Lasers may help to reduce pain in orthodontic treatment: but more high quality research is needed

orthodontics-4Pain is usual during orthodontic treatment, especially when a brace is placed on the teeth. Later adjustments of the brace can also result in pain, sometimes lasting up to a week or more. This can make people stop their orthodontic treatment, meaning that the benefits are lost. Painkillers have been recommended to reduce pain, but an effective non-drug solution would lower the risk of side effects and help people follow the full course of treatment. Continue reading

Filling materials for retreatment of failed root canals – only very low quality evidence is available from RCTs

Composite_resin_fillng_2The living part of the tooth, also known as the tooth pulp, can become irreversibly inflamed as a result of damage or bacterial infection due to tooth decay. To deal with this problem, the dentist has to drill a hole to access the inner space of the tooth or root canal system, and remove the infected tissue and toxic irritants by a combination of mechanical cleaning and irrigation. After this is done, the dentist fills the space with an inert packing material and seals the opening. This procedure is known as root canal therapy. Although results are generally good, a small number of failures do occur. This may be attributed to the complexity of the root canal system, which has many small additional pathways communicating with each other, making it difficult to completely eliminate all of the toxins and irritants. These can spread, causing the infection around the root to last indefinitely. When root canal therapy fails, a retreatment called retrograde filling is a good alternative to save the tooth. During retrograde filling the dentist cuts a flap in the gum and creates a hole in the bone to get access to the bottom tip of the root. After cutting off the tip, then thorough preparation, the apex is sealed (the apical seal) and the hole made by the dentist filled with a dental material. This sealing process is thought to be the single most important factor in achieving success in a retrograde root filling. Many materials have been developed to seal the root tip, mineral trioxide aggregate is the material of interest at present, but there is no consensus about which material is best. Continue reading

Should root canal treatment be performed in one dental visit or over several visits?

This is an update of a review first published in 2007. Root canal treatment, or endodontic treatment, is a common procedure in dentistry. The main reasons that root canal treatment are needed are persistent inflammation of the dental pulp (pulpitis) and death of the dental pulp (dead or non-vital tooth) caused by tooth decay, cracks or chips, or other accidental damage to teeth. Root canal treatment is considered successful when there are no symptoms, for example pain, and when x-rays show no signs of damage to bone and other supporting tissues of the tooth. The success of root canal treatment depends on the preoperative condition of the tooth, as well as the endodontic procedures used. There are two approaches commonly used. In the first, the root canal treatment is performed in multiple visits to the dental clinic, and a dressing is placed in the tooth between appointments to avoid the build up of bacteria that may cause infections. In the second approach, the treatment is performed in one visit to the dental clinic. Which approach leads to less postoperative complications?

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Relieving the symptoms of burning mouth syndrome: what works?

Scratching her mouthBurning mouth syndrome (BMS) is a common painful condition. Symptoms include burning, dryness or uncomfortable sensations in the mouth and changes to taste. There is no obvious underlying medical or dental cause, however scientific research suggests that BMS may be caused by underlying damage to the nerves. BMS is often a persistent and long term condition, which can lead to a reduced quality of life (QoL).  There are many treatments available including drugs for treating psychological conditions and increasing saliva production, protective barriers, and treatments applied to the mouth surface. Continue reading

Lining the cavity to protect the tooth pulp: what’s the evidence?

dentist
Tooth decay is the most common disease affecting children and adults worldwide. If left untreated, acid produced by bacteria in the dental plaque or biofilm forms cavities or holes in the teeth. A number of techniques and a variety of materials can be used to restore or fill teeth affected by decay. One of these materials is tooth-colored, resin-based composite or RBC. This material is increasingly used as an alternative to amalgam (a mixture of mercury and metal alloy particles).

Since the 19th century liners have often been placed in cavities in the teeth under the filling material. The liners are thought to protect the living pulp of the tooth from filling materials themselves and also from their potential to allow more heat or cold through than the natural tooth would. Although RBC filling materials are thought to be similar to the natural material of teeth in terms of how they conduct heat, sensitivity to temperature change is sometimes still an issue for people after treatment.
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