The evidence on flossing and other methods of cleaning between the teeth

Tooth decay and gum diseases affect most people. They can cause pain, difficulties with eating and speaking, low self-esteem, and, in extreme cases, may lead to tooth loss and the need for surgery. The cost to health services of treating these diseases is very high.

As dental plaque is the root cause, it is important to remove plaque from teeth on a regular basis. While many people routinely brush their teeth to remove plaque up to the gum line, it is difficult for toothbrushes to reach into areas between teeth (‘interdental’), so interdental cleaning is often recommended as an extra step in personal oral hygiene routines. Different tools can be used for interdental cleaning, such as dental floss, interdental brushes, tooth cleaning sticks, and water pressure devices known as oral irrigators. Continue reading

Which strength of fluoride in toothpaste is most effective?

Tooth decay (caries) is a widespread disease, affecting billions of people worldwide. Fluoride has long been used to prevent decay, through a variety of different methods including toothpaste, water, milk, mouthrinses, tooth gels and varnish. Regular toothbrushing is recommended to prevent decay and other oral diseases, and toothbrushing for 2 minutes twice daily with a fluoride toothpaste is generally recommended. The typical strength of regular or family toothpaste is around 1000 to 1500 parts per million (ppm) fluoride, but many other strengths are available worldwide. There is no minimum fluoride concentration, but the maximum permissible fluoride concentration for a toothpaste varies according to age and country. Higher concentrations are rarely available over the counter, and are classed as a prescription‐only medicine. Stronger fluoride toothpaste may offer greater protection against decay but also increases the risk of fluorosis (enamel defects) in developing teeth. This is an update of the Cochrane Review first published in 2010. Continue reading

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

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 the 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

No evidence that fluoride supplements taken by pregnant women prevent tooth decay in their babies

Tooth decay is one of the most common health problems among children. If fluoride supplements taken by pregnant women can prevent tooth decay in their children, pregnant women with no access to a fluoridated drinking water supply can obtain the benefits of systemic fluoridation. Fluoride tablets, drops, lozenges or chewing gums are sucked or chewed to provide topical fluoride and ingested to provide systemic fluoride. Continue reading

Children who have sealants applied to their back teeth are less likely to have tooth decay

Although children and adolescents have healthier teeth than in the past, tooth decay (also known as caries) is a problem in some people and places. Most tooth decay in young people occurs on the biting surfaces of back teeth. Tooth decay prevention includes brushing, fluoride supplements (such as tablets), fluoride directly applied to the teeth and dental sealants. Dental sealants aim to prevent bacteria growth that promote tooth decay in grooves of back teeth. Sealants are applied by dentists or dental care team members. The main types used are resin-based sealants and glass ionomer cements. Continue reading