Are antibiotics an effective way to prevent infection following tooth removal?

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.

Continue reading

Receding gums: we evaluate the different surgical techniques for covering an exposed tooth root

Receding gums (also known as gingival recession) is the gradual loss of gum tissue, and if left untreated it can result in exposure of the tooth root, between the gum and the tooth. It can involve one tooth (single recession‐type defect) or many teeth (multiple recession‐type defects). It can affect the look of the teeth, and is also linked to tooth sensitivity. Exposure of the tooth root can be treated by cosmetic surgery; techniques include grafting and gum regeneration. Grafting involves taking tissue from another place in the mouth and stitching it over the area of the exposed root. With gum regeneration, biomaterials are used to regenerate gum tissue without the need for taking it from the roof of the mouth. Procedures used in gum grafting and gum regeneration include: free gingival grafts, coronally advanced flaps, acellular dermal matrix grafts, laterally positioned flaps and guided tissue regeneration. This review is an update of the original version that was published in 2009. Continue reading

Treating communications between the oral cavity and maxillary sinus: insufficient evidence

dental examThe floor of the main sinus near the nose is thin and lies directly above the roots of the teeth at the back of the mouth. Sometimes following infection or dental treatment, this structure becomes damaged and openings or channels between the mouth and the sinus are formed. These are known as oro-antral communications (OAC). If the OAC is left open (then described as an oro-antral fistula (OAF), it may become permanent, leading to long-lasting sinus infections. This condition can be treated surgically by using flaps, grafts and other techniques; or non-surgically using a variety of methods and materials. There is little evidence for the most effective and safe treatments for closing OACs and OAFs and clinicians who treat these conditions have identified an urgent need for this. This is an update of a review first published in May 2016. Continue reading

No evidence from randomized controlled trials on how to treat bleeding after tooth extraction

Female at the dentistAfter tooth extraction, it is normal for the area to bleed and then clot, generally within a few minutes. It is abnormal if bleeding continues without clot formation, or lasts beyond 8 to 12 hours; this is known as post-extraction bleeding (PEB). Such bleeding incidents can cause distress for patients, who might need emergency dental consultations and interventions. The causes of PEB can be local, a systemic disease, or a medication. To control this bleeding, many local and systemic methods have been practised, based on the clinician’s expertise. To inform clinicians about the best treatment, evidence is needed from studies where people have been randomly allocated to one of at least two different groups, which receive different treatments, or no treatment (i.e. ‘randomised controlled trials’ or RCTs). Continue reading

Treating communications between the oral cavity and maxillary sinus: insufficient evidence

dental examThe floor of the main sinus near the nose is thin and lies directly above the roots of the teeth at the back of the mouth. Sometimes following infection or dental treatment, this structure becomes damaged and openings or channels between the mouth and the sinus are formed. These are known as oro-antral communications (OAC). If the OAC is left open (then described as an oro-antral fistula (OAF), it may become permanent, leading to long-lasting sinus infections. This condition can be treated surgically by using flaps, grafts and other techniques; or non-surgically using a variety of methods and materials. There is little evidence for the most effective and safe treatments for closing OACs and OAFs and clinicians who treat these conditions have identified an urgent need for this. This is an update of a review first published in May 2016. Continue reading

Reducing the pain of dental treatment for children and adolescents: unclear evidence

intraoperativeIt can be difficult when giving dental treatment to children and young people to do it simply using a local anaesthetic (LA) injection, as they may experience anxiety or need a lot of treatment at once. For example, they may need many teeth taken out at the same time. In these circumstances, a dental practitioner commonly uses a general anaesthetic (GA) and administers the treatment in a hospital. Problems often arise following this treatment and the most common is pain, the experience of which can cause an emotional as well as a physical response. The experience can make it more difficult for the dental practitioner to give the treatment needed, and it can also cause the child or young person to avoid future dental treatment. This research set out to find out whether giving LA injections during dental treatment under GA will result in numbness and therefore pain not being felt for a couple of hours, after which time painkillers can control the pain. The review looked at the benefits of using LA in this way, but also considered the side-effects. These can include discomfort, dribbling, and accidental lip biting. Also, because painkillers are often used as well, the effect of the LA is not clearly defined. Additionally, it is important to clarify the best doses and kind of injections to use to achieve the maximum benefit. Continue reading

Surgical techniques for removing wisdom teeth

Mandibular wisdom toothThis research assesses the benefits and harms of the different ways to surgically remove wisdom teeth from the lower jaw. Removing wisdom teeth is one of the most common operations in dental surgery. Various techniques have been developed to carry this out, but which is the most effective? The review considered the following risks from surgery: pain after treatment, swelling, infection, the ability to open the jaw fully, damage to the nerves supplying sensation to the tongue and jaw fractures. Continue reading

Nerve damage to the tongue, lower lip and mouth: there is no high quality evidence on effective treatments

Gray778The nerves which supply sensation to the tongue, lower lip and chin can be injured during facial and mouth surgery, including surgery to remove lower wisdom teeth. 90% of these injuries are temporary, but if they last longer than 6 months then further treatment may be needed. Damage to these nerves can lead altered sensation, or even altered taste perception. There are many treatments available: surgical, laser treatment, drug treatments (antiepileptics, antidepressants, painkillers), and counselling. This research considers which one of these interventions is the most effective.
Continue reading

Should you take ibuprofen or paracetamol after having your wisdom teeth out?

wisdom teeth outSurgical operations to remove wisdom teeth are one of the most commonly performed procedures in oral health, in England alone, 63,000 wisdom teeth are extracted each year in NHS hospitals. Many patients need time off work and their quality of life can be significantly affected. Both ibuprofen and paracetamol are commonly used for the relief of pain following the removal of lower wisdom teeth. In 2010, a new painkiller (marketed as Nuromol) containing paracetamol and ibuprofen in the same tablet, was licensed for use in the UK. This review considers the effectiveness of these painkillers. Continue reading