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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Slowly does it: no evidence that slow-release fluoride devices are effective

Tooth decay is not distributed evenly among the population, with certain groups being at greater risk of developing tooth decay than others. For example, research in Scotland has shown that 50% of tooth decay occurs in 11% of 5-year-old children and only 6% of 14-year-old children. In light of this uneven distribution, it is often suggested that these small percentages of children may be offered targeted-caries preventive measures to great potential effect, in a cost effective manner. One such preventive measure is the use of slow-release fluoride devices (e.g. slow-dissolving fluoride-releasing glass beads). Continue reading

What’s the evidence on the best approach to supportive periodontal therapy?

Periodontitis (gum disease) is a chronic condition caused by bacteria, which stimulate inflammation and destruction of the bone and gum tissue supporting teeth. People treated for periodontitis can reduce the probability of re-infection and disease progression through regular supportive periodontal therapy (SPT). SPT starts once periodontitis has been treated satisfactorily, meaning that inflammation has been controlled and destruction of tissues supporting the tooth (bone and gums) has been arrested. SPT aims to maintain teeth in function, without pain, excessive mobility or persistent infection over the long term. SPT treatment typically includes ensuring excellent oral hygiene, frequent monitoring for progression or recurrence of disease, and removal of microbial deposits by dental professionals. Although success of SPT has been suggested through a number of long-term, retrospective studies, it is important to consider evidence available from randomised controlled trials (RCTs). Continue reading

Teeth restored using atraumatic restorative treatment may be more likely to fail, but evidence is low quality

Dental caries (tooth decay) has been considered the most common global disease. Conventional methods (drill and fill) involve the use of electric drills to clear away decayed areas of tooth before filling. Local anaesthetic (painkiller) is normally injected to prevent pain during the procedure. Conventional treatments require highly trained dental health personnel, access to electricity, appropriate tools and are more expensive. These factors may limit access especially in underdeveloped regions of service provision. Atraumatic Restorative Treatment (ART) is an alternative approach for managing dental decay, which involves removal of decayed tissue using hand instruments alone, usually without the use of anaesthesia (injected painkiller) and electrical equipment. Continue reading

Uncertain evidence on the value of school dental screening programmes

Boy having teeth examinedOral diseases, especially dental caries, affect children worldwide. If unchecked, oral health can deteriorate progressively and adversely impact children’s general well-being. It also has a financial bearing at family and community levels. School dental screening is a public health measure where oral examination of children is carried out in the school setting, and then parents are informed about the oral condition and treatment needs of their child. The screening aims to identify oral health concerns at an early stage, and prompt parents to seek treatment where required.  Continue reading

Metal-free materials for making crowns and bridges

Teeth in the foreground

Fixed prosthodontic treatment is a routine dental procedure in which one or more missing or severely damaged teeth are replaced by artificial substitutes. The material used to make the prosthesis may be made of a metal framework with a veneering of an aesthetic material (ceramic) or entirely in metal or it can be made with different non-metal structures (metal-free materials). There is still uncertainty regarding metal-free long-term performance compared to metal-based crowns and bridges. Continue reading