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

Is a laser more effective at removing tooth decay than a traditional drill?

Dentist using a modern diode dental laser for periodontal care. Both wearing protective glasses, preventing eyesight damage. Periodontitis, dental hygiene, preventive procedures concept.

Dental decay is a cavity formation in teeth resulting from the destruction of dental tissue caused by bacteria under certain conditions, including poor oral hygiene and excessive sugar intake. Symptoms may include pain and difficulty with eating, and complications may include tooth loss, infection or inflammation of the gum. Rotating drills are traditionally used to remove decay. However, this mechanical tool may have unexpected side effects, such as the removal of too much or too little decay, in addition to discomfort due to pain, noise and vibration. Laser therapy is a potential alternative to a mechanical drill. Continue reading

Supervised use of fluoride mouthrinse results in large reductions in decay in children’s permanent teeth

Tooth decay is a health problem worldwide, affecting the vast majority of adults and children. Levels of tooth decay vary between and within countries, but children in lower socioeconomic groups (measured by income, education and employment) tend to have more tooth decay. Untreated tooth decay can cause progressive destruction of the tops of teeth (crowns), often accompanied by severe pain. Repair and replacement of decayed teeth is costly in terms of time and money and is a major drain on the resources of healthcare systems.

Preventing tooth decay in children and adolescents is regarded as a priority for dental services and is considered more cost-effective than treatment. Use of fluoride, a mineral that prevents tooth decay, is widespread. As well as occurring naturally, fluoride is added to the water supply in some areas, and is used in most toothpastes and in other products that are available to varying degrees worldwide. As an extra preventive measure, fluoride can be applied directly to teeth as mouthrinses, lozenges, varnishes and gels.

Fluoride mouthrinse has frequently been used under supervision in school-based programmes to prevent tooth decay. Supervised (depending on the age of the child) or unsupervised fluoride mouthrinse needs to be used regularly to have an effect. Recommended procedure involves rinsing the mouth one to two minutes per day with a less concentrated solution containing fluoride, or once a week or once every two weeks with a more concentrated solution. Because of the risk of swallowing too much fluoride, fluoride mouthrinses are not recommended for children younger than six years of age.

This review updates the Cochrane review of fluoride mouthrinses for preventing tooth decay in children and adolescents that was first published in 2003. Continue reading

Sealants versus fluoride varnish – which is better for preventing decay in children’s teeth?

ChildAlthough children and adolescents have healthier teeth today than in the past, tooth decay is still a problem among some individuals and populations, and it affects a large number of people around the world. Most decay in children and adolescents is concentrated on the biting surfaces of permanent back teeth. Preventive treatment options for tooth decay include tooth brushing with a fluoride toothpaste, use of fluoride supplements (e.g. fluoride tablets) and application of dental sealants and topical fluorides at dental clinics. Dental sealants are applied to form a physical barrier that prevents growth of bacteria and accumulation of food particles in the grooves of back teeth. Several sealant materials are available: The main types in use are resin-based sealants and glass ionomer cements. Fluoride varnishes are sticky pastes that are professionally applied to the teeth two to four times a year. Continue reading

Preformed crowns for managing decayed primary molar teeth

Close-up of fused ceramic corona, three elementsTo stop further damage and restore function of primary molar teeth that are decayed or malformed, a dentist will usually use a filling (a soft material that is placed in the cavity and hardened) to restore the tooth to its original shape. Alternatively the dentist may place a crown over the tooth to cover it. This usually requires an injection in the gum to numb the tooth before trimming it down (conventional technique). These crowns are pre-made (i.e. preformed) in a variety of sizes and can be metal or white, with the correct size being chosen to fit the trimmed down tooth. The Hall Technique is an alternative method for fitting metal crowns, where there is no need for an injection or tooth trimming as the crown is simply pushed over the tooth. Preformed crowns are recommended by specialists in children’s dentistry for the management of baby back teeth (molars) when they are affected by moderate to advanced tooth decay, or where the enamel has malformed during development or the tooth has had to have root canal treatment. Continue reading

Micro-invasive treatments for managing dental decay on adjacent tooth surfaces in children’s and adults’ teeth

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Photo copyright Conor Lawless, via Creative Commons Licence

Decay on tooth surfaces that are next to each other (proximal surfaces) is common. Usually it has not progressed into late stages of decay and the tooth surface does not yet have a cavity. Different methods are used to manage proximal dental decay. A common method is drilling the affected tooth tissue and inserting a plastic or metal filling. However, a lot of sound tissue can be removed in the process and this method is regarded as invasive). Another non-invasive methods in use include dental practitioners applying fluoride varnish or advising people to floss regularly. These non-invasive methods do not require removing any tooth tissue. More recent approaches (micro-invasive treatments) involve preparing (conditioning) the tooth surface with an acid and then either placing a sealing (cover) on top of the surface or ‘infiltrating’ the softer demineralised tissue with resins. These newer methods work by installing a barrier either on the tooth surface or within the demineralised tissue to protect it against acids and avoid the further loss of minerals from within the tooth. This, in theory, should stop the decay. This approach can be performed by a dentist or other dental practitioner and involves the loss of a few micrometers of tooth tissue because of the need to condition the tooth surface with acid. There is still uncertainty as to how effective micro-invasive treatments are for managing proximal decay. It is also unclear which if any of these techniques are better than others. For example, a stronger acid is needed to infiltrated porous tissue with resin than when the tooth surface is simply sealed or covered. While infiltration might be a more effective method of protecting the tissue than sealing it, the use of a stronger acid also means losing more tissue. The aim of this review was to investigate the best approach for managing such decay in adults and children. Continue reading

Fluoride gel reduces tooth decay in children

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Gel is normally applied using dental trays

Tooth decay affects 60% to 90% of children. Levels of tooth decay vary between and within countries, but it is generally true that children in lower socioeconomic groups (measured by income, education and employment) have more tooth decay. Over time, untreated tooth decay causes progressive destruction of the tops of teeth (crowns); this is often accompanied by severe pain. Repairing and replacing decayed teeth is extremely costly in terms of time and money and is a major drain on the resources of healthcare systems. The prevention of tooth decay in children and adolescents is regarded as a priority for dental services and is considered more cost-effective than its treatment. The use of fluoride, a mineral that prevents tooth decay, is widespread. As well as occurring naturally, fluoride is added to the water supply in some areas, and it is used in most toothpastes and in other products that are available to varying degrees worldwide. As an extra preventive measure there are other ways of applying fluoride directly to teeth, such as mouthrinses, lozenges, varnishes and gels. Fluoride gel is usually applied by a dental professional, or self applied under supervision (depending on the age of the child), from once a year to several times a year. The gel is usually placed in a tray that the child or young person must keep in their mouth and bite into for about four minutes. It is not uncommon for young people to accidentally swallow some of the gel; feelings of sickness, vomiting, headache and stomach pain have been reported when too much is swallowed. Due to this risk of toxicity, fluoride gel treatment is not generally recommended for children younger than six years old. Continue reading

Not enough evidence to recommend chlorhexidine treatment to reduce tooth decay in children

tooth decayTooth decay is a very common disease that over time destroys the tooth surface. It has been estimated to affect up to 80% of people in high-income countries and, despite being preventable through oral hygiene and dietary measures and the use of agents such as fluoride that reduce risk of decay, it is likely to remain a problem, especially in low-income countries. Tooth decay can result in pain and infection, and in young children may require treatment in hospital under a general anaesthetic. As well as causing anxiety and pain, this may mean the child or young person missing time at school and their parents or carers having to take time off work, possibly losing income and incurring extra costs. Prevention of tooth decay is simpler and possibly cheaper than waiting until it occurs and then requires extensive treatment. Tooth decay is largely preventable, and a range of things may assist this: twice-daily toothbrushing with a fluoride toothpaste, and reducing both the amount of and number of times per day sugar is eaten. Tooth decay occurs when certain types of bacteria (germs) in the mouth, such as Streptococcus mutans, produce acids from the sugar we eat, which dissolve the hard enamel coating on our teeth. Some studies have shown that the chemical antiseptic treatment chlorhexidine is highly successful at destroying these bacteria and can be used safely at home in the form of a gel, spray, chewing gum, toothpaste or mouthrinse. Alternatively, chlorhexidine can be applied as a varnish to the surface of teeth by a dentist. But what is the evidence that it works to reduce tooth decay in children? Continue reading