Electrical conductance for the detection of early tooth decay

Dentists often aim to identify tooth decay that has already advanced to a level that needs a filling. If dentists were able to find tooth decay when it has only affected the outer layer of the tooth (enamel) 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. This is one of a series of reviews on diagnostic tests for dental caries, we also have reviews on imaging modalities, transillumination, fluorescence devices and tests to detect root caries.

The aim of this Cochrane Review was to find out how accurate electrical conductance devices (non‐invasive devices that send an electrical current to the surface of the tooth) are for detecting and diagnosing early tooth decay as part of the dental ‘check‐up’ for children and adults who visit their general dentist. Researchers in Cochrane included seven studies published between 1997 and 2018 to answer this question.

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Dental imaging methods for the detection of early tooth decay

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 (enamel) 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 given when caries is absent.

This Cochrane Review aimed to find out how accurate X-ray images and other types of dental imaging are for detecting early tooth decay as part of the dental ‘check-up’ for children and adults who visit their general dentist. Researchers in Cochrane included 77 studies published between 1986 and 2018 to answer this question.

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Light‐based tests for the detection and diagnosis of early tooth decay

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 (enamel) 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.

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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.

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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.

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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. Continue reading

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. Continue reading

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. Continue reading

Pain in children’s milk teeth caused by extensive decay: we examine the best ways to treat the dental pulp

Tooth decay is one of the most common diseases in children. Tooth decay in the primary or milk teeth tends to progress rapidly, and it often reaches the pulp. Dental pulp consists of nerves, tiny blood vessels and connective tissue that make up the centre of a tooth. Symptoms of this extensive tooth decay include pain, swelling and abnormal tooth movement.

Dentists often have to perform one of three pulp treatment techniques to resolve the problem:

  1. Direct pulp capping: where a healing agent is placed directly over the exposed pulp. The most common materials used for direct pulp capping are calcium hydroxide, mineral trioxide aggregate, formocresol or an adhesive resin, placed directly over the tooth’s nerve.
  2. Pulpotomy: removal of a portion of the pulp. After a pulpotomy, one of four materials is generally used to fill the cavity: ferric sulphate, formocresol, calcium hydroxide or mineral trioxide aggregate.
  3. Pulpectomy: removal of all of the pulp in the pulp chamber and root canal of a tooth. After a pulpectomy, a material is put into the space created by pulp removal.

This review looks at the three techniques, and the effectiveness of different materials (known as medicaments) for pulp capping, pulpotomy and pulpectomy. Continue reading

Slowly does it: no evidence that slow-release fluoride devices are effective

Tooth decay is not distributed evenly among the population, with certain groups being at greater risk of developing tooth decay than others. For example, research in Scotland has shown that 50% of tooth decay occurs in 11% of 5-year-old children and only 6% of 14-year-old children. In light of this uneven distribution, it is often suggested that these small percentages of children may be offered targeted-caries preventive measures to great potential effect, in a cost effective manner. One such preventive measure is the use of slow-release fluoride devices (e.g. slow-dissolving fluoride-releasing glass beads). Continue reading