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. 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

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

Education for nursing home staff and/or residents to improve residents’ oral health

kind care for senior womanNursing home residents are often unable to carry out proper oral care, which is an important factor in maintaining the health of the mouth, teeth, and gums. Nursing home staff may not be prepared to provide adequate care. Therefore, oral health care education for residents and/or nursing staff may be one strategy to improve this situation. Continue reading

Is a laser more effective at removing tooth decay than a traditional drill?

Dentist using a modern diode dental laser for periodontal care. Both wearing protective glasses, preventing eyesight damage. Periodontitis, dental hygiene, preventive procedures concept.

Dental decay is a cavity formation in teeth resulting from the destruction of dental tissue caused by bacteria under certain conditions, including poor oral hygiene and excessive sugar intake. Symptoms may include pain and difficulty with eating, and complications may include tooth loss, infection or inflammation of the gum. Rotating drills are traditionally used to remove decay. However, this mechanical tool may have unexpected side effects, such as the removal of too much or too little decay, in addition to discomfort due to pain, noise and vibration. Laser therapy is a potential alternative to a mechanical drill. Continue reading

Does isolating the site of a dental restoration during treatment improve the performance of the restoration?

dentist at work with patient, installation of rubber dam or kofferdam

Restorative dental treatments are used to repair damage to teeth caused by tooth decay or accidents. Creating a physical barrier around a treatment site to reduce contamination of the site with saliva is a common practice. Reducing the amount of saliva in the area may enable the materials used for repair to bond together more effectively, improving the performance and reliability of the restoration. It may also reduce exposure to bacteria in the mouth.

Two methods of creating a barrier are commonly used; either a rubber dam around the tooth or cotton rolls together with suction to remove excess saliva. The rubber dam method involves using a sheet of latex in a frame. A small hole is made in the sheet and it is placed over the tooth to be treated creating a barrier around it. Using a rubber dam can isolate the tooth from the rest of the person’s mouth, which allows the tooth to be repaired dry and with relatively less exposure to bacteria in the mouth. A common alternative method of isolation of the tooth is the use of cotton rolls combined with the removal of excess saliva by suction. The evidence on the effects of rubber dam usage versus cotton roll usage is conflicting. Continue reading