Teeth that are affected by decay or gum disease or painful wisdom teeth are often removed by dentists. Tooth extraction is a surgical procedure that leaves a wound in the mouth that can become infected. Infection can lead to swelling, pain, development of pus, fever, as well as ‘dry socket’. Dry socket is where the tooth socket is not filled by a blood clot, and there is severe pain and bad odour. These complications are unpleasant for patients and may cause difficulty with chewing, speaking, and teeth cleaning, and may even result in days off work or study. Treatment of infection is generally simple and involves drainage of the infection from the wound and patients receiving antibiotics.
Antibiotics work by killing the bacteria that cause infections, or by slowing their growth. However, some infections clear up by themselves. Taking antibiotics unnecessarily may stop them working effectively in future. This ‘antimicrobial resistance’ is a growing problem throughout the world. Antibiotics may also cause unwanted effects such as diarrhoea and nausea. Some patients may be allergic to antibiotics, and antibiotics may not mix well with other medicines. Dentists frequently give patients antibiotics at the time of the extraction as a precaution in order to prevent infection occurring in the first place. This may be unnecessary and may lead to unwanted effects.
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: Continue reading →
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. Continue reading →
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. Continue reading →
The gag reflex is a normal process to protect the throat and airway from foreign objects and prevent choking. Many people have an exaggerated gag reflex that causes distress during dental treatment. This can make it difficult or even impossible to perform the treatment. The interventions used to manage gagging include anti-nausea medicines, sedatives, local and general anaesthetics, herbal remedies, behaviour therapy and cognitive behaviour therapy, acupressure, acupuncture, lasers and prosthetic devices.
We wanted to know how effective and safe these interventions are in helping people to complete their dental treatment with less gagging. We compared them to no intervention or a placebo or to other interventions. Continue reading →
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 →
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 →
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 →
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 →
Nursing 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 →