New title registered at the Cochrane Oral Health Group

teeth

Photo by: babyparenting.about.com/

The Cochrane Oral Health Group registered one new title at their Editorial Meeting in April:

Interventions for preventing early childhood caries in pregnant women and mothers of infants up to 12 months old

This new review looks at early and maternal prevention of tooth decay in babies and is part of a larger project to improve oral health outcomes for children of migrant refugee communities.

 

Continue reading

Review of the month: critically ill patients can benefit from improved oral health

vap

C Cambridge University Hospitals NHS Foundation Trust

Critically ill people who need machines to help them breathe are at high risk for developing chest infections and pneumonia. This is known as ventilator-associated pneumonia, or VAP. Can a programme of oral care (such as mouthwashes, toothbrushing) help to prevent this life-threatening condition?

What was the research?

A systematic review of the evidence to find out whether oral health care can reduce the likelihood of a patient in intensive care on a ventilator developing pneumonia.

Who conducted the research?

The research was conducted by a team led by Zongdao Shi on behalf of the Cochrane Oral Health Group. Huixu Xie, Ping Wang, Qi Zhang, Yan Wu, E Chen, Linda Ng, Helen V Worthington, Ian Needleman and Susan Furness were also on the team.

What evidence was included in the review?

Data was extracted from 35 randomised controlled trials. A total of 5,374 patients participated in the trials. The trials looked at:

  1. Chlorhexidine antiseptic mouthrinse or gel compared with a placebo or usual care.
  2. Toothbrushing compared with no toothbrushing
  3. Powered compared with manual toothbrushing
  4. Oral care with other solutions.

Participants were all critically ill and needed assistance from hospital staff, who administered the oral care.

What did the evidence say?

The review found that chlorhexidine administered as a mouthrinse or gel reduces the odds of VAP by 40%. For every 15 people in hospital in intensive care, use of oral hygiene including chlorhexidine will prevent one person developing VAP. There was no evidence that chlorhexidine makes a difference to the numbers of patients who die in intensive care, or the length of their stay in the intensive care unit. There was no evidence that toothbrushing or oral care without toothbrushing affected the risk of developing VAP. Two studies showed some evidence of a reduction in VAP with povidine iodine antiseptic mouthrinse. There was not enough evidence of the effects of other oral care solutions, such as water, saline or triclosan.

How good was the evidence?

Only 14% of the studies included in this review were well conducted and described. Almost half of the included studies were at high risk of bias.

What are the implications for intensive care staff and the general public?

Effective oral hygiene care is important for ventilated patients in intensive care to reduce ventilator-associated pneumonia. There is evidence from this review that oral hygiene care incorporating chlorhexidine mouthrinse or gel is effective in reducing the development of ventilator-associated pneumonia in adult patients in intensive care. The definition of oral hygiene care varied among the studies included in this review but common elements include cleaning of the teeth and gums with a swab or gauze, removing secretions using suction and rinsing the mouth.

What should researchers look at in the future?

Although the included studies provided some evidence of the benefits of oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia, incomplete reporting of studies is a major limitation. Further trials of oral hygiene care (including use of manual or powered toothbrushes, or swabs) should report both measures of effectiveness of plaque removal and prevention of ventilator-associated pneumonia.

Link

Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, Ng L, Worthington HV, Needleman I, Furness S. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD008367. DOI: 10.1002/14651858.CD008367.pub2.

New publications from the Oral Health Group in Issue 5 of the Cochrane Library for 2013

The latest edition of The Cochrane Library is out today, and features 1 new review and 3 new protocols from the Cochrane Oral Health Group. Follow the links to read more!

Children ToothbrushesNew Review:
Primary school-based behavioural interventions for preventing caries
Anna M Cooper, Lucy A O’Malley, Sarah N Elison, Rosemary Armstrong, Girvan Burnside, Pauline Adair, Lindsey Dugdill, Cynthia Pine

This review considers the clinical effects of school based interventions aimed at changing behaviour related to toothbrushing and the frequency of consumption of sugary food and drink. Are programmes aimed at making lasting changes to toothbrushing habits and reducing sugary food and drink consumption in 4-12 year olds effective?

Four clinical trials were included in the review. Three of these showed that there was less dental plaque in the children who had received the programme, and one small study showed there was less tooth decay when children had undergone the educational intervention. However, more high quality research is needed.

New protocol:
Dental cavity liners for Class I and Class II resin-based composite restorations
Andrew B Schenkel, Ivy Peltz, Analia Veitz-Keenan

This review will be undertaken by a team from the College of Dentistry at the University of New York. It will assess the effects of using dental cavity liners in the placement of restorations.

New protocol:
Oral health educational interventions for nursing home staff and residents
Martina Albrecht (nee Bunge), Ramona Kupfer, Daniel Reissmann, Burkhard Haastert, Ingrid Mühlhauser, Sascha Köpke

This new review will assess the effects of educational interventions to improve the oral and dental health of nursing home residents. These interventions could include training programmes for staff or for the residents in oral hygiene, oral care practice, diet and skills training.

New protocol:Triclosan/copolymer containing toothpastes for oral health
Philip Riley, Thomas Lamont

This review will assess the effects (i.e. including both the efficacy and safety) of triclosan/copolymer containing fluoride toothpastes, compared to fluoride toothpastes, for the long-term control of tooth decay, plaque and gingivitis in children and adults.

Other highlights of Issue 5 of the Cochrane Library include:

New titles registered with the Cochrane Oral Health Group

It has been a bumper month for new titles at the Cochrane Oral Health Group, with a total of 5 new title registrations:

Herbal medicine for gingivitis
Matthew Leach, Lisa Thoms

A new review which will look at all herbal medicines for treating gingivitis, including gels, mouthrinses and toothpastes.

Techniques for increasing acceptance of local anaesthetic in children having dental treatment
Joana Monteiro, Susan Parekh, Paul Ashley, Aviva Petrie, Ajit Tanday

A team from the Eastman Institute at University College London has registered a new title considering different approaches to administering dental anaesthesia to children.

Assessment of radioprotective agents for adverse effects of radiotherapy in adult patients with head and neck cancer
Adriana Dibo da Cruz,  Cassia Maria Fischer Rubira, Rebeca de Souza Azevedo, Ademar Takahama-Junior, Solange Maria de Almeida, Frab Norberto Boscolo, Glaucia Maria Bovi Ambrosano

This review on the important subject of preventing the adverse effects of radiotherapy will be undertaken by a team based in Brazil.

Adjunctive surgical interventions for accelerating tooth movement in patients undergoing orthodontic treatment
Padhraig Fleming, Nicolas Pandis, A Johal

Non-surgical interventions for accelerating tooth movement in patients undergoing orthodontic treatment
Ahmed El-Angbawi, David Bearn, Grant McIntyre

These two reviews will consider surgical and non-surgical ways of speeding up tooth movement during orthodontic treatment.

Look out for the protocols on the Cochrane Library!

New edition of the Cochrane Library features three new reviews from the Oral Health Group

The latest edition of the Cochrane Library for September 2012 features three new reviews from the Oral Health Group.

Irrigants for non-surgical root canal treatment in mature permanent teeth
Zbys Fedorowicz, Mona Nasser, Patrick Sequeira-Byron, Raphael Freitas de Souza, Ben Carter, Marc Heft

This new systematic review examines the antiseptic and antibacterial irrigating solutions available to help to eliminate infection during root canal treatment. 11 studies were included, with 851 participants. The review concludes that there was no difference between some of the irrigants or between the different strengths of individual irrigants.

Preoperative analgesics for additional pain relief in children and adolescents having dental treatment
Paul F Ashley, Susan Parekh, David R Moles, Prabhleen Anand, Amal Behbehani

This review examines whether or not to give children painkillers before dental treatment, in order to reduce pain afterwards. Five trials were included, with 190 participants. However, the available evidence was not sufficient to determine efficacy. There was some evidence that it could be of benefit before orthodontic treatment.

Systemic interventions for recurrent aphthous stomatitis (mouth ulcers)
Paul Brocklehurst, Martin Tickle, Anne-Marie Glenny, Michael A Lewis, Michael N Pemberton, Jennifer Taylor, Tanya Walsh, Philip Riley, Julian M Yates

25 trials with 21 interventions were included in this new systematic review on recurrent mouth ulcers. No single treatment was found to be effective and the results remain inconclusive.

Other highlights of the Cochrane Library, Issue 9, 2012 are:

New publications from the Cochrane Oral Health Group in the Cochrane Library, Issue 4 for 2012

The Cochrane Oral Health Group has one new review and one new protocol now available in the Cochrane Library, Issue 4 for 2012.

New review: Interventions for the management of temporomandibular joint osteoarthritis
by Raphael Freitas de Souza, Claudia H Lovato da Silva, Mona Nasser, Zbys Fedorowicz, Mohammed A Al-Muharraqi

This review investigates the effects of different surgical and non-surgical therapeutic options for patients with osteoathritis in the temporomandibular joint (the joint connecting the jawbone to the face). Three trials were included in the review, finding weak evidence indicating that intra-articular injections of sodium hyaluronate (a natural constituent of cartilage) and betamethasone (an anti-inflammatory steroid) had equivalent effectiveness in reducing pain and discomfort. Occlusal adjustment, food supplements and ibuprofen were among other treatments investigated.

New protocol: Gingival retraction for fixed prosthodontic treatment
by Zhaoyang Ban, Yuanyuan Jia, Chunjie Li, Zhimin Zhu, Yu Ban, Zongdao Shi

This review intends to assess the effects of different gingival retraction methods used with any type of abutment (teeth and implants) in fixed prosthodontic treatment, with regard to the outcomes of gingivitis, periodontitis, aesthetics, and tooth sensitivity.

Other highlights of the Cochrane Library, Issue 4 for 2012:

See also the Editorial on the COMET (Core Outcome Measures in Effectiveness Trials) Initiative and its role in improving Cochrane Reviews