Routine scale and polish has little or no effect on gingivitis

Scaling and polishing removes deposits such as plaque and calculus (tartar) from tooth surfaces. Over time, the regular removal of these deposits may reduce gingivitis (a mild form of gum disease) and prevent progression to periodontitis (severe gum disease). Routine scale and polish treatment is sometimes referred to as “prophylaxis”, “professional mechanical plaque removal” or “periodontal instrumentation”. Many dentists or hygienists provide scaling and polishing for most patients at regular intervals even if the patients are considered to be at low risk of developing gum disease. There is debate about whether scaling and polishing is effective and the best interval between treatments. Scaling is an invasive procedure and has been associated with a number of negative side effects including damage to tooth surfaces and tooth sensitivity.

For the purposes of this review, a ‘routine scale and polish’ was scaling and polishing of both the tooth and the root of the tooth to remove plaque deposits (mainly bacteria), and calculus. Calculus is so hard it cannot be removed by toothbrushing alone and this along with plaque, other debris and staining on the teeth is removed by the scale and polish treatment. Scaling or removal of hardened deposits is done with specially designed dental instruments or ultrasonic scalers, and polishing is done mechanically with special pastes. In this review, we included scaling above and below the gum level; however, we excluded any surgical procedure on the gums, any chemical washing of the space between gum and tooth (pocket) and root planing, which is more intense scraping of the root than simple scaling.

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No conclusion is possible on the best methods of delivering one-to-one oral hygiene advice

Dentist using props to show a patient how to brush her teethPoor oral hygiene habits are known to be associated with high rates of dental decay and gum disease. The dental team routinely assesses oral hygiene methods, frequency and effectiveness or otherwise of oral hygiene routines carried out by their patients. Oral hygiene routines can include toothbrushing, reducing sugar intake, interdental cleaning with floss or interdental brushes, and using a fluoride mouthwash or dentifrice. One-to-one oral hygiene advice is regularly provided by members of the dental team with the aim of motivating individuals and improving their oral health. The most effective method of delivering one-to-one advice in the dental setting is unclear. This review’s aim is to determine if providing patients with one-to-one oral hygiene advice in the dental setting is effective, and if so what is the best way to deliver this advice. 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

How often should you see your dentist?

Heritage_Dental_appointment_reminderThe frequency with which patients should attend the dentist for a routine check-up has been the subject of an ongoing debate. There is no universally recognised definition of the term “routine dental check up”, and recommendations vary between countries and dental healthcare systems. Should you see your dentist every six months, or less often? This Cochrane review looks at the evidence.

What was the research?

A systematic review of the evidence to find out the optimal interval for dental check-ups (the time period between one dental check up and the next).

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Review of the Month: Is your child scared of the dentist? Can hypnosis help?

pocket-watchThis week is Face Your Fears week. Many children are scared of going to the dentist, studies have shown a world-wide variation in the prevalence of dental anxiety with estimates ranging between 3% and 43% (Folayan, 2004). Our review of the month aimed to find out whether hypnosis can help children to cope with dental treatment.  The advantage of hypnosis is that it requires no specialist equipment, the patient remains conscious, and there are no side effects of the kind you may see with sedation or drug interventions.

What was the research?

A systematic review of the evidence to find out the effectiveness of hypnosis for behaviour management of children who are receiving dental care.

Who conducted the research?

The research was conducted by a team led by Sharifa Al-Harasi from the Military Dental Centre in Oman, on behalf of the Cochrane Oral Health Group. Paul F. Ashley, David R. Moles, Susan Parekh and Val Walters were also on the team.

What evidence was included in the review?

Data was extracted from 3 randomised controlled trials. A total of 69 children participated in the trials, and were randomly assigned to hypnosis or non-hypnosis groups. The children in the hypnosis groups could also be having some form of sedation in addition to the hypnosis. The children in the control groups either had sedation or nothing. The participants were all under the age of 16, and could be having any form of dental treatment.

What did the evidence say?

Very few studies on hypnosis for children undergoing dental treatment have been carried out, and only 3 trials were found that met the inclusion criteria. Two studies found that hypnosis had some beneficial effects during the administration of local anaesthetic, but it was not as effective during the removal of teeth. The majority of the children in one of the studies preferred sedation to hypnosis. One study found that hypnosis could make children undergoing orthodontic treatment more co-operative.

How good was the evidence?

Two of the studies were at high risk of bias, and one study at moderate risk of bias. Reporting of methods was generally poor. Only one of the studies was double-blind.

What are the implications for dentists and the general public?

There is some anecdotal evidence of the benefits of hypnosis for children undergoing dental treatment, when they are showing signs of anxiety. However, on the basis of these three studies there is not enough evidence to recommend it as a practice.

What should researchers look at in the future?

There is a need for well-conducted randomized controlled trials on this topic. Future research should follow-up patients to find out if the effect of hypnosis has modified the patient’s perception towards having dental treatment. Study design should be parallel and how the sample size was calculated should be reported.

Link

Al-Harasi S, Ashley PF, Moles DR, Parekh S, Walters V. Hypnosis for children undergoing dental treatment. Cochrane Database of Systematic Reviews 2010, Issue 8. Art. No.: CD007154. DOI: 10.1002/14651858.CD007154.pub2.

Reference

Folayan MO, Idehen EE, Ojom OO. The modulating effect of culture on the expression of dental anxiety in children: a literature review. International Journal of Paediatric Dentistry, 2004, 14(4): 241-5