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
Critically ill people, who may be unconscious or sedated while they are treated in ICUs, often need to have machines to help them breathe (ventilators). The use of these machines for more than 48 hours may result in ventilator-associated pneumonia (VAP). VAP is a potentially serious complication in these patients who are already critically ill. Oral hygiene care, using a mouthrinse, gel, toothbrush, or combination, together with breathing-in of secretions, may reduce the risk of VAP in these patients. Continue reading
Nursing home residents are often unable to carry out proper oral care, which is an important factor in maintaining the health of the mouth, teeth, and gums. Nursing home staff may not be prepared to provide adequate care. Therefore, oral health care education for residents and/or nursing staff may be one strategy to improve this situation. Continue reading
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.
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:
- Chlorhexidine antiseptic mouthrinse or gel compared with a placebo or usual care.
- Toothbrushing compared with no toothbrushing
- Powered compared with manual toothbrushing
- 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.
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.
Follow the links for more information!
Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia
by Zongdao Shi, Huixu Xie, Ping Wang, Qi Zhang, Yan Wu, E Chen, Linda Ng, Helen V Worthington, Ian Needleman, Susan Furness
Ventilator associated pneumonia is a potentially serious complication in patients who are already critically ill. This new systematic review looks at whether keeping the mouth and teeth clean and preventing the build up of plaque on the teeth helps to reduce the risks. 35 randomized controlled trials were included, involving 5,374 participants. The review found that chlorhexidine mouthrinses or gels reduces the risk of ventilator-associated pneumonia by 40% but there was not enough research information available to provide evidence of the effects of other mouth care rinses such as water, saline or triclosan.
Interventions for the management of dry mouth: non-pharmacological interventions
by Susan Furness, Gemma Bryan, Roddy McMillan, Helen V Worthington
This new review looks at non-drug treatments used to stimulate saliva production for the relief of dry mouth. Nine clinical trials were included in the review, and they covered treatments including acupuncture, electrostimulation and powered toothbrushes. 366 people participated in the trials. The review found that the evidence was generally of poor quality.
Hypnosis for alleviation of anxiety in adults undergoing dental treatment
by Catherine Potter, Paul Coulthard, Richard Brown, Tanya Walsh
This is a protocol for a new Cochrane Oral Health Group review, which will consider the effects of hypnosis (with or without conscious sedation) in reducing anxiety in dental treatment.
Other highlights of the Cochrane Library, Issue 8, 2013 include:
Three new editorials:
- Mosquito larval source management: Evaluating evidence in the context of practice and policy by Robert D. Newman, Abraham Mnzava and Zsofia Szilagyi
- Oxygen therapy in acute myocardial infarction – good or bad? by Pascal Meier, Shah Ebrahim, Catherine M. Otto & Juan P. Casas
- Factor Xa inhibitors: a step forward in the treatment of atrial fibrillation? by Ale Algra
- ‘Mediterranean’ dietary pattern for the primary prevention of cardiovascular disease
- Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children
- Simple behavioural interventions for nocturnal enuresis in children
- Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrial fibrillation
- Smoking cessation interventions for smokers with current or past depression
- Midwife-led continuity models versus other models of care for childbearing women
- Multimedia educational interventions for consumers about prescribed and over-the-counter medications
- Mosquito larval source management for controlling malaria
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.
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.
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:
- School-based programmes for preventing smoking
- Interventions to improve antibiotic prescribing practices for hospital inpatients
- Vaccines for measles, mumps and rubella in children
- Swimming training for asthma in children and adolescents aged 18 years and under
- Multimedia educational interventions for consumers about prescribed and over-the-counter medications
- Training to recognise the early signs of recurrence in schizophrenia
- Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus
- Oral evening primrose oil and borage oil for eczema