Surgical treatments for mouth and throat cancer: uncertainty in the evidence

Oral cancer is among the most common cancers worldwide, with more than 400,000 new cases diagnosed in 2012. This review looks at oral cavity cancer (mouth cancer) and oropharyngeal cancer (throat cancer). The treatment of these cancers can involve surgery, chemotherapy, radiotherapy or a combination of two or all three therapies. This topic area was identified as a priority by the an expert working group for oral and maxillofacial surgery in 2014.

Treating communications between the oral cavity and maxillary sinus: insufficient evidence

The floor of the main sinus near the nose is thin and lies directly above the roots of the teeth at the back of the mouth. Sometimes following infection or dental treatment, this structure becomes damaged and openings or channels between the mouth and the sinus are formed. These are known as oro-antral communications (OAC). If the OAC is left open (then described as an oro-antral fistula (OAF), it may become permanent, leading to long-lasting sinus infections. This condition can be treated surgically by using flaps, grafts and other techniques; or non-surgically using a variety of methods and materials. There is little evidence for the most effective and safe treatments for closing OACs and OAFs and clinicians who treat these conditions have identified an urgent need for this. This is an update of a review first published in May 2016.

Do the drugs work? Cochrane evidence on antibiotics in dentistry

13-17 November is World Antibiotic Awareness Week. The World Health Organization (WHO) has said that antibiotic resistance is:  “one of the biggest threats to global health, food security, and development today”. Antibiotics are used to prevent and treat bacterial infections, but if over-used they can cause bacteria to change and become resistant. This makes infections more difficult to treat, and results in longer hospital stays, higher medical costs and increased mortality (World Health Organization, 2017).

Antibiotics are still commonly used in dentistry, Cope et al (2014) estimate that 8-10% of antibiotics used in primary care are prescribed by dentists in some parts of the world. Their effectiveness has been explored by several Cochrane Oral Health reviews over the years, looking at some of the scenarios where they might be prescribed. Today we have a look back over the evidence…

Procedures for retreatment of failed root canal therapy

In root canal therapy, the infected pulp of a tooth is removed, and the root cavity is disinfected and filled with a sealing material. However, if micro-organisms that caused the infection are not completely removed, after some time they may cause a disease at the tip of the root, called a periapical lesion. Treatment for this requires a second intervention, which can be performed in the same way as the first treatment, from the crown into the root canal, to remove the existing filler and clean and disinfect as well as possible before sealing again. Alternatively, should this procedure fail, or if it is not feasible, a surgical intervention can be used.

No evidence from randomized controlled trials on how to treat bleeding after tooth extraction

After tooth extraction, it is normal for the area to bleed and then clot, generally within a few minutes. It is abnormal if bleeding continues without clot formation, or lasts beyond 8 to 12 hours; this is known as post-extraction bleeding (PEB). Such bleeding incidents can cause distress for patients, who might need emergency dental consultations and interventions. The causes of PEB can be local, a systemic disease, or a medication. To control this bleeding, many local and systemic methods have been practised, based on the clinician’s expertise. To inform clinicians about the best treatment, evidence is needed from studies where people have been randomly allocated to one of at least two different groups, which receive different treatments, or no treatment (i.e. ‘randomised controlled trials’ or RCTs).

Treating communications between the oral cavity and maxillary sinus: insufficient evidence

The floor of the main sinus near the nose is thin and lies directly above the roots of the teeth at the back of the mouth. Sometimes following infection or dental treatment, this structure becomes damaged and openings or channels between the mouth and the sinus are formed. These are known as oro-antral communications (OAC). If the OAC is left open (then described as an oro-antral fistula (OAF), it may become permanent, leading to long-lasting sinus infections. This condition can be treated surgically by using flaps, grafts and other techniques; or non-surgically using a variety of methods and materials. There is little evidence for the most effective and safe treatments for closing OACs and OAFs and clinicians who treat these conditions have identified an urgent need for this. This is an update of a review first published in May 2016.

Treatments for osteonecrosis of the jaw bones associated with bisphosphonate drugs

Bisphosphonates are drugs very similar to pyrophosphate (a normal substance found in bone). They are used to lessen symptoms and complications due to the spread of cancer to the bones, and to prevent and treat fragile bones in osteoporosis (a conditon where tiny holes in the bones makes them brittle). These drugs can cause a rare but serious condition called bisphosphonate-related osteonecrosis of the jaw or ‘BRONJ’. BRONJ affects the healing of bone damage by interrupting the process of removing dead bone and laying down new bone. When this happens, parts or all of the jaw bone becomes friable (a bit like chalk), and eventually this dead bone can be exposed. This makes it difficult for people to eat, speak or brush their teeth, and it often causes severe pain. Many different treatments are currently used for BRONJ. They can be categorised as non-invasive treatments (such as antibiotics and mouth rinses), surgical approaches or “add-on” treatments used to enhance usual care (for example, ozone therapy or use of blood plasma that has been enriched with platelets). Different treatments may be combined.

Reducing the pain of dental treatment for children and adolescents: unclear evidence

It can be difficult when giving dental treatment to children and young people to do it simply using a local anaesthetic (LA) injection, as they may experience anxiety or need a lot of treatment at once. For example, they may need many teeth taken out at the same time. In these circumstances, a dental practitioner commonly uses a general anaesthetic (GA) and administers the treatment in a hospital. Problems often arise following this treatment and the most common is pain, the experience of which can cause an emotional as well as a physical response. The experience can make it more difficult for the dental practitioner to give the treatment needed, and it can also cause the child or young person to avoid future dental treatment. This research set out to find out whether giving LA injections during dental treatment under GA will result in numbness and therefore pain not being felt for a couple of hours, after which time painkillers can control the pain. The review looked at the benefits of using LA in this way, but also considered the side-effects. These can include discomfort, dribbling, and accidental lip biting. Also, because painkillers are often used as well, the effect of the LA is not clearly defined. Additionally, it is important to clarify the best doses and kind of injections to use to achieve the maximum benefit.

Prioritising our reviews – the results are in!

The Cochrane Oral Health Group has been conducting a prioritisation exercise over the last six months, and the results are now available!

Surgical techniques for removing wisdom teeth

This research assesses the benefits and harms of the different ways to surgically remove wisdom teeth from the lower jaw. Removing wisdom teeth is one of the most common operations in dental surgery. Various techniques have been developed to carry this out, but which is the most effective? The review considered the following risks from surgery: pain after treatment, swelling, infection, the ability to open the jaw fully, damage to the nerves supplying sensation to the tongue and jaw fractures.