Review of the Month: Is your child scared of the dentist? Can hypnosis help?

pocket-watchThis week is Face Your Fears week. Many children are scared of going to the dentist, studies have shown a world-wide variation in the prevalence of dental anxiety with estimates ranging between 3% and 43% (Folayan, 2004). Our review of the month aimed to find out whether hypnosis can help children to cope with dental treatment.  The advantage of hypnosis is that it requires no specialist equipment, the patient remains conscious, and there are no side effects of the kind you may see with sedation or drug interventions.

What was the research?

A systematic review of the evidence to find out the effectiveness of hypnosis for behaviour management of children who are receiving dental care.

Who conducted the research?

The research was conducted by a team led by Sharifa Al-Harasi from the Military Dental Centre in Oman, on behalf of the Cochrane Oral Health Group. Paul F. Ashley, David R. Moles, Susan Parekh and Val Walters were also on the team.

What evidence was included in the review?

Data was extracted from 3 randomised controlled trials. A total of 69 children participated in the trials, and were randomly assigned to hypnosis or non-hypnosis groups. The children in the hypnosis groups could also be having some form of sedation in addition to the hypnosis. The children in the control groups either had sedation or nothing. The participants were all under the age of 16, and could be having any form of dental treatment.

What did the evidence say?

Very few studies on hypnosis for children undergoing dental treatment have been carried out, and only 3 trials were found that met the inclusion criteria. Two studies found that hypnosis had some beneficial effects during the administration of local anaesthetic, but it was not as effective during the removal of teeth. The majority of the children in one of the studies preferred sedation to hypnosis. One study found that hypnosis could make children undergoing orthodontic treatment more co-operative.

How good was the evidence?

Two of the studies were at high risk of bias, and one study at moderate risk of bias. Reporting of methods was generally poor. Only one of the studies was double-blind.

What are the implications for dentists and the general public?

There is some anecdotal evidence of the benefits of hypnosis for children undergoing dental treatment, when they are showing signs of anxiety. However, on the basis of these three studies there is not enough evidence to recommend it as a practice.

What should researchers look at in the future?

There is a need for well-conducted randomized controlled trials on this topic. Future research should follow-up patients to find out if the effect of hypnosis has modified the patient’s perception towards having dental treatment. Study design should be parallel and how the sample size was calculated should be reported.

Link

Al-Harasi S, Ashley PF, Moles DR, Parekh S, Walters V. Hypnosis for children undergoing dental treatment. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD007154. DOI: 10.1002/14651858.CD007154.pub2.

Reference

Folayan MO, Idehen EE, Ojom OO. The modulating effect of culture on the expression of dental anxiety in children: a literature review. International Journal of Paediatric Dentistry, 2004, 14(4): 241-5

Review of the month: critically ill patients can benefit from improved oral health

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C Cambridge University Hospitals NHS Foundation Trust

Critically ill people who need machines to help them breathe are at high risk for developing chest infections and pneumonia. This is known as ventilator-associated pneumonia, or VAP. Can a programme of oral care (such as mouthwashes, toothbrushing) help to prevent this life-threatening condition?

What was the research?

A systematic review of the evidence to find out whether oral health care can reduce the likelihood of a patient in intensive care on a ventilator developing pneumonia.

Who conducted the research?

The research was conducted by a team led by Zongdao Shi on behalf of the Cochrane Oral Health Group. Huixu Xie, Ping Wang, Qi Zhang, Yan Wu, E Chen, Linda Ng, Helen V Worthington, Ian Needleman and Susan Furness were also on the team.

What evidence was included in the review?

Data was extracted from 35 randomised controlled trials. A total of 5,374 patients participated in the trials. The trials looked at:

  1. Chlorhexidine antiseptic mouthrinse or gel compared with a placebo or usual care.
  2. Toothbrushing compared with no toothbrushing
  3. Powered compared with manual toothbrushing
  4. Oral care with other solutions.

Participants were all critically ill and needed assistance from hospital staff, who administered the oral care.

What did the evidence say?

The review found that chlorhexidine administered as a mouthrinse or gel reduces the odds of VAP by 40%. For every 15 people in hospital in intensive care, use of oral hygiene including chlorhexidine will prevent one person developing VAP. There was no evidence that chlorhexidine makes a difference to the numbers of patients who die in intensive care, or the length of their stay in the intensive care unit. There was no evidence that toothbrushing or oral care without toothbrushing affected the risk of developing VAP. Two studies showed some evidence of a reduction in VAP with povidine iodine antiseptic mouthrinse. There was not enough evidence of the effects of other oral care solutions, such as water, saline or triclosan.

How good was the evidence?

Only 14% of the studies included in this review were well conducted and described. Almost half of the included studies were at high risk of bias.

What are the implications for intensive care staff and the general public?

Effective oral hygiene care is important for ventilated patients in intensive care to reduce ventilator-associated pneumonia. There is evidence from this review that oral hygiene care incorporating chlorhexidine mouthrinse or gel is effective in reducing the development of ventilator-associated pneumonia in adult patients in intensive care. The definition of oral hygiene care varied among the studies included in this review but common elements include cleaning of the teeth and gums with a swab or gauze, removing secretions using suction and rinsing the mouth.

What should researchers look at in the future?

Although the included studies provided some evidence of the benefits of oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia, incomplete reporting of studies is a major limitation. Further trials of oral hygiene care (including use of manual or powered toothbrushes, or swabs) should report both measures of effectiveness of plaque removal and prevention of ventilator-associated pneumonia.

Link

Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, Ng L, Worthington HV, Needleman I, Furness S. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD008367. DOI: 10.1002/14651858.CD008367.pub2.

Learn + Teach with the UK Cochrane Centre

Learn + TeachThe UK Cochrane Centre is offering a range of training resources for UK and Ireland based authors and Editorial Base staff. Cochrane authors in Bahrain, Egypt, Iraq, Jordan, Kuwait, Lebanon, Oman, Palestine, Qatar, Saudi Arabia, Sudan, Syrian Arab Republic, Turkey, United Arab Emirates, Yemen, Israel, Iran and Bermuda and British Virgin Islands may also be eligible to attend the workshops and training courses.

These include:

 

AMG

Professor Anne-Marie Glenny

Oral Health Group Editor Professor Anne-Marie Glenny is now part of the Learn + Teach faculty as an associate lecturer, and will be teaching on some of the Cochrane Workshops.

Check out the Learn + Teach website for more information and a Workshop Timetable.

Controlling gum disease may help to control diabetes, but more research is needed

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Periodontal scaler

This week is National Diabetes Week. Did you know that looking after your gums may help to reduce your blood sugar levels if you are diabetic? Read more about our Review of the Month for June.

What was the research?

A systematic review of the evidence to find out whether treating gum disease in people with diabetes helps to lower blood sugar levels. The review looked at several different types of intervention to treat periodontal disease in diabetic patients.

They included:

  • Scaling (cleaning between the gums and teeth)
  • Subgingival curettage and gingivectomy (removal of inflamed or diseased gum tissue)
  • Flap surgery (cleaning the tooth roots and repairing bone damage)
  • Antiseptic mouthrinses, gels and toothpastes
  • Treatment with drugs such as antibiotics
  • Training people in oral hygiene measures.

Who conducted the research?

The research was conducted by a team led by Terry C. Simpson from Edinburgh Dental Institute in the UK, on behalf of the Cochrane Oral Health Group. Ian Needleman, Sarah H. Wild, David R. Moles and Edward J. Mills were also on the team.

What evidence was included in the review?

Data was extracted from 7 randomised controlled trials. The trials looks at the intervention compared to no intervention, placebo or “usual care”. 460 participants were included across the 7 trials.

What did the evidence say?

The evidence suggests that there may be small but significant improvements in blood sugar control from treating pre-existing gum disease in people with Type 2 Diabetes Mellitus. There was little data on people with Type 1 Diabetes Mellitus. The studies looked at ultrasonic scaling, antibiotics, root planing, and oral hygiene measures.

How good was the evidence?

Although seven trials met the inclusion criteria, only 3 compared the intervention with no treatment or “usual care”. Only two of the seven trials was at low risk of bias. The few studies available lacked the power to detect a significant effect, and the quality of the evidence was generally low.

What are the implications for dentists and the general public?

Periodontal therapy in individuals with diabetes might help to improve the management of their condition, and an oral health assessment should be recommended as part of routine care for diabetes. If diagnosed, trained oral health professionals should manage the periodontitis. Communication between professionals is important so that patients become aware of the importance of periodontal disease management to controlling blood sugar levels.

What should researchers look at in the future?

Both periodontal disease and diabetes are prevalent, and further studies examining the link between the two should be a public health priority. More larger scale randomized controlled trials are necessary, as the studies in this review were too small to show a significant effect.

Link

Simpson TC, Needleman I, Wild SH, Moles DR, Mills EJ. Treatment of periodontal disease for glycaemic control in people with diabetes. Cochrane Database of Systematic Reviews 2010, Issue 5. Art. No.: CD004714. DOI: 10.1002/14651858.CD004714.pub2.

Are you coming to the 21st Cochrane Colloquium?

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The Oral Health Group’s Contribution to the 20th Anniversary wall-hanging

What is it?

The Cochrane Colloquium is an international meeting, providing an opportunity for Cochrane authors, editors, consumers and editorial base staff to meet and learn more about the Cochrane Collaboration.

Over 5 days there will be:

  • Four plenary sessions on the theme of “Better knowledge for better health”
  • Meetings of Cochrane Groups and Entities
  • Workshops covering a range of topics and a chance to learn new skills
  • Oral and poster sessions
  • A welcome reception and 20th Anniversary Gala

Guest speakers will include:

  • David Bornstein (Author of How to Change the World: Social Entrepreneurs and the Power of New Ideas)
  • Lorraine Johnson (Co-Chair, Consumers United for Evidence Based Healthcare Steering Committee)
  • Dr France Legare (Canada Research Chair in Implementation of Shared Decision Making in Primary Care)
  • Professor Sir Michael G. Marmot (Director, UCL Institute of Health Equity)
  • Chris Mavergames (Cochrane’s Director of Web Development)
  • Dr Andrew D. Oxman (Researcher, Global Health Unit, Norwegian Knowledge Center for the Health Services)
  • Professor Thomas J Walley (Director, NIHR Evaluation, Trials and Studies)

Where and when is it?

The Colloquium will be held 19-23 September 2013, at Centre Des Congres de Quebec, Quebec City, Canada.

Who’s going from the Cochrane Oral Health Group?

The Group’s co-ordinating editors Professor Jan Clarkson and Professor Helen Worthington will be in attendance, along with Deputy Managing Editor Phil Riley, Trials Search Co-ordinator Anne Littlewood, and Editors Dr. Anne-Marie Glenny and Dr. Tanya Walsh.

Why now?

The Cochrane Collaboration is celebrating 20 years this year, so the Quebec Colloquium will be extra special. Come along and celebrate with us!

How can I register?

Go to the Colloquium website to register for the event. Please note that early bird registration at discounted rates is only available until 15 July.

You can also follow the Colloquium on Twitter with the hashtag #cochranequebec.