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

Our review on the treatment of post-extraction bleeding has been updated, but there is still no evidence on the topic from randomized controlled trials…

Cochrane Oral Health

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).

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Do the drugs work? Cochrane evidence on antibiotics in dentistry

799px-Medication_amoxycillin_capsule13-17 November is World Antibiotic Awareness Week. The World Health Organization (WHO) has said that antibiotic resistance is:  “one of the biggest threats to global health, food security, and development today”. Antibiotics are used to prevent and treat bacterial infections, but if over-used they can cause bacteria to change and become resistant. This makes infections more difficult to treat, and results in longer hospital stays, higher medical costs and increased mortality (World Health Organization, 2017).

Antibiotics are still commonly used in dentistry, Cope et al (2014) estimate that 8-10% of antibiotics used in primary care are prescribed by dentists in some parts of the world. Their effectiveness has been explored by several Cochrane Oral Health reviews over the years, looking at some of the scenarios where they might be prescribed. Today we have a look back over the evidence… Continue reading

Preventing oral cancer by treating oral leukoplakia: limited evidence

shutterstock_163829423Oral leukoplakia is a white patch formed in the mouth lining that cannot be rubbed off. It often does not hurt and may go unnoticed for years. People with leukoplakia develop oral cancer more often than people without it. Preventing this is critical; rates of oral cancer survival longer than five years after diagnosis are low. Drugs, surgery and other therapies have been tried for treatment of oral leukoplakia. Medical and complementary treatments can be locally applied (i.e. directly onto the white patch) or systemic (affecting the whole body, e.g. taken as a pill). Continue reading

Answering the questions: new titles registered with Cochrane Oral Health

Answering questionsLast month we had a meeting of our international editorial team to discuss the new title applications we had received over the last 6 months. We had a lot of applications, and unfortunately were not able to register all of them. We decided that five titles should go forward to protocol stage, from teams in India, Malaysia, and a team based in Germany, the UK and Yemen.

Look out for the protocols coming soon on the Cochrane Library!

 

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Can keeping the mouth cold during cancer treatment help to prevent mouth soreness and ulcers?

Ice cubesPeople receiving treatment for cancer are at risk of developing a sore mouth and ulcers as a side effect. This side effect is called oral mucositis and affects over 75% of high-risk patients (those receiving radiotherapy to the head and neck or high-dose chemotherapy). The pain caused by this condition can be severe and can stop the person’s ability to eat and drink, which may mean they need to take strong pain killers, stay in hospital and be fed through a tube into their stomach, or even into their veins. This in turn can lead to disruption to their cancer treatment, meaning they are not receiving the best possible treatment. The results may be a reduction in the patient’s chances of survival, and increased costs to the healthcare system. Cancer patients have weakened immune systems due to their treatment, meaning that their bodies are less able to fight infections. This can be a problem if bacteria enter the body through the ulcer, which is an open wound. This can lead to sepsis (a dangerous inflammatory reaction of the body to infection), which requires antibiotics and hospitalisation, and can cause death.

Oral cryotherapy is the cooling of the mouth using ice, ice-cold water, ice cream or ice lollies/popsicles. It is thought to help prevent oral mucositis in people receiving certain types of chemotherapy because the coldness makes the blood vessels in the mouth narrower, and this reduces the amount of blood containing chemotherapy drugs from reaching the mouth and causing oral mucositis. It is a low-cost, natural treatment without serious side effects. Continue reading

Oral Health Group publications in the new issue of the Cochrane Library

Cochrane Review on distalising upper first molars - does an extraoral appliance work better than an intraoral appliance?

Cochrane Review on distalising upper first molars – does an extraoral appliance work better than an intraoral appliance?

October’s edition of the Cochrane Library saw the publication of one new review and one updated review from the Cochrane Oral Health Group. Continue reading

Editors’ and Clinical Advisors’ Meeting

Chancellors Hotel with its autumnal gardens was the setting for the day

The Cochrane Oral Health Group held an event for their editors and clinical advisors at the Chancellors Hotel in Manchester. Co-ordinating Editors Helen Worthington and Jan Clarkson were the hosts at a tasty dinner on 22nd October, followed by a full day’s training and discussion on Cochrane Methods on 23rd October.

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Professor Jan Clarkson outlines the agenda for the day

The day kicked off with Managing Editor Luisa Fernandez-Mauleffinch explaining the expectations of the role of an Oral Health Group editor. Editors should have completed a review, be able to attend at least two Cochrane events a year (eg editorial meetings, regional meetings, colloquia, training days), be able to input into the editorial process and act as contact editor for review teams. Luisa explained that contact editors were expected to provide advice through the whole review process, and judge whether the review was ready for peer review. Contact editors should also be able to advise on who should referee the review, look over submitted comments, look at revised reviews and confirm whether the review is ready for final sign-off. Contact editors should look upon themselves as mentors for review teams, particularly inexperienced teams. Luisa welcomed any input from current editors on how the editorial base could help make the process easier. The consensus was that communication from the editorial base could be improved, and that editors would welcome more information on where various review teams were up to in the review process.

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Professor Helen Worthington discusses prioritization of reviews

Helen Worthington reported back on our last prioritization exercise, in the field of paediatric dentistry. We consulted all the authors of our paediatric reviews and asked them to rank them in terms of importance. Then we conducted two teleconferences with an international expert panel and asked them their opinion of the importance of the reviews and to identify any gaps in our portfolio. Prevention of caries and our reviews on fluoride varnishes, gels, mouthrinses, toothpastes and dental sealants came up as important areas. For treatment of caries, pulp treatment and preoperative analgesics as well as other methods of managing decay were priorities. Gaps in our portfolio were identified as complex interventions for preventing caries, caries diagnosis and management of early carious lesions. A result of the prioritization exercise was the realization that paediatric experts wanted to collaborate with the Oral Health Group over guidelines. We have now set up a guideline repository on our website. We also recognise as a group that we need more involvement in prioritization, from consumers, patients and policy makers.

Helen introduced the Methodological Expectations of Cochrane Intervention Reviews (MECIR), a set of standards for the conduct and reporting of Cochrane reviews. She took us through the concepts and how the standards were developed, and gave us some examples.

Toby Lasserson from the Cochrane Editorial Unit presented some information on the Cochrane screening project. All new reviews are now screened by the Editorial Unit before copyediting and final sign off. The team at the Editorial Unit are looking at particular problem areas, including appropriateness of conclusions, clarity of key messages and consistency between the abstract, the full-text and the plain language summary. Reviews can now be held back if they are incoherent or if there are serious errors in analysis or unjustifiable interpretation of evidence. The focus is very much on identifying and sharing good practice, so that the quality of Cochrane reviews can be continuously improved. Helen commented that to date the Oral Health Group have found the screening process a positive experience, with very helpful comments coming back from the Editorial Unit.

The afternoon session was presented by Cochrane Editors Anne-Marie Glenny, Tanya Walsh and Phil Riley. Using the review Flossing for the management of periodontal diseases and dental caries in adults as an example, they highlighted how to apply MECIR standards to a Cochrane review. Topics covered included how to evaluate an abstract, risk of bias, setting appropriate outcome measures and what to look for in a summary of findings table.

DSCN1671The slides from the day can be accessed below:

Here are some photos from the dinner, featuring the Oral Health Group heraldic shield competition!