have been recently used. They are concentrates of the platelets of patient’s own blood containing growth factors that are thought to promote tissue regeneration. The aim of this review was to assess if the addition of APC brings any benefits in the treatment of infrabony defects when combined with different surgical treatments. Continue reading